The Health Care Manager

Volume 37, Number 2, pp. 158–163

Copyright # 2018 Wolters Kluwer Health, Inc.
All rights reserved.

The Challenges of Leadership

Robert C. Myrtle, DPA
Perhaps in no other period in recent times have the challenges leaders face been so profound. In
these times of uncertainty and turbulence, we look to leaders who create a sense of purpose, who
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generate feelings of trust and optimism, and who tap the passion, talent, and efforts of those so
essential to the success of the organization and of the people it serves. Our research suggests that
becoming the leader whom people look to and admire requires an active commitment to responding
to 5 essential leadership challenges. These are (1) creating a sense of purpose, (2) devising means for
aligning the actions of the followers with that sense of purpose, (3) establishing a context that
enables others to behave in a way that is consistent with the vision and values of the organization,
(4) ensuring that the work that is done provides meaning to those engaging in the work activities,
and (5) adding to the sum of everyone’s knowledge through learning through reflective actions.
In this article, we describe these challenges and offer suggestions that you can take to become
a more effective and respected leader. Key words: alignment, empowerment and learning,
leadership, vision

I T HAS BEEN said that leadership is one of

the most discussed and least understood con-
cepts in the management literature. A Google
challenge. How you respond to that and the other
challenges will determine how effective you
will be as the leader you may wish to become.
search will return more than 10 million hits.
Refine your search just to focus on the academ- Understanding leadership
ic literature, and close to 200 000 books and
articles are identified. With a topic so diverse Our initial views of leadership were influenced
and so complex, is it possible to create ideas by a focus on individuals who had a decisive
and insights that might be useful to a manager impact on people, organizations, or nation states.
or leader interested in becoming a leader whom Often characterized as the Great Man theory,
people look to and admire? Recent research efforts at that time explored the role of intel-
suggests that becoming this type of leader de- ligence, charisma, social status, or political
pends on how effective you are in responding skills in explaining leadership effectiveness.
to the leadership challenges that every leader As inquiries into understanding leadership
faces. These are (1) the vision challenge, (2) the expanded, the idea that leadership was some-
alignment challenge, (3) the empowerment thing that was limited to a few changed. New
challenge, (4) the motivational challenge, and insights suggested that leadership was some-
(5) the learning challenge. We characterize the- thing that could be developed. This led to a
se challenges in combination as the leadership focus on identifying the traits associated with
the effectiveness of leaders. While ongoing
research suggests that traits are important,
studies found that traits alone did not explain
Author Affiliation: Health Services Administration, leadership effectiveness.1,2 Other factors, par-
Public Administration, Sol School of Public Policy, Los
Angeles, CA. ticularly the behaviors of leaders, emerged as im-
portant contributors to leadership effectiveness.
The author has no conflicts of interest to disclose. Lewin and colleagues3 noted that the be-
Correspondence: Robert C. Myrtle, DPA, Health Services haviors of leaders were important in influencing
Administration, Sol Price School of Public Policy, the actions of people. They found that whereas
University of Southern California, Los Angeles, CA authoritarian leaders achieved higher levels of
90089-0626 ([email protected]).
production, participative leaders were gener-
DOI: 10.1097/HCM.0000000000000215 ally more effective in achieving higher-quality
158

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

 The Challenges of Leadership 159

results. Later, McGregor4 characterized the The vision challenge

differences between authoritative and par-
Hamm7 points out that the real job of a leader
ticipative leaders as ‘‘theory X, theory Y.’’ This
is to inspire the organization to take responsi-
was followed by research that suggested the
bility for creating a better future. Kouzes and
situation facing a leader influenced the ef-
Posner8 add that people are moved by a clear
fectiveness of the leadership behaviors being
vision of a hoped-for future; they want a vi-
applied. Contingency models of leadership
sion of the future that reflects their own as-
suggested that there was no one best way of
pirations. Hence, this ability to create a vision
leading. Instead, leadership effectiveness was
is an essential part of successful leadership.
influenced by the context under which the
Indeed, Korn/Ferry International’s survey of
work was performed and the experience and
the ability of the worker in responding to the leaders found that the dominant quality de-
demands of the task. sired in leaders was the ability to convey a
More recently, our views of leadership have strong sense of vision.9 However, as Kouzes
been extended to recognize that leaders are and Posner8 note, this is not something that
not limited to only reacting to the situations most leaders do good job. Not surprisingly, this
they and their followers are facing. Leaders lack of vision is often cited as a key reason for
were found to act in an effort to bring about the downfall of many chief executive officers.
changes in the environment under which the The message is clear; for you to succeed as a
organization operates.5 Not only do leaders leader, you must have a vision, you must com-
respond proactively to shape conditions in municate that vision, and more importantly
their environment, but they also act in a similar your actions must be seen as aligned with that
fashion to bring about changes in their orga- vision. Yet, a vision is more than a statement of
nization to exploit the opportunities emerging purpose. Rather, it is an aspirational expres-
in their environments. These transformational sion of the future the organization is seeking
efforts of leaders to enhance their organization’s to achieve. As an example, Oxfam10 offers
effectiveness add new insights to the prevailing this vision ‘‘a just world without poverty’’ to
logic that underscores our understanding of guide its actions. Johnson & Johnson begins
the work of leaders. its vision with the statement, ‘‘Be Yourself,
Bennis6 summarized these decades of lead- Change the World’’ encouraging ‘‘every person
ership study by noting that if we have learned to use their unique experiences and back-
anything about leaders and leadership it is grounds, together—to spark solutions that create
that leaders do not exist in a vacuum. He a better, healthier world.’’11
notes that leadership exists only with the Although it is common to see vision making
acceptance of the followers. He suggests that as something that occurs at the top, effective
the challenges confronting organizations and leaders recognize that crafting a vision is a
nations today require exemplary leadership. responsibility at all levels of the organization.
Our research suggests that responding to As Kouzes and Posner8 note, the visions that
these challenges requires addressing 5 funda- capture the imagination and the commitment
mental issues. These are (1) creating a sense of of people are those that are shared. Doing so
purpose, (2) devising means for aligning the requires the involvement and engagement of
actions of the followers with that sense of team members to create a vision that is forward
purpose, (3) establishing a context that enables looking and anchored more on the possibilities
followers to behave in a way that is consistent of the future than the constraints of the pres-
with the vision and values of the organization, ent. One place to begin in this process is to use
(4) ensuring that the work that is done provides the organization’s vision statement as a begin-
meaning to those engaging in the work activi- ning point. Then, with this as a reference point,
ties, and (5) adding to the sum of everyone’s begin to engage your team to craft an aspi-
knowledge through learning through reflective rational statement that describes how you
actions. will act to achieve what is expressed in the

