. 2021 Oct 27;14:3035–3051. doi: 10.2147/JMDH.S329628

Table 3.

Synopsis of Leadership Theories and Approaches

Theory	Date	Description	Strengths/Weaknesses	Relevance to H&HS
Great Man Theory¹⁶⁰	1840s	Rare individuals were born with unique characteristics that predisposed them to take command and lead others. Based on the idea that leaders were born to rule.	The heroic leader as an influential person that comes to prominence when needed. Key weakness is the lack of scientific evidence for the theory.	Outdated theory providing little value to H&HS leadership.
Trait Approach⁴⁴^,⁵⁸^,¹⁶¹	1930s	This approach asserted that leaders demonstrate certain physical, social, and personal characteristics that make them better suited to leadership. Whilst great man theory contends that traits are inherited, trait theory does not specify where they come from.	Particular traits shown to promote leadership are openness, extroversion, self-confidence, energy, inclusiveness, and motivation to manage. Conversely, there is no consensus on a definitive list of leadership traits that are consistently associated with great leaders.	Pure trait theory fails to identify all variables for H&HS leadership.
Skills Approach⁴⁴^,^61–63^,¹⁶²	1940s	This leader-centric approach focussed on the acquired skills that the leader requires to perform rather than on personality traits with the implication that these skills can be learned.	Key strength is that this approach categorised leadership as an identifiable set of skills which can be learned, developed, and improved. Weakness is the lack of precision and inability to identify how variations in the skills will lead to positive leadership performance.	A pure skills approach also fails to identify all variables for H&HS leadership.
Styles Approach⁶⁷^,⁶⁸^,⁸¹^,¹⁶³^,¹⁶⁴	1940s	This approach asserts that different styles of leadership may be more appropriate for different types of decision-making and ultimately influence the success of an organization. Leadership styles are categorized as democratic, autocratic, or laissez-faire.	Similar to the Behavioural Approach this is easy to understand and has been validated through research. Key Weakness with this approach is that no one style have been identified as suitable for all situations or contexts.	A pure styles approach also fails to identify all variables for H&HS leadership.
Behavioural Approach⁴⁴^,⁶⁴^,¹¹⁵^,¹⁶⁵	1950s	This approach focussed on what leaders do. The theories assert that different patterns of behaviour are observed in successful leaders with leaders being either task-oriented or people-orientated.	Strengths are that it is easy to understand and has been validated by a broad range of studies. Weakness is that despite a substantial research base the results have been contradictory and inconclusive and has not identified universal behaviours associated with effective leadership.	A pure behavioural approach also fails to identify all variables for H&HS leadership.
Situational/Contingency Approaches⁵⁰^,⁶⁹^,^71–74^,¹⁶⁶	1960s	This approach asserted that effective leaders use a combination of styles that are contingent upon the particular situation, the personalities involved, the task, and the organizational context. These approaches demonstrate the evolution of leadership theory from the one-dimensional leader-centric approaches discussed above.	Key strength of this approach is that it allows the leader to be more flexible in their approach as it also considers the situation or context. Identified weaknesses are the lack of a strong body of research, the ambiguous conceptualisation of the followers developmental levels and the fact that the approach does not address the issue of individual versus group leadership.	The inclusion of multiple variables provides potential for informing H&HS leadership, but the indistinct concepts make these difficult to implement.
Leader Member Exchange (LMX)⁴⁴^,⁷⁶^,¹⁶⁷^,¹⁶⁸	1970s	This theory focuses on the relationship between leaders and followers and the psychological effect of leaders building positive or negative relationships with employees. LMX theory explains that in any organization, there are in-group members and out-group members.	A key strength of this theory is that it validates how people within organizations relate to each other and directs our attention to the importance of communication in the leader-follower relationship. Weaknesses are that it does not identify a specific guide to the process of relationship building and there is limited evidence of actual practical applications.	Demonstrated potential in health information management
Transactional Theories¹⁴^,⁴⁶^,⁴⁸	1970s	In this theory the focus is on the exchange of value between employee performance and the leader’s response to it. Based on systems of reinforcement and punishment this theory is task orientated. Also known as management theories.	Strength is the simplicity of the theory. Transactional leaders set goals and standards for employees and provide rewards in return for them being met. Biggest weakness is the assumption that everyone can be motivated by reward and punishment.	Limited value in H&HS leadership with applicability in selected situations.
Transformational Theories¹²^,¹⁴^,⁴⁶^,⁷⁸^,⁸⁴^,⁸⁶^,¹²⁷^,¹²⁸^,^131–134	1980s	Transformational leadership encompasses idealised influence (charisma), inspirational motivation, individualized consideration and intellectual stimulation, with the leader maintaining a continuous challenge to followers by espousing new and innovative ideas and approaches. This theory is one of the most studied, researched and advocated theories, and were seen as an improvement over earlier theories.	Theory is intuitively appealing, places a strong emphasis on the empowerment of others and has been purported to be an effective form of leadership. Criticisms of transformational leadership include lack of conceptual clarity with an overlap between the key constructs, treating leadership as a personality trait, bias toward executive and heroic notions of leadership, lack of a causal link between transformational leaders and changes in organizations/ teams and that it has the potential to be abused as it is concerned with changing people’s values	Potential to inform H&HS leadership has been identified in numerous studies across multiple settings.
Authentic Leadership Theory^88–92^,^135–139	1980s	Emphasizes the values system of the leader and its role in leading from a base of self-awareness, integrity, compassion, interconnectedness, and self-discipline. Builds on from Transformational theory and includes charismatic leadership theory.	Take the positives from Transformational theory and add a values orientation. Weaknesses identified include that the theory has not been substantiated, over-emphasis on person-centred factors and perpetuation of the ‘heroic leader’.	Demonstrated applicability in healthcare settings but needs to be tested in a variety of populations and settings.
Servant Leadership Theory^93–96	1990s	A multidimensional leadership theory that starts with a desire to serve followed by the intent to lead and develop others. first priority should be to serve others, not to promote their own agendas over the good of their followers	This intuitively appealing theory take the positives from Transformational theory, adds a values orientation, and places a strong emphasis on teamwork. Key weakness is that it is largely atheoretical, highly altruistic, and not supported by empirical data.	Aligns with healthcare and professional ethics but does not suit situations where quick decisions are required.
Collective/Shared/Distributed Leadership Approaches^97–103^,^140–142^,¹⁶⁹	2000s	This approach argues the no one individual is the ideal leader in all situations or circumstances and that leadership is diffuse throughout the organisation. Includes dispersed, collaborative, collective, devolved, relational, democratic, concurrent, and co-operative approaches. Boundaries have been somewhat blurred by the range of different terms employed by these plural forms of leadership.	Shared leadership has been positively correlated with increased team effectiveness and organizational performance. Critics of this approach cite the lack of empirical methodological rigour, measurement issues with the construct and the transferability or application in different cultural settings	Demonstrated applicability in healthcare settings and has been adopted by the NHS in the UK. Needs further exploration in the wider H&HS context.
Complexity Theory⁹⁸^,^104–106	2000s	This theory focusses on leadership as part of a complex system and the inter-relationships between patterns of behaviour, power structures and networks of relationships.	Strength is that complexity theory provides a framework in which effective leadership can thrive in dynamic environments. Weakness is that there is little consensus on when and in which situations complex leadership should be applied.	Potential to inform due to the complex and unpredictable nature of H&HS leadership but requires further research