TYPES OF LEADERSHIP

AUTHORITARIAN or AUTOCRATIC

- Focuses on power and approval of status by others

- Exercises control and directive behavior
- Makes decisions alone and expects obedience of instructions
- Uses undertones of coercion

Example Scenario:
You’re in a company meeting and the leader is talking about ways to achieve
their goal. Autocratic leader would not consult the rest of the team and set their
own goals and assume that the group members would achieve them up to their
expectations.

DEMOCRATIC OR PARTICIPATIVE

- Formally seeks the views of all relevant parties

- Displays a wish to consult and work with individuals and teams
- Uses human relations approach
- Engages in open two-way communication
- Encourages collaborative teamwork

Example Scenario:
You’re in a company meeting and the leader is talking about ways to achieve
their goal. A democratic leader would discuss with the group members, goals
that would be obtainable. An example of these are the SMART goals - specific,
measurable, achievable, relevant and timely.

1
 PERMISSIVE OR LAISSEZ FAIRE

- Uses few established rules and policies

- Monitors performance from distance, and therefore might appear detached
- Permits individuals and teams to work autonomously.

Example Scenario:
You’re in a company meeting and the leader is talking about ways to achieve
their goal. Laissez-faire leader would not set long term goals for the group to
achieve and allow members to work at their own pace and independently.

BUREAUCRATIC

- Follows established policies and rules to the letter

- Power is exercised by applying fixed and inflexible rules
- Communications are impersonal
- Only makes decisions based on norm

Example Scenario:
You’re in a company meeting and the leader is talking about ways to achieve
their goal. A bureaucratic leader would set the time for the goals to achieve
according to the rule implemented by the organization.

1 Gopee, N., & Galloway, J. (2014). Leadership and Management in Healthcare 2nd Edition. London: Sage Publications Ltd.

2
 CORE TRAITS OF A LEADER

Although the research on traits spanned the entire 20th century, a good
overview of this approach is found in two surveys completed by Stogdill (1948,
1974). In his first survery, Stogdill analyzed and synthesized more than 124 traits
studies conducted between 1904 and 1947. In his second study, he analyzed
another 163 studied completed between 1948 and 1970.

Stogdill’s first survey identified a group of important leadership traits that

were related to how individuals in various groups became leaders. His results
showed that average individual in the leadership role is different from an average
group member with regard to the following eight traits:

1. Intelligence
2. Alertness
3. Insight
4. Responsibility
5. Initiative
6. Persistence
7. Self- confidence
8. Sociability

The findings of Stogdill’s first survey also indicated that an individual does
not become a leader solely because that individual possesses certain traits.
Rather, the traits leaders possess must be relevant to situations in which the
leader is functioning. Leaders in one situation may not necessarily be leaders in
another situation.

3
 Stogdill’s second survey published in 1974, analyzed 163 new studies and
compared the findings of these studies to the findings he had reported in his first
survey. The second survey was more balanced in its description of the role of
traits and leadership. Whereas the first survey implied that leadership is
determined principally by situational factors and not personality factors, the
second survey argued more moderately that both personality and situational
factors were determinants of leadership. In essence, the second survey validated
the original trait idea that a leader’s characteristics are indeed a part of
leadership.

Similar to the first survey, Stogdill’s second survey also identified traits
that were positively associated with leadership. The list included the following 10
characteristics:

1. Drive for responsibility and task completion;

2. Vigor and persistence in pursuits of goals;
3. Risk taking and originality in problem solving;
4. Drive to exercise initiative in social situations;
5. Self-confidence and sense of personal identity;
6. Willingness to accept consequences of decision and action;
7. Readiness to absorb interpersonal stress;
8. Willingness to tolerate frustrations and delay;
9. Ability to influence other people’s behavior; and
10. Capacity to structure social interaction systems to the purpose at hand.

Mann (1959) conducted a similar study that examined more than 1,400
findings regarding personality and leadership in small groups, but he placed less
emphasis on how situational factors influenced leadership. Although tentative in
his conclusions, Mann suggested that personality traits could be used to

4
 distinguished leaders from nonleaders. His results identified leaders as strong in
the following six traits:

1. Intelligence
2. Masculinity
3. Adjustment
4. Dominance
5. Extraversion
6. Conservatism

Yet another review argues for the importance of leadership traits:

Kirkpatrick and Locke (1991, p. 59) contended that “it is unequivocally clear that
leaders are not like other people.” From a qualitative synthesis. Kirkpatrick and
Locke postulated that leaders differs from nonleaders on six traits:

1. Drive
2. Motivation
3. Integrity
4. Confidence
5. Cognitive ability
6. Task knowledge

What, then, can be said about trait research? What has a century of
research on the trait approach given us that is useful? The answer is an
extended list of traits that individuals might hope to possess or wish to cultivate
if they want to be perceived by others as leaders. Some of the traits that are
central to this list include:

5
 1. Intelligence
- Accdg to Zaccaro et.al (2004) found support for the finding that leaders tend to
have higher intelligence than nonleaders. Having strong verbal ability, perceptual
ability and reasoning appears to make one a better leader.

