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Nursing Management and Leadership

James R. Maramis

I. Understanding the Theory of Leading, Following, and Managing

1. Leadership and Followership

2. Management Theories

3. Leadership Theories

1. Leadership and Followership

Leadership

Definition

Leadership is an influence relationship among leaders and followers who intend real changes and outcomes that reflect their shared purposes.

• A job title alone does not make a leader. Only a person’s behaviour determines whether he occupies a leadership position.

• Good leaders aren’t born, they are made

Leadership is much broader concept than management.

Management is focused on the achievement of the organization goals.

Leadership occurs whenever one person attempts to influence the behavior of an individual or group – up, down, sideways in the organization – regardless of the reason.

It may be for the personal goals or for the goals of others, and these goal may or may not be congruent with organizational goals.

Leadership is influence.

Leading is … • A process of influence in which a leader influences

others toward goal achievement.(Yuki,1998). • Is about creating change & leading change involves

establishing a direction, aligning people through empowerment, motivating & inspiring them toward producing change & achieving the vision

• Requires attending to & acknowledging others, personally authentic & accountable. (Lewine & Regine,2000)

• Leaders affect others by inspiring & engaging others to participate.

• Tourangeau (2003) described leaders as one who challenge the process, inspire a shared vision, enable others to act, model the way & encourage the heart.

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The Army uses this definition:

Leadership is influencing people by providing purpose, direction and motivation while operating to accomplish the mission and improve the organization

What is MANAGEMENT? Definition:

Management is one’s act or manner of emphasizing control.

* hours

* work

* salary

* overtime

* inventory

* supply

5M

• Man

• Money

• Machine

• Method

• Materials

Leadership refers to the ability to guide, motivate and inspire and to instill vision and purpose.

-Influencing beliefs, opinions, and behaviors of others

-Persuade others to follow the direction

Management refers to activities such as planning, organizing, directing, and controlling with the purpose of accomplishing specific goals and objectives within an organization.

- Involves coordination and integration of resources to accomplish specific tasks.

Managers are those who work in the system, Leaders are those who work on the system.

Leader versus Manager

* A leader most often has no delegated authority but obtains his power through other means such as influence.

* A manager has an assigned position within the formal organization.

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* A leader is not necessarily a part of the formal organization

* A manager has a legitimate source of

power due to the delegated authority that accompanies his position.

* A leader has a wider variety of roles as against a manager who holds a limited extent of assignment.

• A leader focuses on group process, information gathering, feedback and empowering others.

• A manager manipulates people, the environment, money, time and other resources to achieve organizational goals.

A leader directs willing followers.

A manager directs willing and unwilling subordinates.

LEADER versus MANAGER

• A leader innovates, a manager administers

• A leader develops, a manager maintains

• A leader focuses on people, a manager focuses on systems and structures

• A leader has a long-term perspective, a manager has a short-range view

• A leader trusts, a manager controls

• A leader has his eye on the horizon, a manager has his eye on the bottom line

• Management is a process of coordinating actions & allocating resources to achieve organizational goals.

• Management process- a discipline emerged with a focus on service of mgt.& view that mgt. is an art of accomplishing of things through people.

• Henri Fayol- a manager wrote book called General & Industrial Management, described functions of planning, organizing, coordinating& controlling-as management process.

• Gulick & Urwick- defined mgt process according to 7 principles, acronym:POSDCORB,planning, organizing,staffing,directing, coordinating, reporting and budgeting.

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3 Skills of an Effective Leader

1. Technical Skill

Ability of the leader to do the task

2. Human-relation Skill (Communication skill)

- Ability of the leader to relay the information and communicate with subordinates

- Leadership skills

3. Conceptual Skill

Ability of the leader to see the organization as a whole. This includes the understanding of vision and mission.

Bennis & Nanus(1985) as cited by Kelly,P,2008, a leader must have the three fundamental qualities: 1.Guiding Vision-leaders focus on professional &

purposeful vision that provides direction toward the preferred future.

