Understanding Organisational Dynamics

  • Paul TurnerEmail author
Part of the Organizational Behaviour in Health Care book series (OBHC)


Setting objectives and crafting a strategy to achieve them are important facets of the roles of Senior Leaders. Using personal insight as the basis of leadership capability, a leadership identity to reflect on the most appropriate approach, and having professional credibility to ensure the engagement of colleagues in all disciplines and at all levels will provide a foundation on which the organisation’s strategy can be built. However, if strategic objectives are to be translated into practical success, then an understanding of the dynamics of the organisation will also be a factor for consideration. Being able to combine effectiveness in both tangible elements of strategy and operations and the intangibility of organisational culture and its associated complexities may be the difference between leadership success and failure. The many interpretations of the role of the leader and the nature of leadership are one consideration; but how leaders and leadership are impacted by organisational dynamics is another.


Organisational dynamics Organisational culture Organisational structures Values Symbols 


  1. Abor, P. A., Abekah-Nkrumah, G., & Joshua Abor, J. (2008). An Examination of Hospital Governance in Ghana. Leadership in Health Services, 21(1), 47–60. Scholar
  2. Alimpic, Z. (2013). New Growth Platform Framework for Swiss Acute Hospitals – An Empirical Study for the Development of Dynamic Capabilities. Serbian Journal of Management, 8(2), 185–199.CrossRefGoogle Scholar
  3. Aubry, M., Richer, M., & Lavoie-Tremblay, M. (2014). Governance Performance in Complex Environment: The Case of a Major Transformation in a University Hospital. International Journal of Project Management, 32(8), 1333–1345.CrossRefGoogle Scholar
  4. Basistic, S., Cerne, M., & Vogel, B. (2017). Just How Multi-Level Is Leadership Research? A Document Co-Citation Analysis 1980–2013 on Leadership Constructs and Outcomes. The Leadership Quarterly, 28(1), 86–103.CrossRefGoogle Scholar
  5. Baxter, K., Weiss, M., & Grand, J. L. (2008). The Dynamics of Commissioning Across Organisational and Clinical Boundaries. Journal of Health Organization and Management, 22(2), 111–128.CrossRefGoogle Scholar
  6. Beaulieu, S. A., & Pasquero, J. A. (2002). Reintroducing Stakeholder Dynamics in Stakeholder Thinking. The Journal of Corporate Citizenship, 2002(6), 53. Scholar
  7. Bentley, M., Freeman, T., Baum, F., & Javanparast, S. (2018). Interprofessional Teamwork in Comprehensive Primary Healthcare Services: Findings from a Mixed Methods Study. Journal of Interprofessional Care, 32(3), 274–283. Scholar
  8. Bish, M., Kenny, A., & Nay, R. (2015). Factors That Influence the Approach to Leadership: Directors of Nursing Working in Rural Health Services. Journal of Nursing Management, 23(3), 380–389. Scholar
  9. Bowen, D. J. (2015). Becoming a Nimble Leader: Leading Teams Through Change Requires Agility and Masterful Execution. Healthcare Executive, 30(6), 8.Google Scholar
  10. Bowers, L., Nijman, H., Simpson, A., & Jones, J. (2011). The Relationship Between Leadership, Teamworking, Structure, Burnout and Attitude to Patients on Acute Psychiatric Wards. Social Psychiatry and Psychiatric Epidemiology, 46(2), 143–148. Scholar
  11. Bowie, N. (2000). A Kantian Theory of Leadership. The Leadership and Organisation Journal, 21(4), 185–193.CrossRefGoogle Scholar
  12. Bresnen, M. (2017). Managing Modern Healthcare: Knowledge, Networks and Practice. New York: Routledge.CrossRefGoogle Scholar
  13. Cacioppe, R. (1997). Leadership Moment by Moment. Leadership and Organisation Development Journal, 18(7), 335–345.CrossRefGoogle Scholar
  14. Chapman, A. N., Johnson, D., & Kilner, K. (2014). Leadership Styles Used by Senior Medical Leaders. Leadership in Health Services (1751–1879), 27(4), 283. Scholar
  15. Chelliah, J., Boersma, M., & Klettner, A. (2016). Governance Challenges for Not-for-Profit Organisations: Empirical Evidence in Support of a Contingency Approach. Contemporary Management Research, 12(1), 3–23. Scholar
  16. Donnelly, T. (2017). Leadership: Briefing and Debriefing in the Operating Room. Journal of Perioperative Practice, 27(7), 154–157.CrossRefGoogle Scholar
