Leadership Theory

1. Situational theory
Leader behaves according to a given
situation
Considers a persons qualities and
motivations, role expectations of the group,
and social forces at work
Also CONTINGENCY STYLE
Leaders style matches the situation and
its needs
Fiedler and Chemers state that in the work
situation, the managers style and
expectations, and the followers,
characteristics and expectations blend
together and form a productive
combination
Five Kinds of Leader
1. NATURAL LEADER - becomes a leader in
spite of himself. Does not seek role yet
group thrusts the leadership upon him by
tide of events

2. CHARISMATIC LEADER - authentic hero

in the eyes of his followers. To them, he
cant do wrong. Inspires people to make
sacrifices for the cause they represent
3. RATIONAL LEADER-consistent and
persistent in what he thinks is right
4. CONSENSUS LEADER- perceived to be
acceptable to all
5. DOMINATES BY FORCE & FEAR Ruthless in suppressing opposition. Do not
reign long. Contains within itself the seeds
of self destruction
2. Trait Theory

Based on the belief that leaders are born

with certain qualities that properly develop
to enable them to be successful leaders
Trait theories assume that a person must
have a certain innate abilities, personality
traits, or other characteristics in order to
be a leader
Six Categories of Trait

1. PHYSICAL CHACTERISTICS- age, built,

height, weight, bearing
2. BACKGROUND INFORMATION education,
social status, experience
3. INTELLIGENCE- knowledge, judgment,
ability
4. PERSONALITY- decisiveness,
authoritarianism, extroversion, alertness,
aggressiveness, enthusiasm,
independence, self confidence

5. TASK-ORIENTED CHARACTERISTICSpersistence, responsibility, achievement

need, initiative
6. SOCIAL CHARACTERISTICS- supervisory
activity, popularity, prestige, tact,
diplomacy
3. Theory Z
Ouchi enlarges upon Theory Y and
democratic approach
Has humanistic viewpoint
Focuses on developing better ways of
motivating people
Theory Z Ways of Motivating

Collective decision making-quality circle

Long term employment-commitment &
loyalty
Slower promotion
Indirect supervision-self-directed
Holistic concern-trust, fair treatment,
strong commitment, loyalty -whole=
health, wellbeing, performance

4. TRANSFORMATIONAL LEADERSHIP
Burns Concept (1978) of leaderfollower interaction is raised to higher
levels of motivation and morality
identifies this concept as Transactional
Leadership along Transformational
leadership
5. Transactional leader- traditional,
concerned with day-to-day operation
6. Transformational- has vision, committed,
has ability to empower others
4.1.

4.2. Marquis and Houston (2006)

4.2.1. Transactional leader- focus on
management tasks.

Caretakers who use trade-offs to meet

goals
Dont identify shared values
Dont examine causes
Use contingency reward

4.2.2. Transformational leader

identify common values

are committed
inspire others with long-term vision
Look at efforts
Empower others

Vision is the essence of Transformational

leadership.

ability to picture some future state,

sharing this with others, that they too may
share that dream
Tyrell (1994)- identifies visioning as a
mark of Transformational Leader
Thus, followers realize the
interconnectedness of the this vision and
are themselves empowered to move to that
direction.
Wolfe et al. (1994)-TRUST as a basis for
leader and followers to become united

Motivation

the set of skills the manager uses to help

the employee to identify his/her needs and
finds ways within the organization to help
satisfy them.
Motive
A need or desire that incite and directs a
persons action
MOTIVATION- (Mills) a force within the
individual that influences strength and
direction of behavior
Reflected in the amount and quality of
work accomplished by manager and
subordinates
Manager must create a motivating climate.
GOOD MANAGERS

Inspires teamwork
Considers uniqueness of each worker
Communicate expectations
Challenges experiences and opportunities
Utilize positive feedback
Support recommendation for improvement

Types of Motivation
1. Intrinsic comes from within,
2. Extrinsic - enhanced by environment or
external rewards
Motivation Theories
1. Need Theory
A. Abraham Maslow Hierarchy of NeedsPeople seek higher level needs only when
the lower needs have been satisfied

Self-actualization -maximize potentials, achieve

sense of personal fulfillment, competence,
accomplishment
2. Two Factor Theory
A. Frederick Herzberg(1968, 1991)
HYGIENE FACTORS- working conditions:
Salary, quality of supervision, job security,

