Informal Leadership in the Clinical Setting: Occupational Therapist Perspectives

PURPOSE: This study explored the research question, What is the meaning of participation in the role of informal leader in occupational therapy practice? Leadership has been extensively considered in the literature, but this work has largely targeted formal leadership concepts involving conferred authority. Leadership research in health care has generally mirrored this focus. As work environments use more distributed leadership models, formal leaders become less accessible and new informal leadership roles are created for clinicians. To date, consideration of participation in the role of informal leader has been limited.

METHOD: This qualitative study used a design consistent with interpretative phenomenological analysis to explore the meaning associated with participation in the role of informal leader (Smith et al., 2009). We recruited participants working at a large multicampus (urban/rural) hospital in Ontario, Canada.

A two-stage sampling process was used to enable peer identification of informal leaders. All occupational therapists in clinical roles (N = 99) were invited to participate in a survey in which they could anonymously identify peers whom they perceived as informal leaders. A convenience sample (N = 49) participated in the first stage. In the second stage, occupational therapists identified as informal leaders by at least three peers were contacted and an interview sample (n = 10) established. The sample included nine women and one man (M age = 41.8, range = 29–52) with an average of 16 yr experience. Two participants practiced in mental health and eight in physical health. Three worked in community care and seven in a hospital. Demographic data appeared to be in line with national data (Canadian Institute for Health Information, 2011).

A standardized interview protocol was used, and collected data were coded for themes using an editing style of analysis. Three independent coders of varied clinical and professional backgrounds independently coded the data. Definitions for each code were developed and overarching themes identified. After data analysis, the coding scheme was tested for consistency. Each coder independently coded one transcript using the final coding definitions, and agreement was 85.03%. Several methods were used to establish trustworthiness, including triangulation by analyst and by theory or perspective. Member checking was also used to further validate the themes.

RESULTS: Participant responses supported several overarching themes. The first identified that informal leaders organically shape and define practice as supportive mentors, coaches, and educators. A second noted that informal leaders are inspirational and creative in building strength and capacity. A third indicated that having the freedom and time to realize their vision validates informal leaders.

CONCLUSION: It appears that to authentically consider leadership in the occupational therapy profession, it is paramount to engage, or at minimum acknowledge, those participating as informal leaders. Formal leaders create policy, but informal leaders guide its acceptance and influence. Results of this study speak to the centrality of informal leaders in the clinical setting. As organizations continue to decentralize leadership structures, the relevance of informal leaders can only be enhanced.

IMPACT STATEMENT: In clinical practice, informal leaders are the go-to staff, the problem solvers, the voices of reason, and the shoulders to cry on. They support critical thinking, dissemination of ideas, and innovation. They inform the workplace culture. To date, their professional impact has not been considered. Results of this study identify both the professional relevance and the value of informal leadership in the clinical setting.

References

Canadian Institute for Health Information. (2011). Occupational therapists in Canada, 2011: National and jurisdictional highlights. Retrieved from https://www.cihi.ca/en/ot2011_highlights_profiles_en.pdf

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Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research. London: Sage.