Collaborative leadership with a focus on stakeholder identification and engagement and ethical leadership: a dental perspective - Nature
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
GENERAL
Collaborative leadership with a focus on stakeholder
identification and engagement and ethical leadership:
a dental perspective
Bhaven Modha1
Key points
In these times and beyond, embracing mutually An awareness of, and ability to use, the traditional Alike with clinical knowledge and skills, dental
beneficial relationships based on trust, integrity practices of stakeholder identification and organisations and professionals must self-reflect
and empowerment shall be more important engagement as well as ethical leadership may allow on their own leadership capabilities, be self-
than ever; therefore, there is a great need for dental organisations and professionals to better aware of their strengths and weaknesses, and
collaborative leadership within the dental exercise collaborative leadership. aspire to improve themselves accordingly.
profession.
Abstract
The dental profession is susceptible to change. In order to cope and adapt, individuals and organisations will need to
work together, now more than ever. One approach that may be beneficial in these times, and beyond, is collaborative
leadership. This is where a mutually beneficial relationship is established between two or more parties, who work
towards common goals by sharing authority, responsibility and accountability for achieving results. When groups of
individuals look beyond their personal interests and instead collaborate, they may channel their efforts to successfully
achieve shared goals. However, for this to be fruitful, stakeholders (to include different individuals or groups that
have a vested interest) will need to be identified and engaged, and ethical values based on the objectives of the
organisation and those advocated by professional and regulatory bodies must be upheld. This paper explores how the
traditional practices of stakeholder identification and engagement, as well as ethical leadership, may be of relevance
in attaining success through the contemporary collaborative leadership approach.
Introduction hierarchical control and central direction’3 and gain, then autocratic leadership can produce
a ‘core ideology of self-interest’.4 A professional the more sinister despotic leadership.9 This
Leadership is defined as a ‘process of influencing with a manner of self-interest may be perceived involves: disregarding followers’ needs and
others to understand and agree about what as someone that ‘incessantly seeks more power concerns; holding followers in a somewhat
needs to be done and how to do it, and the and acquisition of material possessions’.5 unquestioning submission; employing
process of facilitating individual and collective Hierarchical control, central direction and self- monopolising schemes to manipulate followers;
efforts to accomplish shared objectives’.1 This interest are typical of authoritarian or autocratic and indulging in morally corrupt behaviour.10
proposes that leadership encompasses several leadership.6 Such a historical approach establishes Relatedly, one article has suggested that some
elements: a process; influencing others; a clear division between leaders and followers. general dental practitioners could be in a clique
working efficiently with others; sharing goals Leaders are positioned at the top or in the with commissioners, therefore possessing the
with others; and collectively attaining these centre, while followers are below or within the benefit of exploiting this relationship for their
goals. With regards to the dental profession, surroundings, and control operates from ‘top- own self-interest.11 Another article states that
it has been asserted that during challenging down’ or from the ‘centre outwards’. Leaders ‘some less than ethical colleagues use the NHS
times, there has been a shortage of ‘strong, have an absolute control over the followers; a full brand to get people through the door and then
proactive leadership’ which has led to feelings command over all decisions; set strict rules and “upsell” private treatments’.12
of ‘professional disillusionment’.2 Dentistry control processes; formulate choices based on Leadership development in dentistry has
itself has been described as having a ‘history of their own ideas and judgements; uphold formal, been described as ‘highly neglected’ when
professional relationships; rarely permit or accept compared to non-health sectors including
1
Whittington Health NHS Trust, Grand Union Village Health any input; and penalise followers for mistakes.6,7,8 global enterprise, higher education and even
Centre, Dental Department – Second Floor, Taywood Road,
Northolt, Middlesex, UB5 6LW, England, UK.
