Leadership styles used by senior medical leaders : patterns, influences and implications for leadership development

Purpose: Clinician leadership is important in healthcare delivery and service development. The use of different leadership styles in different contexts can influence individual and organisational effectiveness. The purpose of this study was to determine the predominant leadership styles used by medical leaders and factors influencing leadership style use. Design: A mixed methods approach was used, combining a questionnaire distributed electronically to 224 medical leaders in acute hospital trusts with in depth ‘critical incident’ interviews with six medical leaders. Questionnaire responses were analysed quantitatively to determine firstly the overall frequency of use of six predefined leadership styles, and secondly, individual leadership style based on a consultative/decision-making paradigm. Interviews were analysed thematically using both a confirmatory approach with predefined leadership styles as themes; and also an inductive grounded theory approach exploring influencing factors. Findings: Leaders used a range of styles, the predominant styles being democratic, affiliative and authoritative. Although leaders varied in their decision-making authority and consultative tendency, virtually all leaders showed evidence of active leadership. Organisational culture, context, individual propensity and ‘style history’ emerged during the inductive analysis as important factors in determining use of leadership styles by medical leaders. Implications: The outcomes of this evaluation are useful for leadership development at the level of the individual, organisation and wider NHS. Originality/value: This study adds to the very limited evidence base on patterns of leadership style use in medical leadership and reports a novel conceptual framework of factors influencing leadership style use by medical leaders.