COMPETENCY APPRAISAL 2

Leadership and Management Concepts

THE MEANING OF MANAGEMENT

We can regard management as: Taking place within a structured organizational setting and with prescribed roles; Directed towards the attainment of aims and objectives; Achieved through the efforts of other people; and Using system and procedures Management is tasks. Management is a discipline. But management is also about people. Every achievement of management is the achievement of a manager. Every failure is a failure of a manager. According to Peter Drucker, a management guru, management is a practice rather than a science or a profession so there is no precise solution, and the ultimate test of management is achievement and performance. There appears to be growing acceptance of the term management as the general descriptive label and administration as relating to the more specific function of the implementation of systems and procedures instigated by management. Management is viewed as applying to both private and public sector organizations; and administration is interpreted as part of the management process, and concerned with the design and implementation of systems and procedures to help.

THE PROCESS OF MANAGEMENT

Managerial activities to forecast and plan, to organize, to command, to co-ordinate and to control Henri Fayol describes these elements as: Planning examining the future, deciding what needs to be achieved and developing a plan of action. Organizing providing the material and human resources and building the structure to carry out the activities of the organizations. Command maintaining activity among personnel, getting the optimum return from all employees for the interest of the whole organization. Co-ordination unifying and harmonizing all activities and efforts of the organization to facilitate work and its success. Control verifying that everything occurs in accordance with plans, instructions, established principles and expressed command.

Input

Management Process
Organizing
Organizational structure and chart Staffing

Output

Note: management process is continuous (does not end with output) and is similar in a lot of ways with the nursing process.

Planning

Directing
Command and coordination Communication

Controlling
Evaluation/Performance Appraisal Quality assurance is estimation of the degree of excellence in patient health outcomes and in activity and other resource outcomes to assure quality. Patient care audits - A concurrent audit is one in which patient is observed and evaluated through rounds or patient interview. Retrospective audit evaluation through review of discharged patient charts, and questionnaires or interviews conducted on discharged patients.

Forecasting

Vision-mission statement; philosophy; goals and objectives

key elements: 5 Ms Manpower Machine Materials Money Moment (time)

Patient Care Classification System

Delegation is a process by which a manager assigns specific task/duties to workers with appropriate authority to do the job.

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Planning activities: Feedback Interview Reading/Research Education Survey

5 major characteristics division of work chain of command nature of work clustering of work levels of management Principles: unity of command hierarchy departmentation span of control exception principle decentralization

Supervision Inspecting, guiding, evaluating, and improving working performance of employees with criteria in which a quality and quantity of work production and utilization of time and resources are made.

Utilization of results

Control of resources (discipline, problem solving, and conflict resolution)

4 Rights of Delegation (Hansten, 1998):

1. Task should be within the scope of the persons practice and consistent with the job description 2. Person should have appropriate license or certificate, an appropriate job description and demonstrated skill and is checked off on the skill checklist to delegate in the first place and to accept the delegated responsibility in the second place. 3. Communication should be clear, concise, complete, and correct. 4. Feedback should ask for input, get the persons recommended solution to the problem, and recognize the persons efforts

GETTING TO KNOW THE MANAGEMENT THEORISTS AND GURUS

FREDERICK TAYLOR HENRI FAYOL
Frederick Winslow Taylor (1856 -1915) postulated the theory of Scientific Management. He advocated that work be studied scientifically to determine the "one best way" to perform each task. He also claimed that "scientific management" required a complete mental revolution on the part of owner, manager, and worker. Steps towards work improvement: 1. Controlled observation of the worker's performance through time and motion study 2. Scientific selection of the best man (or woman) to perform each job. 3. Training of selected worker to perform job task 4. Paying the worker according to a differential rate 5. Appointing a few of the most highly skilled workers to managerial positions and to planning and preparing the task of workers 6. Appointing a foreman for each aspect of the work. He (1841 -1925) developed the following 14 principles of management on account of his experience. 1. Division of work 2. Authority and responsibility 3. Discipline 4. Unity of command 5. Unity of direction 6. Subordinate of individual interest to general interest 7. Remuneration of personnel 8. Centralization 9. Scalar chain 10. Order 11. Equity 12. Stability of tenure of personnel 13. Initiative 14. Esprit de corps

MAX WEBER
He advocated that the ideal form of organization for a complex institution was bureaucracy, or an organization characterized by a well-defined hierarchy of authority, division of work based on specialization or functions, highly specific rules governing duties and rights of position incumbents, detailed procedures for dealing with responsibilities, interpersonal relationships, and selection for employment and promotion on the basis of technical competence.