As a last resort, autocratic leadership might football.13 However, in recent years, the topic of
Correspondence to: Bhaven Modha be applicable in situations involving severe ‘leadership and dentistry’ has seen an increase
Email address: b.modha@nhs.net
time pressures, where followers are unskilled in both scholarly literature and professional
Refereed Paper. or unmotivated, or when there is little margin activities, and the subject continues to attract
Accepted 3 December 2020 for error. If misused for self-aggrandisement, much due interest. Despite such efforts, the
https://doi.org/10.1038/s41415-021-3457-2
self-serving or exploiting followers for personal dental profession still faces some pressing
BRITISH DENTAL JOURNAL | VOLUME 231 NO. 6 | September 24 2021 355
© The Author(s) under exclusive licence to the British Dental Association 2021.GENERAL
issues, a few of which shall be touched upon leader. In such cases, a competent teammate might make suggestions; the researchers recommend
within this paper. temporarily assume the role of a collaborative that team leaders within dental educational
The opposite of a historic autocratic leader. Collaborative leadership (CL) is defined establishments should be encouraged to use CL.33
and despotic type of leadership could be a as ‘a mutually beneficial relationship between CL, henceforth, presents many positive
contemporary one that promotes equality and two or more parties, who work toward common opportunities for the dental profession. For
inclusivity. It would further involve embracing goals by sharing responsibility, authority and instance, interprofessional collaboration between
diversity and working together cordially (that accountability for achieving results’; its theory dental providers and pharmacists to help patients
is, leading collaboratively); appreciating all postulates that when groups of individuals look manage chronic dental pain,34 especially amidst
teammates and meeting their needs (that is, beyond their own personal interests, and instead the current COVID-19 pandemic, where access
identifying stakeholders); maintaining genuine work together, they can channel their efforts to to dental care may be lessened; interprofessional
and constructive relations with all teammates successfully reach shared goals.22 collaboration between medical and dental
(that is, engaging stakeholders); and following Core values of CL include: building authentic professionals,35 so that both groups may be able to
ethical principles to inspire admirable behaviour relationships, instead of expecting these to reduce their frequency of prescribing antibiotics
(that is, leading ethically). The purpose of this occur instinctively; understanding that nobody to patients for dental conditions; and cross-
paper is to shed light on how collaborative has full power over a situation, thus renouncing organisational collaboration between dental
leadership may be achieved by – and through egotism and control; instilling trust and respect general anaesthesia services, primary care and
– stakeholder identification and engagement, in everyone; developing a wide-ranging skillset community prevention teams, to help improve
as well as ethical leadership, with reference to to handle different situations; using adversities the dental needs of children and to reduce
the UK’s dental profession. to take creative yet sensible risks; rejecting their need for dental treatment under general
silos, a ‘my work – your work’ mentality, and anaesthesia.36
Collaborative leadership a blame culture; employing decentralised, flat
hierarchies that consider leaders and followers The importance of stakeholder
It has been long affirmed that dental as equals; forming teams with teammates that identification
professionals are part of a dental team and that have different levels of knowledge and skills,
teamwork is an integral component within the so that diverse perspectives can be explored; Within CL, forming synergistic relationships
profession.14 Yet, it is still reported that many improving decisiveness by avoiding partisan or and shared goals with teammates is of
dentists are lonely and isolated.15,16 Bringing biased choices; fostering an openness to feedback paramount importance, but this may be
together a group of highly skilled professionals and communication; setting well-defined goals unreachable if one does not know their
may, therefore, not guarantee an efficient team with teammates; and incorporating teammates’ stakeholders. Alike teammates and followers,
or that a person will feel part of that team. This contributions into planning and decision-making stakeholders are individuals or groups that have
thought is echoed by the FDI World Dental processes, so that everyone can feel part of the a vested interest in an organisation’s dealings,
Federation, who state that ‘collaborative organisation. Disadvantages of CL may include: on either a personal, political or economic
practice is more than just collaboration’.17 the need for dedicated commitment; an inability level. Stakeholders can be considered as either
Within a team, teammates’ behaviours can to adapt from a teamwork to a collaborative internal (that is, within the organisation:
be classed as either ‘taskwork’ or ‘teamwork’ way of work; encountering situations that may employees, managers and directors), or external
processes. Taskwork involves performing demand a formal leader; lengthier processes; (that is, outside of the organisation: patients,
