Symphony of Success: Leader-Practitioner Reciprocity during Evidence-Based Practice Implementation.

This study aimed to explore the reciprocal relationships between implementation leadership and practitioner implementation citizenship behavior during the implementation of evidence-based practices (EBPs). Data were collected at two timepoints with a time lag of six months during a national implementation of evidence-based treatment for post-traumatic stress disorder in Norwegian mental health clinics. Data from 72 leaders and 346 practitioners were analyzed with a two-wave cross-lagged panel model, accounting for the nested structure and adjusting for demographic variables. Significant positive autoregressive effects for both implementation leadership and implementation citizenship behavior indicated some stability in ratings across time. Significant cross-lagged effects in both directions indicated that practitioners who experienced greater implementation leadership from their leaders demonstrated greater implementation citizenship behavior six months later, and vice versa. Findings hence supported both the social exchange hypothesis and the followership hypothesis, suggesting reciprocal associations between the constructs. The findings underscore the mutually influential relationship between leaders' behavior and practitioners' engagement in citizenship behavior during EBP implementation. The study emphasizes the importance of interventions focusing on leadership behaviors that encourage practitioner engagement and mutually beneficial behavior patterns, highlighting the reciprocal and vital roles that both leaders and practitioners play in successful EBP implementation.

Leadership in the eye of the beholder: Follower self-esteem is associated with divergent perceptions of leadership ability for dominant and prestigious leaders.

OBJECTIVE: Drawing from dual-strategies theory, leader-member exchange theory, and several theories of self-esteem, we develop and test hypotheses about how followers' self-esteem predicts their perceptions of dominant and prestigious leaders' leadership ability. METHOD: Across four studies (N = 1568), we tested the association between self-esteem and perceptions of leadership ability for dominant and prestigious leaders. RESULTS: Individuals with high self-esteem perceived greater leadership ability in prestigious leaders than did those with low self-esteem and individuals with low self-esteem perceived greater leadership ability in dominant leaders than did those with high self-esteem. These results emerged across ratings of leaders from hypothetical vignettes (Studies 1 and 4), abstract beliefs about what constitutes good leadership (Study 1), past personal experiences with leaders (Study 2) and clips of leaders from reality television (Study 3). In Study 4, we also tested potential mechanisms. Compared with followers with low self-esteem, followers with high self-esteem found prestigious leaders more trustworthy, and they anticipated feeling inauthentic around a dominant leader. CONCLUSIONS: Self-esteem is reliably and robustly related to perceived leadership ability of dominant and prestigious leaders, and these differences might stem from differences in trust in prestigious leaders and anticipated authenticity around dominant leaders.

Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148.

Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.

Followership at a distance: Follower adjustment to distal leadership during COVID-19.

Leader distance theory has received scant empirical attention in the extant literature; however, the "work from home" orders associated with COVID-19 have made this theory and its empirical findings highly relevant for organizations. Our study integrates leader distance theory and followership theory to understand how follower role beliefs affect follower effort, performance, and withdrawal under physical leader distance and varying conditions of leader interaction frequency. Using a three-wave survey methodology with 260 adults working remotely, our study finds that followers' levels of effort, performance, and withdrawal were contingent on leader interaction frequency. Specifically, followers with a coproduction role orientation, who see their role as more collaborative, reported higher levels of effort under conditions of high leader interaction. Furthermore, the indirect effect of coproduction on follower performance and withdrawal via effort was moderated by leader interaction frequency. The results for followers with passive role orientations, however, were in the opposite direction. These followers reported less effort when leader interaction was high, and the mediational chain predicting performance and withdrawal was contingent on leader interaction frequency. Our study contributes to the ongoing conversation about the positive and negative effects of leader distance and positions followership characteristics as important boundary conditions of distal leadership.

Is a disease leader attractive? Six tests of whether the COVID-19 pandemic affected follower preferences for attractiveness, health and other traits in political and non-political leaders.

