With the growing scope of leadership theories, as well as with the growing role of leadership in nursing, stakeholders and followers gradually come to realize that true leadership is impossible without ethics. In this context, it is important to understand how ethical leadership can guarantee that followers and stakeholders meet their obligations to clients, customers, patients, and other stakeholders. Bearing in mind that ethical leadership avoids using and imposing power on people, but rather emphasizes obligation, trust, commitment, and emotion in relationships with people, the latter find it easier and more appropriate to follow and improve the quality of leadership practices and interventions in healthcare; in the same way, ethical leadership makes it possible for followers and stakeholders to meet their obligations and needs with regard to patients and consumers.
Leadership in Healthcare
With the growing scope of leadership theories, as well as with the growing role of leadership in nursing, stakeholders and followers gradually come to realize that true leadership is impossible without ethics. In this context, it is critical to distinguish ethics in leadership from all other ethical domains, including healthcare ethics, business ethics, management ethics, etc. Moreover, it is essential that leaders in healthcare view ethics as the dimension of transformational approaches to leadership. Certainly, the question is in how ethical leaders can guarantee that followers and stakeholders integrate their worldviews with those of leaders, and that ethical leadership works to create a new atmosphere of ethical transformation in healthcare. Moreover, it is important to understand how ethical leadership can guarantee that followers and stakeholders meet their obligations to clients, customers, patients, and other stakeholders. The answers to these questions are rather simple: bearing in mind that ethical leadership avoids using and imposing power on people, but rather emphasizes obligation, trust, commitment, and emotion in relationships with people, the latter find it easier and more appropriate to follow and improve the quality of leadership practices and interventions in healthcare; in the same way, ethical leadership makes it possible for followers and stakeholders to meet their obligations and needs with regard to patients and consumers.
For many years, medicine and healthcare existed in a kind of a vacuum, which limited public understanding of healthcare professions and did not leave any chance for doctors to define and apply the principles of leadership in practice. Unfortunately, it was not before the advent of the new technological age and the development of Internet technologies, that professionals in healthcare came to realize that “capable leaders are needed in medicine to shepherd and influence continued evolution of dynamic healthcare systems” (Dowton, 2004). As such, leadership in healthcare and its ethical dimension are called for creating new organizational and professional hierarchies, which would leave professionals and subordinates enough power and freedom of decision-making, and would simultaneously limit their capabilities to the extent that does not damage the ultimate organizational outcomes.
It is also easy to see that very often managers act like bullies at the playground, trying to impose their viewpoints on the subordinates, and not giving them a chance to express their opinions. Of course, this is not leadership; rather, this is a form of coercion, which does not have any ethical side but on the contrary, undermines the stability of the major organizational systems (Rigolosi, 2005). The point of ethical leadership, regardless of the leadership style chosen, is in that the major decisions are taken “from heart”, with reason and mind being powerful supporting categories that work to promote the relevance of these ideas and interventions. Given that leadership is primarily concentrated on the need for transformations and guiding people in a way that would help them adapt to and tackle with the most robust challenges, it is due to ethics that followers and stakeholders can be given sufficient opportunities and skills to master these transformations. The point of ethical leadership is in “influencing and guiding others to respond effectively to adaptive challenge and to work collaboratively to achieve a moral vision; this is possible by establishing and developing a genuine partnership with the people leaders are working with” (Daly, Speedy & Jackson, 2004). Certainly, when guided and not coerced, and when being a partner rather than subordinate, stakeholders will be more attentive to the initiatives proposed by the leader, and will be looking for the means to increase and promote the effectiveness of the major organizational strategies. They will have more opportunities and motivation to work toward their obligations to clients and patients. “If leaders set goals that are consistently unattainable, followers may never feel successful, getting caught in a downward emotional spiral” (Rigolosi, 2005), and in this context ethical leadership implies that prior to setting goals, leaders critically evaluate the opportunities their followers have to achieve them; moreover, it is due to the fact that ethical leaders are more likely to recognize the appreciation of their followers’ attempts and to celebrate their successes, that healthcare professionals can meet their obligations to patients, consumers, and stakeholders.
It should be noted, that ethical leadership is always associated with effective leadership; in other words, a good and well-performing ethical leadership cannot be ineffective. Effective leadership implies that leaders have sufficient power and influence to change the visions of their followers in a way that makes these visions compatible with those of a healthcare organization (Daly, Speedy & Jackson, 2004). When it comes to healthcare, and taking into account the importance and responsibilities healthcare initiatives may have for patients, ethical leaders in healthcare organizations usually have more responsibility with regard to the transformations, which are required to bring in positive changes. Ethical leadership can successfully challenge the established status quo and guarantee the provision of high quality healthcare services to different groups of patients. The success of ethical leadership and the fact that followers and stakeholders appear more prepared to listen to ethical leaders is in that ethical leaders create a good positive example and emphasize the importance of reciprocal relationships with their subordinates; but beyond that, the seven critical elements of ethical leadership make it possible to redirect followers and stakeholders toward the major organizational goals: these elements work altogether to shape the basis for continuous and positive achievement among followers and stakeholders.