core technical competencies (that is, clinical incurring challenges if mismanaged; and regulators, investors and manufacturers). The
procedures). Teamwork involves the assortment misreading collaboration as a consensus type of stakeholder theory advocates that anyone with
of interactive and interdependent behavioural management.22,23,24,25 a vested interest or stake in an organisation has
processes between teammates, which transform Collaboration is growing in prominence a right to be treated as an influential member in
team inputs (that is, teammate characteristics and and many scholars suggest its use within the functioning of that organisation. Therefore,
teammate composition) into outcomes (that is, dentistry.26,27,28,29 Recent examples of cross- stakeholders can influence decision-making in
teammate satisfaction and team performance). organisational collaboration include: different a positive or negative way.37
Within teamwork, each teammate has their own dental bodies coming together to devise an Stakeholder identification processes can be
definite role and assigned duties that contribute Education, Ethics and Dental Team Working utilised to better understand stakeholders from
towards the overall goal.18,19,20 For teamwork to Group to investigate the matter of environmentally an organisational dimension. They should
be successful, there may need to be a fine balance sustainable dentistry;30 a COVID-19 Future highlight each stakeholder’s probable interests,
between both taskwork (that is, clinical work) Planning Task Group to formulate ‘return to benefits, effects, threats and any specific
and teamwork processes (that is, interpersonal work’ guidelines;31 and a Diversity in Dentistry characteristics that are relevant. Stakeholders’
communication), and the presence of a team Action Group to confront equality, diversity and opinions and interests can alter with time,
leader. inclusivity disparities.32 Internationally, some so their attitudes and behaviours should be
Collaboration considers the sharing of roles dental organisations have united to combat embedded into developmental plans to predict
and responsibilities among the individuals within poor child oral health worldwide; the virtues of any possible difficulties. As organisational goals
a group. Unlike teamwork, collaboration does not CL are thought to have been a cornerstone of and strategies may be affected by deviations in
necessarily require a leader, as leadership is shared this venture.13 One American study has shown the values of stakeholders, organisations must
or distributed throughout the group.21 However, that CL had a substantial impact on dental be perceptive and alert, taking note of such
complex situations could arise that necessitate a students’ willingness to raise concerns and changes.38 One classification system categorises
356 BRITISH DENTAL JOURNAL | VOLUME 231 NO. 6 | September 24 2021
© The Author(s) under exclusive licence to the British Dental Association 2021.GENERAL
stakeholders into three distinctive levels, genuine collaborative efforts; regular practitioners with more expertise; being self-
according to their degree of impact – the micro communications and interactions with all aware of one’s own limitations; continually
level (that is, parties involved at a practice level: teammates; team meetings and team-building self-reflecting and stipulating sensible learning
dentists, dental care professionals, competitors, exercises including all teammates; and one- needs; and undergoing necessary training
suppliers and waste collection services); the meso to-one meetings and appraisals with each and continuing professional development
level (that is, management, funding bodies and teammate may help to better involve, support, activities).
groups that can affect professional behaviours: motivate and engage them. It has also been reported that an increasing
educational institutions, royal colleges, societies With regards to collaboration, long- proportion of complaints were made to
and indemnity organisations); and the macro established, well-defined taskwork-related the General Dental Council, where dental
level (that is, groups with the power to make roles and responsibilities of different dental professionals have reported their colleagues
decisions or impose change: governing bodies, professionals within a team could prevent a or other registrants.47 Of course, if patient
regulatory bodies and policymakers).39 full sharing of these roles and responsibilities safety is at risk, then such action might
The advancement of ‘do-it-yourselves’ throughout the team. Of course, this shall be required. If otherwise, what may have
orthodontics has sparked controversy within be important for maintaining patients’ and prevented the stakeholders from engaging and
the dental profession. Although such ventures practice safety. However, by applying the core resolving the issue at a local level? In a CL-type
may be advantageous for certain stakeholders, values of CL and sharing suitable procedures environment, perhaps fair, non-judgemental,
lucrative for the business owners, worthwhile with competent, qualified members of the ‘open-door’ discussions could better encourage
for the digital technologists and potentially team (for instance, extended-duty dental stakeholders to engage with each other to
cheaper for patients, viable stakeholders nurses), this may strengthen collegial relations. resolve such issues, mediate conflicts and
(including the British Dental Association, Relatedly, one Scottish study that investigated prevent escalations beyond the local level.
