Download - 1. Chapters 1, 3 4 Leadership Management-3
Leadership & management PrinciplesChapters 1, 3 & 4
Joseann DeWitt, RN, MSN
3 Essential and Interrelated Elements
Leadership Followership Management
LEADERSHIP
Leadership is the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance.
Effective leaders enable people to move “in the same direction, toward the same destination, at the same speed, not because they have been forced to, but because they want to” (Lansdale, 2002)
Three primary tasks of a leader are (Drath, 2001) : To help people develop a sense of direction and purpose
Through mission, goals, vision, purpose To build the group’s commitment to its goals
Through motivation, spirit, teamwork To face the numerous challenges that arise in a health
care setting Through change and turbulence
Leadership Overview
Leadership is a natural element of nursing practice because themajority of nurses practice in work groups or units.
Possessing the license of an RN implies certain leadership skillsand requires the ability to delegate and supervise the work of others.
Is every nurse a leader?
Are YOU ready to be a leader?
LEADERSHIP THEORIES
Trait Theories Focuses on identifying specific characteristics of
leaders. What a leader is….
Behavioral Theories Focuses on attitudes toward leader behavior. What a leader does…
Situational Theories Focuses on how leadership styles change according to
the situation. How a leader responds…
Trait Theories
Traits (qualities) of leaders: Intelligence Initiative Excellent interpersonal skills High self-esteem Creativity Willingness to take risks Ability to tolerate the consequence of taking
risks
Situational Theories
Adaptability to the situation Doesn’t assume that one particular approach
works in all situations Recognizes the complexity of work situations
and encourage Considers many factors when deciding what
action to take Every situation is different
Behavioral Theories Leadership styles
Authoritarian Leadership Democratic Leadership (Participative) Laissez-faire Leadership
AUTHORITARIAN
AKA Autocratic, Directive, Controlling
Dictates policies and procedures Decides what goals are to be
achieved Directs and controls all activities
without any meaningful participation by the subordinates
DEMOCRATIC
AKA Participative Followers are encouraged
to be part of the decision making process.
Requires the leader to be a coach who has the final say, but gathers information from staff members before making a decision.
LAISSEZ-FAIRE
AKA Permissive, Nondirective
The least possible guidance is given to subordinates.
“Let it alone” Does very little planning or
decision making Fails to encourage others to
participate Truly a lack of leadership
COMPARISON OF LEADERSHIP STYLESAUTHORITARIAN DEMOCRATIC LAISSEZ-FAIRE
Strong Control Less Control No Control
Gives Orders Offers Suggestions Nondirective Style
Does Decision Making Makes Suggestions Abdicates Decision Making
Leader Does Planning Group Does Planning No Planning
Directive Participative Uninvolved
High quantity, good quality output by group
Creative, high quality output by group
Variable output by group, may be poor quality
Fosters Dependency Fosters Independence Fosters Chaos
Breaking it down further… Transformational Leadership Addresses meaning, inspiration and vision People need a sense of mission Communicates vision in a manner that is meaningful
and exciting, which inspires commitment in others Motivates followers to perform to their full potential
over time by influencing a change in perceptions and by providing a sense of direction
Uses charisma, individualized consideration & intellectual stimulation to produce greater effort, effectiveness, and satisfaction in followers
Generates greater follower commitment Generates greater follower satisfaction Generates overall effectiveness
MAGNET RECOGNITION PROGRAM®
5 key components to obtain Magnet status:
1. Transformational Leadership2. Structural Empowerment3. Exemplary Professional Practice4. New Knowledge, Innovations, and
Improvements5. Empirical Outcomes
NOTE: Magnet emphasizes transformational leadership
Qualities of an Effective Leader Integrity
Adherence to a code of personal ethics and a code of professional ethics
Courage Risk-taking
Initiative Act on ideas
Energy Requires effort
Optimism Optimism is “catching” – can re-motivate a discouraged group
Perseverance Do not give up easily
Balance Balance between work and play
Ability to handle stress Coping with stress in a positive and healthy manner
Self-awareness Understand self
Behaviors of an Effective Leader Thinking critically
Careful, deliberate use of reasoned analysis to reach a decision
Solving problems Helps identify problems and to work through the
problem-solving process Respecting the individual
Recognizes the differences in people and helps them find the rewards in their work
Skillful communication Listening to others Encouraging the exchange of information Providing feedback Setting specific goals/communicating a vision for the
future Developing oneself and others
Continue to learn and encourage others to do the same
Winner or Whiner – Which Are You? A winner says…
We have a real challenge here.
I’ll give it my best. That’s great! We can do it. Yes!