Attractive political candidates receive more votes on Election Day compared to their less attractive competitors. One well-cited theoretical account for this attractiveness effect (White et al., 2013) holds that it reflects an adaptive psychological response to disease threats. Voters are predicted to upregulate preferences for attractiveness because it constitutes a cue to health. The global COVID-19 pandemic constitutes an ecologically relevant and realistic setting for further testing this prediction. Here, we report the results from six tests of the prediction based on two large and nationally representative surveys conducted in Denmark (n = 3297) at the outbreak of the pandemic and one year later. Utilizing experimental techniques, validated individual difference measures of perceived disease threat and geographic data on COVID-19 severity, we do not find that disease threats like the COVID-19 pandemic upregulate preferences for attractive and healthy political or non-political leaders. Instead, respondents display heightened preferences for health in socially proximate relations (i.e. colleagues). Moreover, individuals who react aversively to situations involving risks of pathogen transmission (scoring high in Germ Aversion) report higher importance of a wide range of leadership traits, rather than for health and attractiveness in particular. Results are discussed in relation to evolutionary accounts of leadership and followership.

Leadership in interprofessional healthcare teams: Empowering knotworking with followership.

Healthcare professionals need to be able to collaborate in interprofessional healthcare teams (IHTs). This paper discusses how healthcare professionals (can) contribute to IHT effectiveness. Using cultural historical activity theory and its affiliated concept of knotworking, it argues that healthcare professionals would benefit from developing not just leadership but also followership skills. Moreover, IHT collaborators need the ability to switch fluently between leader and follower roles as appropriate to advance patient care. This fluency is essential for collaborative knotworking. Knotworking refers to the process of tying and retying together individual threads of activity and expertise from across the IHT, over time, to achieve specific objects. Knotworking highlights the dynamic dimensions of IHT collaboration that require professionals to be both effective leaders and followers. The perspectives presented in this paper lead to a different view of IHTs, one that recognizes how leaders and followers co-produce the leadership teams need.

Rethinking health professions' education leadership: Developing 'eco-ethical' leaders for a more sustainable world and future.

In this commentary, we discuss health professions' education (HPE) leadership in relation to planetary health emergencies, suggesting that an 'eco-ethical leadership' approach is highly relevant. Building on both traditional and more contemporary leadership approaches and the need for HPE to be socially and environmentally accountable, we define the key features of eco-ethical leadership and its underpinning beliefs and values, then expand on these features in terms of leadership at intrapersonal, interpersonal, team, organisational and system levels. Eco-ethical leadership is needed to tackle a range of 'wicked' problems - a changing climate, environmental pollution, deforestation, all of which threaten global biodiversity and human civilisation. Such leadership requires passionate individuals to role model the behaviours and actions that are required to bring people along with them, not least the learners, many of whom are already concerned about their future. Eco-ethical leadership (and followership) offers an integrated approach for HPE, centred around sustainability, values, collaboration, justice, advocacy and, if need be, activism. The environment cannot not wait. Eco-ethical leaders already exist but their numbers are small. They are required in key positions in academia and healthcare to drive the agenda in partnership with learners, many of whom are already environmental advocates and activists.

Who directs group movement? Leader effort versus follower preference in stickleback fish of different personality.

During collective movement, bolder individuals often emerge as leaders. Here, we investigate whether this reflects a greater propensity of bold individuals to initiate movement, or a preference for shy individuals to follow a bolder leader. We set up trios of stickleback fish comprising a focal individual who was either bold or shy, and one other individual of each personality. We then recorded the movements of all individuals in and out of cover in a foraging context to determine how assiduously the focal fish followed the movements of each other partner. We found that a shy focal fish preferred to follow a leader whose personality matched its own, but we did not detect such a difference in bold fish. Despite this preference, however, the greater propensity of bold individuals to initiate movements out of cover meant that they successfully led more joint trips. Thus, when offered a choice of leaders, sticklebacks prefer to follow individuals whose personality matches their own, but bolder individuals may, nevertheless, be able to impose their leadership, even among shy followers, simply through greater effort.

The evolution of group dispersal with leaders and followers.

In many species, individuals disperse in groups. While there are empirical studies that explore the proximate incentives for group dispersal, theoretical research has primarily examined the consequences rather than the evolution of this phenomenon. We design a simple model to study the origin and evolution of group dispersal. We assume that like many other group activities associated with collective movement, group dispersal in our model is initiated by leaders. We use the theory of inclusive fitness to examine the incentives for leading and following in this context. High relatedness, significant reductions in the cost of dispersal due to dispersing in groups, and reproductive skew in favour of followers facilitates the emergence of group dispersal. In contrast to some previous theoretical work, which has either concluded that leadership is uniformly altruistic or that it is uniformly selfish, we find that at evolutionary equilibrium the incentives for leading can be either selfish or altruistic. The nature of result (selfish or altruistic) depends on ecological and social conditions such as the cost of dispersal and the relatedness between leaders and followers. Our model demonstrates that kin selection is sufficient and that individual differences in condition and ability are not necessary to promote the emergence and maintenance of leader-follower relationships.