2.Passion- expressed by the leader involves the

ability to inspire & align people toward the promises of life.

3.Integrity-based on knowledge of self, honesty

& maturity that is developed through experience & growth.

Followership

Followership and Leadership are separate but a reciprocal roles.

Effective Followers is as important as an Effective Leaders.

Nurses as followers:

- Members of a team

- Attendees at a meeting

- Staff of a nursing care

- etc

Definition

• represents an interaction that occurs when subordinates work concurrently with leaders toward a goal of the organization (FBI Law Enforcement Bulletin)

• willingness to cooperate in working towards the accomplishment of the organization’s goals and objectives, to demonstrate a high degree of teamwork and to build cohesion among the group (faculty member at Dalton State College)

Why does followership matter?

• it’s the followers who get the work done.

• It’s the followers who determine the success or failure of an organization, project, or other enterprise.

• It enables both leaders and followers to build a more effective and harmonious organization.

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Most valuable Follower (Grossman & Valiga) :

- Skilled

- Self-directed employee

- Participate actively in setting the group’s direction

- Invest his/her time and energy in the work of the group

- Thinks critically

- Advocates for new ideas

4 Types of Followers (Kelly, 1992, 1998)

1. Sheep

Passive individuals who comply with whatever the leader or manager directs but are not actively engaged in the work of the group.

2. “Yes” people

actively involved in the group’s work and eagerly support the leaders but they do not initiate ideas or think for themselves.

3. Alienated followers

They think for themselves and often are critical of what the leader is doing but they do not share their ideas openly ; they seem disengaged and they rarely invest their time and energy to suggest alternative solutions or other approaches

4. Effective or exemplary followers

Engaged, suggest new ideas, share criticism with leaders, and invest time and energy in the work of the group

4 Types of Followers (Pittman, Rosenbach, Potter., 1998)

1).Subordinates

- similar like ‘Sheep”

- doing what they are told but not actively involved

2).Contributors

- “Yes” people

- supportive, involved, doing a good job, but not willing to challenge the ideas of the leader

3). Politicians

- willing to give honest feedback and support the leader but they may neglect the job and have poor performance levels

4). Partners

- highly involved

- performed at a high level

- promote positive relationships within the group

- seen as ‘leaders-in-waiting’

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Encounter poor leader/manager?

This may lead to confuse, frustrate, and even distress the nurse. Suggestion when encounter poor leader/manager? • Avoid adopting the ineffective behaviours of this

individual • Continue to do your best work and to provide leadership

for the rest of the group (document all the work clearly) • If the situation worsens, enlist the support of others on

your team to seek a remedy ; do not try to do this alone as a new graduate

• If the situations become intolerable, consider the option of transferring to another unit or seeking another position

2. Leadership Theories

Comparison of transactional and Transformational leaders

Transactional Transformational - Focus on mgt.task - identifies common values

- Is a caretaker - is committed

- Uses trade off to meet goals - inspires others with vision

- Does not identify shared values - has long term vision

- Examines causes - looks at effects

- Uses reward - empowers others

Servant Leadership

• Based on the premise that leadership originates from the desire to serve and that in the course of serving, one may be called to lead.

• Greenleaf, R. (1991)- servant leadership occurs when other people’s needs take priority.

• servant leader must address the question of whether the least advantaged in society benefit from the leader’s service.

• Servant leadership puts serving first, takes holistic approach, shares decision making and builds community.

Larry Spears identified 10 characteristics of servant leader by studying Greenleaf’s work namely:

• Listening,

• empathy,

• healing,

• awareness,

• persuasion,

• conceptualization,

• foresight,

• stewardship,

• commitment to growth of people and

• building community.

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Leadership Styles

Managerial Grid

• The managerial grid model (1964) is a behavioral leadership model developed by Robert R. Blake and Jane Mouton.

• This model originally identified five different leadership styles based on the concern for people and the concern for production.