MOTIVATING Factors- the job itself

Opportunities for growth, development and
advancement
Added responsibilities, challenging aspects
of work, recognition and achievement
Satisfiers
3. McCLellands THREE BASIC NEEDS
THEORY

Esteem -achieve independence, respect,

recognition from others

Strong desire to overcome challenge, to

excel, to grow, to advance, to succeed
Those with high need for achievement set
moderate but achievable goals
Take personal responsibility for finding
solution to problems
Have need for competence
have strong desire for making contribution
or visible outcome
Do quality work
NEED for POWER

Physiologic needs -salary/wage

Belonging -work groups, social support,

cohesion

David McClelland (1961, 1976)

People possess varying degrees:
Achievement
Power
Affiliation
NEED for ACHIEVEMENT

Safety & Security-employee benefits, tenure of

office

interpersonal relations, policies

Growth-producing motivations
Prevent lost productivity
Also called dissatisfiers

Desire to be in control and get others to

behave in contrary to what they would
naturally do
Spend much time thinking how to gain
authority, dominate decisions, and change
others behavior
Control environment around them
They are articulate
Demanding
Manipulative in dealing with peers and
subordinates
NEED for AFFILIATION

Desire to work in pleasant environment

Desire for friendly, close relationships

Desire to relate with people
Those with high need :

a.
b.
c.
d.

Seek out meaningful friendship

Want to be respected and liked
Avoid decisions that oppose the group
More interested in high morale than
productivity

4. EXPECTANCY THEORY
Victor Vroom (1964)
Felt needs of individuals in work are
increased if a person perceives positive
relationship between effort and
performance

PRINCIPLES of COMMUNICATION

5. OPERANT THEORY

B. F. Skinner (1969)
Employees work motivation is controlled by
conditions in the external environment
instead of internal needs and desires
Reinforcer consequence- may be positive
or negative
Should be administered immediately after
the desired behavior

Human exhibit 2 types of behavior

1. respondent- result from direct
stimulation
2. operant- occurs in the absence of any
apparent external stimulation. To
increase or decrease the recurrence of
these behaviors, there should have
consequence.
6. EQUITY THEORY

Jo Stacy Adam (1960)

Employees assess fairness by considering
their input and the psychological, social
and financial rewards in comparison with
those of other.
Communication
transmission of information, opinions &
intentions & among the individuals.
Facilitates work, increases motivation,
effects change, optimizes patient care,
increases workers satisfaction and
facilitates coordination
involves the what, how, by whom, and why
of directives or effectively using the
communication process

Nurse managers communicate for purposes:

Facilitate work
Increase motivation
Effect change

Optimize care
Increase workers satisfaction
Facilitate coordination

Clear lines of communication serve as the

linking process by which parts of
organization are unified toward goal
achievement.
Simple, exact, and concise messages
ensure understanding of the message to be
conveyed.
Feedback is essential to effective
communication.
Communication thrives best in a
supportive environment which encourages
positive values among its personnel.
A managers communication skill is vital to
the attainment of the goals of the
organization
Adequate and timely communication of
work-related issues or changes that may
affect jobs enhance compliance.
TYPES of COMMUNICATION

1.Spoken words
2.Written words - memo, hospital order,
documentation, records, reports
3.Physical expression/significant gestures

Personal appearance
Intonation of voice
Facial expression
Posture/ gait
touch
LINES of COMMUNICATION

1. Downward Communication superior to

subordinate, primarily directive and
activities are coordinated at various level of
the organization.
2. Upward Communication from
subordinates goes upward. Shows in a
form of feedback to show extent of which to
which downward communication has been
received, accepted & implemented.
3. Outward Communication - deal with
information that flows from caregiver to
his/her patients, families, relatives,
visitors and the community.
4. Horizontal or Lateral Communicationbetween peers, personnel or departments
on the same level.

