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    Steve Brewer
    Steve Brewer, MBA, CMPE, FACHE

    Healthcare is a complex environment that continues to experience exponential rates of change. Effective leaders are attentive to the pressures to constantly improve quality, adapt to the notion of consumerism and reduce costs. Moreover, leaders are faced with the significant challenge of providing more services with increasingly disproportionate resources.

    As an added problem, all of this is happening while governmental programs, private insurers and individuals are looking to reduce overall healthcare costs. Systems also are attempting to navigate a shifting focus from treating illness and injury to wellness and population health. Navigating these complex and daunting challenges requires strong leaders who are proficient in leading change. A solid understanding of contemporary leadership theories equip leaders to effectively guide people and organizations in a turbulent and evolving environment.

    Contemporary leadership theories — An emphasis on people and change

    What makes a successful leader has been the topic of extensive research and developing theories for many decades. These theories range in focus from innate characteristics of individuals — including personal status, wealth and prestige — to broader, personality-based traits such as creating a vision, the ability to motivate and building trust among followers.1 Contemporary leadership theories should be differentiated from common behavioral styles, which include autocratic, participative, consultative and laissez-faire approaches to leadership.2  Rather, current models are broader in concept and include transformational, servant and adaptive leadership theories.3 As the following descriptions and discussion will demonstrate, each has distinct focus while also helping people to understand, accept and adapt to continued change.

    Transformational leadership

    Healthcare organizations are having to adjust and look for ways to transform their systems to match the changing environment.4 This includes how clinicians interact with patients, administrators approach strategic planning, and frontline workers do their day-to-day tasks. Transformational leadership has been put forth as foundation for anticipating and leading change in healthcare.5 

    Transformational leadership primarily focuses on inspiring individuals to look beyond their own interests and align with and work toward achieving organizational goals.6 Transformational leaders prioritize moving an organization toward future success, but they also have a high regard for developing individuals to perform at their highest ability. Transformational leaders enhance their organization’s capacity to realize a shared vision of future success by boosting the motivation and capabilities of individuals.

    Northouse describes four factors that transformational leaders employ in driving effective evolution and change:

    1. Idealized influence, which includes being an inspirational role model with high integrity and respect
    2. The ability to inspire by communicating a common and inspiring vision
    3. Promoting innovation and finding new approaches to current challenges
    4. Considering individual needs in relation to organizational goals and emphasizing a coaching philosophy to support growth.7 

    When compared to a more traditional transactional model, which focuses on rewarding or reprimanding behavior, transformational leadership has been the model employees prefer.8,9 However, other models have additional traits and attributes that should be considered when addressing the healthcare environment.

    Servant leadership

    Servant leadership theory was first developed by Robert Greenleaf in 1970.10 Greenleaf described the servant leader as one who prioritizes serving others, with a focus on enriching lives, developing organizations and, ultimately, creating more caring communities.11 The notion of servant leadership has gained significant attention in popular writings and scholarly research. Common themes within servant leadership include putting the needs of individuals ahead of oneself, an emphasis on attending to follower’s needs, building capacity for working towards common good, fostering a culture of respect, trust and continuous development.12 

    In 1992, Spears proposed 10 characteristics of servant leadership to deepen the understanding of this model and provide more context for its application.13 The 10 characteristics include listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to growth of people and building community. A full exploration of each characteristic is beyond the scope of this paper; however, Trastek suggests these traits are well aligned with healthcare leadership and the intrinsic motivation of clinicians and others to serve patients and their communities.14 In addition, the characteristics of servant leadership are directly linked to the patient-centered relationship that has been shown to increase outcomes and improve the patient experience. Servant leadership has been cited in building stronger relationships and common objectives between physicians and health administrators.15 

    Adaptive leadership

    To successfully navigate turbulent times, leaders must guide their organizations in adapting to changes in the landscape while ensuring safe and effective care continues. The theory of adaptive leadership emphasizes the need to face realities and help people anticipate and adjust to the dynamics of considerable challenge.16

    The adaptive leader model focuses on the behaviors and interactions that help motivate people and organizations to change with new paradigms and evolving realities.17 Unlike many other change management models, adaptive leadership stands out because it is specially designed to address major changes when clear solutions are unknown.18 Embedded in the adaptive leadership theory is the distinction between technical problems and adaptive problems — the former being situations where solutions are known through past knowledge and experience, and the latter being complex situations that require new and innovative problem solving.19,20,21

    There are six behaviors linked to adaptive leadership.

