Doctoral Education for Transformational Leadership in a Global Context
The pace of change in the world is unprecedented, calling for nurse leaders who are responsive to new workplace environments, which require new strategies that question prevailing assumptions. Doctoral education in nursing must be reframed to prepare leaders with new skills to transform the organizational culture in which care delivery takes place. Leaders must be able to analyze trends in the healthcare market, manage growing diversity, and incorporate emerging evidence about the workplace.
Doctoral education is charged with preparing leaders who can think outside the box and stimulate creative problem solving in others, invigorating nurses to claim a voice in crafting a vision of healthcare delivery that recognizes the essentialness of nursing. What are the essential elements of doctoral education that promote and enable transformation, that changing of the worldview which offers the ability to lead in a dynamic way?
Leadership that can move people as well as organizations to transformation is a key strategy for advancing nursing in a global context. It becomes an essential component of nursing doctoral curricula in the rapidly developing global healthcare environment. Traditional leadership models are giving way to dynamic approaches that focus on personal development as the core ingredient of the leadership journey.
This new vision for professional development based on critical reflection allows one to understand individual differences, the context in which nursing practice takes place, and the organizational culture that influences transformational changes. Transformational leadership can produce quality outcomes for patients as well as for nurses.
Imperative for Change Amid Global Challenges
Nursing has been challenged by the label of silent profession. Historical developments related to views of nursing as a calling, symbol of the angel of mercy, socialization associated with being a predominantly female profession, environments entrenched in steep hierarchy, and other societal factors have contributed to the lack of voice attributed to nurses in the decision -making arena that drives the healthcare market.
The convergence of many factors offers new opportunities that perhaps are best met with preparation of new leadership skills in doctoral education. A view of nursing that recognizes each nurse as a leader requires new approaches to leadership development and changes in doctoral curricula.
Evolution in Healthcare
This is a dynamic era in which healthcare systems are evolving worldwide, opening an opportunity for increased attention to nursing brought by the challenges of a global shortage of nurses to meet patient care needs. Analysis of the context of healthcare delivery confirms the leadership potential for nurses. Nurses are the discipline present with patients around the clock, and the discipline charged with coordinating care among all the disciplines.
Globalization has brought the world community together, as technology expands and information exchange happens instantly Nurses communicate around the globe on a daily basis, sharing information, coaching and mentoring, and expanding research opportunities for evidence-based practice. In fact, education is no longer delivered only in synchronous modes, but instead, it is frequently delivered on demand using various delivery modes.
The exponential growth of medical and technological advances has changed the way healthcare operates with an overwhelming knowledge expansion. It is no longer what one knows, but how well and how quickly one can retrieve the required information. Nursing curricula have to move from content-driven to new models based on integration and synthesis within a critical thinking modality.
The twenty-first century learner is action-oriented, calling for new delivery methods with fewer boundaries, given the proliferation of technology-driven programs . These shifts have the nursing faculty in stages of change, while addressing the dual challenges of how classes are to be delivered, and revamping what is delivered, the changing curriculum itself.
Changing the work environment is a new wave recruitment and retention strategy helping propel nursing beyond the blue-collar syndrome in which nurses were compensated based on an hourly salary. Similar to other professions that are moving beyond the industrial age, nursing is primed for new leadership strategies that foster transformational changes in education, service delivery, work environments, recruitment and retention, and performance-based compensation.
The new generation of nurses, most born after the technology revolution began in the 1970s, have always lived in a world of technology, and so respond to leadership that recognizes their individuality, and motivates and inspires (Zemke et al, 2000). This generation can, with exposure to transformational leaders, help move nursing from silence to voice. What, then, is the role of doctoral education in making the changes that are needed?
Moving Towards Transformational Change
It is argued in many parts of the world that leadership within nursing is receiving unprecedented focus and development (Graham, 2003). Traditional leadership methods have focused on managing people, how-to strategies and management theories. Emerging leadership approaches have evolved from self-development as a central component of the leadership journey.
By creating a new vision for professional growth, one can begin to understand the significance of the influence of individual differences, context, organization and culture (Cranton, 1996). Even as Porter-O’Grady and Malloch (2003) warn of the end of the current era of nursing education and practice as known by current practitioners and educators, changes are evident.
New skills are imperative to survive in the rapidly developing interdisciplinary arena. The nature of nursing and nursing work is changing around the globe. New leadership models must seize the moment to lead nursing into the evolving healthcare arena, challenging the nurse educators who prepare the new generations of leaders.
Traditional Leadership Models
Traditional approaches to leadership in nursing have been centered around transactional models. Such models are being challenged, with Thyer (2003) contesting that a transactional style of leadership, as opposed to a transformational approach, potentially contributes to the high attrition rates within the profession. In her recent study, she provides specific examples of the impact of transactional leadership and contrasts them with what might result if a transformational leadership model was embraced.
Principles of Transformation
Leadership approaches for twenty-first century nursing can be considered to fit the process of individual transformation described in three stages by Cranton (1996): self-directed learning, critical reflection and transformative learning. Self-directed learning sets the foundation for transformation as the learner takes responsibility and accountability for the process rather in contrast with the teacher-controlled, content-driven approach used by traditional lecture-only educators.