COORDINATION

Unites personnel and services toward a

common objective
Synchronization of activities among
various services and departments
Prevents overlapping of functions
Promotes good working relationships
COORDINATION with:

Medical Service:

Know medical staff and their services

Their rounds schedule
Know patients in the unit, their diagnosis
and actual condition
Their programmed medical plan of care
and treatment

Administrative Service:

Medical Social Service:

Participate in budget planning for staffing,

adequate facilities and material resources
Need for repairs and maintenance of
equipment
Requisition of linen, supplies and
equipment

Laboratory Service:

Laboratory examinations
Properly labeled specimen
Properly filled out requests and forwarded
to the Laboratory
Facilitate easy reference to laboratory
results

Radiology Service:

Properly filled out requests and forwarded

to the department
Provide specific instructions to clients
Determine and endorse allergy test results

Pharmacy Service:

Participate in UNIT DRUG DOSE SYSTEM

planning
Document and replenish emergency drugs
for emergency cart
Request and return meds

Dietary Service:

Forward diet list

Take into consideration special diets,
allergies or food preferences and religious
restrictions
Feedback if food is served on time,
comments on presentation and palatability

Refer psycho-social-economic problems of

clients

Medical Record Service:

Complete and accurate documentation and

chart of clients
Include safety and confidentiality of
patients data

With Community Agencies, other

Institutions, and Civic Organizations
Medical Record Service

Pre-discharge teaching for clients with

special diets

Networking or linkages with community

agencies, civic organizations, or other
institutions for continuity of patient care
Two- way referrals for feedbacking
Bases for Power

The ability and willingness to influence

anothers behavior for the sake of
producing intended effects
The ability to do or act, results in
achievement.
NURSES use power to improve delivery of
care and to enhance their profession.
POWER that is EFFECTIVE is POWER
that is SHARED
SIX Bases of Power

CONTROLLING

It is the use of formal authority to assure

the achievement of goals & objectives.
It involves assisting, regulating, monitoring
& evaluating individual/ group
performance.
Control involves establishing standards of
performance, determining the means to be
used in measuring performance,
evaluating performance, and providing
feedback of performance data to the
individual so behavior can be changed.
Management by objectives (MBO) can be
considered as a control mechanism. Based
on MBO principle determining objectives
(standards) against which performance can
be measured can be stated
Second, specific measures have to be
established to determine whether these
objectives are metThird, the actual
accomplishment of the objectives would be
measured in relation to the standard and
this information would be fed back to the
individual.
On EVALUATION

agency to deliver care. Number and

categories of nursing personnel.
Education, personal qualities,
professional qualities, proficiencies,
function physical facilities,
equipment

Is an ongoing function of management

Occurs during planning, organizing &
directing.
Verifying whether everything occurs in
conformity with the plans.(Fayol)

As a FUNCTION of Management:

seeing that everything is being carried out

in accordance with the orders
Is the sum of the findings of the means in
use to determine whether the goal is being
achieved. (Donovan)
Uses evaluation and regulation. ( Kron &
Gray)
The measurement & correction of the
performance in order to make sure that
enterprise objectives & the plans devised to
attain them are accomplished. (Urwick)

PRINCIPLES OF CONTROLLING

A Critical Few, meaning that fewer people

involved in control, brings about the best
results.
Point of Control or a centralization or
decentralization of authority.
Self-control or Discipline, which
translates to personal acceptance of
responsibility & accountability.
TYPES OF CONTROL

b) Process standard- decision and

actions of the nurse relative to the
nursing process which are
necessary to provide good using
intervention assessment, plan of
care, nursing intervention

Feed forward Control-the control is focus

on operations before they begin
Concurrent Control- the control is
applied to processes as they are
happening.
Feedback Control- the control is focus on
the results of operations

c) Outcome standards- designed to

measure the results of care
provided in terms of changes in the
health status of clients served.
Changes in the level of knowledge,
skills, and attitudes. Satisfaction of
those served members of the health
team
2. Establishment of objectives and
methods for measuring performance.
Objectives- provides clear direction and
communication of expected levels of
achievement. Methods of measurementtask analysis, quality control
Task analysis- actions and
procedures such as written guides,
schedules, rules, records, and
budgets are inspected
Quality control- activities and techniques
employed to achieve and maintain the quality
of products, service, or process

3. Measuring Actual Performance

BASIC COMPONENTS of the CONTROL

PROCESS

1. Establishment of standards, objectives,

and methods for measuring performance

Standards-desirable sets of
conditions and performance
necessary to ensure the quality of
nursing care services which are
acceptable to those instrumental to
or responsible for setting and
maintaining them.