2. Self – confidence
- It is the ability to be certain about one’s competencies and skills. It includes self-
esteem and self-assurance and the belief that one can make difference.
Leadership involves influencing others, and self-confidence allows the leader to
feel assured that his or her attempts to influence others are appropriate and
right.

3. Determination
- It is the desire to get the job done and includes characteristics such as initiative,
persistence, dominance and drive. People with determination are willing to assert
themselves, are proactive and have the capacity to persevere in the face of
obstacles. Being determined includes dominance at times and in situations where
followers need to be directed.

4. Emotional Intelligence
- Has to do with our emotions (affective domain) and thinking (cognitive domain)
and the interplay between the two. Specifically, emotional
intelligence can be defined as the ability to perceive and express emotions, to
use emotions to facilitate thinking, to understand and reason with emotions, and
so effectively managed emotions within oneself and in relationship with others.

2 Northhouse, P. G. (2010). Leadership Theory and Practice 5th Edition. California, USA: Sage Publications Inc. .

6
THE DIFFERENCE OF LEADERSHIP AND MANAGEMENT

Leadership is a process that is similar to management in many ways.

Leadership involves influence, as does management. Leadership entails working
with people, which management entails as well. Leadership is concerned with
effective goal accomplishment, and so is management. In general, many
functions of management are activities that are consistent with definition of
leadership.

But leadership is also different form management. Whereas the study of

leadership can be traced back to Aristotle, management emerged around the
turn of 20th century with the advent of our industrialized society. Management
was created as a way to reduce chaos in organizations, to make them run more
effectively and efficiently. The primary functions of management, as first
identified by Fayol (1916), were planning, organizing, staffing and controlling.
These function are still representative of the field of management today.

In a book that compared the functions of the management with the

functions of leadership, Kotter (1990) argued that functions of two are quite
dissimilar (see table below). The overriding function of management is to provide
order and consistency to organizations, whereas the primary function of
leadership is to produce change and movement. Management is about seeking
order and stability; leadership is about seeking adaptive and constructive
change.

7
 The Difference between the Functions of Leadership and Management

MANAGEMENT LEADERSHIP

Process Order and Consistency Produces Change and Movement

PLANNING AND BUDGETING ESTABLISHING DIRECTION

 Establish agendas  Create a vision

 Set timetables  Clarify big picture
 Allocate resources  Set strategies

ORGANIZING AND STAFFING ALIGNING PEOPLE

 Provide structure  Communicate goals

 Make job placements  Seek commitment
 Establish rules and procedures  Build teams and coalitions

CONTROLLING AND PROBLEM SOLVING MOTIVATING AND INSPIRING

 Develop incentives  Inspire and energize

 Generate creative solutions  Empower subordinates
 Take corrective actions  Satisfy unmet needs

Northhouse, P. G. (2010). Leadership Theory and Practice 5th Edition. California, USA: Sage Publications Inc. .

8
 LEADERSHIP AND MANAGEMENT THEORIES

LEADERSHIP THEORIES

1. Fielder’s Contingency Theory

 Views the pattern of leader behavior as dependent upon the interaction of the
personality of the leader and the needs of the situation. The needs of the
situation or how favorable the situation is toward the leader involves leader-
member relationships, the degree of task-structure, and the leader’s position of
power.

Leader- Member Relation are the feelings and attitudes of followers regarding
acceptance, trust, and credibility of the leader. Good leader- member relations
exist when followers respect, trust, and have confidence in the leader. Poor
leader- member relations reflect distrust, a lack of confidence and respect, and
dissatisfaction with the leader by the followers.

Task-Structure refers to the degree to which work is defined, with specific

procedures explicit directions, and goals. High task-structure involves routine,
predictable or clearly defined work tasks. Low task-structures involves work that
is not routine, predictable, or clearly defined, such as creative, artistic, or
qualitative research activities.
Position of Power is the degree of formal authority and influence associated with
the leader. High position power is favorable for the leader, and low position
power is unfavorable.
When all these dimensions- leader-member relations, task structure, and position
power- are high, the situation is favorable to the leader. In both of these

9
 circumstances, Fielder showed that task directed leader, concerned with task
accomplishment, was effective. When the range of favorableness is intermediate
or moderate, a human relations leader, concerned about people, was most
effective. These situations need a leader with interpersonal and relationship skills
to foster group achievement. Fielder’s contingency theory is an approach that
matches the organizational situation to the most favorable leadership style for
that situation.