Leadership and Followership in Health Professions: A Systematic Review.

Objective: Leadership discussion, including leadership development programs, is common. However, discussion of followership as a component of leadership seems less frequently discussed. With a focus on leadership and followership, this investigation reviewed the health-professions education literature and characterized leadership-followership within health-professions education. Methods: Using PubMed, ERIC, and Google Scholar, two investigators independently and systematically searched health-professions education literature for articles related to leadership and followership. Reports were categorized based on the articles by type, application, profession, leadership, and followership qualities. Results: Eighty-one articles were included. More than half [59% (48/81)] were theoretical, 27% (22/81) empirical, 7% (6/81) commentaries, and 6% (5/81) letters-to-the-editor). Empirical studies did not share outcomes that could be meaningfully combined quantitatively by meta-analysis; however, the vast majority (96%) of theoretical articles discussed a healthcare-related application of leadership and followership (e.g., improving patient care, improving communication, improving organizational efficiency). Thus, a qualitative review was completed. Of the 81 articles, 57% (n=46) involved multiple professions, while 43% (n=35) focused on a specific profession [Nursing (n=16), Medicine (n=7), Others (n=5) Surgery (n=3), Pharmacy (n=2), Veterinary Medicine (n=2)]. While most articles (75%) discussed leadership qualities (with top qualities of effective communication, visionary, and delegating tasks), fewer (57%) discussed followership qualities (with top qualities of being responsible, committed, and supportive). Of note, some qualities overlapped in both leadership and followership (with top qualities of effective communication, being supportive, and providing/receiving feedback). Conclusions: Leadership-Followership was described in many health-professions' education literature. However, Pharmacy and Veterinary Medicine had substantially fewer articles published on this topic. Notably, followership did not receive nearly as much attention as leadership. Leadership has a dynamic and complex interaction with followership highlighting that an effective leader must know how to be an effective follower and vice versa. To improve leadership within healthcare teamwork, education should focus on both leadership-followership.

The dual impacts of guanxi closeness on followership: Mediating roles of burnout and power distance.

Guanxi and followership play important roles in employees' interaction with their supervisors. Extant studies have found that supervisor-subordinate guanxi can predict subordinates' attitudes and behaviors toward their supervisors. However, little is known about the relationship between guanxi closeness and subordinates' following supervisors. Accordingly, drawing on conservation of resource theory (COR), we develop a two-path mediation model and examine the direct impact of guanxi closeness on followership, the mediating role of burnout and power distance orientation, discussing the dual impacts of guanxi closeness. To reduce the common method basis, a two-wave time-lagged (interval of one month) study was conducted. Then, we collected 239 pieces of data to test our hypotheses using path analyses. Results show that the direct effect of guanxi closeness on followership is significant. Additionally, guanxi closeness weakens followership by reducing employee burnout. Meanwhile, guanxi closeness can decrease employees' power distance orientation (PDO) and then enhance followership. These findings reveal the dual impacts of guanxi closeness and extend our understanding of guanxi showing positive impact as well as negative impact. Therefore, managers should cultivate guanxi closeness with subordinates to enhance followership by reducing subordinates' PDO while providing resources and support to employees involved in burnout. These behaviors are conducive to helping managers to attain subordinates' following.

Experience overrides personality differences in the tendency to follow but not in the tendency to lead.

In many animal groups, coordinated activity is facilitated by the emergence of leaders and followers. Although the identity of leaders is to some extent predictable, most groups experience frequent changes of leadership. How do group members cope with such changes in their social role? Here, we compared the foraging behaviour of pairs of stickleback fish after a period of either (i) role reinforcement, which involved rewarding the shyer follower for following, and the bolder leader for leading, or (ii) role reversal, which involved rewarding the shyer follower for leading, and the bolder leader for following. We found that, irrespective of an individual's temperament, its tendency to follow is malleable, whereas the tendency to initiate collective movement is much more resistant to change. As a consequence of this lack of flexibility in initiative, greater temperamental differences within a pair led to improved performance when typical roles were reinforced, but to impaired performance when typical roles were reversed.

