Influence of contextual factors on health‐care leadership

To extend understanding of the influence of contextual factors on: power and influence; creativity and innovation; and leadership behaviour.

The review has been compiled following a search of seven electronic databases from 1999 to 2004. The author also uses her experience as a physiotherapy manager within a children's hospital NHS Trust to reflect on some of the theories in the workplace.

While the literature is contradictory in places, some trends do emerge. Bureaucratic organizations can inhibit an empowering environment, as can those that are poor at disseminating information or communicating a vision. Hierarchical structures, high staff turnover and lack of resources are likely to stifle creativity and innovation. Organic structures tend to facilitate a more transformational leadership style, whereas bureaucratic structures encourage a more transactional style. The quality of leader‐member exchange is thought to be related to work group size, work group cohesiveness and organizational climate.

Care is needed in applying these findings to the National Health Service as theory that is developed in one organisation or culture may not be transferable to another. The author suggests that an empirical investigation should be undertaken in different National Health Service units.

This paper explores an aspect of leadership that is often neglected. Organizations that wish to nurture and develop their leaders and managers will need to be mindful of the environmental context within which this takes place.