In this dialogic process, the teacher and learner share mutual work together. The learner moves forward through critical reflection to learn from experience by recalling, reflecting, analyzing , theorizing, and recontextualizing to arrive at new conclusions and behaviors through understanding. The final stage is the application through transformative learning. Here, through critical self-reflection in the inward journey of self-discovery, the learner articulates assumptions and questions those assumptions to move into meaningful perspectives.
Applied to leadership, the transformational process takes the learner into the inward journey of self -awareness. The journey of leadership is defined as a journey of self-development; no leader is stronger than his or her inner core of the person, honed through character, commitment, connectedness, compassion and confidence (Kowalski and Yoder-Wise, 2003).
Leaders have primarily been taught to manage people; Twenty-first century leadership demands that leaders motivate and manage movements to achieve lasting change. Leading the movement of change demands a critically reflective practitioner, and an individual who is willing to engage in a constant critical dialogue with their practice. In this way transformational leadership becomes associated with healthcare improvement, what Graham (2003) describes as the cornerstone of clinical leadership.
Transformational leadership helps capture the elusive quality of leadership, the inner strength and character cultivated through critical reflection of experiences, particularly those based on difficult circumstances that test one’s mettle. In managing movements, leaders manage dynamism, requiring that they be dynamic themselves (Porter-O’Grady and Malloch, 2003). Trofino (1995) concurs with this view, stating that healthcare situations require leaders who develop individuals committed to action, convert and empower followers, and transform leaders into change agents.
Key concepts in doctoral curricula strengthen the ability to apply principles of change as the foundation for leadership development that strives to unleash entrenched assumptions and management patterns. Transformational leaders must themselves understand the basics of change as well as lead others into the change process, thus transforming circumstances.
The first stage in the process is recognizing the need for change leading to different ways of thinking and performing. Unfreezing old behaviors requires unbundling assumptions, departing from tradition and questioning why something is the way it is. Change is itself a continuum and moves from recognition of the need to identifying possibilities and designing new approaches, methods, or ways to think or act. Transformation results as new patterns are embraced and become part of the routine.
Reinforcing and maintaining change is a difficult stage as people have a tendency to revert back to former, entrenched behaviors . It is important in the recognizing stage for those involved to have the time and direction for critical reflection to internalize the need for change, eg the necessity of understanding the improved outcome that will result from the change.
Real change and growth is an on-going process of examining and questioning assumptions, values and perspectives. A pervasive attitude of continuous advancement thus revitalizes the workplace so that it is a dynamic environment attracting the best minds. The ability of the leader to manage such movement is an embedded skill of the transformational leader (Porter-O’Grady and Malloch, 2003).
The challenge for doctoral education is designing learning activities to apply the processes critical to transformational leadership as well as determining essential content strands. The preceding sections presented the challenges to leadership in the current environment and described the process for preparing leaders. The following discussion examines a framework for preparing transformational leaders.
An emerging Leadership Paradigm in Doctoral Education
Doctoral educators are themselves challenged by the rapid change in healthcare delivery and application of organizational development gleaned from the business world. An examination of organizational culture sets the stage for emerging leadership for the twenty-first century offering a framework for doctoral curricula. While most examples relate to the practice arena, the same principles apply to the academic settings for nursing education where leadership is an essential curriculum topic.
Organizational Culture
One goal of doctoral education is to create a shift in the worldview of the doctoral student so that they move beyond the individual to consider the organizational context. Transformational leadership requires a systems thinking approach capable of deconstructing the organizational context in which care delivery occurs. Analysis of context begins with understanding the organization’s culture—regardless of its location in the world, every organization has a culture which derives from the way the stated philosophy is actualized in the workplace.
It is influenced by how well the stated philosophy is matched by everyday reality at the point of service (Bolman and Deal, 1997). It is first modeled by institutional leaders; a healthy organization maintains the same standards for top leadership and for those delivering services at all levels of the organization. This point poses a challenge for academia: finding sufficient faculty prepared to teach from an updated curriculum, made more poignant by the critical faculty shortage of the early twenty-first century. Most current faculty are themselves new learners of the emerging transformational leadership paradigm, having been schooled in more traditional approaches.
The new generation nurse leaders must be able to move outside traditional hierarchical models of leadership to balance economic needs of the organization with employee motivation, satisfaction and morale, and quality outcomes. Values management recognizes that expert staff or experienced faculty are an essential yet scarce resource such that each worker becomes important in providing adequate services.
The challenges of developing responsive leaders to manage the shifting healthcare environment demand re-examination of the leadership paradigm and the underlying assumptions. Curricula threads examining organizational context lead to analysis of various factors influencing the workplace. There is increasing global awareness of key factors in workplace satisfaction. The first factor is how involved and engaged nurses are in the work they do. Being present and engaged in one’s task can offer deep satisfaction.
Secondly, administrators must be willing to change from supervision to facilitation in which workers are enabled and motivated to accomplish work effectively, that is, they own their responsibilities and are accountable for the outcomes (Bolman and Deal, 1997). The reality is that the prevailing emphasis on efficiency and economics encourages micromanagement for output such that employees often feeling depersonalized is a commodity in the budget.