Oral Health Foundation, British Orthodontic skill mix use in a child oral health programme Having several, varying stakeholders that
Society and some orthodontic professionals) revealed that a ‘lack of support from colleagues’ deliver diverse opinions can be challenging
have raised concerns about the potential risks acted as a barrier to dental nurses using their for collaboration. Stakeholder engagement
of such treatment modality.40 From the outset, extended skills.42 may be further tested by a person belonging
were these viable stakeholders identified? Was One article from 2016 commented that some to many different stakeholder groups, each of
there any collaboration to decipher and evaluate dental nurses felt ‘undervalued, unsupported which may have its own interests and be of a
these stakeholders’ opinions, interests, benefits, and paid unfairly’.43 However, a recent article differing power.48 For instance, in a study that
effects, threats and changing perceptions? comments that some dental nurses feel a ‘severe investigated dentists’ views on the impact of
From a CL viewpoint, an early and thorough lack of support’ and that many are ‘leaving direct access, respondents gave favourable
stakeholder identification process could be the profession’.44 Had collaboration occurred views on the prospect of receiving referrals
central to building trusting relationships and to engage this stakeholder to ascertain and from dental hygienists and therapists for
shared values with stakeholders, as well as in address their concerns and expectations at the treatments beyond their scope of practice.
preventing conflict and barriers that might be appropriate micro, meso and macro levels? However, the majority of respondents
caused by a failure to engage the expertise of If so, were changes or improvements made held unfavourable views about the overall
key individuals. that were mutually beneficial to all relevant implementation of direct access.49 Depending
stakeholders? The same questions may need to on the given situation, certain stakeholders
The importance of stakeholder be asked with regards to the finding that ‘nearly may endorse their own principles or agendas,
engagement two-thirds of principal dentists and over half which could make it difficult to attain an
of all associate dentists across the UK often authentic engagement; a compromise or
To enable productive collaborations, think of leaving dentistry’, in the most recent negotiation might be required to help balance
stakeholders will need to be successfully ‘Dentists’ working patterns, motivation and the interests of different stakeholders.48
engaged with the organisation. Stakeholder morale’ survey.45
engagement involves a two-way, iterative The increase in patient awareness, The importance of ethical
system between the organisation and the expectations and demands, and a general rise leadership
stakeholders. Here, communication, opinions in the litigious nature of society, might be
and proposals flow in both directions. contributing towards the surge in orthodontic CL involves looking beyond personal interests
Resultantly, the organisation can learn about allegations raised against registrants.46 To and instead working together. This interrelates
the perceptions, expectations and concerns of prevent such occurrences, and to ensure that with the standard ethical principles,
its stakeholders, and vice versa. Both parties can patients receive optimal holistic care, perhaps particularly beneficence: doing good to others
then utilise this information to make changes there may need to be greater collaborative and acting with kindness, mercy, charity and a
or improvements. Nonetheless, the success of engagements with pertinent stakeholders moral obligation.50 Thus, using ethics to engage
this will be reliant on the organisation’s ability to include: patients, other practitioners, stakeholders, and to guide or lead teammates,
to sustain long-term, symbiotic relationships, educational bodies and one’s self (that is: fully could be vital to the success of CL. Ethical
rather than conducting one-off consultations.41 determining patients’ needs and expectations, leadership proposes that leaders are in pursuit
For example, in a dental practice, teammates and managing these realistically; increasing of attaining values that are morally correct and
may well differ in terms of their work ethics, coordination with colleagues and specialists that leaders’ decisions have an impact on others
enthusiasm and involvement. Therefore, to seek second opinions; referring patients to in the achievement of organisational goals.51
BRITISH DENTAL JOURNAL | VOLUME 231 NO. 6 | September 24 2021 357
© The Author(s) under exclusive licence to the British Dental Association 2021.GENERAL
Its theory purports that leaders encourage all stakeholders’ sensitivities? Relatedly, a between different faculty departments.65,66,67
followers to excel and overachieve; strive for recent study investigated the effect of viewing One English study highlights the importance
social, environmental and financial success; idealised smile images versus nature images of cross-faculty interprofessional education
and generate innovative practices. Such via social media on the immediate facial and collaboration between humanities, arts
leadership can be applied in political contexts satisfaction in young adults. This found that and clinical sciences. These subjects were
to enhance society.52 Qualities essential to exposure to ‘ideal’ facial images on social integrated into the dental curriculum of an
ethical leadership include: empathy, integrity, media decreased facial satisfaction, with educational establishment, so that students
honesty, humility, fairness, responsibility, such effect being greater in those with high could develop the tolerance of ambiguity.