MARY FOLLETT
She saw management as a social process that consisted primarily of motivating individuals and groups to work towards the common end. Follett suggested that a manager should not give orders to an employee; rather, the two of them should analyze the situation and then take order form the situation.

ELTON MAYO and FRITZ ROETHLISBERGER

Between 1927 and 1933, they conducted a series of studies at Chicago Hawthorne West Electric plant where they inferred that some unidentified psychological factors had influenced work output They concluded that much more than the physical environment affected worker productivity.

KURT LEWIN
Kurt Lewin, a social psychologist, put forward the Field Theory of Human Behavior. He proposed those interaction between the worker's personalities, the structure of the primary work group, and the socio-technical climate of the workplace influence a worker's behavior. He concluded that the process of attitude and behavior change occurs in three phases: Unfreezing, Changing; and Refreezing Page 2 of 8 Source: ULTIMATE LEARNING GUIDE | Dr. Carl Balita

DOUGLAS McGREGOR
According to him, the traditional manager of a bureaucratic organization operates on a set of assumption about human nature that he referred to as Theory X. These assumptions are: the average individual has an inner dislike for work and will avoid it whenever possible; prefers to be directed, hopes to avoid responsibility, and is more interested in financial incentives than in personal achievement; they must be controlled, threatened, and coerced to put forth sufficient effort to meet the organizations objectives. McGregor questioned the validity of these assumptions and suggested that a different set of assumptions (Theory Y) reflected a more accurate assessment of human nature; one would encourage workers to develop their potential The assumptions of Theory Y are: expenditure of physical and mental effort in work is as natural as rest or play: Man will exercise selfcontrol and self-direction in the service of objectives to which he is personally committed; average person learns, under proper conditions, both to seek and to accept responsibility; The capacity to apply imagination and creativity to the solution of organizational problems is widely, rather than narrowly, distributed among workers.

CRIS ARGYRIS
According to Argyris (1964), during maturation the individual moves to a condition of a greater independence, increase activity, more varied activity, longer time prospective, and increase self-control. He proposed that the rigid structure and stringent rules of the bureaucracy block normal maturation changes, encouraging employees to become passive and dependent and diminishing their job satisfaction and emotional well-being.

RENSIS LIKERT
He proposed that effective organization is that which focuses attention on building effective work groups with high performance goals, so that workers become strongly identified with organizational goals and exhibit favorable attitudes toward superior and other workers.

HERBERT SIMON
Simon is an information-and-decision theorist who viewed business or service institutions as networks of decision makers. He asserted that employees at all levels of organization made decisions as an information processor. He came up with a differentiation between two approaches to decision making: "optimizing", which is the one used by the so-called Economic Man; and "satisfying," which is the method used by what we call Administrative Man.

ALVIN TOFFLER
He suggested that the only way people would be able to maintain a sense of equilibrium in the face of an increasing rate of change is for them to design personal and social change regulators that are capable of deflecting, decelerating, shaping, or (occasionally) accelerating change selectively.

HENRY MINTZBERG
It is his notion that the typical manager's job encompasses ten roles; of which three are interpersonal roles: figurehead, leader, and liaison; three informational roles are monitor, disseminator, and spokesperson; and four decisional roles: entrepreneur, disturbance handler, resource allocator, and negotiator.

MOTIVATING
It is believed that an employees motivation is somehow related to his productivity, job satisfaction, absenteeism, and job turnover. However, the exact nature of these relationships has not been clearly established.

NEED THEORY ABRAHAM MASLOW

He described humans as "wanting" organisms that satisfy their basic needs in a specific sequence. According to him, higher level needs do not emerge as motivators until lower level needs are satisfied (a satisfied need no longer motivates behavior).

FREDERICK HERZBERG
He proposed a two-factor motivational need theory in which he posited that workers are motivated by two type of needs associated with working conditions: hygiene factors, and needs associated with the work itself that he called motivating factors. Hygiene factors include pay, working conditions, and quality of supervision, job security, and Maslows Hierarchy of Needs agency policy. He claimed that although satisfying, the worker's hygiene needs will not provide job satisfaction. Lack of hygiene factors causes job dissatisfaction; hence, hygiene factors are termed "dissatisfiers". Motivating factors include challenging aspects of the work itself, added responsibility, opportunities for personal growth, and opportunities fro advancement. According to Herzberg, absence of motivation factors causes lack of job satisfaction rather than job dissatisfaction; so motivating factors are termed as "satisfiers".

