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Management and Leadership in Dental Public Health

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Outline

• Difference between management and leadership

• Management tools

• Leadership and change

• Organizational change

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Management vs Leadership

• There are good managers who are not innovative leaders; they are just good status quo leaders

• Leaders must be good managers; but to be a great leader requires a whole set of skills and experiences

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Management

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Management

• Improve performance against agency mission• Win over stakeholders• Create a roadmap

– Identify performance objectives– Set priorities– Roll out the change program

• Take a comprehensive approach

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Team members

• Hiring– The most difficult process

– Heavy price for failure

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Enemies of Trust

• Inconsistent messages

• Inconsistent standards

• False feedback

• Failure to trust others

• ‘Elephant in the parlor’

• Rumors

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• On the folly of rewarding A, while hoping for B. Kerr S. Academy of Management

Executives 1995;9:7-14. – Whether dealing with monkeys, rats, or

human beings, it is hardly controversial to state that most organisms seek information concerning what activities are rewarded, and then seek to do those things, often to the virtual exclusion of activities not rewarded.

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Leadership

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Vision

• There is a process for developing vision.

• An understanding of the environment and defining of the problems facing an organization are prerequisites for developing a realistic and direct vision.

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Leadership from the trench

Leadership, like swimming, cannot be learned by reading about it.

Henry Mintzberg

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Failure is a Prerequisite

• Many of life's failuresare people who did not realizehow close they were to successwhen they gave up.

  Thomas Edison

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Accuracy does not matter, all the time

To achieve the impossible,one must think of the absurd; to look where everyone else has looked, but to see what no else has seen.    Unknown

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Resiliency in Organizations

• The middle of every successful project looks like a disaster.     Rosabeth Moss Cantor

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Management and Leadership

• Introducing challenges that the culture cannot address

• All players participate in planning

• Information sharing

• Making adversaries stakeholders, building relationships, and making positive political strategies

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From Good to Great

James Collins

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From Good to Great

• Level 5 Leadership– No ego– No self-interest– Humility– Professional will and unwavering resolve– Fanatically driven, infected with an incurable need to

produce sustained results– Diligence (plow horse rather than a show horse)– When things go wrong they look in the mirror and blame

themselves– Success is credited to others

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Mode of Operation

• Sustaining

• Disruptive– Personal computers– Cell phone– Microwave oven– Airline travel

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Disruptive• Mid-level providers• ART• Implants• Bio-regeneration• Evidence-based dentistry• Online classes• Individual insurance

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Leadership Pitfalls

• Not communicating directly and clearly the plan for change

• Not defining realistic results and adhering to them

• Telling people what to do

• Time management

• Organizational culture

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Organizational Change

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Change (Fishman. Fast Company April-May 1997;64-73.)

• You cannot change an organization without changing yourself.– In any change effort, the first person to

change is you.

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Choosing Strategy for Change (Kotter JP, Schlesinger LA. HBR March-April 1979)

– It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.

Machiavelli, The Prince

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Choosing Strategy for Change (Kotter JP, Schlesinger LA. HBR March-April 1979)

• An acceleration of the rate of change will result in an increasing need for reorganization.

• Reorganization is usually feared because it means disturbing the status quo, a threat to people’s vested interests in their jobs, and an upset to established ways of doing things. – For these reasons, needed reorganization is often

deferred, with a resulting loss in effectiveness and an increase in costs.

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Choosing Strategy for Change (Kotter JP, Schlesinger LA. HBR March-April 1979)

– Diagnosing resistance• All people experience emotional turmoil• Four reasons

– Desire not to lose something of value– Misunderstanding of the change and its implications– Belief that the change does not make sense for the

organization– Low tolerance for change

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Choosing Strategy for Change (Kotter JP, Schlesinger LA. HBR March-April 1979)

– Dealing with resistance• Education and communication• Participation and involvement• Facilitation and support• Negotiation and agreement• Manipulation and co-optation• Explicit or implicit coercion

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Change requires Chaos

A former 3M CEO ordered a young employee named Richard Drew to abandon a project that the CEO insisted would never work. Drew disregarded the order and went on to invent masking tape, one of 3M’s breakthrough products. Drew’s perseverance also laid the foundation form 3M’s defining product: Scotch tape.

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Change is a Process

• Defining change as a process has a major advantage in implementing any change plan.

• Single change acts tend to fail and, hence, lead to skepticism.

• A process of change by contract portrays a journey with certainties and uncertainties, benefits and risks, and successes and setbacks.

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Change and Personal Gain

You cannot change others unless they benefit from the change.

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Organizational Culture

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It is about culture

• Leaders don’t create value; they create the culture, competencies, and organizational practices that produce value.

• Leaders are biased towards types of leadership and typically employ practices that reflect their bias, not necessarily the needs of the situation.

• HOW your organization operates determines WHAT it creates. – Initiatives often need to be managed differently depending on the

requirements of each stage.• Every leader needs to develop multi-tasking skills

because they must add value in a variety of situations contiguously.

• Every leader needs to surround themselves with colleagues who have diverse perspectives.

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Implementing Change (HBR April 1991;1-12)

Ten Commandments1. Analyze the organization and its need for change2. Create a shared vision and common direction3. Separate from the past4. Create a sense of urgency5. Support a strong leader role6. Line up political sponsorship7. Craft an implementation plan8. Develop enabling structures9. Communicate, involve people, and be honest10.Reinforce and institutionalize change

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Organizational Change1. G Identify any significant changes or developments in the organization’s

external environment by examining customer expectations, competitor strengths, best- in-class peers, and industry trends.

2. O Conduct a preliminary analysis of the organization’s internal environment in terms of its capabilities, competencies, and weaknesses.

3. D Determine whether change is necessary and, if so, estimate the level and degree of change required.

4. J Share data on the organization’s environments with key internal stakeholders to acquire their perspectives, promote understanding, assess their support, and build a sense of urgency for change.

5. Q Assemble a diverse committee whose members are powerful, credible, and willing to work together to define and lead organizational change.

6. A Conduct a thorough assessment of the organization’s resources and design, including its strategies, structures, systems, and culture.

7. L Develop a shared vision for change that is clear, challenging, feasible, and universally appealing.

8. N Develop a general strategy for attaining the vision for change that identifies the major initiatives, themes, or priorities.

9. C Communicate the vision and strategy for change, build consensus, and model desired behaviors.

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Organizational Change

10. F Direct corporate resources to support the attainment of the vision by aligning structures, systems, and policies; establishing mechanisms for integration and feedback; providing training; and dealing with resistance.

11. P Within units, establish specific objectives that will promote quick wins and move the organization toward its vision.

12. H Identify and implement nontraditional processes, new ways of managing, or technical innovations to attain unit-level objectives.

13. K Monitor the implementation process and encourage feedback from managers and employees on what is and is not working.

14. E Refine the implementation process, keep people informed of the progress made by units, and visibly recognize and reward those who exemplify desired behaviors and contribute to the attainment of objectives.

15. M Sustain and expand the use of processes, practices, and technologies that contribute most to unit-level improvements through training, communicating, and appropriate adjustments to structures, systems, and policies.

16. B Evaluate the organizational change process to ascertain whether it produced the desired results and to document the lessons learned.

17. I Establish mechanisms to maintain the gains realized from the organizational change process and to promote future learning and adaptation.