Examination of Leadership and Personality Traits on the Effectiveness of Professional Communication in Healthcare

A common perception exists that extroverts are better communicators than introverts, and thus make the best leaders. Research studies throughout time have consistently resulted in the belief that extroverts are more likely to emerge as leaders and are more likely to be perceived as effective. The Trait Theory of Leadership and the Personality Type Theory have been used in research to suggest that theories support that extraversion is key to professional leadership communication and success. The purpose of this article was to conduct a thorough review of leadership communication from a personality perspective. Leadership and personality theories were examined in depth through review of current and past research studies. There is a growing body of research adding to the newfound belief that introverts possess traits that can contribute to their success in leadership roles. According to a review of recent research, organizations may benefit immensely from the inclusion of introverts in leadership positions. Thus, the field of healthcare would benefit from further research regarding how best to utilize introverts within leadership of organizations. Since introverts communicate in different ways than extroverts, organizations should look at their current methods of communication and ensure that the channels of communication are effective for all types of leaders.


Introduction
The popular ideal, as well as the consensus from research, is that extroverts are the best leaders due to their social nature, which leads to the belief that they are better at communicating organizational information [1]. Introverts are commonly thought of as individuals who are shy, withdraw into themselves, and prefer to be alone, while extroverts are commonly thought of as individuals that are outgoing, sociable, and seek the company of others. Communication may be more natural for extroverts than introverts. However, having all extroverted leaders in an organization can lead to ineffective communication. Chaos can ensue due to the power struggle between a groups of extroverts all trying to express their views at the same time [1]. Thus, further examination of introverts as leaders is warranted. This issue is of particular relevance to the field of healthcare due to the heavy reliance on leaders to drive success in the organization.

ARCHIVOS DE MEDICINA ISSN 1698-9465
Journal of Healthcare Communications ISSN 2472-1654 communicator is highly regarded as key to success in leadership positions [5]. Thus, making the connection between personality traits that influence communication and how these traits affect leadership qualities is can be influential to the field of healthcare.

Literature Review
A survey of the literature was conducted to explore past and present research on the various aspects of personality that affect leadership abilities. A particular focus was placed on research that explored extraversion and introversion in regards to leadership.

Defining Leadership
Leadership has been described as "a complex process by which a person sets direction and influences others to accomplish a mission, task, or objective, and directs the organization in a way that makes it more cohesive and coherent" [6]. So, what makes an individual a leader? What makes a leader effective? The Implicit Theory of Leadership states that the term "leader" is simply a cognitive representation of an individual's characteristics and traits that are used to classify a person as a leader or follower [7]. A leader's communication style can be defined as "a distinctive set of interpersonal communicative behaviors geared toward the optimization of hierarchical relationships in order to reach certain group or individual goals" [8]. It is well known that effective leadership is essential to organizational success and, over time, many researchers have attempted to characterize leaders according to their unique styles and traits [9]. Previous studies have shown that the personality characteristics of a leader are contributors to their leadership style [9]. The question is to what extent the extraversion-introversion trait contributes to leadership effectiveness. Additionally, how leadership effectiveness is defined is also an important determinant.

Trait Theory of Leadership
The basic premise of the trait theory of leadership is that leaders possess particular traits that distinguish them from other individuals [10]. The Trait Theory of Leadership involves determining the essential characteristics of leaders based on the characteristics of past successful and unsuccessful leaders, and using those findings to predict the effectiveness of leaders. The trait approach identifies personality traits, such as extraversion, that often align with leader emergence and effectiveness [11].
The trait theory of leadership is typically not used alone due to the fact that good leadership does not simply arise from inherit genetic traits without consideration of motivation and initiative [12].
The Big Five model of personality describes personality in terms of five dimensions, openness, conscientiousness, extraversion, agreeableness, and neuroticism, known as OCEAN [13]. Openness refers to being outgoing and interested in new experiences. Conscientiousness refers to being organized and hard-working. Extraversion, on this scale, refers to being outgoing and social. Agreeableness refers to being helpful and understanding. Neuroticism refers to the degree to which a person is emotionally stable. Each trait is expressed on a continuum, meaning that person can exhibit a presence of or lack of each trait. Studies have shown that the Big Five approach is consistent as a predictor for leadership [14]. Another study by Judge et al. found a 0.39 correlation between the Big Five Personality Traits and leadership effectiveness. While the study did establish an empirical relationship between Big Five personality traits and leadership effectiveness, it did not reveal why that relationship exists [15].
So, the answer to the question as to why there are individual differences that are predictors of leadership effectiveness is still unclear [16]. Thus, further examination of the Big Five model in relation to leadership effectiveness is needed.

Personality Type Theory
One of the early pioneers in personality theory, Gordon Allport, defined personality as "the dynamic organization within the individual of those psychophysical systems that determine his unique adjustments to his environment" [17]. The Personality Type Theory by Carl Jung identifies psychological types used to characterize individuals, called personality types. The two fundamental categories he identified are extraversion and introversion. Jungian theory states that the classification of introversion and extraversion deals with whether a person's energy and motivation come from internal or external sources. Personality Type Theory states that the energy of extroverts is obtained externally, from things and people, and that the energy of introverts is obtained internally, from thinking and ideas [18]. Culturally, extroverts are seen as individuals that are achievement-oriented, seek action, and like working with others, whereas introverts are seen as individuals that are reserved, passive, and like to work alone [19]. Carl Jung stated, "One can never give a description of type, no matter how complete, which absolutely applies to one individual, despite the fact that thousands might, in a certain sense, be strikingly characterized by it" [20].
Prior studies have determined that traits such as demographics, skills, abilities, and personality traits are predictors of an individual's leadership effectiveness [11]. However, "little is known about why personality traits are related to leadership emergence & effectiveness" [10]. Jung asserted that while psychological typology is a way to describe and understand behavior, one must be cautious not to discount individual differences and uniqueness [19].

