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• 01 May 2024
• What Do You Think?

Have You Had Enough?

James Heskett has been asking readers, “What do you think?” for 24 years on a wide variety of management topics. In this farewell column, Heskett reflects on the changing leadership landscape and thanks his readers for consistently weighing in over the years. Open for comment; 0 Comments.

• 26 Apr 2024

Deion Sanders' Prime Lessons for Leading a Team to Victory

The former star athlete known for flash uses unglamorous command-and-control methods to get results as a college football coach. Business leaders can learn 10 key lessons from the way 'Coach Prime' builds a culture of respect and discipline without micromanaging, says Hise Gibson.

• 26 Mar 2024
• Cold Call Podcast

How Do Great Leaders Overcome Adversity?

In the spring of 2021, Raymond Jefferson (MBA 2000) applied for a job in President Joseph Biden’s administration. Ten years earlier, false allegations were used to force him to resign from his prior US government position as assistant secretary of labor for veterans’ employment and training in the Department of Labor. Two employees had accused him of ethical violations in hiring and procurement decisions, including pressuring subordinates into extending contracts to his alleged personal associates. The Deputy Secretary of Labor gave Jefferson four hours to resign or be terminated. Jefferson filed a federal lawsuit against the US government to clear his name, which he pursued for eight years at the expense of his entire life savings. Why, after such a traumatic and debilitating experience, would Jefferson want to pursue a career in government again? Harvard Business School Senior Lecturer Anthony Mayo explores Jefferson’s personal and professional journey from upstate New York to West Point to the Obama administration, how he faced adversity at several junctures in his life, and how resilience and vulnerability shaped his leadership style in the case, "Raymond Jefferson: Trial by Fire."

• 24 Jan 2024

Why Boeing’s Problems with the 737 MAX Began More Than 25 Years Ago

Aggressive cost cutting and rocky leadership changes have eroded the culture at Boeing, a company once admired for its engineering rigor, says Bill George. What will it take to repair the reputational damage wrought by years of crises involving its 737 MAX?

• 02 Jan 2024

Do Boomerang CEOs Get a Bad Rap?

Several companies have brought back formerly successful CEOs in hopes of breathing new life into their organizations—with mixed results. But are we even measuring the boomerang CEOs' performance properly? asks James Heskett. Open for comment; 0 Comments.

• Research & Ideas

10 Trends to Watch in 2024

Employees may seek new approaches to balance, even as leaders consider whether to bring more teams back to offices or make hybrid work even more flexible. These are just a few trends that Harvard Business School faculty members will be following during a year when staffing, climate, and inclusion will likely remain top of mind.

• 12 Dec 2023

Can Sustainability Drive Innovation at Ferrari?

When Ferrari, the Italian luxury sports car manufacturer, committed to achieving carbon neutrality and to electrifying a large part of its car fleet, investors and employees applauded the new strategy. But among the company’s suppliers, the reaction was mixed. Many were nervous about how this shift would affect their bottom lines. Professor Raffaella Sadun and Ferrari CEO Benedetto Vigna discuss how Ferrari collaborated with suppliers to work toward achieving the company’s goal. They also explore how sustainability can be a catalyst for innovation in the case, “Ferrari: Shifting to Carbon Neutrality.” This episode was recorded live December 4, 2023 in front of a remote studio audience in the Live Online Classroom at Harvard Business School.

• 05 Dec 2023

Lessons in Decision-Making: Confident People Aren't Always Correct (Except When They Are)

A study of 70,000 decisions by Thomas Graeber and Benjamin Enke finds that self-assurance doesn't necessarily reflect skill. Shrewd decision-making often comes down to how well a person understands the limits of their knowledge. How can managers identify and elevate their best decision-makers?

• 21 Nov 2023

The Beauty Industry: Products for a Healthy Glow or a Compact for Harm?

Many cosmetics and skincare companies present an image of social consciousness and transformative potential, while profiting from insecurity and excluding broad swaths of people. Geoffrey Jones examines the unsightly reality of the beauty industry.

• 14 Nov 2023

Do We Underestimate the Importance of Generosity in Leadership?

Management experts applaud leaders who are, among other things, determined, humble, and frugal, but rarely consider whether they are generous. However, executives who share their time, talent, and ideas often give rise to legendary organizations. Does generosity merit further consideration? asks James Heskett. Open for comment; 0 Comments.

• 24 Oct 2023

From P.T. Barnum to Mary Kay: Lessons From 5 Leaders Who Changed the World

What do Steve Jobs and Sarah Breedlove have in common? Through a series of case studies, Robert Simons explores the unique qualities of visionary leaders and what today's managers can learn from their journeys.

• 06 Oct 2023

Yes, You Can Radically Change Your Organization in One Week

Skip the committees and the multi-year roadmap. With the right conditions, leaders can confront even complex organizational problems in one week. Frances Frei and Anne Morriss explain how in their book Move Fast and Fix Things.

• 26 Sep 2023

The PGA Tour and LIV Golf Merger: Competition vs. Cooperation

On June 9, 2022, the first LIV Golf event teed off outside of London. The new tour offered players larger prizes, more flexibility, and ambitions to attract new fans to the sport. Immediately following the official start of that tournament, the PGA Tour announced that all 17 PGA Tour players participating in the LIV Golf event were suspended and ineligible to compete in PGA Tour events. Tensions between the two golf entities continued to rise, as more players “defected” to LIV. Eventually LIV Golf filed an antitrust lawsuit accusing the PGA Tour of anticompetitive practices, and the Department of Justice launched an investigation. Then, in a dramatic turn of events, LIV Golf and the PGA Tour announced that they were merging. Harvard Business School assistant professor Alexander MacKay discusses the competitive, antitrust, and regulatory issues at stake and whether or not the PGA Tour took the right actions in response to LIV Golf’s entry in his case, “LIV Golf.”

• 01 Aug 2023

As Leaders, Why Do We Continue to Reward A, While Hoping for B?

Companies often encourage the bad behavior that executives publicly rebuke—usually in pursuit of short-term performance. What keeps leaders from truly aligning incentives and goals? asks James Heskett. Open for comment; 0 Comments.

• 05 Jul 2023

What Kind of Leader Are You? How Three Action Orientations Can Help You Meet the Moment

Executives who confront new challenges with old formulas often fail. The best leaders tailor their approach, recalibrating their "action orientation" to address the problem at hand, says Ryan Raffaelli. He details three action orientations and how leaders can harness them.

How Are Middle Managers Falling Down Most Often on Employee Inclusion?

Companies are struggling to retain employees from underrepresented groups, many of whom don't feel heard in the workplace. What do managers need to do to build truly inclusive teams? asks James Heskett. Open for comment; 0 Comments.

• 14 Jun 2023

Every Company Should Have These Leaders—or Develop Them if They Don't

Companies need T-shaped leaders, those who can share knowledge across the organization while focusing on their business units, but they should be a mix of visionaries and tacticians. Hise Gibson breaks down the nuances of each leader and how companies can cultivate this talent among their ranks.

Four Steps to Building the Psychological Safety That High-Performing Teams Need

Struggling to spark strategic risk-taking and creative thinking? In the post-pandemic workplace, teams need psychological safety more than ever, and a new analysis by Amy Edmondson highlights the best ways to nurture it.

• 31 May 2023

From Prison Cell to Nike’s C-Suite: The Journey of Larry Miller

VIDEO: Before leading one of the world’s largest brands, Nike executive Larry Miller served time in prison for murder. In this interview, Miller shares how education helped him escape a life of crime and why employers should give the formerly incarcerated a second chance. Inspired by a Harvard Business School case study.

• 23 May 2023

The Entrepreneurial Journey of China’s First Private Mental Health Hospital

The city of Wenzhou in southeastern China is home to the country’s largest privately owned mental health hospital group, the Wenzhou Kangning Hospital Co, Ltd. It’s an example of the extraordinary entrepreneurship happening in China’s healthcare space. But after its successful initial public offering (IPO), how will the hospital grow in the future? Harvard Professor of China Studies William C. Kirby highlights the challenges of China’s mental health sector and the means company founder Guan Weili employed to address them in his case, Wenzhou Kangning Hospital: Changing Mental Healthcare in China.

What is leadership?

All leaders, to a certain degree, do the same thing. Whether you’re talking about an executive, manager, sports coach, or schoolteacher, leadership is about guiding and impacting outcomes, enabling groups of people to work together to accomplish what they couldn’t do working individually. In this sense, leadership is something you do, not something you are. Some people in formal leadership positions are poor leaders, and many people exercising leadership have no formal authority. It is their actions, not their words, that inspire trust and energy.

