​

Problem Statement

Aldon (1998), Cardona (2000), Crossan, et al. (2002), and Larkin (1994) have proffered

that transcending leadership is a progression of, or expansion to, the normative understanding of Burns' (1978) transactional-transforming model and Bass and Avolio's (1994) full range of leadership model. In doing so, Aldon (1998), Cardona (2000), Crossan et al (2002), and Larkin (1994) have stimulated a meaningful inquiry into the plausibility of transcending leadership as a legitimate construct within leadership theory. What needs to be explored, however, is how - if at all- such a leadership construct varies from, or expands upon transactional and transformational leadership theory. That is, are there discernible differences between perceived transcendent leaders and those who would be deemed "transactional" or "transformational" as described by Burns (1978) and Bass and Avolio (1994)? Or, is the notion of a discrete transcending leadership construct quixotic and merely "good leadership", therefore ingrained within the existing transformational construct? This initial step is apposite to describing the phenomenon of transcending leadership. 

Research exploring the prospective relevance of a transcending leadership construct and,

by extension, transcendent leaders is significant for scholars and researchers of leadership theory as they grapple to understand the means to conjoin the deontological obligations (i.e., moral responsibility to tell the truth, keep promises, respect others, etc.) of leaders in contemporary society with the fiduciary responsibilities owed to their organizations, stakeholders, and the broader community. Conceptualizing a synchronistic union between leaders' moral obligations and their organizational duties is particularly relevant in the healthcare community as leaders seek to balance clinical health outcomes, commitment to the organization's human assets, financial stewardship of their institutions, and service to community and society. 

Purpose Statement

The purpose of the phenomenological study is to describe the leadership dynamic as

experienced through the lives of perceived transcendent healthcare leaders. By exploring the experiences of seven physician leaders and seven hospital/health system leaders, this study investigates the characteristics exhibited by these individuals and articulates the essence of their experience as healthcare leaders. In operational terms, it explores the ways perceived transcendent healthcare leaders impact their collaborators, their organizations, and their communities. 

Understanding and described a potentially emerging leadership construct would be

instructive in examining and perhaps expanding the continuum of leadership theory within the healthcare environment. Such an understanding could contribute to an integrated perspective on leadership theory and practice, a perspective in which the deontological actions of leaders and followers reside in harmony with their teleological, or consequential, outcomes. 

Although no stipulated definition of transcending leadership exists, a description - drawn

from Burns' (1978) seminal text, Leadership - is posited as a means of instigating this study's inquiry. Burns' own parsimonious description of a transcending leadership construct and the added dimension of moral virtue, which he stipulates as integral to authentic leadership, have been conflated to suggest a tentative definition of transcending leadership: 

Transcending leadership is dynamic leadership in the sense that the leaders throw themselves into a relationship with followers who will feel "elevated" by it and often become more active themselves, thereby creating new cadres of leaders. Transcending leadership is leadership engagé, which demands attention to a moral virtue where: leaders and followers have a relationship not only of power but also of mutual needs, aspirations, and values; leaders take responsibility for their conduct, character, and commitments; and leaders and led reach out to wider social collectivities and seek to establish higher and broader moral purposes.

Consistent with the rhetoric of qualitative research, this definition is not fixed, but mutable and may evolve throughout the study pursuant to information garnered from the study participants (Creswell, 2003, p. 89). The intent in offering this tentative definition is to convey a general sense of the central phenomenon, as originally alluded to by Burns (1978). 

Research Questions

Fundamental inquiry into the plausibility of a transcending leadership phenomenon must,

of necessity, begin by asking how it could be construed as differing from extant transactional and transformational leadership theory. Determining added dimensions that enrich the current literature on the full range of leadership model is essential to suggesting the reasonableness of a transcending leadership construct. Viewing this purported phenomenon through the lived experiences of individuals perceived as transcendent healthcare leaders is, therefore, pertinent to understanding the essences evidenced by these individuals in their interactions with collaborators and their communities. 

The research questions posed in this study will seek, therefore, to describe the

experiences of healthcare professionals nominated by informed collaborators as transcendent healthcare leaders. 

R1.     What are the key characteristics of healthcare professionals who are perceived to

be transcendent leaders? 

R2.     Do the key characteristics evidenced by healthcare professionals, perceived as

transcendent leaders, differ from those of transactional and transformational leaders as stipulated in Burns' (1978) transactional-transforming leadership paradigm and Bass and Avolio's (1994) full range of leadership model? 

R3.     Is it reasonable to propose a transcending leadership construct?

Population

Medical doctors (physicians) who are in leadership roles and hospital/healthcare

administrators who have evidenced exceptional capabilities in shepherding their respective organizations served as a representative body from which study participants were identified. Physician leaders of exceptional merit were solicited through the chief executive officers of state medical societies throughout the United States. Concurrently, health and hospital administrators were nominated as participants through the chief executives of state hospital associations. Each of these state organizations has a broad membership that bridges ethnic, racial, cultural, and gender differences and for whom the findings of this phenomenological inquiry would appear to have specific relevance. 