collectivism, transparency, concern for self-discrepancy scores.59 Activities involved close observation and
stakeholders’ wellbeing, interpersonal rapport It has been reported that ‘any cosmetic group reading of texts, intent listening, and
building and empowerment.53,54 These traits dentist on Instagram treats their patients as openly addressing obscurity and uncertainty.
resemble the core values of CL, as well as the consumers’ and that certain companies are The researchers concluded that these activities
ethical attributes that dental professionals actively encouraging clinicians to treat their may cultivate students’ ‘capacity to be the
ideally need to have. patients as ‘consumers.’56 Cosmetic dentistry leaders and innovators of the future’ and
While dentistry continues to be a itself is not a recognised speciality, and crafting promote ‘higher order skills’.68 Perhaps, such
competitive field, especially within the private, illusions of having specialist knowledge and innovative, collaborative endeavours might be
cosmetic sector, practising ethically remains using non-existent terms akin to ‘perfect a starting point for overcoming discriminatory
a fundamental obligation. Patients may well smiles’, and self-descriptive designations such as habits at educational establishment and
be one of the most crucial stakeholders; their ‘cosmetic dentist’ without specialist registration, institutional levels.
needs and interests must be carefully identified could mislead patients.60,61 Relatedly, one article
and, of course, managed ethically. However, an comments that the ‘shameless promotion of Conclusion
upsurge in ‘self-aggrandising advertisements rapid smiles and DIY aligners has regrettably
and claims for egotistical, narcissistic dentistry, turned our unsuspecting patients into mere ‘Leadership and dentistry’ is a subject that may
often promoted by younger, or apparently “profit centres”’.62 Strategies involving the be further complicated by the multifaceted
non-specialist dentists’ has been reported.55 delivery of services for self-aggrandisement practice of dentistry, which encounters a
Some organisations and ‘influencers’ might avarice or profiteering, rather than providing dichotomy of interests between the provision
also endorse questionable products or care in the patients’ best interests, do not of healthcare and generating a profit. CL
advertisements for a payment without making demonstrate CL; they instead demonstrate appears to be refreshing and promising.
relevant conflict of interest declarations.56 despotic leadership. With regards to CL, However, if stakeholders with competing
Because these ‘influencers’ may appear to be perhaps ethical traits of empathy, integrity and interests do not look beyond any differences or
popular and well connected, their exaggerated humility may better empower teammates (that confinements, then these may act as barriers to
or non-evidence-based claims might pass is, patients) to accomplish shared goals (that is, fully engaging in collaborative pursuits. Thus,
unchallenged.56,57 This may also be the case completing mutually agreed treatment plans careful and tactful stakeholder identification
when certain eminent organisations endorse that are in the patients’ best interests). and engagement processes might be critical to
dubious advertisements.12,57 Was there any form Owing to organisational failures being the success of CL.
of collaboration with relevant stakeholders to linked to the unethical actions of leaders and Leadership extends beyond local, physical,
identify their exact needs and interests, and if individuals, there has been an increase in the organisational and clinical boundaries to
so, did these findings inform such ‘influential’ scholarly work of ethical leadership.63 However, include online, digital and social media realms,
approaches? Are these types of engagements one recent article outlines that there have been where teledentistry, virtual conferencing and
mutually beneficial to all stakeholders? Are accusations of racism at a dental educational dental advertising occur. Such innovations
such ‘influencers’ collaborative leaders? Have establishment, where Black and Minority may promote effective collaborations:
patients been given well-informed information Ethnic students ‘have been subjected to racist consulting patients and providing advice,
that facilitates the engagement in a serious language’ from ‘teaching staff, some students, and delivering educational programmes and
process of informed consent? and even patients’. This article further states ethical marketing ventures. However, dental
Alongside its advantages, social media usage that there could be a ‘wider issue of racism organisations and professionals must be
is thought to be contributing towards increased within the dentistry industry’.64 Discrimination mindful of how their conduct and decision-
comparisons, envy, low self-esteem, body ignores ethical principles and the core values of making in such domains might impact on
dysmorphia and social anxiety.58 Advertising CL, and it disregards stakeholder identification the quality of collaborative engagements with
‘perfect smiles’ or ‘ideal’ facial images on this and engagement processes. Rather, promoting stakeholders, and likewise, the impact of these
domain might well attract followers (that is, equality, diversity and inclusivity, which stakeholders in such domains.