A whiner says… This is really a
problem. Do I have to? That’s nice, I guess. Impossible. It can’t be
done. Maybe…
Holman (1995)
SKILLS NECESSARY TO BE A NURSE LEADER
American Organization of Nurse Executives' (AONE):five domains of nurse executive competency:
1. Communication and relationship management 2. Leadership 3. Business skills and principles 4. Knowledge of the health care environment 5. Professionalism
LEADERSHIP DO’S
A profile of leaderships “do’s” includes: Honesty Energy Drive Tenacity Creativity Flexibility Visibility Emotional stability Knowledge Conceptual skills Leadership motivation
Leadership is founded on trust and does not survive without it.
Leadership is hard, sustained work that requires a great deal of energy and sputters without it.
LEADERSHIP DON'TS
A profile of leadership “don'ts” includes: Untrustworthiness Insensitivity to others
a likely cause for ineffective leadership Aloofness Over-managing Abrasiveness Inability to think strategically or staff effectively Inability to build a team Focusing on internal organizational politics (overly
ambitious)
Followership
“If you think you are leading and no one is following you, then you are just taking a nice walk.”
— John Maxwell
FOLLOWERSHIP
Followership and Leadership are separate but reciprocal roles
A leader can’t lead without followers A follower can’t follow without a leader Followership is NOT passive and unthinking!
5 CATEGORIES OF FOLLOWERS
“Sheep” Lack initiative, sense of responsibility, and critical thinking
“Yes-people” Lack enterprise and yield to the opinions, will or decisions of others
“Alienated” followers Capable of independence and critical thinking but appear passive
because they resist open opposition The result is frustration and disillusionment
“Survivors” Never make waves or take risks; they go which way the wind blows
“Effective” followers Have initiative and think for themselves. Manage themselves well and are responsible and well balanced. Competent and committed.
Effective followers are an asset to be nurtured, developed, and valued. Effective followers contribute to success in organizations.
TIPS FOR BEING A GOOD FOLLOWER
The most valuable follower is a skilled, self-directed employee, who participates actively in setting the group’s direction, invests his/her time and energy in the work of the group, thinks critically and advocates for new ideas. (Grossman & Valiga, 2000) Inform team leader or manager of a problem. Offer
suggestions for solving the problem. Invest interest and energy in your work. Be supportive of new ideas. When you disagree, explain why. Listen carefully and reflect. Continue to learn as much as you can about your specialty. Share what you learn with others.
Pygmalion Effect
The greater the expectation placed upon employees the better they perform
Management Effective nursing managers are responsible for
ensuring safe patient care and ensuring that it is given in the most effective, efficient and cost-effective manner possible.
Management (Fayol, 1916) Plan Organize Command Coordinate Control work
Mintzberg (1989) The manager’s function is to do whatever is necessary
to make sure that employees do their work and do it well.
Differences Between Leadership and Management
Leadership Based on influence and
shared meaning An informal role An achieve position Pare of every nurse’s
responsibility Initiative Independent thinking
Management Based on authority and
influence A formally designated
role Formal authority to
direct the work of a given set of employees
An assigned position Usually responsible for
budgets, hiring and firing people
Improved by the use of effective leadership skills
Key Point
Leadership is an essential part of effective management
You do not have to be a manager to be a leader BUT you do need to be a good leader to be an effective manager
The Importance of Effective Leadership Skills
First, it is important to nurses because of the size of the profession
Second, nursing's work is complex, often conducted in complex settings. Authenticity and caring are valued in nurse leaders and are
exhibited by people who are genuine, trustworthy, reliable, and believable and who create a positive environment
Third, nurses enter the practice of nursing by licensure but they come from a variety of educational backgrounds. Nurses need a strong leadership to resolve the
interprofessional dilemmas derived from educational diversity and issues related to professionalization and employment.
Leadership is Key to the Success of Health Care Organizations
Leadership principles can be learned through education and practice.
Leaders must know themselves and their followers, the situation, the communication process, and goals, and they must be flexible enough to make necessary adaptations.
Leaders are those who innovate and take the risks inherent in new approaches.
Effectiveness means matching leadership behaviors to the environment and then adapting within that environment.
Leaders who never vary their style are probably ineffective some of the time.
Leadership involves a concern for task and a concern for people. Good leaders need good followers.
