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Citation:
Kutz,
MR., Necessity of leadership development in allied health education.
The Internet Journal of Allied Health Sciences and Practice.
April 2004.Vol. 2 Num. 2.
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Key words and
terms: allied health, leadership training, allied
health education |
Introduction
Why should educational programs teach
leadership, and why should universities and colleges who offer
allied health care programs be concerned with training future
clinicians to be leaders? Leadership development is a topic wrought
with passion among business professionals and educators alike.
Leadership is something everybody needs and it remains vague and
ambiguous. Leadership is a mystical, almost ethereal, quality that
you cannot define, yet know when you see. Advancing the allied
health care professions and the members of the allied health care
community is proving to be difficult without the necessary
leadership skills. More and more clinicians and students are looking
to and expecting educational programs to help in their leadership
development.
Success and promotion of the allied health sciences and the
individual practitioners from various disciplines depends highly on
leadership ability. In allied health care, like many other
organizations, the way leadership is taught, passed on and evaluated
is critical. Leadership development is an important issue that every
organization and every institution must address to ensure survival.
It is no secret that strong intentional leadership is highly valued
in our society. This value raises the question all organizations
ask, how is leadership developed? Is leadership developed through
mentoring, curricular activities, co-curricular, extra-curricular,
didactic education, or the proverbial “school of hard knocks?” These
and similar questions must be answered if leadership development
within our educational programs is to be successful.
What to Teach?
A survey of the popular literature reveals a consensus that
leadership skills and abilities can be learned and developed, while
many agree that some people have natural leadership ability while
many aspects of leadership can be learned through skill development,
competencies and experience. How people come to learn leadership is
of key consequence in leadership development. Densten and Gray5
state that, “teachers face many challenges in designing programs to
enhance the leadership capabilities of their students.”
Educators face many obstacles and
confounding variables when designing practical leadership
experiences and implementing pragmatic instructional methods.
Organizational leaders everywhere (church, corporate, educational,
health care) must ask, how is leadership learned best? Are there
leadership competencies that are “universal” and what are they, and
what leadership competencies are discipline specific? Within the
context of allied health educators and professionals must
investigate the same questions. Once each discipline determines what
to teach, then how to teach it becomes relevant.
Instructional Methods: Where to Begin?
Traditionally there are three sources of how people learn to lead;
the first is “trial and error”, the second “observation of others”
and lastly, “education."3 Closely related to these
“three sources” other longitudinal studies found three categories of
how managers learn to manage: 1) job experience and assignments; 2)
relationships; and 3) formal education/training3. Implementing these
three instructional methods is critical for successful leadership
development. Through clinical education and clinical experiences
much of allied health care education already includes these two
sources, “trial and error” and “observations of other.” It is the
“educational” method of leadership development where the struggles
begin. One other potentially significant issue observed in the
literature is the difference between “observations of others” and
“relationships”, identified by Brown.3 While these two
have similarities, intrinsic in the terminology are key differences.
Many leadership development programs
include an aspect of mentoring, but does that mentoring include
developing relationship or are they merely observation. Although not
explicitly stated, it is apparent from other of Brown’s3
statements such as, “people learn to respond to who and what we
are,” and “leading is a dynamic process of human interaction,” and
“what was missing from this context [leadership development] was
attention to people” that her idea of relationship is more than mere
“observation,” tag-a-long or watch-and-do. Leadership development
involves aspects of relationship between mentor and student that
requires intentional investment of time and resources. Ideally one
manages work and leads people.3
Cress, Astin, Zimmerman-Oster, and Burkhardt4 state that, “many
educational institutions only give minimal attention to developing
student leaders in terms of specific leadership programs and/or
curricula.” There is no shortage of opinions on leadership, the
literature is replete with differing opinions and findings of how
leadership is defined, instructed, identified and evaluated. Other
authors suggest that leadership development is “sporadic”,
“haphazard” and “illogical”; and that the word leadership is a
“nebulous” term1. For example, students commonly
perceived to have leadership skills tend to “shine” by being less
shy, better students (i.e., grasping concepts and application of
knowledge), motivated, and articulate. These students are dubbed to
have “leadership potential” and as a result have higher expectations
placed on them. This typically is the extent of our leadership
preparation or education. These students’ failure or success is now
dependent on their effort in light of these new or higher
expectations.