Organizational culture affects satisfaction, which affects retention, and ultimately influences recruitment. Workplace culture is significant, yet few healthcare providers understand how to shape the environment for their workers’ engagement, health and satisfaction.
A critical role of the leader is knowing how to create and manage the work environment as well as deconstruct the culture when needed (Jones and Redman, 2000). Culture is built from shared values and group behavior norms. Values influence decisions that lead to group behavior norms, common ways of acting among group members that persist as they are reinforced by group members; the connection between behavior and its consequences contributes to the culture.
When personal values fail to match those of the organization, there is dissonance and dissatisfaction. Herein lies a strategic component for doctoral education in preparing the new generations of leaders. Changing the culture means changing behaviors to match philosophy, mission and values to everyday work, difficult under any circumstances.
Leaders create strength in adaptive organizations by constantly reinforcing mission, goals, and strategies so that all workers know what is important and how things are done (Jones and Redman, 2000). Those working closest to the patient or the point of service are the ones who are the heart of an organization. Leaders must remember that the needs of workers are as important as the needs of customers; both serve the needs of the organization.
Leaders must be prepared to face barriers to a healthy culture: centralized leadership, poor communication, powerlessness, alienation, reliance on policy and procedure, and workplace stress (Grindel et al, 1996). Evidence indicates that a healthy workplace culture is linked with autonomy, communication with direct managers and peers, and recognition or feedback for good work, and contributes to physical and mental well-being of the patients and staff, thus playing a role in healthy outcomes for both.
Changes in Healthcare Leadership
If it is to change, the healthcare workplace needs a new leadership paradigm that can ensure meaningful work and reduce fragmentation and shortages (American Hospital Association, 2002). Increasing patient acuity coincided with personnel shortages, thus overloading the workforce contributing to the disillusionment that is part of the poor image of nursing as a profession (Sherwood, 2003).
Traditional management-based leadership has been challenged to move the organization to focus on mission and values-based healthcare. The healthcare market is driven by economics and outcomes, shifting the emphasis of nursing to decreasing length of hospital stay and measuring quality benchmarks against industry leaders to determine outcomes of care.
Nursing shortages, medical errors, poor image, a graying work force, declining numbers, and poor compensation contribute to poor morale in many countries around the globe, not solved by past leadership strategies. Continuing the same strategies will not change the results (Porter-O’Grady and Malloch, 2003). Nurse leaders with knowledge of how organizations work have the opportunity to reshape the structure and influence the culture (Laschinger et al, 2000).
Each nurse a leader’ means each nurse uses his or her sphere of influence, wherever they are in their work setting, to move the profession forward, to offer administrative leadership, to lead teams of workers in delivery of care, to mentor and guide students, to shape policy, or to advocate for patients.
Claiming voice means learning techniques for productive interdisciplinary communication, speaking up for what is right and just, guiding patients through the healthcare maze, and influencing policy formation and curriculum decisions. Wherever the nurse works, there is opportunity for leadership, often unclaimed. Changing the way we prepare leaders so that we build from the inner core of the person can produce a new generation of leaders for the profession.
Sherwood et al (2002) called for a relational model of leadership to build teamwork, requiring a new kind of provider skilled in the art and science of nursing. Leadership as an art and a science melds accountability based on responsibility, connecting through relationships, reverence that respects each individual, and exchange of knowledge for care delivery. Relational leadership is built through development of emotional competencies including self-awareness , self-regulation, self-motivation and empathy.
Relationship skills help to collaborate and communicate with others while influencing and managing conflict, and building consensus and support. The four cornerstones of partnerships described by Parker and Gadbois (2000) sum up the developmental process of a relational model of leadership: seeing oneself differently through inner self-discovery; seeing others differently as a community connected through dialogue and communication; seeing power differently with a balance of influence and integrated, value-based decision making; and seeing the whole differently with a shift from mechanistic to organic with revamped values, mission and vision.
In summary, leadership that guides an organization through turbulent times must be able to break out of the box to see a new version of the present reality, thus viewing the workplace and its workers with a new lens. Transformational leaders create the possibility of building a culture that promotes the autonomy, communication and recognition that foster a satisfied workforce. Doctoral educators have the task of developing curricular models based on the emerging leading paradigm and moving from the traditional transactional model towards one of transformation.
Doctoral Education Developing Leadership as a Journey of the Self
In the silent voice mode, nurses have often assumed that ‘someone else can do it’, yet each nurse has a responsibility to be a leader in shaping the environment. Adaptation of doctoral curricula explores how any change process begins with the individual and expands in the circle of influence. Transformational leadership, leaders who create lasting change, begins then as a journey of the self (Bolman and Deal, 2001).
Leadership derives from giving one’s self and spirit, propelling a reciprocal process as others give of themselves in return. Each person and their individual development into self-awareness are the focus of effective leadership. Emotionally intelligent leaders develop self-awareness, searching for the true self (Vitello- Cicciu , 2002). The workplace is transformed only as the leader transforms his or her own self, nurturing spirit in the organization by inspiring each worker to begin their own journey.