Assumptions

There are several assumptions presented in this phenomenological inquiry. Perhaps the

most significant assumption posited is the tentative definition of transcending leadership, which formed the basis on which state medical society and state hospital association executives were asked to predicate their nominations. Creswell (2003) encourages providing a general working definition of the phenomenon being explored in qualitative research. The intent is to convey to the reader a broad sense of the central phenomenon (p. 88). Employing the seminal sentiments articulated by Burns (1978) concerning a transcending leadership construct would appear a reasonable basis from which to begin this phenomenological inquiry. Further, it is assumed that the nominators have a reasonably extensive knowledge of their member's experiences, accomplishments, and qualities, and were able to draw upon this knowledge in nominating individuals who best fit the operational definition of transcending leadership. Additionally, there is an expectation that each nominator can and would act as a corroborating informant attesting to the veracity and accuracy of the study participant's responses and further enrich the story of experiences shared by the study participant. Finally, it was assumed that the lived experiences shared by each nominated healthcare leader would add a rich depiction to the understanding of leadership practice, which may establish a basis to asert the reasonableness of a transcending leadership construct. 

Significance

Countless scholars, researchers, and practitioners from a myriad of backgrounds and

professions have long probed the essence of leadership in an attempt to understand the nature of and dynamics involved in the leadership process. Peterson and Hunt (1997) and Rendova and Starbuck (1997) trace the study of leadership theory as far back as ancient Egypt and China. A review of the literature suggests there are almost as many definitions of leadership as there are scholars who have attempted to articulate the concept (Bass, 1990). Bennis and Nanus (1997) noted that, "decades of academic analysis have given us more than 850 definitions of leadership" (p. 4). Any number of studies have attempted to dissect, label, codify, and create constructs around the paradigm of leadership. Given the plethora of opinions, theories, and schools of though on leadership, why would adding a new construct of transcending leadership to this amalgam be of significance to healthcare leaders in today's geopolitical marketplace? 

First, the focus of transcending leadership may rest on a new posture for leaders, a stance

that could suggest that the leader seeks first to empower and assist followers in achieving their desired aspirations as opposed to first pursuing leader self-interests. This perspective seems counterintuitive in today's corporate environment, but may be prescient to the next iteration of leadership theory. This enhanced dimension in leader motivation would be of value to healthcare leaders and their collaborators as each seeks new and more fundamentally satisfying means in which to interact, both professionally and personally. 

Secondly, students in health administration or in the medical professions preparing to

enter the leadership ranks of healthcare delivery may find a leadership construct based upon a movement beyond self-centeredness personally compelling (Bowditch & Buone, 1994) and responsive to the demand for enhanced healthcare quality and access. The Institute of Medicine (2001, 2003) has suggested a correlation between leadership competencies of healthcare executives and clinicians and the quality of healthcare delivery in the United States. The Institute of Medicine's (IOM) 2001 report entitled Crossing the Quality Chasm: A New Health System for the 21st Century suggests that the current healthcare system is fundamentally troubled and calls for changes in the current training programs of healthcare clinicians and leaders. "Although curriculum changes are essential in providing new skills to health professionals, they are not sufficient by themselves. It is also necessary to address how health education is approached, organized, and funded to better prepare students" (p. 223). Determining the viability of an emergent leadership construct which positively effects the intrinsic needs of healthcare leaders and followers could be significant in responding to the ails currently associated with our healthcare system. 

An apposite link between leadership theory and practice and its impact upon national and

international public health considerations is a third point of possible significance to this study. In the United States, the Institute of Medicine (2003) has issued a series of reports outlining the shortcomings within our current healthcare system and has called for the drastic redesign of our healthcare delivery system in an attempt to narrow the gap between best clinical practice and usual [healthcare] practice (IOM, 2003, p. xi). The National Roundtable on Health Care Quality (1998) has previously issued a similar statement: "Serious and widespread quality problems exist throughout American medicine (healthcare) ... [they] occur in small and large communities alike, in all parts of the country... Very large numbers of Americans are harmed as a result." (Chassin & Galvin, 1998, p. 1000). More recently, the Journal of the American Medical Association published an article by the Physicians Working Group for Single-Payer National Health Insurance (2003) calling for a renewed dialogue in crafting a national insurance plan that would address the over 45 million Americans, representing 15.6% of the country's population (U.S. Census Bureau, 2004) - who have no health insurance and the cadre of others who are underinsured. According to the 8,000 physician members who have endorsed this integrated health benefit initiative, the United States has instigated and perpetuated a healthcare system that provides financial benefit to insurers and providers by avoiding the delivery of care to those individuals who may be least profitable, thereby creating a paradox within the healthcare system "based upon avoiding the sick" (p. 798). Access, delivery, and financing of quality healthcare in the United States are concerns of paramount importance to healthcare stakeholders including clinicians, goverment authorities, public health policy makers, the general public, and healthcare leaders. These national considerations are magnified exponentially in other areas of the world, which are less wealthy or developed. 