    1. Taking a step back to assess situations and “get on the balcony” to gain a comprehensive view of the landscape
    2. Identifying challenges that will require new approaches to overcome 
    3. Working to relieve pressures on individuals and allowing for free and safe dialogue in seeking ideas 
    4. Being disciplined in focus to assure continued progress 
    5. Giving the work back to those on the front lines and empowering them to act 
    6. Listening to the viewpoints of those involved in seeking alternative solutions and opportunities.22

    By adopting these behaviors, leaders are better able to shepherd individuals toward common interests while facing significant changes that must be addressed to ensure success.

    Comparing and contrasting theories

    Studying the transformational, servant and adaptive leadership theories quickly identifies several recurring themes. All three theories have the element of fostering individuals toward growth and developing organizations. While each theory may have a distinct nuance that is prompting a need for change, all three describe leaders who strive to help people understand the need for new approaches while respecting individual perspectives. Put another way, the three theories acknowledge the importance of human dynamics and motivation in the pursuit of organizational development. Each theory also has direct applicability to the current healthcare environment and can be used as foundations on which to build common visions and reshape solutions to new problems.

    One of the more distinctive contrasts of the theories lies in the primary focus of the leader’s objectives. Transformational leadership’s priority is altering the organization to be successful in relation to an evolving environment. Servant leadership, in contrast, puts the need to serve at the forefront of the leader’s motivation while also moving their organization forward. Adaptive leadership theory incorporates many of the behaviors and traits described in the transformational and servant models. However, the distinctive element for adaptive leadership is the magnitude and complexity of the needed change. While transformational and servant leadership models may rely on established approaches to solving issues, the adaptive model is better suited for facing new and more urgent problems that demand a greater willingness to embrace change and to support stakeholders as they adapt to new realities.


    The pace and magnitude of change in healthcare continues to intensify. To be successful, leaders should grasp and embody key elements found in the contemporary theories of transformational, servant and adaptive leadership. Given the complex nature and volume of change in healthcare — as well as the diverse perspectives of clinicians, administrators and frontline workers — effective leaders will be adept in knowing when and how to apply the correct techniques to the appropriate situation and context.


    1. Northouse PG. (2018). Leadership: Theory and practice (8th ed.). SAGE Publications, Inc.
    2. Liebler JG, McConnell CR. (2017). Management principles for health professionals (7th ed.). Jones and Bartlett Learning.
    3. Borkowski N. (2016). Organizational behavior in health care. Jones and Bartlett Learning.
    4. Trastek VF, Hamilton NW, Niles EE. (2014). “Leadership models in health care — a case for servant leadership.” Mayo Clinic Proceedings, 89(3), 374–381.
    5. Borkowski.
    6. Liu H, Li G. (2018). “Linking transformational leadership and knowledge sharing: The mediating roles of perceived team goal commitment and perceived team identification.” Frontiers in Psychology, 9.
    7. Northouse.
    8. Medley F, Larochelle DR. (1995). “Transformational leadership and job satisfaction.” Nursing Management (Springhouse), 26(9), 64JJ.
    9. Notgrass D. (2014). “The relationship between followers’ perceived quality of relationship and preferred leadership style.” Leadership & Organization Development Journal, 35(7), 605–621.
    10. Savel RH, Munro CL. (2017). “Servant leadership: The primacy of service.” American Journal of Critical Care, 26(2), 97–99.
    11. Greeleaf Center for Servant Leadership. (2016). “What is servant leadership.” Available from:
    12. Northouse.
    13. Spears LC. (2019). “Ten characteristics of servant leadership.” The Spears Center for Servant Leadership. Available from:
    14. Trastek, et al.
    15. Anderson RJ. (2003). “Building hospital-physician relationships through servant leadership.” Frontiers of Health Services Management, 20(2), 43–47.
    16. Northouse.
    17. Arthur-Mensah N, Zimmerman J. (2017). “Changing through turbulent times - why adaptive leadership matters.” The Journal of Student Leadership, 1(2), 1–13.
    Steve Brewer

    Written By

    Steve Brewer, MBA, CMPE, FACHE

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