Get to know and directly engage with senior McKinsey experts on leadership

Aaron De Smet is a senior partner in McKinsey’s New Jersey office, Carolyn Dewar is a senior partner in the Bay Area office, Scott Keller is a senior partner in the Southern California office, and Vik Malhotra and Ramesh Srinivasan are senior partners in the New York office.

What’s more, leadership is not something people are born with—it is a skill you can learn. At the core are mindsets, which are expressed through observable behaviors , which then lead to measurable outcomes. Is a leader communicating effectively or engaging others by being a good listener? Focusing on behaviors lets us be more objective when assessing leadership effectiveness. The key to unlocking shifts in behavior is focusing on mindsets, becoming more conscious about our thoughts and beliefs, and showing up with integrity as our full authentic selves.

There are many contexts and ways in which leadership is exercised. But, according to McKinsey analysis of academic literature as well as a survey of nearly 200,000 people in 81 organizations all over the world, there are four types of behavior that account for 89 percent of leadership effectiveness :

• being supportive
• operating with a strong results orientation
• seeking different perspectives
• solving problems effectively

Effective leaders know that what works in one situation will not necessarily work every time. Leadership strategies must reflect each organization’s context and stage of evolution. One important lens is organizational health, a holistic set of factors that enable organizations to grow and succeed over time. A situational approach  enables leaders to focus on the behaviors that are most relevant as an organization becomes healthier.

Senior leaders must develop a broad range of skills to guide organizations. Ten timeless topics are important for leading nearly any organization, from attracting and retaining talent  to making culture a competitive advantage. A 2017 McKinsey book, Leading Organizations: Ten Timeless Truths (Bloomsbury, 2017), goes deep on each aspect.

How is leadership evolving?

In the past, leadership was called “management,” with an emphasis on providing technical expertise and direction. The context was the traditional industrial economy command-and-control organization, where leaders focused exclusively on maximizing value for shareholders. In these organizations, leaders had three roles: planners (who develop strategy, then translate that strategy into concrete steps), directors (who assign responsibilities), or controllers (who ensure people do what they’ve been assigned and plans are adhered to).

What are the limits of traditional management styles?

Traditional management was revolutionary in its day and enormously effective in building large-scale global enterprises that have materially improved lives over the past 200 years. However, with the advent of the 21st century, this approach is reaching its limits.

For one thing, this approach doesn’t guarantee happy or loyal managers or workers. Indeed, a large portion of American workers—56 percent— claim their boss is mildly or highly toxic , while 75 percent say dealing with their manager is the most stressful part of their workday.

For 21st-century organizations operating in today’s complex business environment, a fundamentally new and more effective approach to leadership is emerging. Leaders today are beginning to focus on building agile, human-centered, and digitally enabled organizations able to thrive in today’s unprecedented environment and meet the needs of a broader range of stakeholders (customers, employees, suppliers, and communities, in addition to investors).

What is the emerging new approach to leadership?

This new approach to leadership is sometimes described as “ servant leadership .” While there has been some criticism of the nomenclature, the idea itself is simple: rather than being a manager directing and controlling people, a more effective approach is for leaders to be in service of the people they lead. The focus is on how leaders can make the lives of their team members easier—physically, cognitively, and emotionally. Research suggests this mentality can enhance both team performance and satisfaction.

In this new approach, leaders practice empathy, compassion, vulnerability, gratitude, self-awareness, and self-care. They provide appreciation and support, creating psychological safety so their employees are able to collaborate, innovate, and raise issues as appropriate. This includes celebrating achieving the small steps on the way to reaching big goals and enhancing people’s well-being through better human connections. These conditions have been shown to allow for a team’s best performance.

More broadly, developing this new approach to leadership can be expressed as making five key shifts that include, build on, and extend beyond traditional approaches:

• beyond executive to visionary, shaping a clear purpose that resonates with and generates holistic impact for all stakeholders
• beyond planner to architect, reimagining industries and innovating business systems that are able to create new levels of value
• beyond director to catalyst, engaging people to collaborate in open, empowered networks
• beyond controller to coach, enabling the organization to constantly evolve through rapid learning, and enabling colleagues to build new mindsets, knowledge, and skills
• beyond boss to human, showing up as one’s whole, authentic self

Together, these shifts can help a leader expand their repertoire and create a new level of value for an organization’s stakeholders. The last shift is the most important, as it is based on developing a new level of consciousness and awareness of our inner state. Leaders who look inward  and take a journey of genuine self-discovery make profound shifts in themselves and their lives; this means they are better able to benefit their organization. That involves developing “profile awareness” (a combination of a person’s habits of thought, emotions, hopes, and behavior in different circumstances) and “state awareness” (the recognition of what’s driving a person to take action). Combining individual, inward-looking work with outward-facing actions can help create lasting change.

Introducing McKinsey Explainers : Direct answers to complex questions

Leaders must learn to make these five shifts at three levels : transforming and evolving personal mindsets and behaviors; transforming teams to work in new ways; and transforming the broader organization by building new levels of agility, human-centeredness, and value creation into the entire enterprise’s design and culture.

An example from the COVID-19 era offers a useful illustration of this new approach to leadership. In pursuit of a vaccine breakthrough, at the start of the pandemic Moderna CEO Stéphane Bancel increased the frequency of executive meetings  from once a month to twice a week. The company implemented a decentralized model enabling teams to work independently and deliver on the bold goal of providing 100 million doses of vaccines in 12 months. “The pace was unprecedented,” Bancel said.

What is the impact of this new approach to leadership?

This new approach to leadership is far more effective. While the dynamics are complex, countless studies show empirical links among effective leadership, employee satisfaction, customer loyalty, and profitability.

How can leaders empower employees?

Empowering employees , surprisingly enough, might mean taking a more hands-on leadership approach. Organizations whose leaders successfully empower others through coaching are nearly four times more likely to make swift, good decisions and outperform other companies . But this type of coaching isn’t always natural for those with a more controlling or autocratic style.

Here are five tips to get started  if you’re a leader looking to empower others:

• Provide clear rules, for example, by providing guardrails for what success looks like and communicating who makes which decisions. Clarity and boundary structures like role remits and responsibilities help to contain any anxiety associated with work and help teams stay focused on their primary tasks.
• Establish clear roles, say, by assigning one person the authority to make certain decisions.
• Avoid being a complicit manager—for instance, if you’ve delegated a decision to a team, don’t step in and solve the problem for them.
• Address culture and skills, for instance, by helping employees learn how to have difficult conversations.
• Begin soliciting personal feedback from others, at all levels of your organization, on how you are experienced as a leader.

How can leaders communicate effectively?

Good, clear communication is a leadership hallmark. Fundamental tools of effective communication  include:

• defining and pointing to long-term goals
• listening to and understanding stakeholders
• creating openings for dialogue
• communicating proactively

And in times of uncertainty, these things are important for crisis communicators :

• give people what they need, when they need it
• communicate clearly, simply, and frequently
• choose candor over charisma
• revitalize a spirit of resilience
• distill meaning from chaos
• support people, teams, and organizations to build the capability for self-sufficiency

Learn more about our People & Organizational Performance Practice .

Is leadership different in a hybrid workplace?

A leader’s role may look slightly different in remote or hybrid workplace settings . Rather than walking around a physical site, these leaders might instead model what hybrid looks like, or orchestrate work based on tasks, interactions, or purpose. Being communicative and radiating positivity  can go a long way. Leaders need to find other ways to be present and accessible, for example, via virtual drop-in sessions, regular company podcasts, or virtual townhalls. Leaders in these settings may also need to find new ways to get authentic feedback. These tactics can include pulse surveys or learning to ask thoughtful follow-up questions that reveal useful management insights.

Additional considerations, such as making sure that in-person work and togetherness has a purpose, are important. Keeping an eye on inclusivity in hybrid work  is also crucial. Listening to what employees want, with an eye to their lived experience, will be vital to leaders in these settings. And a focus on output, outcomes, results, and impact—rather than arbitrary norms about time spent in offices— may be a necessary adaptation in the hybrid era .

How should CEOs lead in this new world?

Just as for leadership more broadly, today’s environment requires CEOs to lead very differently. Recent research indicates that one-third to one-half of new CEOs fail within 18 months.

What helps top performers thrive today? To find out, McKinsey led a research effort to identify the CEOs who achieved breakaway success. We examined 20 years’ worth of data on 7,800 CEOs—from 3,500 public companies across 70 countries and 24 industries. The result is the McKinsey book CEO Excellence: The Six Mindsets That Distinguish the Best Leaders from the Rest (Scribner, March 2022). Watch an interview with the authors for more on what separates the best CEOs from the rest .

