Valuation and handling of dialogue in leadership: a grounded theory study in Swedish hospitals

Leadership can positively affect the work environment and health. Communication and dialogue are an important part in leadership. Studies of how dialogue is valued and handled in first-line leadership have not so far been found. The aim of this study is to develop a theoretical understanding of how first-line leaders at hospitals in western Sweden value and handle dialogue in the organisation.

The study design was explorative and based on grounded theory. Data collection consisted of interviews and observations. A total of 11 first-line leaders at two hospitals in western Sweden were chosen as informants, and for four of them observation was also used.

One core category emerged in the analysis: leaders' communicative actions, which could be strategically or understanding-oriented, and experienced as equal or unequal and performed equitably or inequitably, within a power relationship. Four different types of communicativeactions emerged: collaborative, nurturing, controlling, and confrontational. Leaders had strategies for creating arenas and relationships for dialogue, but dialogue could be constrained by external circumstances or ignorance of the frameworks needed to conduct and accomplish dialogue.

First-line leaders should be offered guidance in understanding the consequences of consciously choosing and strengthening the communication component in leadership.

The positive valuation of dialogue was not always manifest in practical action. One significant consequence of not using dialogue was that information with impact on organisational efficiency and finances was communicated upwards in the management system.