TYPES of PERFORMANCE STANDARDS

3
a) Standards on structure-structure
or management system used by the

Monitoring activity
Finding and eliminating causes of
problems
Assess level of nursing care and its effect
to clients

on-going, repetitive process with the actual

frequency dependent on the type of activity
measured
Maybe scheduled in advance, periodically,
unannounced intervals, at random

4. Comparing Results of Performance with

Standards and Objectives
5. Reinforcing Strengths or Successes and
Taking Corrective Action as Necessary

Positive feedback stimulates motivation,

consistent high performance, and growth
of employee
Corrective actions are applied to improve
performance

BUDGETING

Defined as allocating of scarce resources

based on forecasted needs for a proposed
activity over a specified period.
A numerical expression of expected income
and planned expenditure for an
organization for a specified period of time.
A financial roadmap and plan that serves
as an estimate of future costs in the
operating budget of an organization.
It utilizes man power, material and other
resources to cover costs in operating
projects and program.
By budgeting, managers identify resources
such as money, material and human
resource.
It also communicates performance
expectations.

b. cost per day of service

c. costs per diagnosis.

Nursing Budget

A plan for allocation of resources based on

preconceived needs for a proposed series of
programs to deliver patient care during one
fiscal year

A financial plan to meet future service

expectations
Need for manpower, equipment and
supplies for highest level of quality at a
minimum cost

COMPONENTS OF BUDGETING
REVENUE BUDGET- summarizes the income
which management expects to generate
during the planning period
Plant/Capital-outlines the programmed
acquisitions, disposals and improvements in
an institutions physical capacity
Cash Budgets - are planned cash receipts and
disbursements as well as the cash balances
expected during the planning period

to make adequate funds available as needed

and to use any extra funds profitably.
ensure that the agency has enough, but not
too much, cash on hand during the
budgetary period.

A RIM is 1 minute of nursing resource use.

RIMS are coasted and allocated to DRG
case-mix categories through three steps
The cost of a RIM is calculated by dividing
the total nursing costs for a hospital by the
total minutes of care estimated or nursing
resources used to provide care to all
patients.
The number of minutes used by the total
hospital population, including adjustments
for downtime, such as sick leave and
vacation time, is calculated
The cost of care for each patient is
determined by multiplying the RIM by the
minutes of care required by the patient as
estimated by an equation
e. patient classification systems (costs
per nursing workload measures

COSTING OF NURSING SERVICES

The medical diagnosis is frequently used to

identify groupings.
Diagnosis Relative Group (DRGs) use this
method.
The medical diagnosis is frequently used to
identify groupings.
Diagnosis Relative Group (DRGs) use this
method.
d. costs per relative intensity measures
(RIMs)

Hospital Budget

costs by the number of patient days for a

specific period
Nursing costs are usually considered as
salary and fringe benefits for staff and
administrative nursing personnel.
These costs can be calculated for individual
cost centers, subdivisions, or the entire
nursing service.

a. per diem

The oldest methods used for both rate

setting and reimbursement.
Average nursing care cost per patient day is
calculated by dividing the total nursing

Patient classification systems were developed to

allocate nursing staffing before DRG-based
reimbursement.
Some to calculate the cost of the nursing
component of room rate has used nursing
workload data.
Cost accounting methods allow calculations for
whole patient care units and for individual
patients; consequently, it is possible to generate
a separate charge for nursing services for
individual patients.
These methods are also used to allocate
nursing costs to DRGs or cost centers.
Unfortunately, there is limited irretrievability of
data, because few hospitals record patient
classification data for individual patients in the
patient record or on a database, data collection

and analysis are expensive, and practice may

not adhere standards.
PERFORMANCE EVALUATION/ APPRAISAL

It is a method of acquiring & processing

information needed to improve the
individuals performance &
accomplishments.
Can also reward high performers with merit
pay, recognition & other awards

METHODS of MEASURING PERFORMANCE

Done both formally and informally.

1. Informal appraisal may consist of

Incidental observation of work

performance while engaged in
performing nursing care.
Responses made by worker during
conferences.
Noting the interaction of worker
with clients families, co-workers.

METHODS of MEASURING PERFORMANCE

Formal appraisals
Accomplished regularly & methodically

a. ESSAY - Appraiser writes a paragraph or

more covering the workers strengths,
weaknesses & potentials.
b. CHECKLISTS -contains compilations of all
nursing performances expected of a worker.

c. RANKING- evaluator ranks employees

according to how she or he fared with coworkers with respect to certain aspects of
performance or qualification