Getting perspective on leadership from CEOs themselves is enlightening—and illustrates the nuanced ways in which the new approach to leadership described above can be implemented in practice. Here are a few quotes drawn from McKinsey’s interviews with these top-level leaders :

• “I think the fundamental role of a leader is to look for ways to shape the decades ahead, not just react to the present, and to help others accept the discomfort of disruptions to the status quo.” — Indra Nooyi , former chairman and CEO of PepsiCo
• “The single most important thing I have to do as CEO is ensure that our brand continues to be relevant.” — Chris Kempczinski , CEO of McDonald’s
• “Leaders of other enterprises often define themselves as captains of the ship, but I think I’m more the ship’s architect or designer. That’s different from a captain’s role, in which the route is often fixed and the destination defined.” — Zhang Ruimin , CEO of Haier
• “I think my leadership style [can be called] ‘collaborative command.’ You bring different opinions into the room, you allow for a really great debate, but you understand that, at the end of the day, a decision has to be made quickly.” — Adena Friedman , CEO of Nasdaq
• “We need an urgent refoundation of business and capitalism around purpose and humanity. To find new ways for all of us to lead so that we can create a better future, a more sustainable future.” — Hubert Joly , former chairman and CEO of Best Buy

What is leadership development?

Leaders aren’t born; they learn to lead over time. Neuroplasticity refers to the power of the brain to form new pathways and connections through exposure to novel, unfamiliar experiences. This allows adults to adapt, grow, and learn new practices throughout our lifetimes.

When it comes to leadership within organizations, this is often referred to as leadership development. Programs, books, and courses on leadership development abound, but results vary.

Leadership development efforts fail for a variety of reasons. Some overlook context; in those cases, asking a simple question (something like “What, precisely, is this program for?”) can help. Others separate reflections on leadership from real work, or they shortchange the role of adjusting leaders’ mindsets, feelings, assumptions, and beliefs, or they fail to measure results.

So what’s needed for successful leadership development? Generally, developing leaders is about creating contexts where there is sufficient psychological safety in combination with enough novelty and unfamiliarity to cultivate new leadership practices in response to stimuli. Leadership programs that successfully cultivate leaders are also built around “placescapes”—these are novel experiences, like exploring wilderness trails, practicing performing arts, or writing poetry.

When crafting a leadership development program, there are six ingredients to incorporate  that lead to true organizational impact:

• Set up for success:
• Focus your leadership transformation on driving strategic objectives and initiatives.
• Commit the people and resources needed.
• Be clear about focus:
• Engage a critical mass of leaders to reach a tipping point for sustained impact.
• Zero in on the leadership shifts that drive the greatest value.
• Execute well:
• Architect experiential journeys to maximize shifts in mindsets, capabilities, and practices.
• Measure for holistic impact.

A well-designed and executed leadership development program can help organizations build leaders’ capabilities broadly, at scale. And these programs can be built around coaching, mentoring, and having people try to solve challenging problems—learning skills by applying them in real time to real work.

What are mentorship, sponsorship, and apprenticeship?

Mentorship, sponsorship, and apprenticeship can also be part of leadership development efforts. What are they? Mentorship refers to trusted counselors offering guidance and support on various professional issues, such as career progression. Sponsorship is used to describe senior leaders who create opportunities to help junior colleagues succeed. These roles are typically held by more senior colleagues, whereas apprenticeship could be more distributed. Apprenticeship  describes the way any colleague with domain expertise might teach others, model behaviors, or transfer skills. These approaches can be useful not only for developing leaders but also for helping your company upskill or reskill employees quickly and at scale.

For more in-depth exploration of these topics, see McKinsey’s insights on People & Organizational Performance . Learn more about McKinsey’s Leadership & Management  work—and check out job opportunities if you’re interested in working at McKinsey.

Articles referenced include:

• “ Author Talks: What separates the best CEOs from the rest? ,” December 15, 2021, Carolyn Dewar , Scott Keller , and Vik Malhotra
• “ From the great attrition to the great adaptation ,” November 3, 2021, Aaron De Smet  and Bill Schaninger
• “ The boss factor: Making the world a better place through workplace relationships ,” September 22, 2020, Tera Allas  and Bill Schaninger
• " Leading agile transformation: The new capabilities leaders need to build 21st century organizations ," October 1, 2018, Aaron De Smet , Michael Lurie , and Andrew St. George
• " Leading Organizations: Ten Timeless Truths ," 2017, Scott Keller  and Mary Meaney
• “ Leadership in context ,” January 1, 2016, Michael Bazigos, Chris Gagnon, and Bill Schaninger
• “ Decoding leadership: What really matters ,” January 1, 2015, Claudio Feser, Fernanda Mayol, and Ramesh Srinivasan

Want to know more about leadership?

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Leadership Research Paper

This sample leadership research paper features: 7900 words (approx. 26 pages), an outline, and a bibliography with 38 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

I. Introduction

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II. Leadership Defined

III. The Trait Approach to Leadership

IV. What Do Leaders Do? The Behavioral Approach

V. Situational Approaches to Leadership

VI. Contingency Theories of Leadership

VII. Leader-Member Exchange Theory

VIII. Charismatic and Transformational Leadership

IX. Leader Emergence and Transition

X. Leadership Development

XI. Summary

XII. Bibliography

More Leadership Research Papers:

• Implicit Leadership Theories Research Paper
• Judicial Leadership Research Paper
• Leadership Styles Research Paper
• Police Leadership Research Paper
• Political Leadership Research Paper
• Remote Leadership Research Paper

Introduction

There are few things more important to human activity than leadership. Most people, regardless of their occupation, education, political or religious beliefs, or cultural orientation, recognize that leadership is a real and vastly consequential phenomenon. Political candidates proclaim it, pundits discuss it, companies value it, and military organizations depend on it. The French diplomat Talleyrand once said, “I am more afraid of an army of 100 sheep led by a lion than an army of 100 lions led by a sheep.” Effective leadership guides nations in times of peril, promotes effective team and group performance, makes organizations successful, and, in the form of parenting, nurtures the next generation. Winston Churchill, the Prime Minister of Great Britain during World War II, was able to galvanize the resolve of his embattled people with these words: “I have nothing to offer but blood, toil, tears, and sweat.” When leadership is missing, the effects can be equally dramatic; organizations move too slowly, stagnate, and often lose their way. The League of Nations, created after the World War I, failed to meet the challenges of the times in large part because of a failure to secure effective leadership. With regard to bad leaders, Kellerman (2004) makes an important distinction between incompetent leaders and corrupt leaders. To this we might also add leaders who are “toxic.” Bad leadership can perpetuate misery on those who are subject to its domain. Consider the case of Jim Jones, the leader of the Peoples Temple, who in 1978 ordered the mass suicide of his 900 followers in what has been called the Jonestown Massacre, or the corrupt leadership of Enron and Arthur Anderson that impoverished thousands of workers and led to the dissolution of a major organization. These examples remind us that there are many ways in which leadership can fail.

Leadership Defined

When you think of leadership, the ideas of power, authority, and influence may come to mind. You may think of the actions of effective leaders in accomplishing important goals. You may think of actual people who have been recognized for their leadership capabilities. Dwight D. Eisenhower, 34th president of the United States, defined leadership as “the ability to decide what is to be done, and then to get others to want to do it.” Leadership can be defined as the ability of an individual to influence the thoughts, attitudes, and behavior of others. It is the process by which others are motivated to contribute to the success of the groups of which they are members. Leaders set a direction for their followers and help them to focus their energies on achieving their goals. Theorists have developed many different theories about leadership, and although none of the theories completely explains everything about leadership, each has received some scientific support. Some of the theories are based on the idea that there are “born leaders” with particular traits that contribute to their ability to lead. Other theories suggest that leadership consists of specific skills and behaviors. Some theories take a contingency approach that suggests that a leader’s effectiveness depends on the situation requiring leadership. Still other theories examine the relationship between the leader and his or her followers as the key to understanding leadership. In this research paper, we examine these various theories and describe the process of leadership development.

The Trait Approach to Leadership

Aristotle suggested that “men are marked out from the moment of birth to rule or be ruled,” an idea that evolved into the Great Person Theory. Great leaders of the past do seem different from ordinary human beings. When we consider the lives of Gandhi or Martin Luther King, Jr., it is easy to think of their influence as a function of unique personal attributes. This trait approach was one of the first perspectives applied to the study of leadership and for many years dominated leadership research. The list of traits associated with effective leadership is extensive and includes personality characteristics such as being outgoing, assertive, and conscientious. Other traits that have been identified are confidence, integrity, discipline, courage, self-sufficiency, humor, and mystery. Charles de Gaulle described this last trait best when he noted that “A true leader always keeps an element of surprise up his sleeve, which others cannot grasp but which keeps his public excited and breathless.”

