One of the joys of writing this blog is the way it encourages me to think more deeply about issues that matter to me.  Another is the opportunity it provides to chew over interesting new research studies.  A couple of recent papers that caught my eye were Vianello et al's "Elevation at work: The effects of leaders' moral excellence" and Westerlund & colleagues' "Managerial leadership is associated with employee stress, health, and sickness absence independently of the demand-control-support model".  The first study found that " ... leaders' interpersonal fairness and self-sacrifice are powerful elicitors of elevation, and that this emotion fully mediates leaders' influence on followers' organizational citizenship behavior and affective organizational commitment" and the second study found "AML (Attentive Managerial Leadership) was associated with perceived stress, age-relative self-rated health, and sickness absence due to overstrain/fatigue after controlling for the Demand-Control-Support model. Lack of AML was significantly associated with a high stress level in all subgroups".  

As a single-handed practitioner I'm not involved in obvious organizational leadership in a day-to-day way.  I am however regularly struck by how clients coming to see me are often affected, for better or worse, by the quality of their bosses.  McAvoy & Murtagh, in their BMJ editorial "Workplace bullying: the silent epidemic", wrote "A deadly combination of economic rationalism, increasing competition, "downsizing," and the current fashion for tough, dynamic, "macho" management styles have created a culture in which bullying can thrive, producing "toxic" workplaces. Such workplaces perpetuate dysfunction, fear, shame, and embarrassment, intimidating those who dare to speak out and nurturing a silent epidemic ... Workplace bullying has been estimated to affect up to 50% of the United Kingdom's workforce at some time in their working lives, with annual prevalences of up to 38%, and is becoming increasingly identified as a major occupational stressor. In the United Kingdom costs have been estimated at £2-30bn ($3-48bn; 3-44bn) per annum".

Leadership is a very big subject.  Searching on Medline using "leadership" as a keyword gives me over 21,000 citations - and Medline only picks up a proportion of the important articles published on any subject.  If I dramatically restrict the search to "leadership" as a "major topic" in articles published in 2010, I still get 437 citations.  I've skimmed through their titles.  Fascinating.  Some that caught my eye included "Transformational leadership and staff retention: an evidence review with implications for healthcare systems", "Transformational leadership and depressive symptoms: a prospective study", "Transformational leadership and employee safety performance: a within-person, between-jobs design", "A study of leadership behaviors among chairpersons in allied health programs", "Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review" and "The contribution of hospital nursing leadership styles to 30-day patient mortality".  Good leadership is hugely important for staff performance, wellbeing, burnout & depression, sickness absence, and even death.  Other recent studies highlight these findings - "Managerial leadership is associated with self-reported sickness absence and sickness presenteeism among Swedish men and women" and "Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study".

Health professionals are often involved in a "leadership" role with clients.  Even as parents we sometimes need to "lead" our children.  As with the broader organizational field, our influence is likely to be better if it comes more from "prestige" than "dominance" - see the important earlier article "The evolution of prestige: freely conferred deference as a mechanism for enhancing the benefits of cultural transmission".  There are fascinating overlaps between transformational leadership for groups, effective therapeutic alliance for patients, and good parenting for children.  These fields intertwine - for example, see the recent article "Leaders as attachment figures".

For more on transformational leadership, read the Wikipedia article.  And Bass & Rigio's key book "Transformational leadership" looks well worth exploring ... something else for my Christmas list!

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