When innovation flourishes in a specific part of an organization or system, but then fails to diffuse more widely, it suggests a lack of effective leadership.
Considering how ‘shared leadership’ between managers and professionals might help spread innovation into everyday practice, two Warwick Business School professors, Graeme Currie and Dimitrios Spyridonidis, studied the diffusion of promising health care innovations from an R&D centre to hospitals throughout an English city.
The most successful diffusion involved chronic obstructive pulmonary disease (COPD), for which an innovative process created a new pathway to improve the safe discharge of patients, and improved the patient experience.
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Focusing especially on the COPD innovation to understand how leaders involved with the innovation were able to diffuse it so widely, the researchers made valuable observations which have relevance beyond the health service.
With most health care initiatives, three categories of leaders are involved:
- Doctors, who because of their expertise and knowledge tend to be the most powerful leaders in the system.
- Nurses, subordinate to doctors and whose leadership influence is limited largely to other nurses – influence that is based on hierarchy.
- Managers, who attempt to exert leadership influence over doctors and nurses through various mechanisms, such as human resource management and performance management systems as well as their involvement in organizational strategy, business plans, etc.
In the diffusion of innovation, how does shared leadership among these three categories of leaders evolve? In previous research on innovation leadership, managers are often given an outsized role over professionals (here, the doctors and nurses). In a health care setting, however, doctors, as mentioned above, have the greatest influence.
This research revealed that managers are indeed the more important drivers of innovation diffusion, but only in the early part of the effort. Then the doctors take the lead through their professional influence.
Specifically, the study showed that in successful innovation diffusion occurred in three phases:
Phase 1 (year 1-2 of the study): Managers created the climate for innovation through their initial mandate from NHS; seeking and providing resources from commissions; and implementing educational programs related to the innovation to get buy-in from hospital chief executives and doctors.
Phase 2 (year 3 of the study): Doctors then took the lead as they facilitated the diffusion of the innovations into other hospitals by promoting the innovations to the city commissioners (thus influencing funding) and presenting the evidence to and educating their peers in other hospitals. Doctors in other hospitals also took a leadership role as they began adapting the innovations to better fit the situation in their hospitals.
While nurses followed the lead of the doctors, they also helped to adapt the innovations to local conditions, and provided valuable help in engaging frontline personnel.
Phase 3 (year 4 of the study): The doctors, still in the lead, focused on building medical networks to diffuse evidence and best practices related to the COPD innovation. Managers sought to provide resources to sustain the innovation but in general ceded leadership to the doctors, and nurses increased their leadership role in the adaptation of the innovation and engagement of nurses and other support staff in their hospitals.
The COPD innovation diffusion was a resounding success of shared leadership as all three types of leaders played their roles diligently. The researchers note, however, that some other factors beyond shared leadership also played a role in the varying success of the other initiatives, including financial challenges, disengaged nursing corps and less collaborative cultures, the latter which is key to the success of shared leadership.
As revealed in this study, shared leadership among managers and professionals is different from hierarchical leadership in three ways:
- The ‘who’ of leadership: hierarchical leadership is not about the personal attributes and characteristics of senior leaders; shared leadership involves practices enacted by leaders at all levels, although the top leadership role may evolve (e.g. from managers to doctors).
- The ‘what’ of leadership: rather than top-down control and command, shared leadership takes place through social interactions among all levels of leaders; followers have a role to play in influencing and creating leadership.
- The ‘how’ of leadership: shared leadership works through the skills and abilities of leaders to enable and enhance collective learning. Educating others – commissioners, chief executives, and doctors and nurses in other hospitals – on the merits of the COPD innovation was key.
Innovators trying to diffuse innovations throughout their organization or beyond should look for the leaders with influence who are willing to take on non-hierarchical, multi-level and evolving shared leadership roles in the process.
Access the research paper: Sharing Leadership for Diffusion of Innovation in Professionalized Settings. Graeme Currie and Dimitrios Spyridonidis. Human Relations (October 2018).