Another trait often attributed to effective leaders is intelligence. However, intelligence is a two-edged sword. Although highly intelligent people may be effective leaders, their followers may feel that large differences in intellectual abilities mean large differences in attitudes, values, and interests. Thus, Gibb (1969) has pointed out that many groups prefer to be “ill-governed by people [they] can understand” (p. 218). One important aspect of intelligence that does predict leader effectiveness is emotional intelligence, which includes not only social skills but strong self-monitoring skills, which provide the leader with feedback as to how followers feel about the leader’s actions.

Finally, personal characteristics such as attractiveness, height, and poise are associated with effective leadership. After decades of research, in which the list of traits grew dramatically, researchers realized that the same person could be effective in one context (Winston Churchill as war leader) but ineffective in another context (Winston Churchill, who was removed from office immediately after the war was over). The failure of this approach to recognize the importance of the situation in providing clear distinctions between leaders and followers with regard to their traits caused many scientists to turn their attention elsewhere. However, theorists using more sophisticated methodological and conceptual approaches have revived this approach. Zaccaro (2007) suggests that the revival of the trait approach reflects a shift away from the idea that traits are inherited, as suggested in Galton’s 1869 book Hereditary Genius, and focuses on personal characteristics that reflect a range of acquired individual differences. This approach has three components. First, researchers do not consider traits as separate and distinct contributors to leadership effectiveness but rather as a constellation of characteristics that, taken together, make a good leader.

The second component broadens the concept of trait to refer not only to personality characteristics but also to motives, values, social and problem-solving skills, cognitive abilities, and expertise. For example, in a series of classic studies, McClelland and his colleagues (see McClelland & Boyatzis, 1982) identified three motives that contribute to leadership. They are the need for achievement, the need for power, and the need for affiliation. In their work, leader traits are not attributes of the person but the basis for the leader’s behavior. The need for achievement is manifested in the desire to solve problems and accomplish tasks. In the words of Donald McGannon, “Leadership is action, not position.” The need for power is evident in the desire to influence others without using coercion. As Hubert H. Humphrey once said, “Leadership in today’s world requires far more than a large stock of gunboats and a hard fist at the conference table.” The final motive, need for affiliation, can be a detriment to effective leadership if the leader becomes too concerned with being liked. However, it can provide positive results from the satisfaction a leader derives in helping others succeed. Lao Tse once wrote, “A good leader is a catalyst, and though things would not get done well if he weren’t there, when they succeed he takes no credit. And because he takes no credit, credit never leaves him.”

The third component of this new approach focuses on attributes that both are enduring and occur across a variety of situations. For example, there is strong empirical support for the trait approach when traits are organized according to the five-factor model of personality. Both extraversion and conscientiousness are highly correlated with leader success and, to a lesser extent, so are openness to experience and the lack of neuroticism.

What Do Leaders Do? The Behavioral Approach

Three major schools of thought—the Ohio State Studies, Theory X/Y (McGregor, 1960), and the Managerial Grid (Blake & Mouton, 1984)—have all suggested that differences in leader effectiveness are directly related to the degree to which the leader is task oriented versus person oriented. Task-oriented leaders focus on the group’s work and its goals. They define and structure the roles of their subordinates in order to best obtain organizational goals. Task-oriented leaders set standards and objectives, define responsibilities, evaluate employees, and monitor compliance with their directives. In the Ohio State studies this was referred to as initiating structure, whereas McGregor (1960) refers to it as Theory X, and the Managerial Grid calls it task-centered. Harry S. Truman, 33rd president of the United States, once wrote, “A leader is a man who can persuade people to do what they don’t want to do, or do what they’re too lazy to do, and like it.” Task-oriented leaders often see their followers as undisciplined, lazy, extrinsically motivated, and irresponsible. For these leaders, leadership consists of giving direction, setting goals, and making unilateral decisions. When under pressure, task-oriented leaders become anxious, defensive, and domineering.

In contrast, person-oriented leaders tend to act in a warm and supportive manner, showing concern for the well-being of their followers. Person-oriented leaders boost morale, take steps to reduce conflict, establish rapport with group members, and provide encouragement for obtaining the group’s goals. The Ohio State studies referred to this as consideration, the Managerial Grid calls this country club leadership, and McGregor uses the term Theory Y. Person-oriented leaders see their followers as responsible, self-controlled, and intrinsically motivated. As a result, they are more likely to consult with others before making decisions, praise the accomplishment of their followers, and be less directive in their supervision. Under pressure, person-oriented leaders tend to withdraw socially.

Leadership effectiveness can be gauged in several ways: employee performance, turnover, and dissatisfaction. As you can see in Table 68.1, the most effective leaders are those who are both task and person oriented, whereas the least effective leaders are those who are neither task nor person oriented. A recent meta-analysis found that person-oriented leadership consistently improves group morale, motivation, and job satisfaction, whereas task-oriented leadership only sometimes improves group performance, depending on the types of groups and situations.

In thinking about what leaders do, it is important to distinguish between leadership and management. Warren Bennis (1989) stated, “To survive in the twenty-first century, we are going to need a new generation of leaders— leaders, not managers.” He points out that managers focus on “doing things right” whereas leaders focus on “doing the right things.” Table 68.2 provides a comparison of the characteristics that distinguish a leader from a manager. As you look at the list, it is clear that a person can be a leader without being a manager and be a manager without being a leader.

Situational Approaches to Leadership

The Great Person theory of leadership, represented by such theorists as Sigmund Freud, Thomas Carlyle, and Max Weber, suggests that from time to time, highly capable, talented, charismatic figures emerge, captivate a host of followers, and change history. In contrast to this, Hegel, Marx, and Durkheim suggest that there is a tide running in human affairs, defined by history or the economy, and that leaders are those who ride the tide. The idea of the tide leads us to the role of situational factors in leadership. For example, Perrow (1970) suggests that leadership effectiveness is dependent upon structural aspects of the organization. Longitudinal studies of organizational effectiveness provide support for this idea. For example, Pfeffer (1997) indicated that “If one cannot observe differences when leaders change, then what does it matter who occupies the positions or how they behave?” (p. 108). Vroom and Jago (2007) have identified three distinct roles that situational factors play in leadership effectiveness. First, organizational effectiveness is not strictly a result of good leadership practices. Situational factors beyond the control of the leader often affect the outcomes of any group effort. Whereas leaders, be they navy admirals or football coaches, receive credit or blame for the activities of their followers, success or failure is often the result of external forces: the actions of others, changing technologies, or environmental conditions. Second, situations shape how leaders act. Although much of the literature on leadership has focused on individual differences, social psychologists such as Phil Zimbardo, in his classic Stanford Prison Experiment, and Stanley Milgram, in his studies of obedience, have demonstrated how important the situation is in determining behavior. Third, situations influence the consequences of leader behavior. Although many popular books on leadership provide a checklist of activities in which the leader should engage, most of these lists disregard the impact of the situation. Vroom and Jago (2007) suggest that the importance of the situation is based on three factors: the limited power of many leaders, the fact that applicants for leadership positions go through a uniform screening process that reduces the extent to which they differ from one another, and whatever differences between them still exist will be overwhelmed by situational demands. If all of these factors are present, it is probably true that the individual differences between leaders will not significantly contribute to their effectiveness. Nevertheless, in most of the situations in which leaders find themselves, they are not that powerless and their effectiveness is mostly a result of matching their skills with the demands of the situation, which brings us to a discussion of contingency theories.

Contingency Theories of Leadership

One of the first psychologists to develop a contingency approach to leadership effectiveness was Fred Fiedler (1964, 1967), who believed that a leader’s style is a result of lifelong experiences that are not easy to change. With this in mind, he suggested that leaders need to understand what their style is and to manipulate the situation so that the two match. Like previous researchers, Fiedler’s idea of leadership style included task orientation and person orientation, although his approach for determining a leader’s orientation was unique. Fiedler developed the least-preferred coworker (LPC) scale. On this scale, individuals rate the person with whom they would least want to work on a variety of characteristics. Individuals who rate their LPC as uniformly negative are considered task oriented, whereas those who differentiate among the characteristics are person oriented. The second part of his contingency theory is the favorableness of the situation. Situational favorability is determined by three factors: the extent to which the task facing the group is structured, the legitimate power of the leader, and the relations between the leader and his subordinates. The relation between LPC scores and group performance is complex, as can be seen in Table 68.3. A meta-analysis conducted by Strube and Garcia (1981) found that task-oriented leaders function best in situations that are either favorable (clear task structure, solid position power, and good leader/member relations) or unfavorable (unclear task structure, weak position power, and poor leader/member relations). In contrast, person-oriented leaders function best in situations that are only moderately favorable, which is often based on the quality of leader-member relations.