The indifferent (previously called impoverished) style (1,1): evade and elude.

• In this style, managers have low concern for both people and production.

• Managers use this style to preserve job and job seniority, protecting themselves by avoiding getting into trouble.

• The main concern for the manager is not to be held responsible for any mistakes, which results in less innovative decisions.

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The accommodating (previously, country club) style (1,9): yield and comply.

• This style has a high concern for people and a low concern for production.

• Managers using this style pay much attention to the security and comfort of the employees, in hopes that this will increase performance.

• The resulting atmosphere is usually friendly, but not necessarily very productive.

The dictatorial (previously, produce or perish) style (9,1): control and dominate. • With a high concern for production, and a low concern for people, managers using this style find employee needs unimportant; they provide their employees with money and expect performance in return. • Managers using this style also pressure their employees through rules and punishments to achieve the company goals. • This dictatorial style is based on Theory X of Douglas McGregor, and is commonly applied by companies on the edge of real or perceived failure. • This style is often used in cases of crisis management.

The status quo (previously, middle-of-the-road) style (5,5): balance and compromise.

• Managers using this style try to balance between company goals and workers' needs.

• By giving some concern to both people and production, managers who use this style hope to achieve suitable performance but doing so gives away a bit of each concern so that neither production nor people needs are met.

The sound (previously, team style) (9,9): contribute and commit.

In this style, high concern is paid both to people and production. As suggested by the propositions of Theory Y, managers choosing to use this style encourage teamwork and commitment among employees.

This method relies heavily on making employees feel themselves to be constructive parts of the company.

The opportunistic style: exploit and manipulate.

• Individuals using this style do not have a fixed location on the grid.

• They adopt whichever behaviour offers the greatest personal benefit.

The paternalistic style: prescribe and guide.

• In The Power to Change, it was redefined to alternate between the (1,9) and (9,1) locations on the grid.

• Managers using this style praise and support, but discourage challenges to their thinking.

Major Theories of Management

A. TRADITIONAL MANAGEMENT METHODS

1. The Scientific Management

2. General Administrative Theory

3. Bureaucratic Management

B. THE BEHAVIORAL MANAGEMENT MOVEMENT

C. THEORY Z: JAPANESE MANAGEMENT STYLE

D. 21ST-CENTURY MANAGEMENT THOUGHT

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A. TRADITIONAL MANAGEMENT METHODS

1. The Scientific Management

• Frederick Winslow Taylor (1856–1915) is known as the father of scientific management

• During Industrial Revolution, frustrated with what he called “systematic soldiering,” where workers achieved minimum standards doing the least amount of work possible, Taylor postulated that if workers could be taught the “one best way to accomplish a task,” productivity would increase.

His principles included the ideas that:

1. a worker’s job could be measured with scientific accuracy;

2. workers’ characteristics could be selected scientifically and could be developed to investigate the causes of and solutions to work problems;

3. productivity would be improved through scientific selection of and progressive development of the worker; and

4. there should be continuing cooperation of management and workers

• Taylor’s scientific management principles were based on managing time, materials, and work specialization.

• By controlling these variables, he was able to decrease production costs and increase productivity.

• Taylor believed that organizational function was optimal when the roles of individuals were designed to be highly specialized.

• This emphasis on specialization was an early impetus for the development of specialty certification in nursing

2. General Administrative Theory

• Henri Fayol (1841–1925)

• Management, according to Fayol’s work, includes five overriding concepts:

(1) Prevoyance, or the anticipation of the future and the development of a plan of action to deal with it;

(2) Organization of people and materials;

(3) Command of the activity among personnel;

(4) Coordination of the parts of the organization into a unified whole; and

(5) Control through application of rules and procedures.

Henri Fayol’s 14 Principles Of Management

1. Division Of Work

Specialization allows the individual to build up experience, and to continuously improve his skills. Thereby he can be more productive.

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2. Authority

The right to issue commands, along with which must go the balanced responsibility for its function.

