Latest / Safe As Podcast / E71: Leaders, schmeaders...the age of FOLLOWERSHIP is here

Transcript

E71: Leaders, schmeaders...the age of FOLLOWERSHIP is here · Safe As Podcast

• 0:07
  Leaders are known for leading, but to lead, you naturally need
• 0:12
  somewhere to follow. So let's look at followership.
• 0:15
  Good day everyone. I'm Ben Hutchinson and This is
• 0:18
  Safe as a podcast dedicated to the thrifty analysis of safety,
• 0:23
  risk and performance research. Visit safetyinsights.org for
• 0:27
  more research. In dynamic environments like
• 0:30
  healthcare and other complex organisations, organisational
• 0:34
  success relies not just on leaders but significantly on the
• 0:38
  team members or followers. While leadership often takes
• 0:42
  centre stage with really extensive research and training
• 0:45
  programmes dedicated to IT followers, representing the
• 0:49
  majority of most workplace workforces, at least 80% in
• 0:53
  Healthcare, is a less explored yet equally critical component
• 0:57
  of organisational success. I couldn't find a single paper
• 1:01
  on followership that I was really content with.
• 1:03
  It covered everything that I wanted to.
• 1:05
  So I'm covering 2 papers today instead and really hope it hits
• 1:08
  the mark. The 1st is followership, A
• 1:11
  review of the literature in Healthcare and beyond by Lung ET
• 1:15
  al 2018 in the Journal of Critical Care, and 2nd Assertive
• 1:20
  Followership, How to Make a Team Safer by Hey David ET al 2022 in
• 1:27
  the British Journal of Oral and Maxillo Facial Surgery.
• 1:31
  They both shed light on the crucial role of followership and
• 1:34
  particularly its impact on job satisfaction, performance and
• 1:38
  safety. Followership can be broadly
• 1:40
  defined by how people follow, who they follow, and the degree
• 1:44
  of engagement and influence that they exert.
• 1:48
  Unlike leadership, which traditionally focuses on
• 1:50
  directing and guiding, followership emphasises the
• 1:54
  active role individuals play in supporting, challenging and
• 1:58
  contributing to the team's objectives, often through
• 2:01
  independent thought and initiative.
• 2:04
  These papers have a focus on healthcare, so I'm going to use
• 2:06
  healthcare examples today. So modern healthcare workers,
• 2:09
  for instance, are increasingly educated and expected to problem
• 2:13
  solve independently, moving beyond passive subordination.
• 2:18
  The stark contrast in focus is evident.
• 2:21
  For every sixty articles on leadership in medical
• 2:24
  literature, there's only one on followership.
• 2:27
  This disparity highlights a significant gap in understanding
• 2:31
  a really vital aspect of team dynamics and organisational
• 2:34
  success. So what can we learn from the
• 2:36
  papers? So from the 1st paper,
• 2:39
  Followership, a review of the literature in healthcare and
• 2:42
  beyond. So, Lung ET al conducted A
• 2:45
  scoping review to examine the existing literature on
• 2:48
  followership, focusing on its association with job
• 2:51
  satisfaction and performance outcomes across healthcare and
• 2:54
  some other sectors. Their comprehensive search
• 2:58
  identified a significant absence of studies on followership
• 3:01
  compared to leadership, despite its evident importance.
• 3:05
  Out of 14 observational studies included in their analysis, a
• 3:09
  consistent theme emerged. Followership styles
• 3:13
  characterised by greater active engagement and independent
• 3:17
  critical thinking were associated with positive
• 3:19
  outcomes. To review categorised findings
• 3:22
  in individual satisfaction and performance and organisational
• 3:26
  performance. So on individual satisfaction
• 3:29
  and performance, they found that there was an increased job
• 3:32
  satisfaction and decreased burnout.