Another theory that addresses the relation between leadership style and the situation is path-goal theory (House, 1971). In this theory, path refers to the leader’s behaviors that are most likely to help the group attain a desired outcome or goal. Thus, leaders must exhibit different behaviors to reach different goals, depending on the situation. Four different styles of behavior are described:

• Directive leadership. The leader sets standards of performance and provides guidelines and expectations to subordinates on how to achieve those standards.
• Supportive leadership. The leader expresses concern for the subordinates’ well-being and is supportive of them as individuals, not just as workers.
• Participative leadership. The leader solicits ideas and suggestions from subordinates and invites them to participate in decisions that directly affect them.
• Achievement-oriented leadership. The leader sets challenging goals and encourages subordinates to attain those goals.

According to path-goal theory, effective leaders need all four of these styles because each one produces different results. Which style to use depends on two types of situational factors: subordinate characteristics, including ability, locus of control, and authoritarianism; and environmental characteristics, including the nature of the task, work group, and authority system. According to House and Mitchell (1974), when style and situation are properly matched, there is greater job satisfaction and acceptance of the leader, as well as more effort toward obtaining desired goals. A meta-analysis by Indvik (1986) is generally supportive of the theory. Studies of seven organizations found that task-oriented approaches are effective in situations with low task structure, because they help subordinates cope with an ambiguous situation, and ineffective in situations with high task structure, because they appear to be micromanagement. Additional studies have found that supportive leadership is most effective when subordinates are working on stressful, frustrating, or dissatisfying tasks. Researchers found participative leadership to be most effective when subordinates were engaged in nonrepetitive, ego-involving tasks. Finally, achievement-oriented leadership was most effective when subordinates were engaged in ambiguous, nonrepetitive tasks. A clear implication of the theory is that leaders must diagnose the situation before adopting a particular leadership style.

A third contingency approach is the normative and descriptive model of leadership and decision making developed by Vroom and his colleagues (see Vroom & Jago, 2007). This approach examines the extent to which leaders should involve their subordinates in decision-making processes. To answer this question, the researchers developed a matrix that outlines the five decision processes that range from highly autocratic through consultative to highly participative (see Table 68.4). Which of these approaches is the best? The answer is none of them is uniformly preferred, and each process has different costs and benefits. For example, participative approaches are more likely to gain support and acceptance among subordinates for the leader’s ideas, whereas autocratic approaches are quick and efficient, but may cause resentment. The theory suggests that the best approach may be selected by answering several basic questions about the situation that relate to the quality and acceptance of a decision. Some examples of the type of questions that should be asked are “Do I have enough information to make a decision? How structured is the task? Must subordinates accept the decision to make it work?” By answering such questions and applying the specific rules shown in Table 68.5, a leader is able to eliminate approaches that are likely to fail and to choose the approach that seems most feasible from those remaining.

Leader-Member Exchange Theory

A growing number of researchers have found that subordinates may affect leaders as much as leaders affect subordinates. Yukl (1998) pointed out that when subordinates perform poorly, leaders tend to be more task oriented, but when subordinates perform well, leaders are more person oriented. Similarly, Miller, Butler, and Cosentino (2004) found that the effectiveness of followers conformed to the same rules as those Fiedler applied to leaders. It may be that the productivity of a group can have a greater impact on leadership style than leadership style does on the productivity of the group. This reciprocal relation has been formally recognized in the vertical dyad linkage approach (Dansereau, Graen, & Haga, 1975), now commonly referred to as leader-member exchange (LMX) theory (Graen & Uhl-Bien, 1995). This theory describes how leaders maintain their influence by treating individual followers differently. Over time, leaders develop a special relationship with an inner circle of trusted lieutenants, assistants and advisors—the in-group. The members of the in-group are given high levels of responsibility, influence over decision making, and access to resources. Members of the in-group typically are those who are highly committed to the organization, work harder, show loyalty to the leader, and share more administrative duties. Their reward is greater access to the leader’s resources, including information, concern, and confidence. To maintain the exchange, leaders must be careful to nurture the relationship with the in-group, giving them sufficient power to satisfy their needs but not so much power that they become independent. The leader-member relationship generally follows three stages. The first stage is role taking. During this stage the leader assesses the members’ abilities and talents and offers them opportunities to demonstrate their capabilities and commitment. In this stage, both the leader and member discover how the other wants to be respected. The second stage is role making. In this stage, the leader and member take part in unstructured and informal negotiations in order to create a role for the member with a tacit promise of benefits and power in return for dedication and loyalty. In this stage, trust building is very important, and betrayal in any form can result in the member’s being relegated to the out-group. In this stage the leader and member explore relationship factors as well as work-related factors. At this stage, it is clear that perceived similarities between the leader and follower become important. For this reason, a leader may favor a member who is similar in sex, race, or outlook with assignment to the in-group, although research by Murphy and Ensher (1999) indicated that the perception of similarity is more important than actual demographic similarities. The final stage is routinization. In this phase the pattern established by the leader and member becomes established.

The quality of the leader-member relationship is dependent on several factors. It tends to be better when the challenge of the job is either extremely high or extremely low. Other factors that affect the quality of the relationship are the size of the group, availability of resources, and overall workload.

Charismatic and Transformational Leadership

In a speech given at the University of Maryland, Warren Bennis said, “[A] leader has to be able to change an organization that is dreamless, soulless and visionless…someone’s got to make a wake-up call. The first job of a leader is to define a vision for the organization.…Leadership is the capacity to translate vision into reality.” Effective leaders are able to project a vision, explaining to their subordinates the purpose, meaning, and significance of their efforts. As Napoleon once said, “Leaders are dealers in hope.” Although the idea of charismatic leadership goes back as far as biblical times (“Where there is no vision, the people perish”—Proverbs 29:18), its modern development can be attributed to the work of Robert House. House (1977) analyzed political and religious leaders and noted that charismatic leaders are those high in self-confidence and confidence in their subordinates, with high expectations, a clear vision of what can be accomplished, and a willingness to use personal examples. Their followers often identify with the leader and his or her mission, show unswerving loyalty toward and confidence in the leader, and derive a sense of self-esteem from their association with the leader. Charismatic leaders are usually quite articulate, with superior debating and persuasive skills. They also possess the technical expertise to understand what their followers must do. Charismatic leaders usually have high self-confidence, impression-management skills, social sensitivity, and empathy. Finally, they have the skills to promote attitudinal, behavioral, and emotional change in their followers. Those who follow charismatic leaders are often surprised at how much they are able to accomplish that extends beyond their own expectations. Research on charismatic leadership indicates that the impact of such leaders is greatest when the followers engage in high self-monitoring (observing their effect on others) and exhibit high levels of self-awareness. Charismatic leadership enhances followers’ cooperation and motivation.

It is important to recognize that charismatic leadership can have a dark side. We began this research paper with the example of Jim Jones, the charismatic religious leader who led his people to commit mass suicide. Howell and Avolio (1992) describe the difference between ethical and unethical charismatic leaders. According to their analysis, ethical leaders use their power to serve others, not for personal gain. They also promote a vision that aligns with their follower’s needs and aspirations rather than with their own personal vision. Ethical leaders stimulate followers to think independently and to question the leader’s views. They engage in open, two-way communication and are sensitive to their followers’ needs. Finally, ethical leaders rely on internal moral standards to satisfy organizational and societal interests, not their own self-interests.

In helping followers achieve their aspirations, Bernard Bass (1997) has noted that charismatic leadership is a component of a broader-based concept, that of transformational leadership. Bass believed that most leaders are transactional rather than transformational in that they approach their relationships with followers as a transaction, one in which they define expectations and offer rewards that will be forthcoming when those expectations are met. Transactional leaders use a contingent reward system, manage by exception, watch followers to catch them doing something wrong, and intervene only when standards are not met. Finally, transactional leaders tend to adopt a laissez-faire approach by avoiding the need to make hard decisions.

In contrast, transformational leadership goes beyond mutually satisfactory agreements about rewards and punishments to heighten followers’ motivation, confidence, and satisfaction by uniting them in the pursuit of shared, challenging goals. In the process of doing that, they change their followers’ beliefs, values, and needs. Bass and Avolio (1994) identified four components of transformational leadership. The first component is idealized influence (charisma). Leaders provide vision, a sense of mission, and their trust in their followers. Leaders take stands on difficult issues and urge their followers to follow suit. They emphasize the importance of purpose, commitment, and ethical decision making. The second component is inspirational motivation. Leaders communicate high expectations, express important purposes in easy-to-understand ways, talk optimistically and enthusiastically about the tasks facing the organization, and provide encouragement and meaning for what has to be done. They often use symbols to focus the efforts of their followers. The third component is intellectual stimulation. Leaders promote thoughtful, rational, and careful decision making. They stimulate others to discard outmoded assumptions and beliefs and to explore new perspectives and ways of doing things. The fourth component is individualized consideration. Leaders give their followers personal attention and treat each person individually. They listen attentively and consider the individual needs, abilities, and goals of their followers in their decisions. In order to enhance the development of their followers they advise, teach, and coach, as needed. Yukl (2002) offers the following guidelines for transformational leadership:

• Develop a clear and appealing vision.
• Create a strategy for attaining the vision.
• Articulate and promote the vision.
• Act confident and optimistic.
• Express confidence in followers.
• Use early success in achievable tasks to build confidence.
• Celebrate your followers’ successes.
• Use dramatic, symbolic actions to emphasize key values.
• Model the behaviors you want followers to adopt.
• Create or modify cultural forms as symbols, slogans, or ceremonies.