3. Discipline

Employees must obey, but this is two-sided: employees will only obey orders if management play their part by providing good leadership.

4. Unity Of Command

Each worker should have only one boss with no other conflicting lines of command.

5. Unity of Direction

People engaged in the same kind of activities must have the same objectives in a single plan. This is essential to ensure unity and coordination in the enterprise. Unity of command does not exist without unity of direction but does not necessarily flows from it.

6. Subordination of individual interest

Management must see that the goals of the firms are always paramount.

7. Remuneration

Payment is an important motivator although by analyzing a number of possibilities, Fayol points out that there is no such thing as a perfect system

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8. Centralization (Or Decentralization)

This is a matter of degree depending on the condition of the business and the quality of its personnel.

9. Scalar chain (Line of Authority)

A hierarchy is necessary for unity of direction. But lateral communication is also fundamental, as long as superiors know that such communication is taking place. Scalar chain refers to the number of levels in the hierarchy from the ultimate authority to the lowest level in the organization. It should not be over-stretched and consist of too-many levels

10. Order

Both material order and social order are necessary. The former minimizes lost time and useless handling of materials. The latter is achieved through organization and selection.

11. Equity

In running a business a ‘combination of kindliness and justice’ is needed. Treating employees well is important to achieve equity.

12. Stability of Tenure of Personnel

Employees work better if job security and career progress are assured to them. An insecure tenure and a high rate of employee turnover will affect the organization adversely.

13. Initiative

Allowing all personnel to show their initiative in some way is a source of strength for the organization. Even though it may well involve a sacrifice of ‘personal vanity’ on the part of many managers.

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14. Esprit de Corps

Management must foster the morale of its employees. He further suggests that: “real talent is needed to coordinate effort, encourage keenness, use each person’s abilities, and reward each one’s merit without arousing possible jealousies and disturbing harmonious relations.”

What Is Management? (According To Fayol)

Fayol's definition of management roles and actions distinguishes between Five Elements:

• Prevoyance. (Forecast & Plan). Examining the future and drawing up a plan of

action. The elements of strategy.

• To organize. Build up the structure, both material and human, of the undertaking.

• To command. Maintain the activity among the personnel.

• To coordinate. Binding together, unifying and harmonizing all activity and

effort.

• To control. Seeing that everything occurs in conformity with established rule and expressed command.

Application Of Fayol’s Principles

• Change and Organization.

• Decision-making.

• Skills. Can be used to improve the basic effectiveness of a manager.

• Understand that management can be seen as a variety of activities, which can be listed and grouped.

3. Bureaucratic Management

• Max Weber (1846–1920)

• The ideal bureaucracy includes the concepts of division of labor, authority hierarchy, formal selection, formal rules and regulations, impersonality, and career orientation.

• Weber believed that the more impersonal, rational, and regulated the work environment, the more likely the employees were to be treated fairly, and the more likely the organization was to reach its objectives.

• He perceived that only through concentrating power in the hands of a few people in a hierarchical structure could an organization be managed effectively and efficiently.

• While he did not necessarily agree that bureaucracy was the best strategy, because it removed autonomy from the individual, he believed it was the only way to assure the overall success of an organization

• Traditional management styles have their advantages and disadvantages.

• The prime advantage is that they enhance the organization and efficiency of industry.

• The disadvantages of traditional management include rigid rules, top-down decision making, and authoritarianism.

• In other words, traditional management theory created an environment that was less optimal from a humanistic perspective.

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B. THE BEHAVIORAL MANAGEMENT MOVEMENT

1. Hawthorne Effect

Elton Mayo (1887–1957)

Management must be concerned with reserving the dignity of the workers, demonstrating appreciation for their accomplishments and, in general, recognizing workers as social beings with social needs

Hawthorne Studies/ Effect

• Elton Mayo conducted an investigation study on the effects of changes in illumination on productivity. Lighting was changed for the experimental group but remained constant for the control group.

