Management vs. leadership: moving the relationship between managers and clinicians from transactional to transformational

     Holding a managerial position in a professional setting comes with a multitude of responsibilities. The skills required to successfully manage a group of professionals, large or small, are not skills that everyone possesses. With that being said, what constitutes a successful manager? What qualities make a manager the one who sticks out in your mind as someone who you looked to for guidance, or for whom you felt truly had your back? If you’re one who struggles to bring someone to mind, you’re not alone. This concept of a disconnect between management and staff has been a topic of discussion for decades. Research suggests that managers and practitioners have differing opinions about the performance of management, with management rating themselves significantly higher than their staff even though the only notable difference between the two groups is title (Brollier, 1985; Arroliga et al., 2014; Heard, 2014; Heard et al., 2018). The question to be posed then would be how can that gap be closed? Or at least lessened.

     The saying ‘lead by example’ is used in many situations. Using this approach in healthcare to manage others has the potential to change the healthcare management and administration horizon for the better. Research on the role of leadership in healthcare has been primarily focused on formal leadership roles, meaning titled management positions. Heard and Scott (2018) found occupational therapy practitioners who are identified by peers as informal leaders in their work settings are more accessible, and able to shape and define change organically through supportive mentorship and coaching. In addition, informal leaders are seen as collaborative and are sought out by staff more often than those who hold formal managerial roles (Heard et al., 2018).

     The healthcare industry is evolving and occupational therapy practice is on that same evolutionary path. While research in healthcare has brought about some of the most advanced medical treatment and intervention, the system as a whole is chaotic and unfocused (Arroliga et al., 2014). While the move toward patient-centered care is not a new concept, it is one that requires change on all levels. Change is not easy and finding those people who are best suited to promote change has also proven difficult. Those in managerial roles are often seen as separate from clinical staff with the absence of a true relationship (Yancer, 2012). According to Northouse (2019), while management produces order and consistency, leadership produces change and movement.  

     Leadership can be difficult to define, as the definition has evolved over the years. The components of leadership that are central to its definition are that it is a process, involves influence, occurs in groups, and always involves common goals (Northouse, 2019). So, how can those with leadership qualities and those who hold the title of manager be combined to create those who support their practitioners and move occupational therapy, and healthcare itself, forward?

     To be effective and successful as an organization, companies need to nourish both competent management and skilled leadership (Northouse, 2019). Often times a transactional leadership approach is utilized by management, in which managers and employees have a relationship based on an exchange (Northouse, 2019) However, research suggests employees prefer a transformational leadership approach from their managers, with a focus on encouraging creativity, recognizing accomplishments, building trust, and inspiring a collective vision (Northouse, 2019). Transformational leaders emphasize the relationship between management and the employee, and are concerned with emotions, values, ethics, standards, and long- term goals (Northouse, 2019). Approaching a group of individuals through a transformational leadership lens will often move those individuals, in many cases employees, to accomplish more than what is usually expected of them (Northouse, 2019).

      Occupational therapy practitioners have a strong foundation of leadership skills, with a significant number of them identifying strong leadership qualities as an important part of our education (Fleming- Castaldy & Pastro, 2012). The American Occupational Therapy Association (AOTA) has placed leadership, and the building of leadership skills, at the front of the profession for many years. The goals of the AOTA centennial vision focus on building power and leadership, and on communicating our distinct value as a profession (Clark, 2013). Exploring leadership development through continuing education and programs such as Emerging Leadership and the Mindful Path to Leadership can provide practitioners in management and administration with the skills necessary to become an effective transformational leader (Stoffel, 2015).

    As occupational therapy practitioners make the move to take on more leadership roles, research suggests practitioners should take a more active role in gaining the skills needed to become an effective leader (Shams et al., 2019). The skills of being an effective transformational leader are already built into the scaffolding of occupational therapy. Building a therapeutic relationship, fostering engagement and adaptation, and meeting the needs of others through seeking a common goal are just a small sample of the qualities that overlap between the two worlds. Managing people is a task of organizing and controlling, and there are many out there who hold a managerial title and little more. Leading people is a calling, one that fosters growth, supports change, and works to build a common goal. When faced with the task of managing, take the opportunity instead to lead.



Arroliga, A. C., Huber, C., Myers, J. D., Dieckert, J. P., & Wesson, D. (2014). Leadership in health care in the 21st century: Challenges and opportunities. American Journal of Medicine,127(3), 246-249.

Brollier, C. (1985). Occupational therapy management and job performance of staff. The American Journal of Occupational Therapy, 39(10), 649–54. doi:10.5014/ajot.39.10.649

Clark, F. (2013). As viewed from above: Connectivity and diversity in fulfilling occupational therapy’s centennial vision. American Journal of Occupational Therapy, 67(6), 624–632. https://doi. org/10.5014/ajot.2013.676003

Fleming-Castaldy, R. P., & Patro, J. (2012). Leadership in occupational therapy: Self-perceptions of occupational therapy managers. Occupational Therapy in Health Care, 26(2–3), 187–202. doi:10.3109/07380577.2012.697256

Heard, C. P. (2014). Choosing the path of leadership in occupational therapy. The Open Journal of Occupational Therapy, 2(1), 1-18.

Heard, C. P, Scott, J., McGinn, T., Van Der Kamp, E., & Yahia., A. (2018). Informal leadership in the clinical setting: Occupational therapist perspectives. The Open Journal of Occupational Therapy, 6(2), 1-13.

Northouse, P. G. (2019). Leadership 8th edition. Thousand Oaks, California. SAGE publications.

Shams, S. S., Batth, R., & Duncan, A. (2019). The lived experiences of occupational therapists in transitioning to leadership roles. The Open Journal of Occupational Therapy, 7(1).

Stoffel, V. (2015). Presidential address—Engagement, exploration, empowerment. American Journal of Occupational Therapy, 69(6), 6906140010p1.

Yancer, D. A. (2012). Betrayed trust: Healing a broken hospital through servant leadership. Nursing Administration Quarterly, 36(1), 63–80. doi:10.1097/NAQ.0b013e31823b458b

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