DDHA 8113 Week 6 Followership Discussion Post Example

Week 6 Discussion: Followership

The Charge Nurse's Memo That Stopped a Signed Plan: Followership as a Skill With Its Own Evidence, Not the Absence of Leadership

My claim this week is that followership is a skill with its own body of evidence, and that treating it as what is left over when someone is not leading misreads how decisions in health care actually get made. Uhl-Bien et al. (2014), reviewing the field, argue that followership should be studied as a role and a set of behaviors in its own right, and that following can shape outcomes as much as leading does. Carsten et al. (2010), interviewing working employees, found that some described following as obedience while others described it as active partnership, including voicing concerns and challenging leaders when needed. I want to test the second view against a case from my own service line, because it changed my mind.

Last year the senior team at our composite three-hospital system approved a plan to move patients after uncomplicated elective brain surgery from the neuro ICU to the neuroscience step-down unit after twelve hours rather than the usual twenty-four, freeing ICU beds for transfers we were turning away. It carried four signatures: medicine's and nursing's top executives, the neurosurgery chief and mine. A week before the start date, a night charge nurse in the neuro ICU sent a two-page memo to her manager, copied to me. She did not argue with the goal. She pointed out that the step-down unit staffed one nurse to four patients at night, that hourly neurological checks for four post-surgical patients would consume most of that nurse's hour, and that the night step-down unit had no rapid way to get a CT scan without an ICU nurse to travel with the patient. She attached three anonymized examples from her own shifts of patients who had needed urgent imaging between hours twelve and twenty-four.

The plan stopped. We redesigned it so that early transfers go only to step-down beds staffed one to three at night, and only when a neurosurgery resident confirms the patient's checks can drop to every two hours. It started six weeks later than planned and has run without a missed deterioration that I know of.

What made her memo work is the part I think is a skill. She addressed the goal before the objection, used facts the decision makers did not have, proposed what would make the plan safe and sent it through her manager rather than around her. Morrison (2014), reviewing research on employee voice, notes that people decide whether to speak up by weighing whether it will make a difference and whether it is safe, and that how a concern is framed affects whether it is heard. Those are learnable behaviors. Would you count what she did as leadership instead? If so, what would followership even mean?

Reply to Andre

Andre, you argue that the charge nurse was leading, not following, and that the word followership just relabels leadership from below. I see why, but I think the label matters. She did not try to take the decision away from the senior team, set a new direction or recruit others to her view. She accepted the goal and the authority of the people who made the decision, and she gave them what they needed to decide better. That is a different act from leading. Uhl-Bien et al. (2014) make a related distinction between the role of follower and the process of influence, and I would rather keep both in view than fold one into the other. If we call every useful objection leadership, we lose the ability to teach people how to follow well, which most of our staff do most of the time.

Reply to Priya

Priya, you raise the risk that praising this memo rewards people for slowing decisions. That risk is real, and I would not want every signed plan to wait on a memo. The test I would apply is whether the objection brings facts the decision makers lacked and proposes a way forward. Her memo did both. Carsten et al. (2010) describe followers who saw their job as supporting the leader's goal by raising problems early, and I think that is the distinction you are reaching for. An objection that only says no is not the skill I am describing.

References

Carsten, M. K., Uhl-Bien, M., West, B. J., Patera, J. L., & McGregor, R. (2010). Exploring social constructions of followership: A qualitative study. The Leadership Quarterly, 21(3), 543-562. https://doi.org/10.1016/j.leaqua.2010.03.015

Morrison, E. W. (2014). Employee voice and silence. Annual Review of Organizational Psychology and Organizational Behavior, 1, 173-197. https://doi.org/10.1146/annurev-orgpsych-031413-091328

Uhl-Bien, M., Riggio, R. E., Lowe, K. B., & Carsten, M. K. (2014). Followership theory: A review and research agenda. The Leadership Quarterly, 25(1), 83-104. https://doi.org/10.1016/j.leaqua.2013.11.007