  17. Drucker, P. (2006). What Executives Should Remember. Harvard Business Review, 84(2), 144–152.Google Scholar
  18. Emslie, S., Oliver, C., & Bruce, J. (2006). Getting Governance Right at Board Level: The Policy Governance Approach to Building Better National Health Service Boards. Clinician in Management, 14(2), 69–77.Google Scholar
  19. Ezziane, Z. (2012). The Importance of Clinical Leadership in Twenty First Century Health Care. International Journal of Health Promotion and Education, 50(5), 261–269.CrossRefGoogle Scholar
  20. Goeschel, C. A., Wachter, R. M., & Pronovost, P. J. (2010). Medical Ethics: Responsibility for Quality Improvement and Patient Safety. Hospital Board and Medical Staff Leadership Challenges. Chest, 138, 171–178. Scholar
  21. Gokce, B., Guney, S., & Katrinli, A. (2014). Does Doctors’ Perception of Hospital Leadership Style and Organizational Culture Influence Their Organizational Commitment? Social Behavior & Personality: An International Journal, 42(9), 1549–1561.CrossRefGoogle Scholar
  22. Graber, D. R., & Kilpatrick, A. O. (2008). Establishing Values-Based Leadership and Value Systems in Healthcare Organizations. Journal of Health & Human Services Administration, 31(2), 179–197.Google Scholar
  23. Grint, K. (2005). Leadership: Limits and Possibilities. Basingstoke: Palgrave Macmillan.CrossRefGoogle Scholar
  24. Harvey, G., Boaden, R., Kislov, R., Kislov, R., Harvey, G., Boaden, R., et al. (2014). Rethinking Capacity Building for Knowledge Mobilisation: Developing Multilevel Capabilities in Healthcare Organisations. Implementation Science, 9, 166.CrossRefGoogle Scholar
  25. Heskestad, R. N., Aase, K., & Storm, M. (2016). Inter-Organisational Learning Among Health Care Professionals: A Learning Arena to Address Transitional Care of the Elderly. International Journal of Integrated Care (IJIC), 16(6), 1–3. Scholar
  26. Hunt, C. S., Landry, R. T., & Kerr, B. J. (2016). Formal Leaders’ Perceptions of Informal Leaders. Radiology Management, 38(4), 51–57.Google Scholar
  27. Jones, A., Lankshear, A., & Kelly, D. (2016). Giving Voice to Quality and Safety Matters at Board Level: A Qualitative Study of the Experiences of Executive Nurses Working in England and Wales. International Journal of Nursing Studies, 59, 169–176. Scholar
  28. Jumaa, M. (2008). The ‘F.E.E.L.’ Good Factors in Nursing Leadership at Board Level Through Work-Based Learning. Journal of Nursing Management, 16(8), 992–999. Scholar
  29. Kaplan, R. S., & Norton, D. P. (2006). How to Implement a New Strategy Without Disrupting Your Organisation. Harvard Business Review, 84(3), 100–109.Google Scholar
  30. Kennedy, N., Armstrong, C., Woodward, O., & Cullen, W. (2015). Primary Care Team Working in Ireland: A Qualitative Exploration of Team Members’ Experiences in a New Primary Care Service. Health & Social Care in the Community, 23(4), 362–370. Scholar
  31. Kilburg, R. R., & Donohue, M. D. (2011). Toward a ‘Grand Unifying Theory’ of Leadership: Implications for Consulting Psychology. Consulting Psychology Journal: Practice and Research, 63(1), 6–25. Scholar
  32. Kim, R. H., Gaukler, G. M., & Lee, C. W. (2016). Improving Healthcare Quality: A Technological and Managerial Innovation Perspective. Technological Forecasting and Social Change, 113(Part B), 373–378. Scholar
  33. Klarare, A., Lundh, H. C., Fürst, C. J., & Fossum, B. (2013). Team Interactions in Specialized Palliative Care Teams: A Qualitative Study. Journal of Palliative Medicine, 16(9), 1062. Scholar
  34. Kok, M. C., Dieleman, M., Broerse, J. W., Kea, A. Z., Datiko, D. G., Taegtmeyer, M., et al. (2015). A Qualitative Assessment of Health Extension Workers’ Relationships with the Community and Health Sector in Ethiopia: Opportunities for Enhancing Maternal Health Performance. Human Resources for Health, 13, 80.CrossRefGoogle Scholar
  35. Kotter, J. P. (1996). Leading Change. Boston, MA: Harvard Business Review Press.Google Scholar
  36. Kumar, S., Deshmukh, V., & Adhish, V. S. (2014). Building and Leading Teams. Indian Journal of Community Medicine, 39(4), 208–213. Scholar
  37. Larkin, H. (2015). The New Health Care CEO: In a Rapidly Changing Field, Effective Leaders Require ‘Learning Agility’ and ‘Emotional Intelligence’ as Much–or More–Than Traditional Skills. H&HN Hospitals & Health Networks, 22(6).Google Scholar
