Relational leadership, decision-making and the messiness of context in healthcare

Decision-making is a neglected area in the leadership literature and in healthcare in particular. This paper draws on the Cynefin framework, which is a practice-based approach to decision-making, to theorize about leadership in healthcare. The framework uses a multi-ontology cognitive-based sense-making perspective to identify five domains of decision-making that are linked to individual leadership styles and given contexts. It is markedly different from other complexity approaches by the inclusion of the central domain of Disorder. While this inclusion is vitally important, the leadership implications of the approach are under-theorized. Focusing on the idea of Disorder, we argue alternatively that a relational leadership approach is needed to understand decision-making as a multi-ontology sensemaking approach and this also necessitates accounting for professional sensemaking in healthcare settings. The relational approach adopted here is based on Dian Hosking's work and views decision-making as a task that is undertaken through organizing processes that are cognitive but also social/cultural, political and emotional, and in which the social construction of leadership and context are inseparable individual and collective undertakings. When skilful relating is a part of leadership practice then multi-ontology sensemaking is a possibility in decision-making tasks. We support our arguments with illustrative examples to put forward a relational approach to leadership in healthcare.