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Leadership and management: what’s the difference?
  1. Tim Swanwick1,2
  1. 1 NHS Leadership Academy, NHS England and NHS Improvement, Leeds, UK
  2. 2 Faculty of Medical Leadership and Management, London, UK
  1. Correspondence to Dr Tim Swanwick, NHS Leadership Academy, Health Education England, Leeds LS1 4BJ, UK; tim.swanwick{at}

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It’s more than 40 years since Abraham Zalenzick, in a now classic Harvard Business Review article, asked the question, Managers and Leaders. Are They Different? 1 His conclusion was that ‘yes’, they were, and quite fundamentally so. Decades of debate have followed as leadership and management as distinct, if complementary, practices have been compared, contrasted and scrutinised through innumerable theories, frameworks and lenses. Zaleznik’s fundamental point was that leadership was a creative process requiring imagination and an appetite for risk and uncertainty. Management by contrast tended to seek stability, order and control. And it is this polarity that has been at the heart of the management/leadership debate ever since.


Management’s primary concern is with the here and now and the immediate operational environment. It can be seen to revolve around six core tasks: planning, allocating resources, co-ordinating the work of others, motivating staff, monitoring output and taking responsibility for the process.

Management, then, is about getting things done and doing things right. Managers focus on the process, not the substance, of issues and in doing so may be seen as inflexible, detached and occasionally manipulative.1 Management is inherently a transactional process in which those that are ‘managed’ do so in their own self-interest, in return for some reward or punishment, be it financial, or related to job prospects or prestige. Effective management is essential for the smooth running of organisations, without which they would degenerate into an anarchic melee of competing self-interest groups. And in healthcare, a mounting body of evidence points to the fact that poorly managed organisations fail patients, frustrate staff, deliver poor quality care and are ill-equipped to adapt to the changing demands of the environment in which they operate.2

But management, as defined here, isn’t enough on …

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  • Contributors TS planned, wrote and submitted the article and responded to feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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