2. Hersey and Blanchard’s Situational Theory

 Considers followers’ readiness as a factor in determining leadership style. They

use task behavior and relationship behavior.

High task behavior and low relationship behavior is called a telling leadership
style. A high task, high relationship style is called a participating leadership style.
A low task, low relationship style is called a delegating leadership style.

Follower readiness, called maturity, is assessed in order to select one of the four
leadership style for a situation. For example, according to Hersey and
Blanchard’s situational leadership theory (2000), groups with low maturity,
whose members are unable or unwilling to participate or unsure, need a leader
to use a telling leadership style to provide direction and close supervision.
Participating leadership style is recommended for groups with moderate to high
maturity who are able but unwilling or unsure and who need support or
encouragement. The leader should use a delegating leadership style with groups
of followers with high maturity who are able and ready to participate and engage
in the task without direction and support.

10
3. Path – Goal Theory

 The leader works to motivate followers and influence goal accomplishment. By

using the appropriate style of leadership for the situation (i.e., directive-
supportive, participative, or achievement oriented), the leader makes the path
toward the goal easier for the follower.

The supportive style of leadership is relationship oriented, with the leader

providing encouragement, interest and attention. Participative leadership means
that the leader focuses on involving followers in the decision making process.
The achievement-oriented style provides high structure and direction as well as
high support through consideration behavior.

The path-goal theory is based on expectancy theory, which holds that people are
motivated when they believe they are able to carry out the work, and they think
their contribution will lead to the expected outcome, and they believe that the
rewards for their efforts are valued and meaningful.

4. Charismatic Theory

 House (1971) developed a theory of charismatic leadership that described how

charismatic leaders behave as well as distinguishing characteristics and situations
in which such leaders would be so effective. Charismatic leaders display self-
confidence, have strength in their convictions, and communicate high
expectations and their confidence in others. They have been described as
emerging during crisis, communicating vision, and using personal power and
unconventional strategies (Conger & Kanungo, 1987). One consequence of this
type of leadership is a belief in the charismatic leader that is so strong that it
takes on almost supernatural purpose, and the leader is worshipped as if

11
 superhuman. Charismatic leaders can have a positive and powerful effect on
people and organizations. Examples of charismatic leaders include Florence
Nightingale and Martin Luther King.

5. Transformational Leadership Theory

 Burns defined transformational leadership as a process in which “leaders and

followers raise one another to higher levels of motivation and morality” (Burns
1978, p. 21). Transformational leadership theory is based on the idea of
empowering others to engage in pursuing a collective purpose by working
together to achieve a vision of preferred future.

This kind of leadership can influence both the leader and the follower to higher
level of conduct and achievement that transforms them both (Burns, 1978).
Burns maintained that there are two types of leaders: the traditional manager
concerned with day-to-day operations, called transactional leaders and the leader
who is committed to a vision that empowers others, called transformational
leader.

MANAGEMENT THEORIES

1. Scientific Management

 By Gulick and Urwick (1937), Mooney (1947), Taylor (1947)

 Focuses on goals and productivity; organization is a machine to increase
production
 Selects the right person to do the job; provide the proper tools, training and
equipment to work efficiently.
 Uses time and motion studies to make work efficient.

12
2. Bureaucratic Management

 Weber (1964)
 Focuses on hierarchical superior-subordinate communication transmitted from
top to bottom via a clear chain of command.
 Uses rational, impersonal management; distributes activities among personnel.
 Uses merit and skill as basis for promotion and/or reward
 Uses rules and regulations; focuses on exacting work processes and technical
competence
 Limits personal freedom.
 Emphasizes career service, salaried managers.

3. Human Relations

 Argyris (1964), Barnard (1938), Likert (1967), McGregor (1960), Roethlisberger

and Dickson (1939)
 Focuses on empowerment of the individual worker as a source of control,
motivation, and productivity in meeting the organization’s goals.
 Hawthorne’s studies at Western Electric Plant in Chicago led to the belief that
human relations between workers and managers and among workers are the
main determinants of efficiency.
 The Hawthorne’s effect refers to the phenomena of how being observed or
studied results in a change in behavior.
 It emphasizes that participatory decision making increases worker autonomy and
provides training to improve work.

