Making a difference: how health visitors understand the social processes of leadership

Leadership has become a pre-requisite for all health professionals working at every level in healthcare. The need to strengthen leadership in health visiting has been voiced in health care policy for the past eighteen years (Department of Health (DH), 1999 & 2006; National Health Service (NHS) England, 2016). Yet there is still a lack of research examining how health visitors understand leadership, with, much of the existing research on leadership focusing on leaders “per se” as opposed to leadership as a social process. This study sought to understand how health visitors perceive their leadership role, and how leadership is demonstrated in the delivery of the health visiting service in the context of the NHS. The aim being to enable the researcher to examine how health visitors understand leadership as a social process. The research focused on 17 participants, 16 of whom came from a health visiting background. The participants consisted of three groups: a focus group comprising health visitors in clinical practice taken from one NHS Trust, a further group consisted of team leaders, managers and practice teachers, drawn from the same NHS Trust. The third group comprised of national, strategic leaders in health visiting. The latter two groups were interviewed individually. A constructivist grounded theory approach was used to ascertain the participants’ main concerns in relation to leadership (Charmaz, 2014). A conceptual framework of making a difference: how health visitors understand the social processes of leadership has been constructed to explain how health visitors understand leadership through their professional ideology (Whittaker et al, 2013). The conceptual framework demonstrates how the categories, context of leadership, the purpose of leadership and leadership behavior emerged. These were constructed from the comparative analysis, of the data and encapsulate the participants’ main concerns. The findings support the construction of a conceptual leadership development framework for health visitors. This framework identifies the need to incorporate education based on the three categories and the core category “making a difference” and there is a need to focus on leadership development as a continuous process. In addition, the findings recognize the importance of establishing both a health visitor and leadership identity (Lord & Hall, 2005; Day & Harrison, 2007). This study has provided a framework for leadership development that can be used as a structural framework in health visiting education in both academic and clinical practice settings, and as a way of articulating how health visitors understand leadership. This study sheds light on the importance of building not only health visiting identity but also leadership identity when delivering health visitor education. It provides an interpretive perspective instead of the more common positivist approach to leadership research reported in the literature.