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How Health Visitors Understand the Social Making a difference: how health visitors understand the social processes of leadership STANSFIELD, Karen Available from Sheffield Hallam University Research Archive (SHURA) at: http://shura.shu.ac.uk/23238/ This document is the author deposited version. You are advised to consult the publisher's version if you wish to cite from it. Published version STANSFIELD, Karen (2017). Making a difference: how health visitors understand the social processes of leadership. Doctoral, Sheffield Hallam University. Copyright and re-use policy See http://shura.shu.ac.uk/information.html Sheffield Hallam University Research Archive http://shura.shu.ac.uk Making a Difference: How Health Visitors Understand the Social Processes of Leadership Karen Stansfield A thesis submitted in partial fulfilment of the requirements of Sheffield Hallam University for the degree of Doctor of Business Administration August 2017 Abstract Leadership has become a pre-requisite for all health professionals working at every level in healthcare. The need to strengthen leadership in health visiting has been voiced in health care policy for the past eighteen years (Department of Health (DH), 1999 & 2006; National Health Service (NHS) England, 2016). Yet there is still a lack of research examining how health visitors understand leadership, with, much of the existing research on leadership focusing on leaders “per se” as opposed to leadership as a social process. This study sought to understand how health visitors perceive their leadership role, and how leadership is demonstrated in the delivery of the health visiting service in the context of the NHS. The aim being to enable the researcher to examine how health visitors understand leadership as a social process. The research focused on 17 participants, 16 of whom came from a health visiting background. The participants consisted of three groups: a focus group comprising health visitors in clinical practice taken from one NHS Trust, a further group consisted of team leaders, managers and practice teachers, drawn from the same NHS Trust. The third group comprised of national, strategic leaders in health visiting. The latter two groups were interviewed individually. A constructivist grounded theory approach was used to ascertain the participants’ main concerns in relation to leadership (Charmaz, 2014). A conceptual framework of making a difference: how health visitors understand the social processes of leadership has been constructed to explain how health visitors understand leadership through their professional ideology (Whittaker et al, 2013). The conceptual framework demonstrates how the categories, context of leadership, the purpose of leadership and leadership behavior emerged. These were constructed from the comparative analysis, of the data and encapsulate the participants’ main concerns. The findings support the construction of a conceptual leadership development framework for health visitors. This framework identifies the need to incorporate education based on the three categories and the core category “making a difference” and there is a need to focus on leadership development as a continuous process. In addition, the findings recognize the importance of establishing both a health visitor and leadership identity (Lord & Hall, 2005; Day & Harrison, 2007). This study has provided a framework for leadership development that can be used as a structural framework in health visiting education in both academic and clinical practice settings, and as a way of articulating how health visitors understand leadership. This study sheds light on the importance of building not only health visiting identity but also leadership identity when delivering health visitor education. It provides an interpretive perspective instead of the more common positivist approach to leadership research reported in the literature. ii Acknowledgements I would like to begin by thanking Dr Murray Clark my Director of Studies. I have found your continued support from our first meeting when we discussed why I wanted to undertake a Doctorate, to our constant discussions throughout developing this thesis to be invaluable. You are a person of high integrity and it has been a pleasure to work with you as my supervisor for the duration of this programme. Your constant questions done in such a way as to make me think about every step of the research process has enabled my own development both as a researcher and as a professional. I thank Dr Oliver Couch, my supervisor for your constant support, you have helped me to consider how to be more reflexive and really question my data; you have provided immensely helpful feedback. You have both helped me think about things in a way that I wouldn’t have imagined possible at the start of the programme. I have learnt so much from both of you and I am grateful to have experienced role modeling in action as well as recognizing it in my participants’ experiences. I would like to thank Sheffield Hallam University for the support I received when I started the Doctorate as Deputy Head of Department of Nursing and Midwifery. The support and encouragement has been immense and in recognizing this I must specifically mention Jean Flanagan my line manager at the time that provided so much professional guidance. Jo Lidster who provided an insight and encouragement into the whole research process as a Doctoral student herself it was so reassuring to see you complete and know there was an end to this process. Susan Wakefield for her continued support and discussions about every aspect of the research process and for making hope stay with me throughout this process. I would also like to thank Lisa Jacobs for formatting the thesis and for endless amendments to charts that was always done swiftly and supportively. Thanks goes to Cheryll Adams at the Institute of Health Visiting my current employer, for constantly challenging me to make this Doctoral work something that could be implemented and therefore be of benefit to health visitors in practice. This helped me achieve my personal iii aim of undertaking this work in the first place to “make a difference”. I could not have done this without the participants of this study who gave their time so generously and trusted me with the stories of their experiences. I am immensely grateful to you all. In conclusion, huge thanks goes to my husband Mark, who has provided me with the space to be able to undertake this substantial piece of work and to all my friends and family who have been so supportive, and who will like me be so pleased to see this thesis completed. iv Table of Contents Chapter One ....................................................................................................... 1 1. Introduction ..................................................................................................... 1 1.1 Background to the study ............................................................. 2 1.2 Health Visiting .............................................................................. 5 1.3 The setting for this study ............................................................ 9 1.4 My research journey .................................................................... 9 1.5 Research aims and objectives .................................................. 14 1.6 Contribution of the research ..................................................... 15 1.7 Structure of the thesis ............................................................... 17 1.8 Chapter summary ...................................................................... 19 Chapter Two ..................................................................................................... 21 2. Literature Review .......................................................................................... 21 2.1 Introduction ................................................................................ 21 2.1 Use of literature in grounded theory ........................................ 23 2.2 Policy directing the development of health visiting ............... 25 2.3 Leadership theories ................................................................... 30 2.4 Leadership in the NHS ............................................................... 37 2.5 Leadership in nursing ............................................................... 42 2.6 Leadership in health visiting .................................................... 45 2.7 Leaders and leadership development ...................................... 46 2.9 Chapter summary ...................................................................... 49 Chapter Three ................................................................................................... 51 3. Methodology ................................................................................................. 51 3.1 Introduction ................................................................................ 51 3.2 The research process ................................................................ 52 v 3.3 Research methods ..................................................................... 72 3.4 Data collection technique ......................................................... 79 3.5 Reflexivity ................................................................................... 82 3.6 Ethical considerations ............................................................... 83 3.7 Chapter summary ...................................................................... 84 Chapter Four ....................................................................................................
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