The more, the better? Exploring vertical and horizontal leadership in cross-professional health care teams

Abstract

Purpose

This paper seeks to explore vertical and horizontal leadership and the relationship of the form of leadership to effectiveness in Swedish cross-professional health care teams.

Design/methodology/approach

Questionnaire data were collected from a sample of 47 teams and observation data from a sub-sample of 38 teams. Data on leadership were condensed to indices: directive and participative leadership (vertical leadership) and functional influence and self-regulation (horizontal leadership). Effectiveness was estimated using five measures: team climate, self-assessed effectiveness, teamwork organisation, assessments of results from a simulated case conference (case quality) and manager-rated effectiveness.

Findings

Positive relationships were found between leadership and effectiveness with one exception: case quality was negatively associated with vertical leadership though positively to functional influence. When controlled for team climate the correlations between self-assessed effectiveness and leadership disappeared. However, it remained between vertical leadership and the assessment of teamwork organisation. The results suggest that hierarchical and horizontal/shared leadership are complementary forms.

Research limitations/implications

The small number of teams together with the problem of causality in this cross-sectional study are the main limitations.

Practical implications

One implication for practice is the need for clarification of how leadership and influence should be distributed from a contingency perspective.

Originality/value

This study takes both horizontal and vertical leadership into account compared with previous studies often focusing on one facet. In addition, cross-professional health care teams with their special characteristics are underrepresented within research on team leadership.

Citation

Emma Christine Thylefors, I. and Persson, O. (2014), "The more, the better? Exploring vertical and horizontal leadership in cross-professional health care teams", Leadership in Health Services, Vol. 27 No. 2, pp. 135-149. https://doi.org/10.1108/LHS-09-2012-0031