  38. LeBrasseur, R., Whissell, R., & Ojha, A. (2002). Organisational Learning, Transformational Leadership and Implementation of Continuous Quality Improvement in Canadian Hospitals. Australian Journal of Management (University of New South Wales), 27(2), 141.Google Scholar
  39. Lewis, A. (2012). Organisations Adjusting to Change: A Discussion of the Impact of an Improving Access to Psychological Therapies (IAPT) Service on the Organisational Dynamics of an Existing Psychological Therapies Department. Counselling Psychology Review, 27(1), 22–29.Google Scholar
  40. Lingard, L., Vanstone, M., Fleming-Carroll, B., Lowe, M., Sinclair, L., Rashotte, J., et al. (2012). Conflicting Messages: Examining the Dynamics of Leadership on Interprofessional Teams. Academic Medicine, 87(12), 1762–1767.CrossRefGoogle Scholar
  41. Lv, C., & Zhang, L. (2017). Original Article: How Can Collective Leadership Influence the Implementation of Change in Health Care? Chinese Nursing Research, 4, 182–185. Scholar
  42. Makan, A., Fekadu, A., Murhar, V., Luitel, N., Kathree, T., Ssebunya, J., et al. (2015). Stakeholder Analysis of the Programme for Improving Mental Health Care (PRIME): Baseline Findings. International Journal of Mental Health Systems, 9(1), 1–12. Scholar
  43. Malik, N., Dhar, R. L., & Handa, S. C. (2016). Authentic Leadership and Its Impact on Creativity of Nursing Staff: A Cross Sectional Questionnaire Survey of Indian Nurses and Their Supervisors. International Journal of Nursing Studies, 63, 28–36.CrossRefGoogle Scholar
  44. Mannion, R., Davies, H., Jacobs, R., Kasteridis, P., Millar, R., & Freeman, T. (2017). Do Hospital Boards Matter for Better, Safer, Patient Care? Social Science & Medicine, 177, 278–287. Scholar
  45. Martins, F. A., Ferreira-da-Silva, A., & Machado-Santos, C. (2014). Gestão dos Stakeholders na Captação de Recursos nos Hospitais Filantrópicos e Religiosos. RAC – Revista De Administração Contemporânea, 18, 65–85. Scholar
  46. Mastrangelo, A., Eddy, E. R., & Lorenzst, S. J. (2004). The Importance of Personal and Professional Leadership. The Leadership and Organisational Development Journal, 25(5), 435–451.CrossRefGoogle Scholar
  47. McBride, A. B. (2017). Serving on a Hospital Board: A Case Study. Nursing Outlook, 65, 372–379. Scholar
  48. McKimm, J., & Phillips, K. (2009). Leadership and Management in Integrated Services. Exeter: Learning Matters.Google Scholar
  49. Meier, N. (2015). Configurations of Leadership Practices in Hospital Units. Journal of Health Organization and Management, 29(7), 1115–1130. Scholar
  50. Millar, R., Mannion, R., Freeman, T., & Davies, H. T. (2013). Hospital Board Oversight of Quality and Patient Safety: A Narrative Review and Synthesis of Recent Empirical Research. Milbank Quarterly, 91(4), 738–770. Scholar
  51. Mishra, A. (2014). ‘Trust and Teamwork Matter’: Community Health Workers’ Experiences in Integrated Service Delivery in India. Global Public Health, 9(8), 960–974. Scholar
  52. Mitleton-Kelly, E. (2011). A Complexity Theory Approach to Sustainability: A Longitudinal Study in Two London NHS Hospitals. Learning Organization, 18(1), 45–53.CrossRefGoogle Scholar
  53. Northouse, P. G. (2016). Leadership, Theory and Practice (7th ed.). Thousand Oaks, CA: Sage Publications Inc.Google Scholar
  54. Opollo, J. G., Lloyd-Busby, A., Foreman, K., & Richardson, D. (2014). Nursing Administrative Officer: Transforming Nursing Leadership in Acute-Care Hospitals. Nurse Leader, 12, 84–90. Scholar
  55. Pencheon, D. (2015). Mini-Symposium: Making Health Care More Sustainable: The Case of the English NHS. Public Health, 129, 1335–1343. Scholar
  56. Pidgeon, K. (2017). The Keys for Success: Leadership Core Competencies. Journal of Trauma Nursing, 24(6), 338–341. Scholar
  57. Porter, M. E., & Teisberg, E. (2006). Redefining Health Care. Boston, MA: Harvard Business School Press.Google Scholar
  58. Reichenpfader, U., Carlfjord, S., & Nilsen, P. (2015). Leadership in Evidence-Based Practice: A Systematic Review. Leadership in Health Services, 28(4), 298–316.CrossRefGoogle Scholar
  59. Rumelt, R. (2011). Good Strategy, Bad Strategy. London: Profile Books.Google Scholar
