management style: impact on care quality and use of …
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WHAT ISMANAGEMENT STYLE
� Characteristic way of
� Making decisions
� Relating to subordinates
� Styles depend on prevailing circumstances
� Styles depend on subyacent theories on human behaviour (X & Y Theory)
� Styles depend on subyacent theories on organizations (CAS vs. Proffesional Bureaucracy)
Tannenbaum 1958, Schmitdt 1973, McGregor 1957, Anderson & McDaniel 2000
MODELO LIDERAZGO BONOMA-SLEVIN
� Consensus Manager (0, 100): estilo directivo basado enteramente en el consenso. Exponen el problema al grupo y animan a que este tome la decisión importante
� Shareholder Manager (0,0): Estilo directivo pobre. Poca o ninguna información es intercambiada con el grupo. El grupo tiene la autoridad final para tomar la decisión.
� Consultive Autocrat
(100,100): Estilo que solicita mucha información al grupo, pero deja todas las decisiones importantes para sí.
� Autocrat (100,0): Piden poca o ninguna opinión del grupo y toma decisiones solo
Teoría X Teoría Y
Persona típica disgusta trabajar y lo evitará
en lo posible
El trabajo es tan natural como el juego o el
descanso
Persona típica evita responsabilidad, poca
ambición, busca seguridad
Las personas por sí mismas no son perezosas.
Llegan a tener ese hábito a través de la
experiencia
La mayoría de personas deben ser
presionadas, controladas y amenazadas con
castigos para hacerlas trabajar
Ejercitará autodirección y autocontrol para
objetivos compromisos
Hay potencial. En condiciones favorables
acepta y busca responsabilidades. Tienen
imaginación, ingenio y creatividad que
pueden aplicarse al trabajo
Papel gerencial: reprimir y controlar Papel gerencial: desarrollar el potencial y
dirigirlo hacia objetivos comunes
McGregor 1957
Underlying theories for human management style
SELF ORGANIZATIONOF COMPLEX ADAPTIVE SYSTEMS
(CAS)
In Physics
� Prigogine, Nobel Prize
1977
� Complex Quantum
Systems 1997
� Irreversible
thermodynamics
In Biology, Human Society, Cybernetics� Capra 1996
� Pareto 1906
� McCulloch 1952-1968
NURSING HOMES ARE COMPLEX ADAPTIVE
SYSTEMS
� Spontaneously self-organizing (whether
recognized or not)
� System parameters alter conditions of self-
organization from which effective behaviors
emerge
� Managers can influence system parameters to
facilitate better outcomes
� Certain mgnt practices work better than others
CAS APPLIED TO MANAGEMENT THEORY
Complex
Adaptive System
� Adaptive capacity to
perturbation
� Homeostasis
� Self-similar
� Non-linear (small causes can have large results)
Multi-agent
System
� System composed of
multiple interacting agents
SYSTEM PARAMETERS OF COMPLEXITY SCIENCE FOR ORGS. & MANAGEMENT
1. Information Flow
2. Connectivity
3. Cognitive Diversity
4. Participation in decision making
5. Formalization
SYSTEM PARAMETER: CONNECTIVITY
High performing NH
� We help each other out
� We are part of decision
making
Low performingn NH
� I don’t bring up issues
unless it harms a resident
� You pay a price if you say
sthg. to Nursing
Mission is
value based
Mgmt is seen
as helping
out on the
floor
Involve
frontline
staff in
planning &
problem
solving
Forbes-Thompson 2007
SYSTEM PARAMETER: INFORMATION FLOW
High performing NH
� Multiple methods of
formal and informal
communication
� Everyone has a say
Low performingn NH
� Formal communication
methods unused
� Little to no informal
� Why don’t they ask us, we
are the ones with the
resident
Multiple
methods of
formal comm
Recognize
and work
with patterns
of informal
decision
making
Transparent
decision
making
Open to
ideas
SYSTEM PARAMETER: COGNITIVE DIVERSITY
High performing NH
� All disciplines involved in
planning
� Family and community
involved in home’s life
Low performingn NH
� Top down decisions
� Problem solving in isolation
� If you offer your opinion, it
doesn’t help
Elicit diverse
opinions and
ideas
Involve all
disciplines
Acceptance
of diversity
Try diverse
ideas
Forbes-Thompson 2007
POWER STYLES & RESTRAINTS
Manager
Employee Employee Employee
Manager Manager
Autocratic Laissez-faireParticipation
Leader Whole group EmployeesDavis & Newstrom 1991
POWER STYLES & RESTRAINTS
Employee
Manager
Laissez-faire
Employees
Lai, IAG 2005: Low intensity interventions ≠ significant
restraints reduction.