13
 4. Contingency

 Burns and Stalker (1961), Lawrence & Lorsch (1967), Perrow (1967), Rundall,
et.al (1998), Thompson (1967)
 Highlights that organizational structure depends on the environment, task,
technology and the contingencies facing each unit.
 Uses flexible approach; emphasizes that there is no one best way to manage
work; encourages managers to study individuals and the situation before
adapting efforts and deciding on a course of action to meet the requirements of
the situation.

5. Resource Dependence

 Williamson (1981)
 Emphasizes the need to secure necessary resources and provided reliable and
valid data on patient care processes and outcomes
4

4 Kelly, P. (2012). Nursing Leadership and Management 3rd Edition. New York City: Cengage Learning.

14
 POSITIVE POWERS OF A LEADER

Related to leadership is the concept of power, the potential to influence.

There are two major kinds of power: position and personal. Position power which
is much like assigned leadership, is the power an individual derives from having a
title in a formal organizational system. It includes legitimate, reward and coercive
power (not a positive power). Personal power comes from followers and includes
referent and expert power. Followers give it to the leaders because they believe
leaders have something of value. Treating power as a shared resource is
important because it deemphasizes the idea that leaders are power wielders.

LEGITIMATE POWER

- Person is assigned the power necessary to do the job

- Based on knowledge, hard work and ability
- This is real power and comes with a title and backing from administration
- Example: Chief Nursing Officer or Director of Nursing

REWARD POWER

- Strong power based if not misused

- If you use this base, be FAIR
- Often is misused as manipulation
- Example: You can give weekends and holidays off and control salary increases

REFERENT POWER

- Caring type of power that many people use but do not recognize as a formal
power base
- It develops from feeling of admiration and respect for another person

15
 - Example: If you knew Dr. Jean Watson personally and shared her views from
your personal conversations with her in class, you would quickly develop referent
power
- People would respect you because you had a relationship with such significant
person

EXPERT POWER

- Strongest power base

- Positive and non-aggressive way to have power
- Requires hard work and an increased level of ability
- Expert power in genuine power; work hard to earn it
- Example: You are seen as “the best” in clinical areas

Dahlkemper, T. R. (2013). Anderson's Nursing Leadership, Management and Professional Practice 5th Edition. Philapdelphia: F.A.
Davis Company.

Pedler, M. (2010). A Manager's Guide To Leadership: An Action Learning Approach 2nd Edition. Berkshire, England: McGraw-Hill
Publishing Company.

16
 EFFECTIVE WAYS TO PROMOTE RESPONSIBILITY AND
ACCOUNTABILITY IN HEALTH CARE ORGANIZATIONS

Nurses are legally liable for their action and are accountable for the over-
all nursing care of their patients. Accountability is being responsible and
answerable for actions and inactions of self or others in the context of delegation
(NCSBN, 1995). Licensed nurse accountability includes the preparedness and
obligation to explain or justify to relevant to relevant others, the relevant
judgments, intentions, decisions, actions, and omissions, as well as the
consequences of those decisions, actions, and behaviors.

Responsibility involves reliability, dependability, and the obligation to

accomplish work when an assignment is accepted. Responsibility also includes
each person’s obligation to perform at an acceptable level- the level to which the
person has been educated. The nurse transfers responsibility and authority for
the completion of the delegated task, but the nurse retains accountability for the
delegation process.

So for me, the ways on how to promote responsibility and accountability

in health care organizations are through the following:

1. Be clear about your professional role responsibilities and organizational goals.

2. Provide direction on how your work should be accomplished.
3. Develop clear standards and metrics against which professional performance is
measured. Nurse leaders need to seek commitment from staff and set standards
for role expectations. It is often said that what is measured is what is done so be

17
 clear about how role expectations will be measured. These expectation should
not only include work performance but also interpersonal skills.
4. Hold professionals accountable for their behavior.
5. Build a culture of accountability.

Kelly, P. (2012). Nursing Leadership and Management 3rd Edition. New York City: Cengage Learning.

18
 5 PRINCIPLES OF EFFECTIVE COMMUNICATION BY SULLIVAN AND
DECKER 1992

1. Principle One
 Aim for clarity and focus
 Be sure that the message is understood. Ask for feedback from the receiver to
clarify any confusion. Bring focus to the interaction. Repeating key words or
phrases as questions or using open-ended questions can accomplish this.
2. Principle Two
 Use direct and exact language
 In both written and spoken messages, use languages that is easily understood
by all involved.
3. Principle Three
 Encourage feedback
 This is the best way to help people understand each other and work better.
Remember, though, that feedback may not be complimentary
4. Principle Four
 Acknowledge the contributions of others
 Everyone wants to feel that he or she has worth
5. Principle Five
 Use the most direct channels of communications available
 The greater the number of individuals involved in filtering messages, the less
likely the message will be received correctly. 7

7 Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2010). Essential of Nursing leadership and Management. PA: F.A Davis

Company.