Perhaps Walter Lippman provided the best summary of transformational leadership. He wrote, “The final test of a leader is that he leaves behind him in other men the conviction and the will to carry on…” The genius of good leaders is to leave behind them a situation that common sense, without the grace of genius, can deal with successfully.

Leader Emergence and Transition

Who becomes the leader? The process by which someone becomes formally or informally, perceptually or behaviorally, and implicitly or explicitly recognized as a leader is leadership emergence. Scholars have debated this question for centuries and in this research paper, so far, we have offered several possible answers. The Great Person Theory suggests that some people are marked for greatness and dominate the times in which they live. Tolstoy’s zeitgeist theory suggests that leaders come to prominence because of the spirit of the times. Trait theories suggest leaders are selected based on their personal characteristics, whereas interactional approaches examine the joint effects of the situation and the leader’s behavior. Research suggests that leadership emergence is an orderly process that reflects a rational group process whereby the individual with the most skill or experience or intelligence or capabilities takes charge. Implicit leadership theories (Lord & Maher, 1991) provide a cognitive explanation for leadership emergence. According to these theories, each member of a group comes to the group with a set of expectations and beliefs about leaders and leadership. These cognitive structures are called implicit leadership theories or leader prototypes. Typically these prototypes include both task and relationship skills as well as an expectation that the leader will epitomize the core values of the group. Members use their implicit theories to sort people into either leaders or followers based on the extent to which others conform to their implicit theory of what a leader should be. These implicit theories also guide members in their evaluations of the leader’s effectiveness. Because these theories are implicit, they are rarely subjected to critical scrutiny. As a result, it is not uncommon for followers to demonstrate a bias toward those who fit the mold of a traditional leader: White, male, tall, and vocal, regardless of the qualifications of that individual to be the leader.

Transition, rotation, succession, change of command; all are words used to describe a central facet of organizational leadership—that leaders follow one another. Despite the frequent occurrence of leader successions in nearly all groups, especially in large stable organizations, relatively little research has addressed this phenomenon. An early review by Gibb (1969) reported on studies of leader emergence and succession mode. In particular, Gibb noted the importance of establishing leadership/followership through early, shared, significant experiences; he also stressed that an important aspect of the organizational climate for the new leader derives from the policies of the former leader, the consequence of which shape followers’ expectations, morale, and interpersonal relations. In general, studies have demonstrated that leadership succession causes turbulence and instability resulting in performance decrements in most organizations and thus constitutes a major challenge to organizations. Thus, the process of becoming the new leader is often an arduous, albeit rewarding, journey of learning and self-development. The trials involved in this rite of passage have serious consequences for both the individual and the organization. As organizations have become leaner and more dynamic, new leaders have described a transition that gets more difficult all the time. To make the transition less difficult, leaders might attend to the following suggestions adapted from the works of Betty Price, a management consultant. Some of these suggestions are particularly important for newly appointed leaders in establishing an effective leadership style early in their tenure as leader.

• New leaders should show passion for their group, its purpose, and its people in order to reassure followers that the new leader is there to make the group better, not to further his or her personal ambitions.
• New leaders should think more strategically than tactically. Look for the big picture and don’t become bogged down in implementation processes.
• New leaders should first learn to listen, and then provide leadership. Leaders should be compelling in their ability to help others embrace the values that drive the group’s success. To do this the new leader must listen intently and provide feedback that demonstrates that he or she has truly heard what others have said.
• New leaders should operate in a learning mode. As the new person on the block, the new leader may be unsure about the reputation of the preceding leader. He or she should honor the insights and knowledge of others, believing that one can learn from everyone. The new leader should engage people purposefully at all levels, knowing that the distance between the front line and senior leadership is often so great that one small piece of information may have tremendous impact.
• New leaders should take particular care in doing what’s right and telling the truth, even if it is painful. One of the first tasks of a new leader is building trust. In the face of uncertainties, being honest, direct, and truthful enables people to move forward with faith. It gives them hope.
• New leaders should encourage their people to take risks in order to achieve their goals, and be prepared to pick up the pieces if they fail. The leader’s role is to cushion the risk by providing support and encouragement, and knowing and drawing from his or her people’s best capabilities.

Leadership Development

Not everyone is born with “the right stuff” or finds himself or herself in just the right situation to demonstrate his or her capacity as a leader. However, anyone can improve his or her leadership skills. The process of training people to function effectively in a leadership role is known as leadership development and it is a multimillion-dollar business. Leadership development programs tend to be of two types: internal programs within an organization, designed to strengthen the organization, and external programs that take the form of seminars, workshops, conferences, and retreats.

Typical of external leadership development programs are the seminars offered by the American Management Association. Their training seminars are held annually in cities across the country and address both general leadership skills as well as strategic leadership. Among the seminars offered in the area of general leadership are critical thinking, storytelling, and team development in a variety of areas such as instructional technology or government. Seminars on strategic leadership address such topics as communication strategies, situational leadership, innovation, emotional intelligence, and coaching.

A second approach to leadership development is a technique known as grid training. The first step in grid training is a grid seminar during which members of an organization’s management team help others in their organization identify their management style as one of four management styles: impoverished management, task management, country-club management, and team management. The second step is training, which varies depending on the leader’s management style. The goal of the training is greater productivity, better decision making, increased morale, and focused culture change in the leader’s unique organizational environment. Grid training is directed toward six key areas: leadership development, team building, conflict resolution, customer service, mergers, and selling solutions.

Internal leadership development programs tend to focus on three major areas: the development of social interaction networks both between people within a given organization and between organizations that work with one another, the development of trusting relationships between leaders and followers, and the development of common values and a shared vision among leaders and followers. There are several techniques that promote these goals. One such technique is 360-degree feedback. This is a process whereby leaders may learn what peers, subordinates, and superiors think of their performance. This kind of feedback can be useful in identifying areas in need of improvement. The strength of the technique is that it provides differing perspectives across a variety of situations that help the leader to understand the perceptions of his or her actions. This practice has become very popular and is currently used by virtually all Fortune 500 companies. Like all forms of assessment, 360-degree feedback is only useful if the leader is willing and able to change his or her behavior as a result of the feedback. To ensure that leaders don’t summarily dismiss feedback that doesn’t suit them, many companies have arranged for face-to-face meetings between the leaders and those who have provided the feedback.

Another form of internal leadership development is networking. As a leadership development tool, networking is designed to reduce the isolation of leaders and help them better understand the organization in which they work. Networking is specifically designed to connect leaders with key personnel who can help them accomplish their everyday tasks. Networking promotes peer relationships and allows individuals with similar concerns and responsibilities to learn from one another ways to better do their job. Research indicates that these peer relationships tend to be long-lasting.

Executive coaching is a method for developing leaders that involves custom-tailored, one-on-one interactions. This method generally follows four steps. It begins with an agreement between the coach and the leader as to the nature of the coaching relationship, to include what is to be done and how it will be done. The second step is an expert’s assessment of the leader’s strengths and weaknesses. The third step provides a comprehensive plan for improvement that is usually shared with the leader’s immediate supervisor. The fourth and final step is the implementation of the plan. Coaching is sometimes a onetime event aimed at addressing a particular concern or it can be an ongoing, continuous process.

Another form of internal leadership development is mentoring. The term mentor can mean many things: a trusted counselor or guide, tutor, coach, master, experienced colleague, or role model. A mentor is usually someone older and more experienced who provides advice and support to a younger, less experienced person (protégé). In general, mentors guide, watch over, and encourage the progress of their protégés. Mentors often pave the way for their protégé’s success by providing opportunities for achievement, nominating them for promotion, and arranging for their recognition. As a form of leadership development, there are several advantages to mentoring. A meta-analysis by Allen, Eby, Poteet, Lima, and Lentz (2004) indicated that individuals who were mentored showed greater organizational commitment, lower turnover, higher career satisfaction, enhanced leadership skills, and a better understanding of their organization.