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B. F. Skinner's operant theory suggested that an employee's work motivation is controlled by conditions from external environment rather than by internal needs and desires. According to Skinner, human exhibits two types of behavior - respondent and operant. Respondent behavior occurs as a result of direct stimulation. When operant behavior is followed by consequences, it is considered a reinforcer. A positive reinforcer is a consequence that increases the probability that the behavior will be repeated. A negative reinforcer is a consequence that, if removed, would increase the probability that the behavior would be repeated.

OPERANT THEORY

EXPECTANCY THEORY

Victor Vroom asserted that an individual's attitude and behavior are shaped by the degree to which he or she finds such peculiarities effective in obtaining valued outcomes. Porter and Lawier (1968) modified expectancy theory by suggesting that a worker's job effort outcomes and his evaluation of expected rewards.

EQUITY THEORY

Adam proposed that workers continuously compare their own work inputs (skill, effort and time) and outcomes (status, pay, and privileges) with those of other employees.

COMPETENCE THEORY

White (1959) proposed a theory of competence motivation where an individual's behavior is motivated by a strong desire to manipulate and control his environment in order to produce a sense of competence.

DIFFERENCE BETWEEN LEADERSHIP AND MANAGEMENT

Motto Challenge Focus Time Frame Methods Questions Outcomes Focuses on Human LEADERSHIP Do the right thing Change/innovation Purposes Future Strategies Why? Journey Potential
LEADERS

MANAGEMENT Do thing right Continuity Structures, process and procedures Present Schedules Who, what, when, where, and how? Destinations/goals Performance
MANAGERS

VERSUS

Do the right thing Are interested in effectiveness Innovate Develop Focus on people Rely on trust Align people with a direction Emphasize philosophy, core values, and shared goals Have a long-term view Ask what and why Challenge the status quo Focus on the future Have their eyes on the horizon Develops visions and strategies Seek change Take risks Inspire people to change Use person-to-person influence Inspire others to follow Operate outside of organizational rules, regulations, policies and procedures Take initiative to lead

Do things right Are interested in efficiency Administer Maintain Focus on systems and structure Rely on control Organize and staff Emphasize tactics, structure and systems Have a short-term view Ask how and when Accept the status quo Focus on the present Have their eyes on the bottom line Develop detailed steps and timetables Seek predictability and order Avoid risks Motivate people to comply with standards Use position-to-position (superior-to-subordinate) influence Require others to comply Operate within organizational rules, regulations, policies, and procedures Are given a position

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TYPES OF LEADERS
AUTOCRATIC
Maintains strong control Gives orders Makes decisions

DEMOCRATIC
Maintains less control Offers suggestions Gives suggestions The whole group does the planning Participative Fosters independence

LAISSEZ-FAIRE
Provides no control Nondirective Relinquishes decision making to others No plans Uninvolved, passive Inefficient (unless an informal leader arises) and fosters chaos Laissez-faire leaders are very permissive, nondirective, passive, and inactive. Members may work independently. Chaos is likely to develop unless an informal leader arises to the situation. Laissez-faire can work with very mature, autonomous workers, but it is more likely to be inefficient and unproductive.

Leader does the planning Directive Fosters dependency

Authoritarian leaders tend to be directive, critical, punitive, and gives themselves higher position than the members which in turn reduces open communication and trust. This type of leadership tends to get good quantity and quality of output but little autonomy, creativity, or self-motivation. Autocratic leadership can be used in emergency situations when the leader knows what to do but this does not develop people.

The democratic leader involves the group in the decision making process and makes suggestions instead of orders. This participation then leads to increased motivation and creativity. Democracy works when the members are knowledgeable, skillfull and work well with others. It may be a tedious and is less efficient than the autocratic method.