Leadership is initially recognized by
the instructor, and depending on the disposition of the instructor
may or may not be facilitated. This can only mean that if leadership
is to be taught then those in faculty and instructor positions, must
increase and fine tune their own leadership ability, activity, and
awareness! Leadership development within Allied Health education is
often coincidental and left to extra-curricular and co-curricular
activities, such as clinical rotations/education, clinical
observations, and peer teaching experiences.
Intentional Leadership Development
Those competencies that do exist in Allied Health education (within
specific disciplines) typically address management, organizational
and administration skills, and lack identification and instruction
of leadership competencies. Leadership development in allied heath
care should be intentional. Intentional leadership assumes everyone
has the ability to lead, at least circumstantially, and therefore
can be taught in its simplest form as a set of attitudes, behaviors,
characteristics, and desires that successful leaders often exhibit.
By identifying ahead of time what constitutes leadership and what
competencies and skills one can posses or learn specific to Allied
Health can provide a more favorable climate for leadership training.
By teaching students how to lead, rather than just how to manage or
administrate, our professions can reach into many other areas of our
communities, ideally leaving good impressions of our specific
professions and individual members.
Managing and Leading
Allied Health educators need to ask, “What leadership skills are
required?" “What are necessary leadership behaviors?” “What are the
specific leadership competencies?" Finally, “How can leadership be
evaluated?” Outside of individual disciplines or academic programs,
any literature on leadership development in Allied Health as a whole
is virtually non-existent. So a grass roots examination needs to be
conducted to determine what leadership behaviors and skills are
necessary to our professions. This is no small task. Adding to the
difficulty of defining leadership performance standards or
competencies within allied health is the diversity of work settings
and job duties. This wide diversity makes it very difficult to
develop universally accepted competencies for leadership. While some
authors have attempted to address “predictors of success” these are
not necessarily leadership outcomes.
Allied Health education seems to be behind the leadership curve.
During the last decade there has been a shift from management
development to leadership development.3 In spite of this
“shift” Allied Health Care education continues to focus on
managerial skills and fails to differentiate between management and
leadership. As an example, Richard Ray8 states in his
textbook on athletic training management [an allied health care
profession] that, “this book is devoted primarily to principles and
techniques intended to improve the athletic trainer’s ability to be
a transactional leader.” Transactional leadership is commonly
thought of as a trade off between superiors and subordinates (i.e.,
management). For example, the trade of money for compliance can be
seen as transactional leadership, no real skill is required by the
“leader” it is positional authority or power only.
On the other hand, there is transformational leadership which is
more akin to current leadership ideas, which encourages subordinates
to maximize their potential even if it means “showing up” the boss.
Transformational leadership promotes individuals and organizations
by transforming current commitment to a set of higher ideals and
values versus self-preservation. One can view the difference between
transactional and transformational leadership as similar to the
differences between management and leadership. As mentioned earlier,
we come back to the idea that management is positional and based on
title while leadership is based on influence.
While teaching management and administration is important and a
large part of what many allied health practitioners do in clinical
practice, it is remiss not to establish a difference between what is
done as a manger and what is done as a leader. Admittedly management
can be easer to teach than leadership. John Kotter3
described it best, “most organizations are over-managed and
under-led.” Allied health and our specific disciplines need to
address issues of leadership with the students in our programs. In
spite of this need, Brown3 reports that, “leadership
development is an underutilized strategy at most universities.” This
can relate to the issue stated earlier that is difficult to
succinctly define, yet much easier to identify when you see it
expressed in others.
Leadership Competencies: A Starting Point
In 1997 the Association of Schools of Allied Health Professions (ASAHP)
set forth as one of their strategic plans, item 1.2.10 which states,
“Cooperate with the National Network of Health Career Programs in
Two-Year Colleges and the Health Professions Network to implement an
allied health leadership program.” This strategy resulted in the
Coalition of Allied Health Leadership which hosts annual “workshops”
on leadership issues. The September 2003 workshop states on the
application the “workshop goals” which include:
• define aspects of leadership as it
relates to allied health education and practice,
• identify personal leadership strengths and weaknesses,
• develop mentoring skills,
• explore how to lead in a time of change in health care systems
and higher education,
• develop the ability to forge relationships with linkages in
allied health education and practice.