Practices Common to Exceptional Leadership Achievement
Challenging the process by searching for opportunities, experimenting, and taking risks
Inspiring a shared vision by envisioning the future and enlisting the support of others
Enabling others to act by fostering collaboration and strengthening others
Modeling the way by setting an example and planning small successes
Encouraging the heart by recognizing contributions and celebrating accomplishments
Management
Management Theories
The Human Relations Approach Emphasizes the relationship aspects of managing
people
Scientific Management Emphasizes the task aspects of management
McGregor’s Theory X and Theory Y Theory X
Reflects a common attitude among managers that most people really do not want to work very hard and that the manager’s job is to make sure that they do work hard
Therefore, a manager needs to employ strict rules, constant supervision, and the threat of punishment to create industrious, conscientious workers
Theory Y Managers believe that the work itself can be
motivating and that people will work hard if their managers provide a supportive atmosphere
Manager emphasizes guidance rather than control, development rather than close supervision, and reward rather than punishment
McGregor’s Theory X and Theory Y
X Work is something to be avoided People want to do as little as possible Use control-supervision-punishment
Y The work itself can be motivating People really want to do their job well Use guidance-development-reward
Contingency Theory
The basic principle is that managers need to consider the situation and all its elements when making a decision.
Managers need to act on the key situational aspects with which they are confronted.
Sometimes described as “it all depends” decision making, contingency theory is most often used for choosing a leadership or management style.
The “best” style depends on the situation
Systems Theory
Managers recognize that changing one part of a system inevitably affects the whole system, creating a ripple effect within the whole.
Complexity Theory
Complexity theory is a more general umbrella theory that encompasses chaos theory.
The focus of complexity theory is the behavior over time of certain complex and dynamically changing systems.
Chaos Theory
Randomness and complexity are two principal characteristics of chaos.
The slightest variation can have enormous results in a dynamic and changing system.
Viewing the organization as similar to a living organism, taking a holistic approach.
Believe that the universe is not orderly and that things do not progress in a linear fashion. Much of nature moves in a circular and ebbing manner. Disturbances create disequilibrium that can lead to growth. Nature is self-organizing and self-renewing. A distinguishing
feature of a self-renewing organization is that it has resiliency instead of stability.
Life tries to find what works and uses messes to arrive at better solutions because messes can be opportunities. It is good for us to be authentic, support each other, and to thrive on our differences
Qualities of an Effective Manager Leadership
The “people skills” of the leader are the core skills needed to function as a manager
Clinical Expertise Need to be able to help others develop their skills and
to evaluate how well they have performed those skills Business sense
Cost of providing care that is given, budgeting, staffing, measuring patient outcomes
What do you think? Is it better to have a “generic” manager and “managing
people is managing people”, or Is it better to have a manager that understands the
tasks of the worker?
Behaviors of an Effective Manager
Three categories Interpersonal Decisional Informational
Behaviors of Effective Manager: Interpersonal
Networking Develop positive working relationships with other
disciplines, departments, and units Conflict negotiation and resolution
Conflicts between employees, between clients and staff members, and between staff members and administration
Employee development Providing continuing learning and upgrading of
the skills of employees Rewards and punishments
Tangible rewards: salary, time off Intangible rewards: praise, recognition
Behaviors of Effective Manager: Decisional
Employee evaluation Performance appraisals
Resource allocation Have a set amount of money for running the unit
Hiring and firing employees Participate in or fully carry out the employment
and termination of staff Planning for the future
Prepare for changes in budgets, organizational priorities, patient populations
Job analysis and redesign Analyze and redesign the work of unit to make it
as efficient and cost-effective as possible
Behaviors of Effective Managers:Informational
Spokesperson Relay information to staff from administration Speak for staff when relaying information to
administration Represent unit/department at meetings or
discussions Monitoring
Monitor activities of unit, including patient population, infection rates, staff, budget
Dissemination Sharing information such as new policies,
development in healthcare
MANAGERIAL ROLES
Management Process
1. Planning2. Organizing3. Coordinating or Directing4. Controlling
Planning
Encompasses determining philosophy, goals, objectives, policies, procedures, and rules
Carrying out long- and short-range projections
Determining a fiscal course of action
Managing planned change
PHASES OF PLANNING
1. Identify the mission2. Conduct an environmental scan3. Analyze the situation: SWOT analysis of
Strengths, Weaknesses, Opportunities, and Threats
4. Establish goals5. Identify strategies to reach goals6. Set objectives to achieve goals7. Assign responsibilities and timelines8. Write a planning document9. Celebrate success and completion
Strategies to Ensure Implementation
Involve the right people in planning. Do a written plan, and communicate it widely. Establish goals and objectives that are specific,
measurable, acceptable, placed in a time frame, stretching, and rewarding.
Build in accountability (regular review). Note deviations and re-plan. Evaluate the planning process and the plan. Conduct ongoing communications. Make the planning process compatible with the
preferences of the planners.