In the future, leadership is likely to become more group centered as organizations become more decentralized. Other changes will come about as a result of new and emerging technologies. Avolio and his colleagues (2003) refer to this as “e-leadership.” Leadership effectiveness will depend on the leader’s ability to integrate the new technologies into the norms and culture of their organization.

Another change is that the future will most likely see more women break through the “glass ceiling” and take leadership positions. Men are considerably more likely to enact leadership behaviors than are women in studies of leaderless groups, and as a result are more likely to emerge as leaders (Eagly, 1987). Even though women do sometimes emerge as leaders, historically they have been excluded from the highest levels of leadership in both politics and business. This exclusion has been called the glass ceiling. Studies of leadership in organizational settings have found that men and women do not differ significantly in their basic approach to leadership, with equal numbers of task- versus person-oriented leaders. However, women are much more likely to adopt a participative or transformational leadership style whereas men are more likely to be autocratic, laissez-faire, or transactional (Eagly & Johnson, 1990). Women’s leadership styles are more closely associated with group performance as well as subordinate satisfaction, and in time our implicit theories about leadership may very well favor those who adopt such approaches.

Diversity and working in a global economy will provide additional challenges to tomorrow’s leaders. Project GLOBE (Global Leadership and Organizational Behavior Effectiveness) is an extensive international project involving 170 researchers who have gathered data from 18,000 managers in 62 countries (House, Hanges, Javidan, Dorman, & Gupta, 2004). A major goal of the project was to develop societal and organizational measures of culture and leader attributes that were appropriate to use across all cultures. There have been several important findings. In some cultures, leadership is denigrated and regarded with suspicion. People in these cultures often fear that leaders will acquire and abuse power and as a result substantial restraints are placed on the exercise of leadership. Twenty-two leadership traits (e.g., foresight and decisiveness) were identified as being desirable across all cultures. Eight leadership traits (e.g., ruthlessness and irritability) were identified as being universally undesirable. Some leadership traits were dependent upon the culture, including ambition and elitism. Six leadership styles common to many cultures were identified. They are charismatic, self-protective, humane, team oriented, participative, and autonomous. Although the charismatic style is familiar to us, some of the others are not. The self-protective style involves following agreed-upon procedures, being cognizant of the status hierarchy, and saving face. The humane style includes modesty and helping others. The team-oriented style includes collaboration, team building, and diplomacy. The participative style encourages getting the opinions and help of others. The autonomous style involves being independent and making one’s own decisions. Cultures differ in their preferences for these styles. For example, leaders from northern European countries are more participative and less self-protective whereas leaders from southern Asia are more humane and less participative.

Although most of us would agree that leadership is extraordinarily important, research in this field has yet to arrive at a generally accepted definition of what leadership is, create a widely accepted paradigm for studying leadership, or find the best strategies for developing and practicing leadership. Hackman and Wageman (2007) attempted to address this problem by reframing the questions we have been asking about leadership effectiveness, with the hope that these questions will be more informative than many of those asked previously.

• Question 1. Ask NOT “Do leaders make a difference?” but “Under what conditions does leadership matter?” The task here is to examine conceptually and empirically the circumstances under which leadership makes a difference and to distinguish those from the circumstances for which leadership is inconsequential.
• Question 2. Ask NOT “What are the traits that define an effective leader?” but “How do leaders’ personal attributes interact with situational properties to shape outcomes?” This approach will require that we reduce our reliance on both fixed traits and complex contingencies. To do this, we should embrace the idea that there are many different ways to achieve the same outcome.
• Question 3. Ask NOT “Are there common dimensions on which all leaders can be arrayed?” but “Are good and poor leadership qualitatively different phenomena?” Recent research has found that ineffective leaders were not ones who scored low on those dimensions for which good leaders scored high, but rather they exhibited entirely different patterns of behavior than those exhibited by good leaders.
• Question 4. Ask NOT “How do leaders and followers differ from one another?” but “How can leadership models be reframed so they treat all members of a group as leaders and followers?” Although it is clear that to be a leader requires that you have followers, it is equally true that most leaders are at times followers and most followers are at times leaders.
• Question 5. Ask NOT “What should be taught in leadership courses?” but “How can leaders be helped to learn?” Research is needed to understand how leaders learn from their experiences, especially when they are coping with crises (see Avolio, 2007).

In the 21st century, the study of leadership will be increasingly collaborative as researchers from multiple disciplines tackle the questions outlined above. Some of the disciplines that must contribute to the study of leadership include media and communications. In today’s world more and more of the relationships between leaders and followers are not face-to-face but mediated through electronic means.

John Kenneth Galbraith, in his book The Age of Uncertainty, wrote that “All of the great leaders have had one characteristic in common: it was the willingness to confront unequivocally the major anxiety of their people in their time. This, and not much else, is the essence of leadership.” In the special issue of the American Psychologist devoted to leadership, Warren Bennis (2007) suggests that the four most important threats facing our world today are these: (a) a nuclear or biological catastrophe; (b) a worldwide pandemic; (c) tribalism and its cruel offspring, assimilation; and (d) leadership of our human institutions. He points out that solving the first three problems will not be possible without exemplary leadership and that an understanding of how to develop such leadership will have serious consequences for the quality of our health and our lives.

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CMR INSIGHTS

Are we asking too much leadership from leaders.

by Herman Vantrappen and Frederic Wirtz

Image Credit | Nick Fewings

Leaders do not have an easy time. In the assumption that the headlines in the management literature are a reliable guide, leaders are expected not only to be brilliant but also servant, humble, transformational, vulnerable, authentic, emotionally intelligent, empathetic, unlocked and connecting – at the least. 1-9 That is a tall order, even for those who are labelled superhuman.

Related CMR Articles

“Transformational Leader or Narcissist? How Grandiose Narcissists Can Create and Destroy Organizations and Institutions” by Charles A. O’Reilly & Jennifer A. Chatman

Fortunately, leaders may not need to take all those exhortations too serious, or certainly not too literal. To begin with, some scholars warn of the shaky grounds of several leadership constructs. For example, Katja Einola et al. point to authentic leadership theory as an example of a “dysfunctional family of positive leadership theories celebrating good qualities in a leader linked with good outcomes and positive follower ‘effects’ almost by definition.” 10 They add that leadership studies should “raise the bar for what academic knowledge work is and better distinguish it from pseudoscience, pop-management, consulting, and entertainment.” Ouch!

Other scholars are adding precautions about the potentially detrimental effects of certain leader behaviors both for the leaders themselves and for the organizations they lead. For example, Joanna Lin et al. point to leader emotional exhaustion resulting from transformational leader behavior. 11 Charles O’Reilly et al. warn of the substantial overlaps of transformational leadership with grandiose narcissism. 12

Still other scholars emphasize that leadership skills are context-specific. For example, Raffaella Sadun emphasizes that the most effective leaders have social skills that are specific to their company and industry. 13 Nitin Nohria points out that charisma often is a liability, yet charismatic leaders can be especially useful at entrepreneurial startups and in corporate turnarounds. 14 Jasmin Hu et al. indicate that humble leaders are effective only when their level of humility matches to what team members expect. 15

The above tells us two things, whether we are a leader or a follower. First, the pertinence of a particular leader behavior depends on the situation. Second, we should temper our expectations of the effect of that behavior. But even then, the question remains: Are we demanding too much from leaders? The answer is nuanced: No, we cannot demand too much; but the real question is how we could lessen the need for those demands to emerge in the first place.

Reading the definitions of those leader behaviors, it would be hard to argue we are demanding too much. Just consider the following examples:

• Servant leaders “place the needs of their subordinates before their own needs and center their efforts on helping subordinates grow.” 1
• Humble leaders “are willing to admit it when they make a mistake, they recognize and acknowledge the skills of those they lead, and they continuously seek out opportunities to become better.” 16
• Vulnerable leaders “intentionally open themselves up to the potential of emotional harm while taking action (when possible) to create a positive outcome.” 4
• Emotionally intelligent leaders “are conscious about and responsive to their emotions, possessing the ability to harness and control them in order to deal with people effectively and make the best decisions.” 17
• Empathetic leaders “genuinely care for people, validate their feelings, and are willing to offer support.” 7
• Connecting leaders “concurrently contend with identities, actions, emotions of a leader and a follower.” 9

While these demands on leaders are pertinent, they are also taxing in terms of time and energy. To solve the quandary, we should look for ways to lessen the need for those demands to emerge in the first place. On many occasions, leaders at the top are led to activate the afore-mentioned behaviors because doubts, disagreements, tensions, trade-offs and eventually conflicts by and between people in the field are allowed to escalate. These frictions may emerge and escalate to the top for all kinds of reasons but they often land there due to organizational design faults: Some designs are intrinsically frictional; others lack mechanisms to resolve friction at origin. Precluding these design faults requires craftsmanship in organization design.

