As we have already learned, transformation leadership is an approach to leadership that seeks to bring about changes in individuals and social systems. In healthcare management, transformational leadership seeks to change the way healthcare professionals and systems deal with different issues in the sector especially the managerial issues. Implementation of transformational leadership in the healthcare system is hindered by some technical and managerial barriers which prevent it from taking full effect in healthcare scenarios. The established healthcare hierarchy is one of these barriers which has hindered implementation of transformational leadership for a long time. Healthcare hierarchy refers to the organization structure of leadership management from the senior to the junior practitioners. Traditionally, the hierarchy in the healthcare system is disciplined and very rigid therefore new ideas such as transformational leadership are hard to introduce into the system (Marshall, 2010).
The Hierarchy in healthcare system like in any other field is made up of people or practitioners who are already in the system. Naturally, the majority of individuals who have been within the systems for a while favor maintenance of status quo because of various reasons such as the fear of changes as well as comfort with the system. The top of the leadership management is the most non-receptive to the concept of transformational leadership because it disrupts their comfort regarding the processes of dealing with issues in the sector as well as contact of healthcare professionals in the work environment (Wendt et al., 2009).
Intellectual stimulation is one of the main aspects promoted by transformational leadership in the healthcare system. This aspect focuses on the ability of a leader to facilitate and encourage the nurses to exercises problem solving and critical thinking skills in the course of their workplace experience. Established hierarchy in the healthcare system especially the top leadership do not particularly like this aspect because they deem it as surrendering their authority to their junior health staff. It is this reasoning that most leadership hierarchy in health care is not keen to implement leadership transformational approach (BAMFORD‐WADE, 2010).
The other thing transformational leadership in healthcare system promotes is openly reporting and discussion of medical error amongst physician and nurses. Clinical professionals from the physicians to the nurses in the clinical setting have been taught to report such cases of errors to only a few individuals, and this is mainly down to the issue of hierarchy. Senior clinical officers for example doctors and physicians do not feel comfortable letting their junior employees that they have made errors. Junior employees, on the other hand, may also fear to report their errors to their seniors will attract disciplinary actions and other repercussions from. This kind of thinking hinders transformational leadership at unit-level and organization level (Castel et al., 2015).
Transformational leadership in a clinical setting also brings about introduction of new ideas and skill requirements which may not be available within institutions. As a result, this may demand the professionals to undergo training and short courses to undertake certain tasks. Established hierarchy may not however like this kind of ideas because some senior practitioners may perceive them as an avenue through which junior staff may overtake them regarding promotions or even compensation. To make sure this does not happen, some of these senior professionals sabotage the programs by unfairly awarding such opportunities to their favored juniors who they do not perceive as a threat (Alexander, 2015).