Caring Leadership-A Model for Transformation

Caring Leadership--A Model for Transformation

Judy McDowell, Randy Williams

Developing and nurturing our leaders is something that we don't always do very well in nursing, healthcare, or in many other professions. Selecting new leaders, orienting them properly, and mentoring them are areas where we often fall short. We usually choose a new leader who has excelled and displayed competence in a particular task or portion of the business. What we often do not consider is their capacity to lead. Do they have the ability to interact with others in a way that inspires and creates engagement? Is there evidence that their guidance allows others to flourish? There are plenty of examples to suggest that when leaders demonstrate these skills and abilities, people become invested in the success of the organization as well as their own. And in turn, happier and healthier work environments are created that generate greater innovation and better outcomes, which, ultimately, are fiscally sound and socially responsible.

Within the healthcare industry, there are myriad challenges to developing effective leaders. And as we began working in this field, we came to believe that teaching and role modeling the principles of caring, blended with the principles of leadership, could truly change the culture of an organization.

But what would a Caring Leadership Model look like? Was it really necessary?

These were a few of the questions we asked ourselves. We recognized that there were already numerous models and theories that could inform our thinking on how leaders should practice in a healthcare environment. But, we also felt strongly that there was a real need for a model that integrated leadership and caring, since in healthcare we are affecting people's lives on a very human level, every day, and at very vulnerable times. The model we began to envision would be a set of values that addressed our leadership responsibilities and also aligned with our intrinsic motivation to work within an industry that is so critical to the health and well-being of the communities we serve.

The result is the Caring Leadership Model©, firmly grounded in the evidence-based theories of:
Dr. Jean Watson, Theory of Human Caring/Caring Science
Dr. Watson's work is built around being heart-centered and authentically present, in the moment, in the work we do, which ultimately is a process of being and becoming. Her theory of human caring--preserving humanity and human dignity--has evolved into a philosophy with 10 enhanced Caritas Processes that address the essence of caring and provide practitioners a solid foundation upon which to carry out their work. (Caritas, from the Latin, means to cherish, appreciate.) A Caritas Practitioner functions from a caring consciousness that permeates from their soul and can be felt by the recipient.
Jim Kouzes and Barry Posner, The Leadership Challenge
Kouzes and Posner's work in the leadership realm speaks for itself. Based on the belief that leadership is, above all, a relationship that is values-based with a foundation of credibility. The Five Practices of Exemplary Leadership® model is easy to understand, appropriate for use in any environment, easy to remember, and practical and realistic. An important message is that mastery of leadership requires mastery of the skills central to developing and maintaining positive relationships with others—and the authors specifically address the challenges leaders have in encouraging the heart.

The Caring Leadership Model© provides an answer to the challenge of encouraging the heart. It brings together the core values of the heart of a caring leader. It marries the most widely recognized caring and leadership theories to create the best basis for growth and development of a leader. Integrating The Five Practices of Exemplary Leadership® with the 10 Caritas Processes, the Caring Leadership Model© identifies a set of five values that we propose are essential to success for any leader in today's environment--especially if success is defined not by wealth alone but by how a leader cultivates and enriches the human condition:

  • Always lead with kindness, compassion, and equality.
  • Generate hope and faith through co-creation.
  • Actively innovate with insight, reflection, and wisdom.
  • Purposely create protected space founded upon mutual respect and caring.
  • Embody an environment of caring-helping-trusting for self and others.
In addition to developing an effective theory of practice, we aimed to develop and implement a sustainable leadership development program using the Caring Leadership Model© that would achieve results. While the model is appropriate for developing leadership capacity in anyone, in any profession or circumstance—formal or informal—we initially focused on working with aspiring nurse leaders.

In a case study recently published by the International Association for Human Caring we describe a successful program involving nurse leaders from 50 patient care areas at Wake Forest Baptist Medical Center, a large academic medical center with 872 licensed beds and the first Magnet-designated hospital in the Carolinas, and Lexington Memorial, a community-based Wake Forest Baptist Health hospital with 94 licensed acute care beds.

The foundation for implementing this dynamic model of care was the hospitals' shared governance structure, which empowers every direct care nurse to have a voice in decisions that affect their practice and the expectations of how that practice will be carried out. Shared governance leaders have extraordinary responsibility, authority, and accountability. As a result, they also must have access to educational opportunities and the mentoring needed to develop and enhance their leadership skills. The leadership theory of Kouzes and Posner is what guided this process.

We believe that the loss of trust and confidence in both our leaders and organizations is at the root of the workforce issues we face today. And where these challenges have existed, we have seen the Caring Leadership Model© and the supporting educational programs play an important role in developing leaders who are eager to engage with staff and colleagues, and adept at creating space for authenticity and mutual respect. We believe it is possible to create environments that allow leaders to live the agreed-upon values and encourage and promote flourishing of the human spirit in the workplace. This ultimately creates not only a positive return on this quarter's score card, but a culture shift that produces exceptional results that are sustainable.

Judy McDowell, RN, MSN, CCRN and Randy Williams, RN, MSN, MBA are coauthors of the Caring Leadership Model© and have a combined total of over 50 years of experience in healthcare and leadership. They believe that true change, innovation, and success come through culture transformation that is inspired by transformational leadership. They can be reached at For information on Dr. Jean Watson's work, visit

Adapted from A Caring Leadership Model for Nursing's Future by Randy L. Williams, Judy B. McDowell, Donald D. Kautz, published in the International Journal for Human Caring 2011,Vol.15, No.1. Pages 31-35. The published article describes the McDowell-Williams Caring Leadership Model and provides institutional guidance for continuing the effective shared governance by the nurses at Wake Forest Baptist Medical Center,as well as strategies for leaders to use with staff as they make their workplace the best place to work and the best place to receive care. Made available by permission from the publisher, International Association for Human Caring.



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