Let us take a stylized example. Laura is the commercial manager in charge of the Brazil region at Widget Inc. As sales this year are going more slowly than planned, she is desperately trying to win a specific new client. To have any chance of winning, she must be able to offer a special off-catalogue product. So she turns to Lucas, the global manager in charge of the product line concerned, who unfortunately has to tell her that the manufacturing plant is fully booked for the next six months, leaving no capacity for the mandatory testing of the special product for her client in Brazil. Tension rises, and the issue escalates to their respective bosses, the EVP Regions and the EVP Products. Unfortunately, these two do not manage to agree on a solution either. Even worse, the incident degenerates into an acrimonious confrontation at the company’s next executive team meeting, where the two blame each other for a chronic lack of flexibility.

The originally operational issue thus lands with a thick thud on the CEO’s desk. After suppressing a deep sigh, she activates various leader behaviors. She is empathetic (“I sense how strongly you both feel about this important matter …”), servant (“I don’t blame you for bringing this to my attention …”), humble (“I realize I should have put in place a way of preventing issues like this …”), vulnerable (“In fact, I once struggled myself with a similar issue …”), and more…

The CEO may be doing all the right things at that moment, but could she have been spared the onus of dealing with the originally operational friction if only the company’s organization had been designed differently? Widget Inc.’s organization architecture features two equally-weighted primary verticals, i.e., “region” and “product”, both having full P&L responsibility, hence competing with each other directly for resources, decision power and attention. While there is no general rule that such an architecture must not be chosen, in general it tends to be an intrinsically frictional design.

The general message for leaders is: When you seek remedies for pain points in your organization, do not count on leader behavior only, but check also for architectural design faults or ambiguities. Here are three examples, each linked to a variable that defines an organization’s architecture.

1. The primary vertical

Small mono-product and mono-market companies tend to have a function-based architecture (e.g., product development, purchasing, production, sales, distribution, after-sales). At large companies, that architecture can be intrinsically frictional. For example, if you are in the business of developing, constructing and maintaining power plants worldwide, the business development people, when they make a bid, might be tempted to foresee low maintenance costs so as to increase their chances of winning the bid. Alas, if the bid is won, the maintenance division will bear the brunt. Such operational tension is inherent to this type of business, but you do not want that tension to constantly manifest itself at the C-suite level. Therefore, consider having “region” rather than “function” as primary vertical and then setting up a function-based organization within each region. 18

2. The corporate parent

Each of a company’s business entities has specific objectives, challenges and priorities. Imagine your company has a mix of large businesses operating in its mature home market and small ventures in promising overseas markets. The latter may be keen to tap into the talent and knowledge that reside in the former, while the former may be reluctant to lend to the latter. Obviously, you do not want every such request and refusal to be elevated to the C-suite level. A global knowledge management and talent mobility system could solve the problem, and you might expect the businesses, out of enlightened self-interest, to set it up among themselves. Alas, that is unlikely to happen, as the benefits are contingent on participation by all businesses. Therefore, consider having a corporate function kick-start the initiative. 19

3. Lateral coordination

Imagine that your organization architecture consists of business entities focused on “product” and others on “customer segment”. Even though these entities by design are relatively self-contained, “product” and “customer segment” still need to coordinate daily on operational matters, such as defining product specs, setting price levels, launching commercial campaigns, etc. Hence you decide to create a matrix, with sales managers reporting both to a product line manager and a customer segment manager. And you expect these matrixed sales managers to make the best possible trade-offs between the partially diverging interests of their two bosses. Alas, a matrix between two verticals with P&L responsibility tends to be intrinsically frictional. 20 The matrixed manager’s anxiety about role conflict and their bosses’ fear of power loss may create festering conflicts escalating to the C-suite level. Therefore, in this case, consider a soft-wired coordination mechanism (such as a periodic joint planning cycle) instead of a hard-wired matrix. 

There are many other examples of organization design faults or ambiguities, not only related to organizational architecture but also to governance, business processes, company culture, people and systems. Admittedly, the perfect organization design does not exist – tension and friction are a fact of corporate life. And we could hardly demand too much authenticity, emotional intelligence, empathy and other commendable behaviors from our leaders, as described at start. But there is an issue when senior leaders are compelled to activate these behaviors to resolve internal conflicts that should not have escalated to the top of the organization. By identifying and removing glaring design faults and ambiguities about roles, we can help lessen the emergence and escalation of such conflicts, and consequently reduce the opportunity cost of senior leaders devoting energy and time to resolving stoppable conflicts. Senior leaders had better focus on genuine people issues, external stakeholders, and the organization’s strategic choices.

References

R.C. Liden, S.J. Wayne, H. Zhao and D. Henderson, “Servant Leadership: Development of a Multidimensional Measure and Multi-Level Assessment,” The Leadership Quarterly 19, no. 2 (2008): 161-177..

E.H. Schein and P.A. Schein, “Humble Leadership: The Power of Relationships, Openness, and Trust,” 2nd ed. (Oakland: Berrett-Koehler Publishers, 2018).

B.M. Bass, “Leadership and Performance Beyond Expectations” (New York: John Wiley & Sons, 1985).

J. Morgan, “Leading with Vulnerability: Unlock Your Greatest Superpower to Transform Yourself, Your Team, and Your Organization” (New York: John Wiley & Sons, 2023).

B. George, “Authentic Leadership: Rediscovering the Secrets to Creating Lasting Value” (New York: Jossey-Bass, 2004).

D. Goleman, “The Emotionally Intelligent Leader” (Boston: Harvard Business Review Press, 2019).

O. Valadon, “What We Get Wrong About Empathic Leadership,” Harvard Business Review, Oct. 17, 2023.

H. Le Gentil, “The Unlocked Leader: Dare to Free Your Own Voice, Lead with Empathy, and Shine Your Light in the World” (New York: John Wiley & Sons, 2023).

“The Connecting Leader: Serving Concurrently as a Leader and a Follower,” ed. Z. Jaser (Charlotte: IAP, 2021).

K. Einola and M. Alvesson, “The Perils of Authentic Leadership Theory,” Leadership 17, no. 4 (2021): 483-490.

J. Lin, B.A. Scott and F.K. Matta, “The Dark Side of Transformational Leader Behaviors for Leaders Themselves: A Conservation of Resources Perspective,” Academy of Management Journal 62, no. 5 (2019): 1556-1582.

C.A. O’Reilly and J.A. Chatman, “Transformational Leader or Narcissist? How Grandiose Narcissists Can Create and Destroy Organizations and Institutions,” California Management Review 62, no. 3 (2020): 5-27.

R. Sadun, “The Myth of the Brilliant, Charismatic Leader,” Harvard Business Review, Nov. 23, 2022.s

N. Nohria, “When Charismatic CEOs Are an Asset — and When They’re a Liability,” Harvard Business Review, Dec. 1, 2023.

J. Hu, B. Erdogan, K. Jiang and T.N. Bauer, “Research: When Being a Humble Leader Backfires,” Harvard Business Review, April 4, 2018.

T.K. Kelemen, S.H. Matthews, M.J. Matthews and S.E. Henry, “Essential Advice for Leaders from a Decade of Research on Humble Leadership,” LSE Business Review, Jan. 17, 2023.

S.T.A. Phipps, L.C. Prieto and E.N. Ndinguri, “Emotional Intelligence: Is It Necessary for Leader Development?” Journal of Leadership, Accountability & Ethics 11, no.1 (2014): 73-89.

H. Vantrappen and F. Wirtz, “When to Change Your Company’s P&L Responsibilities,” Harvard Business Review, April 14, 2022.

H. Vantrappen and F. Wirtz, “How To Get a Corporate Parent That Is Better For Business,” California Management Review, March 5, 2024.

J. Wolf and W.G. Egelhoff, “An Empirical Evaluation of Conflict in MNC Matrix Structure Firms,” International Business Review 22, no. 3 (2013): 591-601.

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Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

• James Shaw 1 , 13 ,
• Joseph Ali 2 , 3 ,
• Caesar A. Atuire 4 , 5 ,
• Phaik Yeong Cheah 6 ,
• Armando Guio Español 7 ,
• Judy Wawira Gichoya 8 ,
• Adrienne Hunt 9 ,
• Daudi Jjingo 10 ,
• Katherine Littler 9 ,
• Daniela Paolotti 11 &
• Effy Vayena 12  

BMC Medical Ethics volume  25 , Article number:  46 ( 2024 ) Cite this article

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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

Conclusions

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Peer Review reports

Introduction

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table  1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table  2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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JS led the writing, contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. CA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. PYC contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AE contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JWG contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AH contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DJ contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. KL contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DP contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. EV contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper.

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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