Management vs symbolic leadership and hospitals in transition : a Swedish example

• Aim To describe, analyse and interpret symbolic leadership in Swedish public hospitals. Background Swedish hospitals are undergoing major structural changes. Hospitals are amalgamated in order to increase productivity and accessibility and reduce health care costs. Method In-depth interviews have been performed with 54 politicians, senior civil servants, medical directors and trade union representatives at nine hospitals. The interviews have been analysed and interpreted following a grounded theory approach. Findings The results show that leadership is manifested in two dimensions—management and symbolic leadership. The management dimension comprises general leadership aspects like planning, regulation and control. In the symbolic leadership dimension, the leader acts as a guide, inspirer and visionary. Leaders consider they are acting in two large arenas: a public arena and a hospital arena. In the public arena their professional competence is thought to be most important and in the hospital arena their social competence. Conclusions Structural changes in Swedish hospitals have forced the actors to come out into the public arena, where they increasingly meet the media and have to defend budget cut-backs. This reduces their manoeuvring space in the hospital arena. When leaders work as a team, and make full use of their symbolic role, this helps to promote the process of transition. Symbolic leadership has a potential to increase the role repertory for not least the head nurse.

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