Followership in interprofessional healthcare teams: a state-of-the-art narrative review.

OBJECTIVE: A state-of-the-art (SotA) literature review-a type of narrative review- was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)? DESIGN: Working from a constructivist orientation, SotA literature reviews generate a chronological overview of how knowledge evolved and presents this summary in three parts: (1) this is where we are now, (2) this is how we got here and (3) this is where we should go next. Using the SotA six-stage methodology, a total of 48 articles focused on followership in IHTs were used in this study. RESULTS: Articles about followership within IHTs first appeared in 1993. Until 2011, followership was framed as leader-centric; leaders used their position to influence followers to uphold their dictums. This perspective was challenged when scholars outside of healthcare emphasised the importance of team members for achieving goals, rejecting a myopic focus on physicians as leaders. Today, followership is an important focus of IHT research but two contradictory views are present: (1) followers are described as active team members in IHTs where shared leadership models prevail and (2) conceptually and practically, old ways of thinking about followership (ie, followers are passive team members) still occur. This incongruity has generated a variable set of qualities associated with good followership. CONCLUSIONS: Leadership and followership are closely linked concepts. For leaders and followers in today's IHTs to flourish, the focus must be on followers being active members of the team instead of passive members. Since theories are increasingly encouraging distributed leadership, shared leadership and/or situational leadership, then we must understand the followership work that all team members need to harness. We need to be cognizant of team dynamics that work within different contexts and use leadership and followership conceptualisations that are congruent with those contexts.

How followers' perception of followership prototype-traits fit impacts their job performance: a moderated polynomial regression analysis.

Introduction: Previous studies about the drivers of follower performance focused on leadership, and most followership studies have used a single perspective to investigate this topic from the followers' lens. Therefore, the purpose of this study is to explore whether, how, and when followers' perception of followership prototype-traits fit influences their job performance. Methods: The study adopted a questionnaire survey (Study 1) and a scenario experiment (Study 2). First, in the questionnaire survey, we collected 72 leaders and 262 followers from 72 teams of 14 companies in China using a two-wave research design. Second, in the scenario experiment, we invited 160 undergraduates from a university in southwest China to participate in the experiment after verifying the effectiveness of the manipulated materials. Results: (1) compared with the misfit, followership prototype-traits fit is more likely to stimulate followers' taking charge; (2) compared with low levels of fit, high-level followership prototype-traits fit is more likely to stimulate followers' taking charge; (3) compared with high followership prototype and low followership traits condition, low followership prototype and high followership traits condition is more likely to stimulate followers' taking charge; (4) followers' taking charge mediates the impact of the followership prototype-traits fit on followers' job performance; and (5) the impact of followership prototype-traits fit on followers' taking charge is more salient for male followers than for female followers. Discussion: This study not only helps capture the bidirectional and complex process of the interaction between leaders and followers during the followership, but also obtains a more comprehensive understanding of how this interaction affects followers' behaviors and performance. The results have practical implications for improving followers' job performance by highlighting the effects of followership prototype-traits fit on followers' behaviors and performance.

Engaged followership and toxic science: Exploring the effect of prototypicality on willingness to follow harmful experimental instructions.

Drawing on the 'engaged followership' reinterpretation of Milgram's work on obedience, four studies (three pre-registered) examine the extent to which people's willingness to follow an experimenter's instructions is dependent on the perceived prototypicality of the science they are supposedly advancing. In Studies 1, 2 and 3, participants took part in a study that was described as advancing either 'hard' (prototypical) science (i.e., neuroscience) or 'soft' (non-prototypical) science (i.e., social science) before completing an online analogue of Milgram's 'Obedience to Authority' paradigm. In Studies 1 and 2, participants in the neuroscience condition completed more trials than those in the social science condition. This effect was not replicated in Study 3, possibly because the timing of data collection (late 2020) coincided with an emphasis on social science's importance in controlling COVID-19. Results of a final cross-sectional study (Study 4) indicated that participants who perceived the study to be more prototypical of science found it more worthwhile, reported making a wider contribution by taking part, reported less dislike for the task, more happiness at having taken part, and more trust in the researchers, all of which indirectly predicted greater followership. Implications for the theoretical understanding of obedience to toxic instructions are discussed.