some potential patients and the attention of are key concepts of CL, would be far more In these uncertain, ever-changing,
some other clinicians). However, how may advantageous. challenging times, and even thereafter,
such advertising affect vulnerable viewers Some studies, which explore leadership in harnessing mutually beneficial relationships
that could have a facial disfigurement or body an academic dentistry context, underline the based on integrity, trust, confidence and other
dysmorphia condition relating to their teeth, need for dental educational establishments ethical virtues shall be more important than
mouth or face? Is such advertising an ethically to obtain a complete integration into their ever. Although CL might appear idealistic,
collaborative engagement that considers university institutions and to cross-collaborate there exists great potential for dental
358 BRITISH DENTAL JOURNAL | VOLUME 231 NO. 6 | September 24 2021
© The Author(s) under exclusive licence to the British Dental Association 2021.GENERAL
organisations and professionals to use a CL 19. Rousseau V, Aubé C, Savoie A. Teamwork behaviours: A 43. Anonymous. Why are dental nurse salaries so low? BDJ
review and an integration of frameworks. Small Group Team 2016; 3: 16152.
style that assimilates its core values and is
Res 2006; 37: 540–570. 44. Bissett G. ‘Severe lack of support’ – dental nurses
adaptable according to the context. As per the 20. Marks M A, Mathieu J E, Zaccaro S J. A temporally based speak out on the impact of COVID-19. 2020. Available
foundations of CL, eradicating divisions and framework and taxonomy of team processes. Acad at https://www.dentistry.co.uk/2020/09/09/dental-
Manage Rev 2001; 26: 356–376. nurses-leaving-profession/ (accessed November 2020).
inequalities, and bringing together teammates, 21. Stagnell S, Patel N, Allen Y, Shah S. The Way Forward for 45. NHS Digital. Dentists’ Working Patterns, Motivation
followers and stakeholders in a productive Dental Leadership. Prim Dent J 2017; 6: 62–65. and Morale – 2018/19 and 2019/20: Official Statistics.
22. Chrislip D D, Larson C E. Collaborative leadership: How 2020. Available online at https://digital.nhs.uk/
and ethical way, might help to form long- citizens and civic leaders can make a difference. San data-and-information/publications/statistical/
lasting, harmonious relationships, where Francisco: Jossey-Bass Inc Pub, 1994. dental-working-hours/2018-19-and-2019-20-working-
23. Green B N, Johnson C D. Interprofessional collaboration patterns-motivation-and-morale (accessed November
initiatives, strategies and goals can be shared in research, education, and clinical practice: working 2020).
for the common good of all people, and be together for a better future. J Chiropr Educ 2015; 29: 46. Singh P. Orthodontic allegations raised against
1–10. registrants by the General Dental Council. Br Dent J
implemented in the best interests of all people. 24. VanVactor J D. Collaborative leadership model in 2016; 221: 291–294.
the management of health care. J Bus Res 2012; 65: 47. Makin J. Keep it local. 2020. Available at https://www.
555–561. dentistry.co.uk/2020/03/30/keep-it-local/ (accessed
Ethics declaration 25. Lawrence R L. Understanding collaborative leadership November 2020).
The author reports no conflicts of interest. The author in theory and practice. New Direct Adult Cont Educ 2017; 48. Alves O M, Moreira J P, Santos P C. Developing
156: 89–96. community partnerships for primary healthcare: An
alone is responsible for the article’s content and 26. Herrero Babiloni A, Lam J T, Exposto F G et al. integrative review on management challenges. Int
writing. Interprofessional Collaboration in Dentistry: Role of J Healthc Manag 2020; 24: 1–9.
physiotherapists to improve care and outcomes for 49. Ross M, Turner S. Direct access in the UK: what do
chronic pain conditions and sleep disorders. J Oral dentists really think? Br Dent J 2015; 218: 641–647.
References Pathol Med 2020; 49: 529–537. 50. Kinsinger F S. Beneficence and the professional’s moral
27. Brunton P. Leadership in modernising dental facilities. imperative. J Chiropr Humanit 2009; 16: 44–46.
1. Yukl G. Leadership in organisations. 6th ed. Upper Saddle
J Dent 2019; 87: 59–61. 51. Mayer D M, Aquino K, Greenbaum R L, Kuenzi M. Who
River: Pearson-Prentice Hall, 2006.