Bourbonniere 2003: Weekend = + Restraints
Huizing 2007: Autonomy in Nurses’ decision making =
+Restraints
Huizing 2006a and 2006b: Low intensity interventions ≠
significant restraints reduction
Olazarán 2010: Metaanalysis: significant reduction with low
intensity interventions, but far from optimum
POWER STYLES & +RESTRAINTS
Employee
Manager
Laissez-faire
Employees
Empowerment of Nurse Aides = + Restraints?
POWER STYLES & +RESTRAINTS
Employee
Manager
Laissez-faire
Employees
Empowerment of Nurse Aides = + Restraints?
Asking direct care staff
to reduce use of restraints
is Management passing on a
hot potato
Lack of Mgnt restraint prohibition
or restraint policy
= lack of commitment
In case of injurious accidental fall:
Who will be to blame?
POWER STYLES & -RESTRAINTS
Manager
Employee
Autocratic
LeaderDavis & Newstrom 1991
Outlawed: Denmark, Japan, some US States
Lai 2005: Management support is crucial, probably more
crucial than staff education
Gulpers, … Capezuti, 2010: EXBELT study (management prohibition)
POWER STYLES &- RESTRAINTS
Employee
Manager
Participation
Whole groupAnderson, Issel and McDaniel 2003
N= 152 nursing homes (Texas)
+ RN participation in decision making = - BPSD
+ level of communication openness = - use of restraints
+ relationship oriented leadership & - formalization = - complications of immobility
STRUCTURAL DIFFICULTIES
� Highly regulated industry -> Rules = thinking
unnecessary
� Nurse Aides = low or undertrained
� Management chain untrained in human
management
� Supervisors’ unrecognized importance
� No legal Change-of-Shift overlap
100500
100
50
0
ROTACIÓN AUXILIARES EN FUNCIÓN AL TIPO DE
LIDERAZGO DE DIRECTORES
Baja Rotación Auxiliares Alta Rotación Auxiliares
ConsultativeAutocrat
AutocratShareholder
ConsensusManager
Donoghue 2009
FACTORES EN AUXILIARES
Rotación
� Falta de respeto
� Dirección inadecuada
� Conflicto laboral o familiar
� Dificultad del trabajo
� Bajas sin cubrir
Retención
� Vocación
� Defensa de paciente
� Relación con residente
� Religión o espiritualidad
� Santuario ante problemas en casa
� Flexibilidad
7 FG, N: 47 Mikas 2009
ESTUDIO CUIDADORES RESIDENCIAS ALBACETE, N=258, 4 MODELOS GESTIÓN
López-Escribano 2009Obsérvese dispersión y valor mínimo = 0
CONCLUSIONS MGT STYLES & RESTRAINTS
� Legal & Managerial restraint prohibition
� Companies defend employees if injurious falls
� Daily 30 min Change-of-Shift overlap = legal requirement to boost participation
� Train Management ladder in CAS
� - restraints
� - costs
� + quality
Testable theoretical model depicting the relationships between nursing management practices and resident outcomes
while controlling for organizational and director of nursing characteristics.
From:Nurs Res. Author manuscript; available in PMC 2007 September 25.
Published in final edited form as:
Nurs Res. 2003; 52(1): 12–21.
MODELO LIDERAZGO BONOMA-SLEVIN
� Consensus Manager (0, 100): estilo directivo basado enteramente en el consenso. Exponen el problema al grupo y animan a que este tome la decisión importante
� Shareholder Manager (0,0): Estilo directivo pobre. Poca o ninguna información es intercambiada con el grupo. El grupo tiene la autoridad final para tomar la decisión.
� Consultive Autocrat
(100,100): Estilo que solicita mucha información al grupo, pero deja todas las decisiones importantes para sí.
� Autocrat (100,0): Piden poca o ninguna opinión del grupo y toma decisiones solo
BURNS 1978, BASS 1998, 2000
Liderazgo transformacional
� Carisma: provee visión y sentido de misión, instila orgullo, granjea respeto y confianza
� Inspiración: Comunica expectativas altas, usa símbolos para centrar esfuerzos, expresa propósitos importantes de forma sencilla
� Estímulo intelectual: Promueve IQ, racionalidad y solución cuidadosa de problemas
� Consideraciones individualizadas: Presta atención personal, trata a cada empleado de forma individual, entrena, asesora
Liderazgo transaccional
� Recompensa condicionada: pacta intercambio de recompensas a cambio de esfuerzo, promete recompensas por buen rendimiento, reconoce logros
� Gestión por excepción (activa):pendiente de desviaciones de normas y estándares, toma acción correctiva
� Gestión por excepción (pasiva): Interviene solo si no se cumplen estándares
MODELO LIDERAZGO BONOMA-SLEVINConsensus
Manager
Consultive
Autocrat
Shareholder Autocrat
50
10050
100
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Grado en el que puede delegar la autoridad y decisiones