  60. Senge, P. M., Lichtenstein, B. B., Kaeufer, K., Bradbury, H., & Carroll, J. S. (2007). Collaborating for Systemic Change. MIT Sloan Management Review, 48(2), 44–53.Google Scholar
  61. Shah, G. H., Sotnikov, S., Leep, C. J., Jiali, Y., & Van Wave, T. W. (2017). Creating a Taxonomy of Local Boards of Health Based on Local Health Departments’ Perspectives. American Journal of Public Health, 107(1), 72–80.CrossRefGoogle Scholar
  62. Shukri, N. M., & Ramli, A. (2015). Organizational Structure and Performances of Responsible Malaysian Healthcare Providers: A Balanced Scorecard Perspective. Procedia Economics and Finance, 28, 202–212. Scholar
  63. Smits, S. J., Bowden, D., Falconer, J. A., & Strasser, D. C. (2014). Improving Medical Leadership and Teamwork: An Iterative Process. Leadership in Health Services (1751–1879), 27(4), 299–315. Scholar
  64. Stacey, R. D. (2011). Strategic Management and Organisational Dynamics: The Challenge of Complexity to Ways of Thinking About Organisations. Harlow: Financial Times Prentice Hall.Google Scholar
  65. Taplin, S. H., Foster, M. K., & Shortell, S. M. (2013). Organizational Leadership for Building Effective Health Care Teams. Annals of Family Medicine, 11(3), 279–281. Scholar
  66. Thorpe, R., Gold, J., & Lawler, J. (2011). Locating Distributed Leadership. International Journal of Management Reviews, 13, 239–250. Scholar
  67. Top, M., Akdere, M., & Tarcan, M. (2015). Examining Transformational Leadership, Job Satisfaction, Organizational Commitment and Organizational Trust in Turkish Hospitals: Public Servants Versus Private Sector Employees. International Journal of Human Resource Management, 26(9), 1259–1282. Scholar
  68. Tran, V., & Voyer, B. (2015). Fostering Innovation: An Organisational Perspective. British Journal of Healthcare Management, 21(3), 141.CrossRefGoogle Scholar
  69. Tsai, Y. (2011). Relationship Between Organizational Culture, Leadership Behavior and Job Satisfaction. BMC Health Services Research, 11, 98.CrossRefGoogle Scholar
  70. Tsai, T. C., Jha, A. K., Gawande, A. A., Huckman, R. S., Bloom, N., & Sadun, R. (2015). Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical Quality Metrics. Health Affairs, 34(8), 1304–1311.CrossRefGoogle Scholar
  71. Tuan, L. T. (2012). Clinical Governance: A Lever for Change in Nhan Dan Gia Dinh Hospital in Vietnam. Clinical Governance: An International Journal, 17(3), 223–247. Scholar
  72. Uhl-Bien, M., & Arena, M. (2017). Complexity Leadership: Enabling People and Organizations for Adaptability. Organizational Dynamics, 46, 9–20.CrossRefGoogle Scholar
  73. Valentijn, P. P., Ruwaard, D., Vrijhoef, H. M., de Bont, A., Arends, R. Y., & Bruijnzeels, M. A. (2015). Collaboration Processes and Perceived Effectiveness of Integrated Care Projects in Primary Care: A Longitudinal Mixed-Methods Study. BMC Health Services Research, 15(1), 1–12. Scholar
  74. Valsecchi, R., Wise, S., Mueller, F., & Smith, C. (2012). The Practice of Teamwork in Health Industry Call Centres. Employee Relations, 34(3), 288–305.CrossRefGoogle Scholar
  75. Vinot, D. (2014). Transforming Hospital Management à la Francaise: The New Role of Clinical Managers in French Public Hospitals. International Journal of Public Sector Management, 27(5), 406–416. Scholar
  76. Walton, A. L., & Mullinix, C. (2016). Increasing the Number of Oncology Nurses Serving on Boards. Clinical Journal of Oncology Nursing, 20(4), 440–442. Scholar
  77. Waring, J., & Bishop, S. (2013). McDonaldization or Commercial Re-stratification: Corporatization and the Multimodal Organisation of English Doctors. Social Science & Medicine, 82, 147–155. Scholar
  78. Williams, J. (2016). Effective Team Working to Improve Diabetes Care in Older People. Journal of Diabetes Nursing, 20, 137–141.Google Scholar
  79. Wilson Pecci, A. (2014). No Nurses on Your Hospital Board? Why Not? Healthcare Leadership Review, 33(11), 8–9.Google Scholar
  80. Yang, J., Liu, Y., Chen, Y., & Pan, X. (2014). Original Article: The Effect of Structural Empowerment and Organizational Commitment on Chinese Nurses’ Job Satisfaction. Applied Nursing Research, 27, 186–191. Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.Leeds Business SchoolLeeds Beckett UniversityLeedsUK

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