28. Williams D M, Mossey P A, Mathur M R. Leadership in displays ethical leadership, and why does it matter?
2. Morison S, McMullan C. Preparing for the future:
global oral health. J Dent 2019; 87: 49–54. An examination of antecedents and consequences of
challenges and opportunities for management and
29. Migliorati C A, Madrid C. The interface between oral ethical leadership. Acad Manag J 2012; 55: 151–171.
leadership skills. Br Dent J 2013; 214: E2.
and systemic health: the need for more collaboration. 52. Zhu Y, Sun L Y, Leung A S. Corporate social
3. Willcocks S G. Exploring leadership in the context of
Clin Microbiol Infect 2007; 13: 11–16. responsibility, firm reputation, and firm performance:
dentistry in the UK. Leadersh Health Serv (Bradf Engl)
30. British Dental Association. Sustainability in dentistry. The role of ethical leadership. Asia Pac J Manag 2014;
2016; 29: 201–216.
2020. Available at https://bda.org/about-the-bda/ 31: 925–947.
4. Trathen A, Gallagher J E. Dental professionalism:
campaigns/sustainable/Pages/Sustainability-in- 53. Northouse P G. Leadership: Theory and Practice. 6th ed.
definitions and debate. Br Dent J 2009; 206: 249–253.
dentistry.aspx (accessed November 2020). Thousand Oaks: Sage Publications, 2013.
5. Certosimo F. The servant leader: a higher calling for
31. Faculty of General Dental Practice. National dental 54. Odeneye A S, Hoon S N, Phlypo K S. Perceptions of
dental professionals. J Dent Educ 2009; 73: 1065–1068.
organisations join forces to agree return-to-work Followers About Ethical Leadership and Attendant
6. Wang Z, Liu Y, Liu S. Authoritarian leadership and task
guidance. 2020. Available online at https://www.fgdp. Effects on Organisational Success. J Soc Change 2018;
performance: the effects of leader-member exchange
org.uk/news/national-dental-organisations-join-forces- 10: 61–70.
and dependence on leader. Front Bus Res China 2019;
agree-return-work-guidance (accessed November 55. Kelleher M. The ‘Uberization of orthodontics’ – or how
13: 19.
2020). low can you go?. Dent Update 2016; 43: 606–607.
7. Harms P D, Wood D, Landay K, Lester P B, Lester G V.
32. Morris S. OCDO sets up group to tackle discrimination 56. Westgarth D. Social media: A picture perfect storm? BDJ
Autocratic leaders and authoritarian followers revisited:
in dentistry. 2020. Available at https://www.dentistry. In Pract 2019; 32: 4.
A review and agenda for the future. Leadersh Quart
co.uk/2020/11/12/tackling-discrimination-dentistry- 57. Wertheimer M B. Pursuit of excellence: A forgotten
2018; 29: 105–122.
ocdo/ (accessed November 2020). quest? APOS Trend Orthod 2018; 8: 10–13.
8. Newsome P, Barrow C. Profitable dental practice: 8
33. Tang W C, Kingsley K, Reinke R. Impact of Collaborative 58. Lewallen J, Behm-Morawitz E. Pinterest or Thinterest?:
strategies for building a practice that everyone loves to
Leadership in Dental School Team Clinics. J Dent Educ social comparison and body image on social media. Soc
visit. London: CRC Press, 2014.
2019; 83: 1436–1444. Media Soc 2016; 2: 1–9.
9. De Hoogh A H, Den Hartog D N. Ethical and despotic
34. Valle-Oseguera C, Boyce E G. Dentists and Pharmacists: 59. Sampson A, Jeremiah H G, Andiappan M, Newton J T.
leadership, relationships with leader’s social
Paradigm Shifts and Interprofessional Collaborative The effect of viewing idealised smile images versus
responsibility, top management team effectiveness
Practice Models. J Calif Dent Assoc 2015; 43: 591–595. nature images via social media on immediate facial
and subordinates’ optimism: A multi-method study.
35. Lo E C. Enhancing health care services through satisfaction in young adults: A randomised controlled
Leadersh Quart 2008; 19: 297–311.
close collaboration between medical and dental trial. J Orthod 2020; 47: 55–64.
