Exploring the relationship between leadership, leadership behaviours and organisational culture

Abstract

This thesis explores the theme of leadership in the NHS, specifically focusing on nursing. Leadership has become an important area in recent years particularly in relation to improving efficiency, effectiveness and quality of services. As nurses provide 80% of care in the NHS their role is pivotal in achieving any change. Despite the importance placed on leadership in the NHS, literature shows little is known about perceptions of leadership, how leaders function or what importance staff place on the culture and context in which they work. This study is based on the findings of 28 qualitative interviews with leaders in two health boards in Scotland. Through the presentation of informants' perceptions, beliefs and collective accounts, the study illustrates how staff view leadership in the NHS and provides some significant results. Firstly, it proposes that leadership is comprised of two elements; one relating to individuals and one relating to how individuals function in organisations. Secondly, it indicates three models of leadership are particularly relevant and how these apply differently according to role and hierarchy. Thirdly, it reveals leadership and management as distinct components. In nursing a number of complexities make these roles challenging, and the culture and context of health boards influence how these function in practice. Finally this research concludes that staff value a clear set of characteristics, styles and behaviours not related to vision and change but which centre on character, values, integrity and engagement. The study has considerable implications for emerging work on leadership in the NHS and for the future development of leadership roles in nursing.