Ties between patients & providers: Contingency Theory

Throughout my time on my internship site, I have noticed the way in which tenants of the contingency theory in particular relate to the overall operation and effectiveness of the clinic. In 1967, Fiedler argued that because leadership is primarily the exercise of social influence, the ease with which a leader is able to influence followers depends on how favorable the leadership situation is for the leader. In particular, the three essential contextual considerations that moderate the favorability of the situation are: the quality of interpersonal relations between leaders & followers, the nature of the task assigned to the group (degree of clarity & structure), and the amount of authority leader holds by virtue of formal position or designation of leadership. Moreover, in Dr. von Ruden’s Theories & Models class, one article we read outlined the primary principles surrounding contingency theory. According to the precepts of contingency theory, “the idea of one universally effective leadership trait or style is a myth.” Moreover, the article argued that “it is also quite clear that leadership is dependent on a subtle set of interpersonal relationships rooted in a particular context of task and authority.” 

Fiedler also argued that in high control situations, where leaders have a clear objective, a high level of authority, and willing followers, task-motivated leadership will be most effective. Meanwhile, in situations of lower control, where the task is less clear and the followers may be more reluctant to coordinate their action, more relational leadership will be more effective. The unique context, history, and demographics of the healthcare clinic where I work influence the leadership approach exercised by the providers here. Within the walls of the clinic, I have seen first-hand how interpersonal relations and task structure in particular influence how healthcare providers to engage their patients. Sometimes, treatment procedure (task structure) for a patient are straightforward. For example, a patient may come in with a sore throat, a fever, and chills. In this case, the provider may run a strep test. If the test results come back positive, the provider will most likely inform the patient, prescribe a medication, and ensure the medication request is processed and sent to the pharmacy. It is a fairly straightforward, task-oriented procedure. However, in the health clinic I work in, the unique demographics, history, and environment of the clinic create situational pressures that often select for more relational leadership styles. Patients often come in with more complex issues than a simple sore throat. Often, providers must implement treatment procedures that are less clear cut and require a more hands on and comprehensive response. Patients frequently come in have a variety of health problems. For example, they come in with low oxygen levels, fatigue, and high blood pressure. In a purely task-oriented environment, a provider may just prescribe a blood pressure medication. However, here, providers collaborate with patients and behavioral health professionals to dig deeper and get to the root of problems whenever possible. In situations where patients may be reluctant, treatment is challenging, and the procedure is less clear cut, there is a benefit to providers engaging in a more relational approach. This patient may have low oxygen levels because they smoke a pack of cigarettes a day. They may be smoking a pack of day to help cope with the anxiety they experience. In addition, their blood pressure is high and they experience fatigue because smoking makes it difficult for them to work out and they choose unhealthy foods because they are cheap and available. Within the context of the clinic, it is important to identify why a patient engages in certain behavioral practices and understand how those contribute to their health. From there, providers then work with patients to come up with individualized treatment plans. They often connect patients with supportive, intensive classes designed to help individuals quit smoking. They will give patients detailed advice and instructions for healthy eating. The health clinic even has a bank of food in the back that providers can use to send patients home with food if necessary. Moreover, providers schedule follow up appointments with patients and commit to partnering with them long term. By seeing the same patient consistently and committing to work with them to develop long-term, sustainable, and individualized treatment plans, providers are able to use relational leadership practices to achieve real results. 

Situational demands require leaders (providers) to modify their behavior and respond in a unique way within our healthcare clinic. Thus, working within the healthcare clinic, and in particular serving a population with unique and complex challenges, has allowed me to understand how the effectiveness of leadership may be contingent on situational factors. In keeping with the contingency theory, what I have noticed is that complex problems more often than not require comprehensive (and often, relational) leadership responses.

One thought on “Ties between patients & providers: Contingency Theory

  • July 10, 2019 at 11:50 am

    Interesting discussion. Seems that what you are describing may also relate to Heifetz’s adaptive work model (in regards to technical and adaptive issues); definitely translates really well into healthcare settings. I encourage you to continue to think about how contingency plays out (and/or other models) and other examples from the site as it will be key to the one major paper you’ll write this fall. It seems that when discussing patients and doctors, doctors always have pretty strong position power by virtue of being the educated, accredited provider. If talking about interactions between other clinic staff and doctors, seems there may be times when those who are not doctors might have greater position power. And of course if talking about doctors and patients, the leader/member relations may vary as there may be instances where providers are working with new patients with whom they have not previously worked and have not developed a relationship/trust. But if talking about other clinic staff and providers, seems the leader/member relations may be less variable.

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