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

160 THE HEALTH CARE MANAGER/APRIL–JUNE 2018

organization’s vision statement. Keep in mind With the transition from a manufacturing econ-
that without a vision no one on your team or in omy to a knowledge economy, a similar transi-
your organizational unit will know what your tion in how we design the means and methods
aspirations are and why they are important. organizations use to achieve the purpose cap-
tured by its vision is required.15 Unfortunately,
The alignment challenge in many organizations, the approaches used
to align people with the vision and the strat-
Most leaders realize that the activities of their
egies necessary to be successful have not kept
people and systems must be aligned if the vision,
pace with these changes. As a result, nearly 20%
strategies, and goals of the organization are to be
of working people in America are actively dis-
realized. Ensuring this is the case is the challenge
engaged from their organizations and the work
of alignment.12 In many organizations, alignment
that it does.18 Even under current uncertain
is seen as an ‘‘ends means chain’’ that cascades
economic conditions, research has found that
down throughout the organization. But what
approximately 30% of people view the work
seems so logical in ensuring that the future
that they do as ‘‘just a job to get them by.’’19
envisioned through strategy rarely unfolds as
Not surprisingly, the link between strategic
planned?13,14 Emerging research suggests that
intent and implementation rarely achieves the
although it is true that alignment involves linking
results expected.20
strategy to action through goals, roles, and re-
Gallup18 notes that great managers use em-
sources, achieving this linkage is less an engi-
powerment methods to motivate their em-
neering challenge and more a one translating
ployees. They seek to overcome obstacles that
action through the behaviors of those respon-
hinder their team in achieving their goals. They
sible for the implementation of strategy.15
act to build trusting relationships by creating a
Covey16 found that the vast majority of those
culture of accountability and support their
employees do not know which actions or
workers by making informed, unbiased de-
behaviors on their part actually contribute to
cisions for the good of their team and com-
their employer’s goals. Semler17 notes that
pany. Creating conditions that empower is
while people have a general understanding of
not easy. First, you need to be sure what you
the organizations’ goals, translating these into
mean by empowerment; what an empowered
behaviors that lead to their realization is an-
work environment might be like, and what be-
chored in the inspirational aspects of the or-
haviors of your employees would be consistent
ganization’s purpose and vision. The underlying
with this vision. Next, you need to reflect on the
reality is this: Until and unless the organiza-
possible changes in your management practices
tion’s culture is aligned with the vision, little
and behaviors that will be required to support
will be achieved. Hence, an important leader-
workplace and worker empowerment expec-
ship task is creating an organizational culture
tations. Goldsmith21 points out that most em-
that enables individual and collective action.
ployees understand their jobs; they know their
One element in aligning worker behaviors
roles, functions and their responsibilities. This
with team, unit, and organizational strategies
suggests that the potential exists for develop-
is that of worker empowerment.
ing an empowered workforce. The key is let-
ting your employees do what they need to do
The empowerment challenge
to get the job done. Of course, they must also
Why do people work? Conventional wisdom have the information, resources, and support
would say ‘‘to earn a living.’’ While financial that are part and parcel of empowerment.
rewards do matter, most workers want to gain
a sense of purpose in what they do. They want
The motivational challenge
to find meaning through their accomplishments,
they seek a sense of mastery over what they The reasons people decide to work for a
do, and they desire to have a degree of control particular organization are many. For some, it
over the factors that affect their performance. is the means to an end, a way of acquiring things