Extraversion/Introversion
Prior studies have found that extroverts are "significantly more likely to emerge as leaders in selection and promotion decisions and be perceived as effective by both supervisors and subordinates" [21]. Although popular belief is that extroverts are better leaders, group performance may not necessarily benefit from having an extroverted leader [21]. A 2011 study by Grant et al found that proactive employees performed better under a less-extroverted leadership style. Leaders that are lessextroverted may be better listeners and more participative leaders [21]. Those leaders may also be more open to hearing opinions and perspectives that are contrary to their own. Many

ARCHIVOS DE MEDICINA ISSN 1698-9465
Journal of Healthcare Communications ISSN 2472-1654 of our greatest leaders, such as Gandhi and Mother Theresa, have been introverts [19]. "Introverts' reflective, relationshipcentered approach to leadership can be as effective as the more outgoing style favored by extroverts" [22]. To put it simply, we all might fare better if more introverts were in charge. The desirableness of leadership traits is somewhat cultural in nature. Some cultures, such as Japan, prefer leaders who are introverted in nature, less visible, and move behind the scenes to get things done, while other cultures, such as the USA, want leaders who are extroverted in nature, take charge, and are visible and assertive [23]. Estimates show that between 50 and 74% of the population is extroverted, and our society places value on extroverted qualities [24]. The prevalence of an extroverted culture is profound in America, which makes research regarding introverts in leadership of particular importance in order to alter the current paradigm.
A study by Stephens-Craig et al. was conducted to examine positive traits of introverts to see how they could be connected to desirable leadership traits [19]. The study surveyed mid to high level executives to examine their perceptions regarding introverted leaders. They found that most of their respondents believed that both introverts and extroverts could be successful leaders [19]. Introverts typically do not get the opportunity to serve in a leadership capacity because they are not as aggressive at seizing opportunities as extroverts [25]. A 2005 study of 4,000 managers at companies in the U.S. found that 96% of people in leadership positions were extroverts [26]. An understanding of why there are not more introverts in leadership positions, and how to break that pattern, is needed.

Leadership Communication
It is well known that communication is central to leadership [7]. "Communication is perhaps one of the greatest challenges facing managers and leaders today" [27]. A leader's ability to communicate is key to their success. A good leader is able to communicate in a way that enhances understanding and aids employees in making good decisions. Clarity of communication is a key characteristic of good leadership, because a message cannot be clearly understood and interpreted unless it is effectively communicated [28]. No matter how intelligent or confident a person is, if they lack effective communication skills it is highly unlikely that they will be successful as a leader. A study by Solaja et al. examined the relationship between leadership communication style, personality traits, and organizational productivity [29]. They surveyed 112 academic staff to determine their perceptions. The results of the study revealed that a connection between leadership communication style and personality traits does exist, that leadership communication style determines organizational productivity, and that personality traits and communication styles together have an effect on organizational productivity [29]. Employee motivation and satisfaction have also been shown to be dependent on effective communication [30].

Theoretical Implications
Recent research has been able to further add to the newfound belief that introverts can be as effective as leaders as extroverts. "A small but growing body of research shows introverts make better leaders-often spectacularly successful ones-largely because they actually listen to what other people say" [26].
Many studies have suggested that the trait theory alone is not a good predictor of leadership effectiveness. This is partially due to the fact that the trait theory of leadership does not distinguish between leadership perceptions, leader emergence, and leader effectiveness [31]. Personality traits may be predictors of leader emergence, but those same traits may not at all be related to leader effectiveness [13].
The belief that introverts are effective in leadership positions is particularly beneficial in the managerial field. Perhaps organizations have been focusing on the wrong traits all along, and introduction of this concept into practical application could bring significant gains for organizations.
There are also implications for the communication discipline. Society has long held the belief that extroverts are better communicators; however, recent research has questioned the validity of that belief. Introverts can be just as good as extroverts at communication, they just communicate in different ways. And, organizations need to understand that in order to create an atmosphere in which introverted leaders can thrive and be successful.

Directions for Future Research
In many ways, our understanding of leadership and what makes a good leader has not significantly changed in the past 20 years. Research needs to break away from the traditional ideals and explore other avenues. A question that needs further investigation is whether we can identify and teach particular behaviors that promote effective leadership [30]. Further research should look at how we can effectively train introverted students to be good leaders. There is some research available on how to work with school-age children who are introverts. But particular focus should be on how to work with introverted students at the college level who are in leadership or management programs. Bias against introverts is entrenched in education. We essentially force introverted students to perform in an extroverted environment. Classroom focus is on cooperative learning, class participation, and public speaking [32]. Leadership classes are built around assignments such as presentations and teamwork that cater more to extroverted personalities. Future research should look at the impact of such assignments on introverts, and alternative ways to foster leadership skills in introverts.
Another potential area for future research is to examine why there are less introverts in leadership positions, particularly in healthcare, and what can be done to open up leadership opportunities for introverts. Organizations need to understand what characteristics or traits they should seek in individuals for leadership positions, rather than the status quo extraverted qualities. An examination of other relevant demographics of introverts, such as gender distribution, would also provide a valuable contribution to the literature. Researchers should also explore if there are certain types of situations, environments, and employees that would be more conducive to introverted leadership. Any such future research could have significant implications for the fields of leadership and healthcare communication.