The Effect of Follower Identity on Followership: The Mediating Role of Self-Efficacy.

Followership is as crucial as leadership for organizational success. Significant efforts have been made by numerous researchers to examine how leadership influences followership; however, not enough attention has been paid to the influence of internal factors of followers on followership from the followers' perspective. This study relies on identity theory to understand the relationship between the influence of followers' perceived self-following traits (FTP) and followership prototype (FP) on followership, and the mediation role of self-efficacy in the relationship between FTP-FP consistency and followership. In order to avoid common method bias and ensure good discriminant validity of the variables, a two-wave time-lagged data collection design was used to collect 276 valid questionnaires from front-line business staff and junior supervisors in private and public sector organizations of China. Polynomial regression and response surface analysis were used to investigate the effect of FTP-FP consistency on followership. The empirical findings indicated that (1) the more consistent FTP-FP, the stronger the followership; (2) compared to the 'low FTP-low FP', employees with 'high FTP-high FP' had stronger followership; (3) employees with 'high FTP-low FP' had stronger followership than 'low FTP-high FP'; (4) self-efficacy played a mediating role between FTP-FP consistency and followership. These findings contribute to management practice by revealing antecedents to followership from the perspective follower identity and the effect of follower identity on followership.

How do Registered Nurses Understand Followership?

BACKGROUND: Despite a consensus that followers and leaders are interdependent, the focus of nursing education, practice, and research has been leader centred. This has spawned calls in the nursing literature for increased scholarship on followership in nursing. PURPOSE: To develop a grounded theory of followership in nursing. METHOD: This study addressed the question - how do registered nurses understand followership? 11 registered nurses participated in online interviews that were later transcribed and analyzed following Charmaz's approach to Constructivist Grounded Theory. RESULTS: The core category of trusting informal and formal leaders was co-constructed from the data. A conceptual model, titled Followership as Trust in Acute Care Nursing Teams, illustrates that the nurses' decision to trust (and subsequently to engage in following) hinges on sharing the load (understanding one's role, accepting one's role, and working together); demonstrating knowledge (having experience, modelling, and mentoring); and connecting through communication (knowing the goal and communicating clearly). When participants fully trust formal and informal leaders, they engage in following as proactive members of the team, provide solutions to problems, and take initiative. Conversely, when they are less trusting of informal and formal leaders, they are less willing to follow. CONCLUSIONS: This study underscores the importance of trust between followers and leaders for effective team function and safe patient care. More research on the follower-leader dynamic in nursing is needed to inform education, policy, and practice so that every nurse possesses the knowledge and skill to be both a follower and a leader.

Friend or fiend? Disentangling upward humor's (De)stabilizing effects on hierarchies.

Humor research in organizations focuses on leaders' humor, but we know far less about followers' humor. Here, we review and synthesize the scattered work on this "upward humor," offering a novel framing of it as a strategy for followers to deal with hierarchies. We propose a continuum of upward humor from stabilizing (i.e., a friend who uses upward humor to reinforce hierarchies, make hierarchies more bearable or stable) to destabilizing (i.e., a fiend who uses upward humor to question or reshape existing hierarchies) depending on perceived intent (i.e., from benevolent to malicious, respectively) and outline key factors that shape these interpretations. We close with novel questions and methods for future research such as power plays, multi-modal data, and human-robot interactions.

Seven leadership and followership lessons from kidney transplantation during lockdown.

BACKGROUND: The renal transplant team in Northern Ireland performed 70 transplants in 61 days during the first wave of COVID-19, an 8-fold increase in their typical activity. Mobilising diverse professional skills to achieve this number, especially under COVID-19 conditions, required extraordinary effort on the part of everyone involved along the transplant patient pathway, management and staff from other patient groups. METHODS: Fifteen transplant team members were interviewed to explore their experiences during this time. RESULTS: Seven key leadership and followership lessons, contextualised within The Healthcare Leadership model, were learnt from these experiences. CONCLUSIONS: While circumstances were untypical, the achievement and motivation of staff were no less commendable. We contend that this was not only because of the unusual circumstances but as a result of extraordinary leadership and followership, teamworking and individual agility.Recommendations for those leading services which require a quick response and collaborative effort are made.