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

 The Challenges of Leadership 161

that provide a sense of well-being.22 For others, of developing and disseminating what is being
it is the work itself and its ability to provide a learned is becoming the ‘‘next source of compet-
sense of purpose, meaning, or achievement.23 itive advantage.’’25 However, this rapid growth
The extent to which these expectations are and dissemination of information often mean
met can have an influence on the effort that that what we believed to be true is now being
workers will devote to meeting the goals and replaced with new insights, theories, and prac-
objectives inherent in their jobs. tices. This transformation of what we know
Gallup,24 in the effort to understand what had led to an increased recognition of the im-
influences worker engagement, identified portance of learning, both individual and or-
2 underlying factors. The first set involved work- ganizational, on the organization’s success.
related conditions. Those surveyed wanted While organizational learning is more than
some degree of autonomy in how they did the summation of individual learning, one of
the work assigned. They wanted work that the key factors affecting organizational learn-
allowed them to develop a level of proficiency ing is the behaviors of individuals who trans-
that can be best described as mastery. Doing late experiences into refinements of beliefs
so required knowing what was expected of or behaviors. While most views of learning
them, having the materials and resources to do suggest that it is the systematic accumulation
the work assigned, and an opportunity to get of experiences, not all experiences are benefi-
into roles that they did best and with feedback cial. And because knowledge has a shelf-life,26
and recognition for their accomplishments. it is important to recognize that successful
The second factor identified by Gallup24 learning requires unlearning as well.27
involved the behaviors and actions of the Can organizations learn? After all, they are
worker’s supervisor in overseeing and supporting artificial constructs designed to align the col-
their carrying out their responsibilities. They lective action of people and technology to
wanted a leader who created a work environ- serve an important social purpose. It might
ment that supported them in their work-related be convenient to view organizational learn-
activities. This meant having a leader who lis- ing as the accumulation and transmission of
tened to them, who made them feel that their the individual experiences to others in the
ideas and opinions mattered, who they felt would organization. However, not all experiences are
support them when the need arose. They wanted value adding, and thus, learning in an organi-
a supervisor who helped them feel trusted and zational context involves the monitoring and
valued, who was concerned with their growth assessment of these experiences to ensure that
and development, who provided them with what is being shared is consistent with the
helpful and useful feedback on how to improve vision and values of the organization. More
what they did, and who provided them with recently, the leaders of organizations have sought
opportunities to grow and develop. to exploit the knowledge creation and dis-
Much of what we know about motivation semination activities within organizations by
suggests that the effort workers give to their constructing knowledge management capaci-
assigned responsibilities is shaped by 2 factors— ties. Whether knowledge management systems
the behaviors and actions of the leader and the will measure up to the potential for improving
work that they are asked to do. Leaders who organizational functioning will depend on how
get their people to do their best create a working well individuals and organizations systemati-
environment that empowers through opportu- cally reflect on and evaluate their accumulated
nities to learn, grow, and develop. experiences and translate those insights into
changes into behaviors or belief systems.
The learning challenge
With 50% of gross domestic product in the
The challenges of leadership
major Organization for Economic Cooperation
and Development (OECD) economies being Kotter28 notes that leaders face 2 fundamental
described as knowledge based, the importance challenges. The first is figuring out what needs

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

162 THE HEALTH CARE MANAGER/APRIL–JUNE 2018

to be done, and the second is making things directing but with the leaders’ guidance and in
happen. This translation of what must get done line with the limits associated with the roles
into results depends on how effective you and responsibilities of the job and the person.
are in addressing the leadership challenges Our research offers a framework for aligning
highlighted in this article. It begins with hav- the actions of people to the vision, values, and
ing a compelling vision that touches the hearts goals of the organization. We argue that effective
and minds of those people. For the most part, leaders create a culture that empowers and
visions do not ‘‘just happen’’; they evolve over encourages people, a culture that focuses on
time. They may begin with a sense of purpose, providing a meaningful work experience that
but as Lucas29 suggests, the vision that is most respects the motivational drives of people. Peo-
likely to move people is one where those re- ple want to be respected; they want to achieve a
sponsible for its implementation participate in level of mastery over the work that they do; they
its development. While the best vision state- want to be able to grow and to learn, and they
ments are anchored in the core values of the or- want to be rewarded fairly for their efforts.
ganization, visions evolve over time—essentially, Bennis6 pointed out that today, perhaps in
they become a living document that sets forth no other period in our human existence, the
the aspirations that drive the organization and challenges leaders face are so profound. We
its people. look to leaders who create a sense of purpose,
Drucker 30 felt that effective leadership who generate trust and optimism, who realize
depended on knowing what motivates people. that none of this can be achieved without the
He believed that leaders create a culture that efforts of others. Becoming the leader whom
encourages people to assume a sense of respon- people look to and admire requires an active
sibility over their work activities. He believed commitment to responding to the leadership
that people should be encouraged to be self- challenges that all leaders face.

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 The Challenges of Leadership 163

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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.