10. Schilling J. From ineffectiveness to destruction:
professionals. Hong Kong Med J 2014; 20: 92–93. 60. Chate R A. Truth or consequences: the potential
A qualitative study on the meaning of negative
36. Lau K T, John J, Eaton K A, Keightley A J. Service implications of short-term cosmetic orthodontics for
leadership. Leadership 2009; 5: 102–128.
evaluation of the paediatric dental general anaesthesia general dental practitioners. Br Dent J 2013; 215:
11. Harris R, Garner J, Perkins E. A discourse of
service in NHS Lothian. Br Dent J 2020; DOI: 10.1038/ 551–553.
disconnection – challenges to clinical engagement and
s41415-020-1982-z. 61. Cannon S. Professional standards for cosmetic practice.
collaborative dental commissioning. Br Dent J 2015;
37. Marques P, Bernardo M, Presas P, Simon A. Corporate London: The Royal College of Surgeons of England,
218: 393–397.
social responsibility in a local subsidiary: internal and 2013.
12. Baker C. What is ethical marketing? BDJ In Pract 2019;
external stakeholders’ power. Euro Med J Bus 2019; 15: 62. Sandler J. Patients. or ‘profit centres’? J World Fed
32: 20–21.
377–393. Orthod 2018; 7: 2–5.
13. Bedi R, Wordley V. Education and training for dental
38. Mitchell R K, Lee J H. Stakeholder identification and its 63. Taylor S G, Pattie M W. When does ethical leadership
leadership–A case study of the Senior Dental
importance in the value creating system of stakeholder affect workplace incivility? The moderating role
Leadership programme. J Dent 2019; 87: 36–39.
work. In Harrison J S, Barney B, Freeman R E, Phillips R A of follower personality. Bus Ethics Quart 2014; 24:
14. General Dental Council. Principles of dental team
(eds) The Cambridge Handbook of Stakeholder Theory. pp 595–616.
working. London: General Dental Council, 2006.
53–73. Cambridge: Cambridge University Press, 2019. 64. Anonymous. Accusations of racism have been made
15. Hayer N, Wassif H S. A lonely business: reflections on
39. Bullock A, Firmstone V. A professional challenge: the within Cardiff’s School of Dentistry. BDJ Student 2020;
the wellbeing and morale of dental teams. Br Dent J
development of skill-mix in UK primary care dentistry. 27: 6.
2019; 226: 559–561.
Health Serv Manage Res 2011; 24: 190–195. 65. Trainor R. What the head of a university expects from
16. Larbie J, Kemp M, Whitehead P. The mental health and
40. O’Dowd A. DIY orthodontics-safe, cheaper option or the leadership of a dental school. J Dent 2019; 87:
well-being of UK dentists: a qualitative study. London:
dangerous gamble? Br Dent J 2020; 228: 321–324. 62–65.
British Dental Association, 2017.
41. Concannon T W, Meissner P, Grunbaum J A et al. A new 66. Gallagher J E, Morison S. Women in academic
17. FDI World Dental Federation. Leading the world to
taxonomy for stakeholder engagement in patient- leadership: A chance to shape the future. J Dent 2019;
optimal oral health. Geneva-Cointrin: FDI World Dental
centreed outcomes research. J Gen Int Med 2012; 27: 87: 45–48.
Federation, 2015.
985–991. 67. Clarkson J, Worthington H. Leadership in evidence
18. McEwan D, Ruissen G R, Eys M A, Zumbo B D,
42. Gnich W, Deas L, Mackenzie S, Burns J, Conway D I. based dentistry. J Dent 2019; 87: 16–19.
Beauchamp M R. The effectiveness of teamwork
Extending dental nurses’ duties: a national survey 68. Zahra F S, Dunton K. Learning to look from different
training on teamwork behaviours and team
investigating skill-mix in Scotland’s child oral health perspectives – what can dental undergraduates learn
performance: a systematic review and meta-analysis of
improvement programme (Childsmile). BMC Oral Health from an arts and humanities-based teaching approach?
controlled interventions. PLoS One 2017; DOI: 10.1371/
2014; 14: 1–13. Br Dent J 2017; 222: 147–150.
journal.pone.0169604.
BRITISH DENTAL JOURNAL | VOLUME 231 NO. 6 | September 24 2021 359
© The Author(s) under exclusive licence to the British Dental Association 2021.You can also read
