Friday, September 3, 2010


I recently read an article titled “Transformational Leadership and Organizational Culture: The Situational Strength Perspective” by Masood et al (2006). Masood and his co-authors provide a framework for understanding the interrelationship between leadership (transformative or non-transformative), culture (hierarchical, market, clan-based, or adhocracy), and context (weak versus strong situations).

In applying this to healthcare organizations that I have worked for in the past and currently, such organizations are typically hierarchical in structure, lead by non-transformative leaders, and present a strong situational context which, on the whole, impedes transforming changes to occur within the organization.

(Note, I do not mean to imply that some leaders do not have transformation qualities, but simply that those qualities are not allowed to be expressed within the organization except in a tight, controlled manner reflective of the hierarchical structure).

In order for transformational change to be most successful, leaders need to not only have transformational qualities (good visioning, rhetorical, and impression management skills, and ability to use these skills to develop strong emotional bonds with followers) but they also need to work within a situational context that allows these qualities to flourish. Similarly, clan and adhocracy cultures are more adept at recognizing opportunities for change, accept ambiguity, and have the energy and motivation to elevate issues to a higher level and produce not just action but results.

To implement “transformation” within a hierarchical organization we often asking leaders and front-line staff to “buck-the-system” which goes against the grain of everything they may have been told (or experienced) the organization values and rewards. This contradiction is simply too much for many leaders and most staff and the transformation effort is destined to fail.

Lastly, implementing transformation is not about achieving the deliverables in a project plan. True transformation starts with leadership and culture and leads to production (i.e., the manner in which work is performed). Transformation, once in place, is ongoing, never ending.

It’s the people – not the processes and policies and products – that highlight a transformative organization. If you are talking about transforming patient care within your organization, ask yourself if you have focused on the people first.

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