First of all, any leader will seek to adhere to a set of predetermined ethical standards. Here, a strict set of ethical guidelines is required; these guidelines are expected to redirect followers’ and stakeholders’ efforts toward organizational and ethical compliance. Simultaneously, that an ethical leader himself is able to behave within the boundaries of these ethical norms also increases motivation among healthcare professionals and promotes integrity between the moral actions and moral ends organizational strategies and interventions are to produce (Daly, Speedy & Jackson, 2004). Second, ethical leaders make people follow them through the development of a comprehensible moral vision. In the process of developing such vision and ethical leader not only strives to do what is right, but by any means possible avoids situations that may seem unjust to subordinates and stakeholders. Moral vision also implies the presence and use of diplomacy, tact, tolerance, diligence, and loyalty (Daly, Speedy & Jackson, 2004), and of course, in this diplomatic atmosphere followers find it easier to come to an agreement with clients and patients, and as a result, satisfy their organizational and medical needs. Third, the process of achieving moral outcomes is the essential component of ethical leadership and the element that provides ethical leaders with a range of instruments followers can use to meet strategic organizational objectives. However, it is not enough to be a good talented leader; moral accomplishment requires well-developed organizational skills. Here, ethical leadership comes out to signify a combination of talents and skills, which altogether influence their followers’ visions and change their perceptions with regard to various organizational objectives (Daly, Speedy & Jackson, 2004).
Objectively, “a leader embraces the duties and obligations that grow from the trust and power given to him (or her). The most critical of these obligations are clear perception, determined action, and an overriding concern for the best interests of his (or her) constituents” (Daly, Speedy & Jackson, 2004). Moral responsibility is another factor that helps ethical leaders create a group of followers, as far as without being able to hear, to listen, to show respect, and to consider the consequences of each action followers will not be willing to display positive attitudes toward leader’s ideas and suggestions. Without such motivation, followers will also be hardly prepared to tackle with the challenges, of which patient and stakeholders’ obligations can be the source. Moral knowing, moral cooperation, and moral role modeling are the three other examples of criteria for evaluating the quality of ethical leadership, and as a result, the elements that create and maintain integrity within healthcare organizations, which are being led by ethical leaders (Daly, Speedy & Jackson, 2004). By being able to control their emotions and to exercise justice principles in the distribution and imposition of power, ethical leaders create organizational environments, in which followers and stakeholders view them as role models and readily accept the standards and norms of ethical conduct in all organizational initiatives.
Professionals in healthcare should remember that ethical leadership is not a separate form of leadership practice in healthcare organizations; rather, it is just one dimension of any appropriate form of leadership chosen by this or that healthcare organization. To a large extent, ethical leadership is highly consistent with transformational leadership, as far as ethical conduct and commitment to morality and tolerance invariably result in broader organizational and ethical transformations in healthcare. Any leader is primarily aimed at initiating and implementing major organizational changes. As long as “the best practices of transformational leaders draw on the values, aspirations, and skills of all members in the leadership process to achieve mutually desired goals” (McElumrry, Tyska & Parker, 1999), these are fully consistent and compatible with the principles of ethics in healthcare leadership; as such, transformational and ethical leadership can produce synergic effects on the quality and effectiveness of organizational ideas. Bearing in mind that both ethical and transformational leadership work to improve the social status of followers, stakeholders and other participants of the leadership processes, ethical leadership turns into the critical element of organizational success, which unites stakeholders and followers around organizational objectives and creates conditions favorable enough to meet the needs and obligations of clients and stakeholders.
Ethical leadership is recognized as the critical dimension of transformational leadership in healthcare, but beyond producing positive effects on the quality of leadership itself, the major question to be answered is in how ethical leaders help their followers meet their obligations to clients, patients, and other stakeholders. The fact is that a set of guidelines which ethical leaders use in practical performance, as well as ethical principles to which they adhere create a favorable environment, in which their followers feel increasingly motivated to fulfill their organizational obligations. It is due to ethics that followers view their leaders as role models, and become better prepared to tackle the emerging challenges, as well as to accept and use proposed organizational and ethical transformations on their way to better customer and stakeholder satisfaction.
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