THEORIES OF LEADERSHIP
Great Man Theory

Charismatic Theory

The great man theory indicates that a few people are born with the necessary characteristics to be great. Great and effective leaders in any situation possess both instrumental and supportive leadership behavior. Instrumental activities: planning, organizing, and controlling the activities of subordinates to achieve goals Supportive leadership: socially oriented, and allows for participation and consultation from subordinates for decisions that concerns them

The charismatic leader inspires others by acquiring emotional commitment from followers and by arousing strong feelings of loyalty and enthusiasm. Charismatic leaders tend to have a strong conviction in their beliefs, high self-confidence, and a need for power. They tend to set example by behavior, communicate high expectations to followers and express confidence in them, and arouse motives for the groups mission. Followers of a charismatic leader tend to trust the leaders beliefs, have similar beliefs, exhibit affection of the leader, and are emotionally involved in and believe they can contribute to the mission.

Trait Theory

Situational Theory

Traits are earlier thought to be inherited but later research indicates that traits could be obtained through learning and experience. Leadership traits are: energy, drive, enthusiasm, ambition, aggressiveness, decisiveness, self-assurance, self-confidence, friendliness, affection, honesty, fairness, loyalty, dependability, technical mastery, and teaching skills Other common traits: Leaders are more intelligent than the group that they lead Must possess initiative, ability to perceive, and start courses of action not conceived by others Creativity and originality Emotional maturity and integrity Adequate communication skills

Suggests that traits required of a leader differ according to situations. These variables are personality of the leader; performance requirement of both the leader and the followers; attitude, needs, and expectations of the leader and followers; degree of interpersonal contact possible; time pressures; physical environment; organizational structure; nature of the organization; state of the organizations development; and the influence of the leader outside the group. A person may be a leader in one situation and a follower in another, and vice versa, because the type of leadership needed depends on the situation.

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Contingency Theory

Path-Goal Theory

Introduced by Fred Fiedler and indicates that leadership will be effective or ineffective depending on the situation. Identified 3 aspects of a situation that structure a leaders role: Leader-member relationship involves the amount of confidence and loyalty the followers have with regard to their leader. Task structure is high if its easy to define and measure a task. The structure is low if it is difficult to define the task and to measure the progress towards its completion. Position power is the authority inherent in a position, the power to use rewards and punishment, and the organizations support of leaders decision.

Derived by House from the Expectance theory and indicates that people act the way they do because they expect their behavior to produce satisfactory results. The leader facilitates task accomplishment by minimizing obstructions to the goals and by rewarding followers task completion.

Situational Leadership Theory

Predicts the most appropriate leadership style from the level of maturity of the followers. Consistent with Cris Argyris immaturity-maturity continuum

Transaction Leadership

Transformational Leadership

Identifies the needs of the followers and provides rewards to meet those needs in exchange for expected performance. It is a contract for mutual benefits, which has contingent rewards. The leader is the caretaker who sets goals for employees, focuses on day-to-day operations, and uses management by exception competitive, task-focused approach in the hierarchy

Fosters employee development, attends to needs and motives of followers, inspires through optimism, influences changes in perception, provides intellectual stimulation, and encourages followers creativity. The leader is a role model who uses individualized consideration, gives a sense of direction, and promotes self-management. Cooperative, process-focused networking.

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CONFLICT MANAGEMENT
Conflict
Inevitable and can be constructive or destructive. A warning or indicator which tells something is wrong Must stimulate a search for new solutions through problem-

Stages of Conflict:
Latent phase of anticipation where antecedent conditions predict conflict behavior Perceived cognitive awareness of an existing stressful situation Felt affective states (feelings and attitudes) are present and affect the conflict Manifest overt behavior resulting from the earlier phases

solving, clarification of objectives, establishment of group norms, and determination of group boundaries Eliminating conflict is not necessary; managing it, however, is necessary for a manager.

Approaches to Conflict Management mutual trust is the basic foundation of conflict

resolution
Avoiding Creates bad situation through unassertive and uncooperative measures since the conflict is not addressed. May be appropriate; when the other party is more powerful, the issue is unimportant; goal is not attainable; cost of dealing with conflict is higher than benefit; the issue should be resolved by another; more information is needed when one wishes to reduce tension and gain composure. Compromising Moderates both assertiveness and cooperation Addresses a problem more effectively than avoidance but less than collaboration. Both parties feel than they sacrifice something and thus feel partially satisfied Useful in reaching expedient answers in limited periods when goals are only moderately important and the parties have equivalent power. Accommodating Cooperative but unassertive. It is self-sacrificing (opposite of competing) since it neglects ones own needs to meet the goals of the other party. Appropriate; the opponent is correct, the opponent is more powerful, or the issue is of more importance to someone else. Can be used when preserving harmony is important or when collecting social credits Collaborating Assertive and cooperative; contributes to effective problemsolving because both parties try to find mutually satisfying solutions. Integrates insights from different perspectives with the commitment developed through participation in resolution of hard feelings. May take some time; however, it is the most effective method of conflict resolution; used for important issues and interpersonal problems.

