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…leadership can only occur if there is followership – without followers and following behaviours there would be no leadership.1
Followership describes how individuals respond to and interact with their leader and others. For many years, however, the spotlight was on identifying approaches the leader should use when interacting with and managing followers, and followers were largely seen as passive and subservient to the actions and instructions of the leader.1 More recently, there has been increasing focus on how followers shape, define, and cocreate leadership and leaders’ actions and identity,1 recognising that all individuals, both in senior and more junior positions, move around the leadership ‘triad’ (figure 1), using leadership, management and followership skills according to the situation, environment or position they find themselves in at any one time.2
All health professionals have to learn how to work effectively in multiple teams and, reflecting this, training programmes place much emphasis on the development of teamworking skills. Traditionally, the development of teamworking and leadership skills have been seen as two separate entities, and consideration of the concept of followership in terms of teamworking is relatively recent.3–5 Learning how to be an authentic leader as well as a ‘proactive’ follower can lead to more effective interprofessional teamworking4 6 and ultimately an improvement in health outcomes.7 In clinical situations, the ‘dance of leadership and followership’ involves being able to step up to take leadership when needed (which may be ‘small “l” leadership’,8 such as leading on a task), to recognise how and when to follow a leader and to acknowledge that leadership may be distributed and rotating, not necessarily vested in one individual.
The types and behaviours of followers
Over the years, researchers have suggested ways of followers based on their role or behaviour within a group and towards their leader (table 1). Initially, the followership typologies provided guidance and direction to the leader in how to motivate and develop their team members. Now these typologies or roles are often used alongside teamworking frameworks (eg, Belbin's team roles9) and self-development activities (eg, Myers-Briggs10 or emotional intelligence11) to help individuals develop understanding of their preferences and behaviours, improving their self-regulation and integration into multiple teams.
What makes a ‘good’ follower?
Organisations, leaders and followers can differ in their perceptions of what makes a good follower. At the organisational and leader levels, this may depend on behaviours that fit with the organisation’s culture, the style of leadership and specific job requirements. From the follower’s perspective, their individual schema (thoughts and beliefs of what makes a good follower) can influence the way they choose to develop or progress within their career or an organisation.12 Box 1 sets out a ‘blueprint’ describing what makes a good or ‘favoured’ follower.
The ‘good’ follower blueprint
Exemplary (‘star’) followers are highly engaged, independent, critical thinkers.17
‘Participants’ and ‘activists’ are also highly engaged, supportive and yet challenging of leaders, good deputies as they are loyal to the leader.19
‘Partners’ are capable of both supporting and offering constructive challenge to the leader.18
Rosenbach et al 20 suggest that
The ‘partner’ role is one where experienced team members are high performers who understand and are committed to organisational goals. Not all team members are going to be partners, but all can aspire to this role.
The ‘ideal partner’ displays a high relationship initiative towards the leader:
Understands and empathises with their leader.
Gains the leader’s trust and confidence in their abilities through their actions.
Willing to speak up and be honest when they believe a leader’s (or teams’) actions are not working towards the goals of the organisation.
Willing to negotiate or mediate with the leader when differences arise.
The ideal partner also displays high-performance initiative:
Works to the best of their ability to get things done.
Works cooperatively in a group.
Gains motivation from group success.
Sees himself/herself as a valuable asset.
Looks after his/her well-being.
Embraces change, viewing it as a challenge or opportunity.
While some differences may exist in the behavioural attributes that distinguish good followers from leaders, Riggio has been quoted as saying ‘many of the same qualities that we admire in leaders – competence, motivation, intelligence – are the same qualities that we want in the very best followers’.13 Leadership and followership both involve working with people, having the emotional intelligence and self-insight to know when to step up (to lead) and when to step back (and follow), and how, when and why you work best with other people.
