Dynamics of distributed leadership during a hospital merger

Abstract

Purpose Mergers have become an influential part of public hospital development, and the successful implementation of such mergers requires skillful management. Recent studies have pointed to the impact of the distribution of leadership tasks amongst employees for implementing planned radical changes, yet this lacks examination with regard to hospital mergers. The purpose of this paper is to investigate the emergence of distributed leadership and this leadership's influence on the implementation of a hospital merger. Design/methodology/approach The emergence of distributed leadership is examined through a qualitative case study of two Danish hospital units in the context of a large hospital merger. The data consist of 21 interviews and documents collected over a three-year period. Findings The findings suggest dynamics of widened and restricted distributed leadership being influenced by and influencing the merger at hospital and local-unit levels, respectively. Importantly, the perceived purpose of widened and restricted distributed leadership mediated the actual effects of widened and restricted distributed leadership on the implementation of a merger. Moreover, the findings show that mergers on both the hospital and local level lead to variations in top-down and bottom-up distributed leadership across pre-merger organizational boundaries. Practical implications Perceived purposeful widening and restriction of distributed leadership at various hospital levels enables merger integration and collaboration across organizational boundaries and hierarchies. Originality/value The paper addresses the need to understand the complex dynamics of widened and restricted leadership distribution in a merger context.

Leadership of Integrated Health and Social Care Services

“…Given that integrated leadership roles within public services do exist, and that public services actively recruit people to undertake these roles, it is important for public services to develop ways to support these staff members (Heifetz, 1996). The theoretical positioning of leadership in public service context has developed from 'heroic' models of leadership to more distributed forms of leadership (Mangan and Lawrence-Pietroni, 2019) particularly in health and social care settings (Currie and Lockett, 2011;Jonasson et al, 2018). Yet many of the tasks and activities of managers encompass not just these new forms of boundary spanning leadership but also the crafting skills of traditional public administration (Rhodes, 2016) and transactional managerial duties also referred to as "craft and graft" (Dickinson, 2014).…”

Middle managers’ roles after a hospital merger

“…A merger is an external disturbance ( Jonasson et al, 2018;Mussari and Ruggiero, 2017;Ernst and Schleiter, 2018), and the way the merged organization is structured and managed will affect changes in the less tangible parts of the merged hospital. These less tangible parts are the norms, values and beliefs guiding the core activities.…”

“…Since these less tangible parts are considered as cultural integration processes (Ernst and Schleiter, 2018), changes are complex and will take time. In line with the arguments of Jonasson et al (2018), we need to examine how such changes are implemented at different organizational levels. In this study, we do this by studying how professional staff and middle managers close to the clinical activities perceive their relationships, with a focus on the managerial practices as defined above.…”

“…In Europe, hospital mergers gradually became more common in the UK and Scandinavia during the late 1990s. Since then, mergers of hospitals in Europe have been studied by several researchers (Choi and Brommels, 2009;Geisler et al, 2010;Solstad and Pettersen, 2010;Choi et al, 2012;Giauque, 2016;Jonasson et al, 2018), as the implementation of these restructuring efforts has turned out to have unexpected and often dysfunctional effects.…”

“…As the two smaller hospitals were effectively taken over by the large one, we chose to focus on these, since most of the profound structural changes were observed here. The new organization was more hierarchical and centralized, which generally leads to longer control spans ( Jonasson et al, 2018).…”