Competing Power-oriented mode that is assertive but uncooperative (aggressively pursues own goal at anothers expense) Appropriate when quick or unpopular decision is needed, when the person is very knowledgeable and able to make a sound decision, or when protecting oneself from aggressive people.

WIN LOSE
Position power, mental or physical power, failure to respond, majority rule, railroading, and competing

LOSE - LOSE
Compromise, bribes, arbitration, and general rules

WIN WIN
Consensus, problem solving, and collaborating

STAFFING SYSTEMS Case Method (Oldest method) Each patient is assigned to a nurse for total patient care Functional Nursing Division of labor where nurses are assigned to perform specific tasks. Team Nursing The team is led by a professional or technical nurse who plans for, interprets, coordinates, supervises, and evaluates nursing care. Modular or District Modification of team and primary nursing Uses smaller teams for geographically grouped patients. Primary Nursing (Most recent method)

ADVANTAGE Total patient care Efficiency Least costly Requires less RNs

DISADVANTAGE Different nurse, different shifts, different days Managerial work done by nurses Patient care done by nurses aides Fragmented & depersonalized care Coordination of delegated work needs time

Team effort Frees patient coordinator to manage the unit Nursing care conferences (main feature) help solve problems and develop staff Nursing care plan (another main feature) Useful when there are only few RNs RNs plan care More time may be spent for direct care (RNs can be aided by paraprofessionals) RNs give total patient care Primary nurse on call (24-

Technical aspects of care done by paraprofessionals

Nurses talents confined only to a limited number of patients

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Philosophy: patients should be the focus of RNs Features: RN gives total patient care to 4-6 patients (responsible 24 hours for the patient throughout hospitalization) The associate nurse is expected to contact the primary nurse regarding the care plan Success depends on the quality of nursing staff and administrative support

hours) Associate nurse works with patient when primary nurse is off-duty Accountability in place Continuity of care is facilitated Decreases number of errors from relay of orders Lesser patient complaints Shorter hospital stay

Associate nurse may change care plan without discussing to the primary nurse

STAFFING SYSTEMS
Managed Care
Involves financing care and risk management of acute, chronic, and terminal diseases by health maintenance organizations (HMOs), preferred provider organizations (PPOs), and integrated care systems. Uses a network of credentialed professionals, covers primary and preventive care, and restricts access to specialty providers.

ADVANTAGE
Incorporates case management Can be used with any nursing care delivery system Standard critical paths Efficiency increases Cost reduces

DISADVANTAGE
Continuity of care is questionable

Case Management

Emphasizes achievement of outcomes in designated time frames with limited resources Sometimes called second-generation primary nursing Health care team meeting provide an interdisciplinary approach to problem solving

Focuses on entire episode of illness Achievement of outcomes is emphasized Case manager coordinates care Critical paths Variation analysis and case consultation Inter-shift report and quality assurance Health care team meetings Interdisciplinary approach

Takes effort to coordinate

Staffing in Relation to Leadership and Management

Leader
Knowledgeable in regard to staffing and scheduling Safe staffing accountability Considers the impact of extraneous factors on staffing Periodically examines the unit standard of productivity to determine if changes are necessary Promotes team approach to staffing

Manager
Develops and disseminates fair scheduling policies Assumes accountability for control and quality of staffing Patients needs are met by staffing Schedules staff in the most efficient and responsible way Keeps policies in compliance with existing laws

PATIENT CLASSIFICATION SYSTEM

Minimal Care (category 1) self care or minimal care Those who are recovering, requiring or awaiting diagnostic studies, and are requiring minimal therapy, with less frequent observation Moderate Care (category 2) intermediate or moderate care Moderately ill, recovering from serious illness or operation, requiring nursing supervision and some assistance in ambulation and care Maximum Care (category 3) total or intensive care Critical Care (category 4) highly specialized and critical Patient needing close attention and complete care in most care activities and requires frequent and complex treatments Unstable and acutely ill patients who have high level of and medication dependency, and requires frequent evaluation and adjustments in therapy.

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