Leaders and followers: building relationships
The relationship between different leaders and followers determines the most appropriate followership to take in different situations. Followers with whom the leaders work regularly and who they trust tend to have more social influence on the leader than others. It can therefore be difficult to have influence when your power is low, you are relatively inexperienced, you do not feel part of the ‘in-group’ or are frequently moving locations. Individual followers therefore need to develop the sort of generic behaviours that are known to engender trust from the leader(s) as set out in box 1. From a patient safety standpoint, it is also vital that health professionals demonstrate self-insight; know their strengths, abilities and limitations; ask for help when they need it; and speak out or challenge actions or behaviours in potentially unsafe situations.
Followers also have a collective power that can give individuals a voice both in supporting a leader and in tackling difficult or intransigent issues. This ‘leadership through followership’ involves followers collaborating to take leadership of a situation. This can be particularly powerful in relation to toxic or destructive leaders (eg, bullies or people who undermine) when approaches from individual followers could be psychologically unsafe. A ‘collective emotion’14 that is negative towards the leader can potentially unite the followers into a form of collaborative leadership in which the more power we share, the more power we have to use.
Moving from followership typologies and behaviours towards a broader categorisation of followership approaches in terms of leadership theories extends our understanding of followership, what sort of a follower we want to be and what sort of leaders we are willing to follow (and not). For example, contingency theories and situational leadership suggest that leaders need to adapt their approach with followers at various stages of experience, competence and willingness, from a more directive style, through to coaching, supporting and finally delegating. Just as you can choose different leadership approaches in various contexts, followers can learn to be more proactive and determine their own followership approaches based on their maturity, experience, competence and confidence in various situations. For example, if a clinical leader is authoritative and an expert in a clinical situation or condition, then you may choose to be more passive and take direction because you trust the leader and their judgement. However, if over time that leader did not start to delegate work to you, you might feel micromanaged and that you are not trusted. Understanding this helps followers think about how they work, behave and communicate in different situations and what sort of leadership they need to flourish. Table 2 sets out various approaches to leadership and followership; however, it is important to remember that in any one moment or context, a blend of approaches may be required, that such typologies are not mutually exclusive and may be prone to oversimplification. A challenge for leaders and followers is to communicate and understand the ‘modus operandi’ of a particular situation or context.
Finally, when working in the ‘leadership triad’, it is not always about the ‘what’ to do or the ‘how’ to do it that is important, it is the ‘why’ that we need to be clear about, and once we have identified the core purpose of why people come into healthcare and leadership, the rest will follow.15 Of course, some leaders behave in ways we do not like or respect, but understanding what drives people can help followers work more effectively based around a shared purpose or value set. If health professionals are to function successfully in today’s complex healthcare systems, then developing effective followership skills is as essential as developing leadership skills.
The traditional focus on leaders and leadership has meant that managers and followers have been seen as somewhat secondary and passive. Just as management and leadership have been described as inter-related sets of activities, which individuals practice in their work, followership is now included in the ‘leadership triad’. This means that it is equally important to learn to follow well, as it is to lead and manage well. Being an effective follower and team member is vital to the delivery of healthcare services and patient safety, in order to provide support for others as well as speak out when needed.
Thinking of leadership in terms of the ‘leadership triad’—leadership, management and followership—helps individuals work more effectively in groups, teams and organisations. No one leads all the time and most of us are in a follower relationship with someone senior to us in the organisation. Leaders need to recognise that followers are vital to leaders, their success, power and survival. When working in practice, thinking about how you might further develop the skills and behaviours of a ‘good’ or ‘favoured’ follower with different leaders can be really useful. This does not mean changing your personality, just being more aware of your impact on your leaders and other team members, and learning what different leaders expect from their followers. For example, you are on a ward round being led by your consultant whom you know and work with very well. They suddenly get called away and the chief registrar (who you don’t know) takes over. You realise that you have to adjust your followership style and be more proactive and engaged if you are to be listened to in the group. Followership, therefore, helps explain why some people seem more valued by leaders than others and how you might develop influence, even if you are fairly junior. Team training should focus on developing exemplary, proactive followers who can work effectively in multidisciplinary teams, speak out when needed and are confident in seeking and developing successful leader–follower relationships.
JM and CLV contributed equally.
Contributors Both authors (JMcK and CLV) have contributed equally to the article.
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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