f leadership that transforms people as it assesses the inner ambition of people and drives them into desiring to attain higher achievements and motivation for the good of others [13] . The Consultant had a vision of the change she wanted to impact and in the process of trying to achieve that goal she had to communicate to the other members of her health team. By doing a clinical teaching, she was not only able to give a vision of the goal her unit was planning to achieve, she also met the training needs of the junior doctors. And by keeping records of the unit’s activity she was able to have a factual evidence of the success and positive impact of the change process which motivated the junior doctors to aspire to do more.

Advocates of transformational leadership favor it for a number of reasons. To start with, it is a type of leadership that offers a clear organizational direction. Because in transformational leadership theory, the leader has a clear vision which he communicates to the followers and motivates the followers in a way that they have confidence in their ability to achieve this vision [12] . This clear sense of direction gives the followers a sense of identity as they put in their efforts towards achieving this goal; it also boosts their confidence and gives them a sense of self efficiency [14] . Secondly, it is a leadership that develops the capacity of its followers. Due to the fact that in transformational leadership, the leader raises the aspirations of the followers, this drives the willingness of the followers to improve the status quo for the benefit of an institution. As a result, the followers identify with the vision of the leader which makes them to own the vision and to put in efforts beyond the basic in order to achieve that goal. Here, there is an emphasis on intrinsic follower development and motivation [15] as the needs of the followers are taken into account in drawing the road map to achieving the organizational goal. This means that the follower in the organizational goals is able to identify with the process and has a deep sense of commitment because he sees the vision as part of a personal development plan. Thirdly, transformational leadership produces better quality leaders because it is a type of leadership in which the leaders experience personal development and training during the process. In transformational leadership the interaction between the leader and the follower creates a higher sense of motivation and moral values that not only develops the follower but also positively transforms the leader [12] . Furthermore, transformational leadership has a social moral benefit that impacts on the society. In transformational leadership, the leaders are strong role models for the beliefs and values that they want their followers to adopt. These leaders have a significant influence on what their followers identify with, are inspired by, trust and have an emotional connection to [16] [17] [18] . A transformation leader can shape the ideology of a whole society resulting in a wide spread movement.

On the other hand, transformational leadership has some limitations and draw backs. For instance, it has the tendency to create one powerful personality as against one strong institution. This is because in transformational leadership the leader has the tendency to be described as a visionary who has this powerful influence to drive people to achieve a common goal [12] . In the context of healthcare management where team work, shared leadership and rotation of leadership roles help efficient patient management, having one big personality with “the vision” to influence the follower could be counterproductive [19] . Also in the social sector the strong sense of loyalty, affection and intense obedience to the ideology of the leader can be detrimental if the vision is antisocial by being self-consumed, power oriented and exploitative like the case of Adolf Hitler and Saddam Hussein [12] . Although some may argue that the emphasis on good morals and values for the good of all would separate an authentic transformation leader from pseudo transformational leaders [15] [17] who have personalized selfish interest, yet, the fact is that they both have the same influence on follower using similar strategies.

Furthermore, transformational leadership can lead to a more tedious and possibly unpredictable road map to achieving a leader’s goal. Because transformational leadership process depends upon meeting the needs of the followers who play a central role in the process of transformational leadership. It also depends on their predisposition and their ability to be motivated to exceed expectations [20] .

5. Situational Leadership

Another leadership theory used in achieving the change described earlier is situational leadership. This is the type of leadership that adapts different styles to various situations as the need arises but with a common objective of achieving a set goal. The various styles are created by use of directive and supportive dimensions in various proportions based on the follower’s need as evaluated by the leader [21] . In the implementation of the change processes in asthma management, various situations required different styles of leadership in order to effect that change.

Situational leadership has many strengths that make it a desirable leadership style, to start with, it is very practical and its practicality makes it easy to comprehend and implement. It recognizes two vital qualities needed in a follower in order to accomplish a task and that is commitment and competence and it goes ahead to prescribe to the leader what leadership style to use for each follower based on their level of development. By the leader’s use of directive and supportive behaviors in various proportions, four leadership styles can be adopted for any follower’s developmental stage thus enabling the leader to delegate, support, coach or direct [22] . The directive behavior clarifies what the goal is, how it is to be achieved, and sets time line for evaluation of that goal while the supportive behavior helps the follower to feel comfortable with themselves and in their working environment in order to accomplish the said task [21] . It is also an accommodating type of leadership style in that it adapts to the follower’s level of development [22] . For instance, followers with the lowest level of development is D1 and they are described as having low competence and high commitment while the highest level, D4, have high commitment and high competence, D2 and D3 are in between. In situational leadership, the leader objectively assesses your developmental level and prescribes what leadership style he needs to work with you in order to achieve the set goals. This makes situational leadership an all-inclusive type of leadership which recognizes the variability in the capability of different followers and adjusts to give them a style that suits them. In other words, it does not make room for rejecting or writing off a follower rather it makes the leaders take ownership of the adjustment in leadership style in order see the follower succeed [23] . A situational leader therefore should be able to identify the competency and commitment level of a follower [24] . In the health sector where lot of training is done, situational leadership can be a good approach for training health workers [25] . This is because when trainees are new, they are usually very eager to learn but are yet to achieve the necessary competence and skill so a directing approach would be recommended at that stage. Along the line however, they gain more knowledge and begin to understand the magnitude of what is required of them which may make them to begin to lose confidence, at this stage, they would require a supportive leadership style. Later in their training they become more experienced, confident and motivated and would then require delegation leadership style [26] .

In addition, situational leadership is a good model for training leaders and has been known to be used for training in various organizations [21] . This is probably because of its prescriptive approach in which it tells the leader the right and wrong approaches in various contexts. Also, the flexibility of situational leadership makes it a good approach in change management, this is because at the implementation of a change process in an organization a lot of workers would be at the learning stage and based on their interest and predisposition they could have varying levels of commitment. The leader in this situation would need to be applying the various styles of situation leadership, to different trainers and at different times in the change process till the whole team is at the required level as was required in the change discussed above.

Critics of situational leadership however have argued that the weighting of the developmental level of the subordinates is ambiguous as well as the components of the factors that constitute development [23] [27] . Also situational leadership seems to be lacking in addressing how group leadership should be handled this is because groups go through various developmental levels and the prescribed leadership style for each group is meant to be adequate for the overall developmental level of the group [28] . However, the individuals in the group would be at different stages of development and situational leadership is not really clear on how the leader should relate with individuals within the group with regards to the prescribed leadership style if it should be based on their individual developmental level or on the group developmental level [21] .

6. Conclusion

In order to successfully implement the change in asthma care, the leader had to use a strategic change management model and more than one leadership ship style. Besides the two leadership styles discussed above other styles include transactional leadership, visionary leadership, authentic leadership, ethical leadership and medical leadership also known as shared leadership [19] . The choice of the type of leadership style to implement is any situation is a combination of the goal to be achieved, the factors that are necessary for its successful completion, the leader’s preference and behavioral attributes.

Cite this paper
Onubogu, U. (2019) How to Implement Change in Asthma Management in a Developing Country. Open Journal of Respiratory Diseases, 9, 26-35. doi: 10.4236/ojrd.2019.91003.
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