Globally, significant progress has been made in the twentieth century toward improving

the health outcomes for millions of individuals. Advances in the treatment of infectious diseases, improvements in public sanitation, supply of potable drinking water, the availability of adequate food resources, and related public health benefits has contributed to this apparent success (Bruntland, 2002). However, the adequacy and equity in the distribution of global health advancements is questionable. The World Health Organization (2002) has reported on the disparity "between the haves and have-nots [coutnries]" (p. xiv) in terms of global public health outcomes. The report stresses the need for enlightened leadership from healthcare and political leaders in recognizing the universality of our interdependence within a worldwide health context. What once were local public health problems of infectious disease of lifestyle (i.e., AIDS, SARS, etc.) are today readily transmitted throughout the world community through the advent of personal travel convenience, transportation of products, immigration, or other means of transference. 

Healthcare leaders sensitive to the ineluctable connection between the quality,

availability, and delivery of healthcare services and the skills required of health professionals to insure these outcomes may require new models of leading which are responsive to the emergent local - national - global health perspective. Filerman and Pearson (2002) call for a new healthcare leadership, which can reshape the current perspective of health as a local concern to one that considers the health outcomes of people thousands of miles away. They cite the need for a new breed of healthcare leader who can "reengineer health systems to address the gap between what we know and what people need" (p. 488). Recognizing that healthcare is increasingly being viewed from a global perspective, Williams (2002), asserts that an emerging "internationalization of public health" paradigm will necessitate a new type of healthcare leader - one who possesses extraordinary vision and the inherent desire to serve individuals and groups (pp. 364-71). 

The fourth and final point of significance in this research study may be in inspiring others

to determine if the essence of a transcending leadership construct, as evidenced in the lived experiences of perceived transcendent leaders, is relevant. Burns (1978) noted that "We fail to grasp the essence of leadership that is relevant to the modern age and hence we cannot agree even on the standards by which to measure, recruit, and reject it. Is leadership simply innovation - cultural or political?" (pp. 1-2). Perhaps the only way to answer Burns' rhetorical question is by studying the lived experiences of such individuals. Such an examination could lead to a richer, and possibly integrated, understanding of leadership theory and practice. 

The transformational leadership construct of the 1970s and 80s - which emphasized the

social exchange relationship between leaders and follower - was a response to the changing cultural dynamics and leadership demands of followers and organizations dissatisfied with the earlier economic exchange (transactional) model of leadership practice. The confluence of today's local, national, and global societal dynamics may instigate the emergence of a further iteration of the leadership phenomenon - one that is transcending. The intent of this study is to explore the feasibility of a transcending leadership construct within the healthcare context. 

Conclusions and Overview of Remaining Chapters

Chapter 1 presented the intent of this proposed phenomenological study. It noted the

seminal work of Burns (1978) and later Bass (1985) and Bass and Avolio (1994) on the broadly stipulated transactional-transformational leadership paradigm. Nascent literature, however, has suggested the possibility of a new leadership construct - termed transcending leadership - which serves to suggest a more robust dimension to the full range of leadership model. Specific definitions, assumptions, and research questions pertinent to this inquiry were presented along with a statement on the significance of the study. 

Chapter 2 offers contextual background on the iterative nature of leadership theory with

specific reference to the preeminent transactional-transformational leadership paradigm. This background is offered as a means of juxtaposing extant transactional-transformational leadership theory with the major studies found in the literature on the proposed construct of transcending leadership (Aldon, 1998; Cardona, 2000; Crossan et al., 2002; Larkin, 1994). 

Chapter 3 provides a description of the research methodology and design employed in

this study. The qualitative-phenomenological strategy of inquiry used to investigate the transcending leadership phenomenon is described as the framework in addressing the research questions.

Chapter 4 offers descriptive findings of the study. Distinguishing attributes of perceived

transcendent healthcare leaders along with emergent themes on the essence of the leadership experience each evidences is presented. This is apposite in responding to research question 1: "(R1): What are they key characteristics of healthcare professionals who are perceived to be transcendent leaders?" Relevant quotations drawn from the study participant and nominator-corroborator interviews add to the rich depiction of the leadership phenomenon. Chapter 4 continues by comparing the findings identified with those characteristics commonly associated with extant transactional-transformational leadership. The purpose in considering this juxtaposition is to identify - if any - discordant attribute(s) between the accepted full range of leadership model and the nascent transcending leadership construct. This analysis addresses research question 2: "R2: Do the key characteristics evidenced by healthcare professionals, perceived as transcendent leaders, differ from those of transactional and transformational leaders...?" Chapter 4 completes the process of triangulation whereby distinctive attributes or themes broadly associated with the study participants, and which appear beyond the influence of the transactional-transformational paradigm, may be compared to propositions posited in the literature concerning transcending leadership. Viewing the research findings through the lens of a multiple theories and propositions presents an opportunity to speculate on the reasonableness of the transcending leadership phenomenon as a legitimate extension to the full range of leadership model and its possible implications with the healthcare milieu. The findings noted in research questions 1 and 2 serve to inform research question 3: "R3: Is it reasonable to propose a transcending leadership construct?"

​

​

 

​