• As the illumination was increased for experimental group, the production of both groups increased, when it was decreased for experimental group, production continued to increase for both groups. The conclusion was lighting had little effect on production.

• Elton Mayo (1933), discovered that employees increased their productivity when they were observed by others.

• Hawthorne Effect- occurs when someone’s behavior is altered because of being studied.

• This has great implications for research because it is always possible that results may be altered by the very acts of observation and increased attention.

• This threat to validity has become known as the Hawthorne Effect, after the name of the company where Mayo conducted his research.

2. Theory X

3. Theory Y

C. THEORY Z: JAPANESE MANAGEMENT STYLE

• William G. Ouchi

• discusses the importance of encouraging group contributions

• In Japan, individuals rarely desire personal recognition because they believe that nothing is possible without everyone’s contributions

• Although in the United States the predominant values focus on individual accomplishments, it is increasingly recognized that shared governance, which recognizes the importance of contributions from every employee, is the desired model.

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Theory Z- a Japanese form of participative management. - with apparent concern for worker where there is

inclusive personal and professional relationships and social support.

- Collective decision making is practiced- ideas pass from manager to manager for approval- that helps established trust and cooperation.

- Quality circles are formed ( 2-10 employees meet to identify problems ,explore options and make decisions. Quality circles have increased worker productivity enhanced job satisfaction and reduced turn over in addition to solving identified problems

- JAPANESE theory Z focuses on four S’s of management; staff, skills, style and super ordinate goals.

- Staff- workers, skills- capabilities of the organization or key personnel, style- refers to cultural style of organization or how managers achieve goals. Super ordinate goals are the guideposts as determine by the personnel.

D. 21ST-CENTURY MANAGEMENT THOUGHT

Motivation Theory • Why people work?

• Why do some employees achieve high productivity while others are contented to less?

• What a manager can do to stimulate motivation?

• Frederick Taylor believed that if energetic people with high productivity learn that they earn more than lazy worker who does as little as possible.

• Incentive is a means of motivating people.

• Pay depends on productivity.

• Incentives like merit increases, bonus profit sharing, savings sharing, piece rates are examples of monistic methods.

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Employee Motivation Theory • McGregor ,Douglas (1932) develop managerial implications of

Maslow’s theory. • Notes that one’s style of management is dependent on one’s

philosophy of humans and categories assumptions as theory X and theory Y.

• Theory X: – people will avoid work if possible because they dislike it. – They must be directed, controlled, coerced and threatened – They have little ambition, avoid responsibility but want security. – Money is the reason for working. – McGregor believe that people behave as in theory X it is because of

what the system has done to them- not because of their inherent nature.

– A manager with a theory X philosophy would probably use fear and threats to motivate personnel, supervise closely, delegate little responsibility and not consider personnel participation in planning.

• Theory Y:

–People like and enjoy work, self directed and seek responsibility, have imagination, creativity and intellectual capacity.

–Value achievement, want to improve quality.

–Money is only one reason for working.

–Manager with theory Y philosophy will use positive incentives like praise, recognition, opportunities for individual growth, be delegated with responsibilities and encourage in participating problem solving.

Mc Clelland Basic Needs Theory

• Identified 3 basic needs that all people have in varying degrees namely; need for achievement, power and affiliation.

• Need for achievement-involves desire to make contribution, to excel and to succeed.

• People with high achievement- needs are eager for responsibility, take calculated risk and desire feedback about their performance

• People with high need for power-want to be in control and desire influence over others. Interested in personal prestige and power than effective performance.

• People with high affiliation needs- desire working in human environments and seek out meaningful relationships. Want to be respected and avoid decisions or actions that oppose group norms.

• Implications: Managers should match personnel needs with assignments.

• Eg. project needs well defined objectives and specific task- person with high achievement need maybe appropriate.

• Project involves unpleasant task with personnel (such as retrenchment) a person with high power needs may do the job best.

• A person with high affiliation needs would not want to make decision that would alienate peers but would be good for fostering morale.

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