• 3:34
  So several studies both within and outside of healthcare
• 3:38
  demonstrated a positive correlation between active and
• 3:41
  critically engaged followership styles and individual well being
• 3:45
  among nurses. They found that exemplary and
• 3:49
  pragmatist followership styles were linked to lower burnout
• 3:52
  scores. Similarly, nursing department
• 3:55
  employees with followership styles showing increased
• 3:58
  critical thinking and active participation, which is the
• 4:01
  exemplary, reported higher job satisfaction.
• 4:06
  Non managed nurses with higher active engagement also reported
• 4:09
  greater job satisfaction in non healthcare settings.
• 4:13
  Exemplary fellowship was positively associated with job
• 4:16
  satisfaction and job related performance among automotive
• 4:20
  company employees. University faculty members
• 4:23
  showed increased job satisfaction also with greater
• 4:26
  active engagement, and teachers with high active participation
• 4:30
  reported higher job satisfaction.
• 4:33
  A large study of U.S. Federal employees found that
• 4:35
  more active followership styles were associated with high
• 4:39
  overall job satisfaction, particularly in environments
• 4:41
  with hyperceived supervisor support.
• 4:43
  And while most studies show positive associations, some
• 4:47
  found no statistically significant effects either.
• 4:51
  So it really highlights the complexity in varied contexts of
• 4:54
  followership in the value that we may derive from it.
• 4:58
  For organisational performance, there was generally improved
• 5:01
  performance measures. So followership styles with high
• 5:05
  active engagement and critical thinking were also linked to
• 5:08
  improved performance outcomes in healthcare.
• 5:11
  High active engagement and critical thinking among
• 5:14
  infection prevention staff were associated with better
• 5:17
  observance of hospital infection policies.
• 5:20
  Exemplary and pragmatic followership styles among people
• 5:23
  who work in hospitals showed an association with higher team
• 5:27
  coordination traits. Outside healthcare, high active
• 5:30
  engagement was positively associated with organisational
• 5:33
  safety culture Measures across various industries.
• 5:37
  Overall impact. The review strongly suggests
• 5:40
  that understanding followers is crucial for an organisation
• 5:44
  success or failure, especially as modern healthcare teams
• 5:47
  become more complex and less hierarchical.
• 5:49
  The authors propose that if followership is adaptable or
• 5:54
  teachable, it could be a powerful tool to address burnout
• 5:57
  and improve organisational performance in a demanding
• 5:59
  environment. So they'll sort of the key
• 6:02
  insights from assertive followership, how to make a team
• 6:04
  safer. So Hey David at El delve into
• 6:08
  the concept of assertive or courageous followership as a
• 6:12
  means to enhance team safety and effectiveness.
• 6:15
  They draw parallels between healthcare, military and
• 6:17
  aviation sectors. They too highlight the
• 6:21
  disproportionate emphasis on leadership over followership in
• 6:25
  training and literature. Paper utilises Kelly's five
• 6:29
  followership styles passive, conformist, alienated,
• 6:33
  pragmatist and exemplary. Exemplary followers are
• 6:37
  distinguished by their high degree of critical thinking and
• 6:40
  active engagement, enabling them to challenge leaders
• 6:44
  constructively and offer viable alternatives.
• 6:47
  They take on responsibilities beyond the minimum and
• 6:50
  significantly contribute to team goals, often exhibiting the
• 6:54
  greatest job satisfaction and performance output.
• 6:58
  The authors advocate for developing staff towards that
• 7:01
  exemplary followership goal, so they also talk about flattening
• 7:05
  team hierarchies, drawing on lessons from military and
• 7:07
  aviation. So organisations with similar
• 7:11
  complexities to healthcare, like military aviation, have
• 7:14
  successfully improved safety by flattening team hierarchies
• 7:18
  through practises like crew resource management.
• 7:21
  In these contexts, personnel are explicitly taught the importance
• 7:25
  of speaking up and questioning authority for safety reasons,
• 7:29
  even when rank differences exist.
• 7:31
  Noting, of course, that just expecting someone to speak up
• 7:34
  because you ask them to speak up isn't enough.
