The study of leadership has significantly evolved in the past century, marked by a proliferation of definitions and approaches. Leadership theories have shifted from focusing on traits, such as intelligence and dependability, to considering the importance of context, including cultural and situational factors influencing leadership.

The "Trait Approach" to leadership, which focused on the traits of individual leaders, remained prominent up until the late 1940s (Day,  2014; Parry & Bryman, 2013; Stogdill, 1948). This approach suggested that leaders inherently possess certain qualities or traits associated with effective leadership, such as intelligence, scholarship, dependability, and sociability. Although the "Trait Approach" laid the foundation for subsequent theories in leadership, it was criticised for failing to account for contextual factors, interactive effects, and the possibility of personal development (Northouse, 2021).

Between the 1940s and 1980s, there was a shift from inherent traits to behavioural approaches, emphasising task-orientation and relationship-orientation in leadership. The "Style Approach" began to emerge in the late 1940s, focusing less on inherent personal characteristics of leaders and more on their behaviour and actions (Northouse,  2021; Parry & Bryman, 2013). This approach distinguished leadership into two axes: task-oriented behaviour and relationship-oriented behaviour. A key feature was that effective leadership involves flexibility and adapting one's leadership style to meet the demands of different situations and team members. The "Style Approach" signified a shift in both leadership development and theory, recognising that leadership behaviours could be changed, leading to a focus on training and development in organisational leadership efforts.

Whereas previous approaches had focused on individual leaders, approaches emerging in the 1980s began to focus on interactions between leaders and followers, specifically on how leaders convey vision and meaning (Northouse,  2021; Parry & Bryman, 2013; Smircich & Morgan, 1982). These "New Leadership" approaches include transactional, transformational, and charismatic leadership. Transactional leadership focused broadly on the use of external motivations, such as payment or rules, to influence followers, while transformational leadership focused on inspiring internal motivation through new perspectives and alignment of vision. Charismatic leadership, closely aligned with transformational leadership, theorised that certain leaders possess innate charisma, transforming the values, aspirations, and needs of their followers from a self-focus to a collective focus (Dopson et al., 2016). These approaches led to a deeper exploration of the psychological and emotional aspects of leadership, providing a more holistic understanding of effective leadership. However, both charismatic and transformational leadership have been criticised for their lack of attention to ethics (van  Knippenberg & Sitkin, 2013).

In the 1990’s, “Shared leadership” approaches began to emerge more prominently in the literature (Bennett  et al., 2003; Parry & Bryman, 2013). These approaches represent a further step away from a focus on individual leaders towards a perspective that considers leadership to exist in the space between leaders, followers, and context. In shared leadership approaches, leadership distributed among team members based on expertise, experience, and situational factors, rather than confined to a formal, designated leader. Within “Shared leadership”, two particular strands emerged: “Group leadership” and “Followership”. “Group leadership” refers to a style of leadership where leadership functions are distributed among different members of a group, rather than centralised in a single individual (Brown  & Gioia, 2002; Pendleton & Furnham, 2016). This approach recognises that different members may have different areas of expertise, skills, and abilities that are valuable in various situations.  “Followership” examines the role and contributions of followers in the leader-follower dynamic (Follett, 1949; Grint, 1997; Kelley, 1988; Mintzberg, 2004;  Uhl-Bien et al., 2014). It implies that individuals within an organisation who are normally designated as followers have a vital role in informing and steering leaders and the organisation by being active, engaged, and constructive members of a team or group. This approach has attracted interest in healthcare where there has been an increasing effort to empower team members traditionally perceived to be “just” followers within established hierarchies to speak up and influence team and leader behaviours, particularly in crises.

In the last twenty years, there has been a surge in approaches attempting to take a broader view of leadership, acknowledging the limitations of previous quantitative and rational approaches in accounting for leadership's complexity (Ardichvili et al., 2016; Avolio et al., 2009; M. West et al.,  2015). This has led to a range of new approaches, including (to name just a few), pragmatic leadership, spiritual leadership, art of leadership, authentic leadership, and complexity leadership. In healthcare, there has also been recent focus on emotional intelligence, ethical leadership, and compassionate leadership (McKimm  & McLean, 2020; Mintz & Stoller, 2014; M. A. West, 2017).

It is perhaps not surprising that the proliferation of leadership research, combined with the lack of agreed best approaches to researching and understanding leadership in general or in healthcare specifically has resulted in fragmentation of approaches to leadership. It remains to be seen which approaches will withstand the test of time.

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