ERRORS THAT MAY CREATE PLANNING FLAWS
Errors of factThe plan is based on misinformation
Errors in assumptionThe plan is based on incorrect assumptions
Errors of logicThe plan is based on faulty reasoning
Organizing
Organizing includes: establishing the structure to carry out plans determining the most appropriate type of
patient care delivery, and grouping activities to meet unit goals
Other functions involve working within thestructure of the organization and
understanding and using power and authority appropriately.
Directing
Usually entails human resource managementresponsibilities such as: Motivating Managing conflict Delegating Communicating Facilitating collaboration
Controlling
Includes: • Performance appraisals• Fiscal accountability• Quality control• Legal and ethical control, and• Professional and collegial control
Important Managerial Skills
Developing peer relationships Carrying out negotiations Motivating subordinates Resolving conflicts Establishing information networks and disseminating information Making decisions in conditions of extreme ambiguity Allocating resources
Role of the Nurse Manager
Managing clinical nursing practice Managing human, fiscal, and material resources Developing personnel Complying with regulatory and professional
standards Making strategic plans Fostering interdisciplinary and collaborative
relationships
Comparison of NURSE EXECUTIVE AND NURSE MANAGER
Manages one or more defined areas of nursing services and is responsible to a nurse executive.
Allocates available resources, coordinate activities, facilitate interactive management
Has a major responsibility for implementing the vision, mission, philosophy, goals, plans, and standards of the organization and nursing services
Responsible for managing organized nursing services from the perspective of the organization as a whole and for transforming values into daily operations to produce an efficient, effective, and caring organization.
Accountable for the environment in which clinical nursing practice occurs.
Provides leadership and direction for all aspects of nursing care
Nurse Manager Nurse Executive (CNO)
EFFECTIVE MANAGERS & EFFECTIVE LEADERS
Envision the future Communicate their visions Motivate followers Lead the way Influence others to
accomplish goals Inspire confidence Take risks Empower followers Master change
Coordinate resources Optimize resource use Meet organizational goals
and objectives Follow rules Plan, organize, control, and
direct Use reward and
punishment effectively to achieve organizational goals
Leaders Managers
ETHICAL PRINCIPLES FOR MANAGERS
1. Frugality and sophisticated therapeutic skill (doing the most with the least resource expenditure)
2. Clinical credibility through organizational competence
3. Presence (visibility)
4. Responsible representation at highest levels
5. Loyal service
6. Deliberate delegation
7. Responsible innovation
8. Fiduciary accountability
9. Self-discipline
10. Continuous learning
Legal Aspects of Management Personal negligence in clinical practice
Liability for delegation and supervision
Organizational liability related to employment issues
Emotional Intelligence
One part of managing people and relationships in organization is to manage the expression of emotion.
Skill building and training in positive thinking and a focus on positive emotions assist nurses to better listen, encourage, motivate, and create connections.
Emotional intelligence is the intersection of thinking and emotion.
The goal is to achieve optimal outcomes.
Essential for Leadership:Emotional Intelligence
Self-Awareness Attuned to own emotional state Recognizing your emotions, differentiating between emotions,
knowing the reason behind the emotion
Self Management Ability to stay calm, clear-headed Maintaining control Resisting or delaying an impulse, drive, or temptation to act;
controlling aggression, hostility, and irresponsible behavior; managing emotions in a flexible and adaptable way
Essential for Leadership:Emotional Intelligence
Perceiving accurately Accurately assessing a situation, having clear vision, keeping a
broad perspective, being objective
Social Awareness Attuned to others’ emotional state Reading others Being aware of the emotions of others, appreciating the
emotions of others, understanding how and why people feel and act as they do
Relationship Management Redirects emotional energies toward shared objectives Communicating with flexibility Having a full range of emotional expressions, being authentic,
addressing your needs as well as the needs of others
Current Issues & Trends in Management
Within health care delivery systems, issues and trends facing today's managers include:
Management of populations with chronic illnesses Resources to acquire technology on an ongoing basis The need for primary and preventive services and programs,
including complementary and alternative programs Integration and seamlessness of clinical and financial services and
information Protection of consumers' privacy Doing more with less Shortages of key personnel, especially registered nurses Financing structures such as capitation and managed care Care delivery and process management Management of knowledge workers and personal accountability Pressures for quality and sustainable outcomes Leadership skills related to change management
American Nurses Association
American Nurses Association membershipThe strength of a profession lies in the number
of members in its professional organization, its internal unity and the ability to mobilize collective action.
ANA represents nursing at the national level. Yet less than 5% of all RNs belong to the organization