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Introduction
Leadership has long been recognized as a social exchange between leaders and followers, reinforcing the notion that behavior is contingent on transaction and exchange relationships (Carter et al., 2015; Homans, 2013; Uhl-Bien and Ospina, 2012; Weber et al., 1947). Defined as how individuals within an organization influence and facilitate action that contributes to the achievement of an organizational purpose, leadership has a variety of health-care performance indicators as follows: hospital star ratings (Shipton et al., 2008), patient safety outcomes (McFadden et al., 2009) and patient care and mortality indexes (Jiang et al., 2009). With this knowledge, there is increasing scholarly focus in health care on the concept of leadership, typically referring to senior positions of power (Currie and Lockett, 2011; Ham and Dickinson, 2008) constructed as the heroic act of individuals who exercise skillful and creative managerial techniques (McKee et al., 2013; Spillane, 2005). Corresponding discussions often focus on identifying the type of person that can fill this role (Tasi et al., 2019) or a set of competencies that can be fostered within them (Fulop, 2012; Onyura et al., 2019). Relatedly, leadership development is widely recognized as a critical activity for improving health-care outcomes (Garman et al., 2020; Gilmartin and D’Aunno, 2007). Missing in this discussion, but still part of this effect, however, how we talk about and invoke leadership has implications for the discussion of leadership development, particularly in health care where communication is intrinsic to both task and outcome.
In contrast to the classical portrayal of leadership as the act of a heroic individual, the type of leadership emerging in complex environments such as hospitals is increasingly characterized as a property shared by multiple individuals, known as distributed leadership (Denis et al., 2001; Gronn, 2002). Distributed leadership is focused on mobilizing leadership expertise through multiple organizational members to create opportunities for change and build capacity for improvement (Chreim et al., 2010; Hallinger and Heck, 2009; Harris, 2013). It entails leadership practices that are shared and emerge collectively through interaction (Leithwood et al., 2009). In this context, the development of leadership competencies in health care has been updated to include social and relational capabilities that facilitate such interaction (Garman et al.