• 7:36
  We obviously have to create safe environments where people do
• 7:39
  have that interpersonal safety at risk taking to be able to
• 7:42
  speak up. But this approach cultivates
• 7:45
  assertive followership by encouraging staff empowerment
• 7:48
  and open communication while maintaining essential command
• 7:52
  structures. Next, I cover some of the
• 7:54
  benefits of assertive followership.
• 7:56
  So psychological safety. High functioning teams require
• 8:00
  an environment of psychological safety where members feel safe
• 8:04
  to speak up and take into personal risks without fear of
• 8:07
  being persecuted or tased or blamed.
• 8:10
  This necessitates leaders who are open to criticism, invite
• 8:13
  feedback, and empower their team.
• 8:16
  It probably also means we need people who are already on the
• 8:19
  path toward this assertive followership, who are actively
• 8:22
  engaged and really feel the need and the value in speaking up and
• 8:26
  trying to change the environment.
• 8:29
  Followers also try to steer leader decisions.
• 8:32
  Assertive followership is crucial not just for countering
• 8:35
  weak leaders but also for supporting strong leaders,
• 8:39
  especially during high workload situations.
• 8:42
  For example, in an operating theatre, supporting staff often
• 8:46
  notice issues outside of a surgeon's concentration tunnel,
• 8:50
  for instance time awareness or wider situational factors, using
• 8:54
  their broader perspective to offer critical suggestions.
• 8:58
  And Assertive followership is connected to moral courage.
• 9:02
  Assertive followers are more likely to challenge superiors,
• 9:05
  not only for safety concerns but also regarding morally
• 9:09
  unacceptable behaviour. Next, they talk about whether we
• 9:12
  can train in assertive followership principles.
• 9:16
  The paper acknowledges that challenging authority requires
• 9:19
  considerable courage, especially given societal norms of
• 9:22
  obedience and potentially in organisations that don't have an
• 9:26
  adequate degree of psychological safety.
• 9:27
  That's just little tolerance for interpersonal risk taking.
• 9:31
  However, consistent interaction can reduce programmed obedience.
• 9:37
  Innovative training methods like medical themed escape rooms.
• 9:41
  These can foster non technical skill collaboration and
• 9:45
  assertive followership by requiring participants to
• 9:47
  question and engage with team members to solve puzzles.
• 9:51
  You may have heard of these called something different in
• 9:53
  your industry. They might be called scenario
• 9:55
  based learning or scenario based training.
• 9:58
  They essentially mimic real life situations allowing participants
• 10:02
  to apply theoretical knowledge to practical scenarios.
• 10:06
  The authors stress that these skills that are really
• 10:08
  implicated within assertive followership must be practise as
• 10:13
  in the healthcare domain, a patient's safety matter, but in
• 10:16
  other industries as just the way that we do business every day.
• 10:20
  And they need to be reinforced through daily mechanisms like
• 10:23
  team briefings, huddles, theatres, pre starts, tool boxes
• 10:28
  etcetera, which foster engagement, collaboration and
• 10:32
  shared responsibility. In conclusion, both papers
• 10:36
  strongly argue that followership is far more than passive
• 10:39
  obedience. It's an active, influential role
• 10:43
  essential for individual well being, team effectiveness and
• 10:47
  organisational safety. However, you define that while
• 10:51
  research in this area is still nascent, the existing evidence
• 10:54
  strongly suggests that cultivating exemplary and
• 10:58
  assertive followership, characterised by critical
• 11:01
  thinking, active engagement and the courage and environment to
• 11:06
  be able to speak up leads to improved job satisfaction,
• 11:10
  reduced burnout, enhance performance and crucially, safer
• 11:14
  environments. Prioritising the understanding,
• 11:18
  development and empowerment of followers is not merely
• 11:21
  beneficial, but increasingly imperative for the success and
• 11:25
  resilience of modern organisations.
• 11:28
  That's it on Safe As I'm Ben Hutchinson, please help share,
• 11:32
  rate and review and checkoutsafetyinsights.org for
• 11:35
  more research. Finally, feel free to support
• 11:39
  Safe As by sharing a coffee link in the show notes.