The dialogue of this workshop and the
semantics of these goals can serve as a starting point in
identifying competencies for leadership in our diverse work
settings. While, in Athletic Training7 for example, the
competency matrix and teaching outcomes cover such things as
communication, establishing relationships and other “crossover”
leadership skills, leadership remains primarily an indirect result
of education. Most students’ leadership abilities are developed via
non-curricular or extra-curricular events. In spite of the fact that
leadership skills are a sought after commodity these “supporting
experience[s]” are given little importance in the hiring of entry
level athletic trainers.6 Because many leadership
competencies are specific to a discipline some leadership
experiences should be gained through Allied Health educational
programming and not rely solely on extra-curricular activities.
Another place to serve as a starting point is in Anderson’s and
Pulich’s2 summary on management competencies in the
health care environment. They outline four competencies with several
sub-points as important competencies in health care. These
competencies include: 1) Planning, a) goal setting, b) decision
making; 2) Organizing, a) cooperating, b) coordinating; 3) Leading,
a) communicating, b) conflict management, c) professionalism; 4)
Controlling, a) empowering. These certainly overlap and include
management ideals, but serve as a starting point for intentional
instruction of students to be leaders in their communities, places
of employment and within their profession. Teaching leadership as a
competency and its related skills (#3 above) outside the context of
management or as a stand alone curriculum is something worth
considering.
Allied Health faculty and instructors need to address issues
specific to leadership and not merely those of management and
administration. Many authors offer theoretical differences between
leadership and management that are based on assumptions, while some
offer differences based on reviews and analysis of empirical
research. Whatever the source it is a relatively accepted ideal that
leadership and management are different. For example: leadership
challenges the status quo and management protects the status quo;
leadership creates vision and management implements vision, also
part of the difference is that management can be seen as positional
or a title where leadership is influence and not necessarily based
on hierarchical position or title. To further explain this
difference it has been reported that, “management focuses on
structuring goals, tasks and roles, whereas leadership focuses on
influencing direction and change, developing quality relations, and
bringing out the best in oneself and others.."3
Conclusions & Discussion
There has always been dialogue about promoting allied health care.
One way to be proactive on this front is to teach Allied Health Care
students to lead. The question now is, “is leadership an entry-level
competency” that needs to be taught at the entry-level, or is this
something to hold off till graduate school or advanced studies?
Surveying the literature available on leadership one can conclude
that leadership transcends position and rank. If this is true then
all indications can be, yes, it can be an entry-level competency.
Many of our health science program’s clinical experiences have
strong hands on/trial-and-error aspects, which is one way leadership
is developed, but in allied healthcare disciplines leadership is
rarely intentionally taught and according to the literature
education is also one of three prominent ways leadership can be
developed.
The challenge to Allied Health Care educators is to enhance our own
leadership abilities and make it a priority to teach leadership.
Promoting student’s leadership ability indirectly promotes and
advances allied health care professions even if the leadership
outlet is somewhere other than in Allied Health Care. Graduates and
practitioners getting involved in leadership positions outside of
Allied Health Care enhances credibility in the eyes of the community
and other professions.
References
1. Alimo-Metcalfe, B. & Lawler, J. (2001). Leadership development in
UK companies at the beginning of the twenty-first century: lessons
for the NHS? Journal of Management in Medicine. 15(5) 387-404
2. Anderson, P., & Pulich, M. (2002). Managerial competencies
necessary in today’s dynamic health care environment. The Health
Care Manager. 21(2), 1-11
3. Brown, L.M. (2001). Leading Leadership Development in
Universities. Journal of Management Inquiry. 10(4), 312-323
4. Cress, C.M., Astin, H.S., Zimmerman-Oster, K., & Burkhardt, J.C.
(2001). Developmental outcomes of college students’ involvement in
leadership activities. Journal of College Student Development.
41(1), 15-27
5. Densten, I.L., & Gray, J.H. (2001). Leadership development and
reflection: What is the connection? The International Journal of
Educational Management. 15(3) 119-124
6. Kahanov, L. and Andrews, L. (2001). A Survey of Athletic Training
employers’ hiring criteria. Journal of Athletic Training. 36(4),
408-412
7. National Athletic Trainers’ Association. (1999). Athletic
Training Educational Competencies. National Athletic Trainers’
Association. Dallas, TX.
8. Ray, R. (2000). Management Strategies in Athletic Training (2nd
ed.). Champaign, IL: Human Kinetics.
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