19
 CHARACTERISTICS OF A SUCCESSFUL DECISION MAKER

Leaders possess many personal qualities and characteristics that

influence their organizational decision-making style. Among these are
accountability, risk tolerance and value orientation. Successful leaders should be
willing to take responsibility for their actions, take calculated risks, and adapt
their values to make decisions that will prove most beneficial for their
organization. Leaders often need to be fearless because “the unpredictability or
uncertainty that surrounds most decision making, as well as the accountability
factor (at least organizationally), means that a person has to assume some
degree to risk with each decision.” (Evans & Ward, 2007)

ACCOUNTABILITY

 A crucial part of decision making is being to take responsibility for the resulting
consequences of doing those decisions into actions. No matter how careful the
decision maker is on choosing the correct course of action, no one can be right
one hundred percent most of the time.
 Evan & Ward (2007), point out that “some people do not like to make mistakes,
so they try to avoid problematic decisions. Essentially they hope to avoid
accountability from decision to go wrong. From an organizational point of view,
someone must be accountable.
 An effective leader must not be afraid to be accountable for all the decisions that
he or she makes, whether they turn out to be right or wrong.

20
 RISK TOLERANCE CONTINUUM

 FLIGHT – avoiding risk, confrontation, and change can lead to procrastination of

decision making.
 FLOW – a balance of extreme based on recent experience is the best way to
maintain balance
 FIGHT – seeing challenges in decisions without worrying about risks can lead to
quick gut decision making.

VALUE ORIENTATION

 ANALYTICAL STYLE
a. High risk, people oriented
b. Reflective, moderate decision making speed
 DIRECTIVE STYLE
a. High risk, task oriented
b. Practical, systematic, slow decision making speed
 CONCEPTUAL STYLE
a. Low risk, people oriented
b. May lack practicality, or seem hard to implement
 BEHAVIORAL STYLE
a. Low risk, task oriented
b. Less decisive, decisions that avoid conflict but do not solve the problem
 CONSISTENT STYLE
a. Balance of risks, tasks, and people8

8
Pownall, I. (2012). Effective Management Decision Making. London: Ian Pownall and Ventus Publishing ApS.

21
 THEORIES OF CHANGE

Change means making something different from the way it was originally.
Change may be planned or unplanned. Unplanned changes bring about
unpredictable outcomes, while planned change is a sequence of events
implemented to achieve established goals. In nursing a change agent is a person
who brings about changes that impact nursing services. The change agent may
be a nurse leader, staff nurse or someone who works with nurses. Change
theories are used to bring about planned change in nursing. Nurses and nurse
leaders must have knowledge of change theories and select the right change
theory as all the available change theories in nursing do not fit all nursing change
situations.

Some widely used theories of change are those of Reddin, Lewin, Rogers,
Havelock, Lippit, and Spradley.

REDDIN’S THEORY

Reddin has developed a planned change model that can be used by

nurses. He has suggested seven techniques by which change can be
accomplished:

1. Diagnosis
2. Mutual setting of objectives group emphasis
3. Maximum information
4. Discussion of implementation use of ceremony or ritual
5. Resistance interpretation

22
 The first three techniques are designed to give those will be affected by
the change, an opportunity to influence its direction, nature, rate and method of
introduction. These individuals are then able to have some control over the
change, to become involved in it, to express their ideas more directly and to
propose useful modifications.

Diagnosis, the first technique, is scientific problem solving. Those affected

by the change meet and identify the problems and the probable outcomes.

Mutual objectives setting, ensures that the goals of both groups, those
instituting the change, and those affected by it, are brought into line. It may be
necessary for groups to bargain and compromise.

Group emphasis is sometimes referred to as change emphasis. Change is

more successful when supported by a team rather by a single person. “Groups
develop powerful standards for conformity and the means of enforcing them.”

Maximum information is important to success of change. Management

should make at least four announcements with regard to a proposed change:

1. That a change will be made.

2. What the decision is and why it was made.
3. How the decision will be implemented.
4. How implementation is progressing.

23
 LEWIN’S THEORY

One of the most widely used change theories is that of Kurt Lewin.
Lewin’s theory involves three changes:

1. The unfreezing stage. The nurse manager or other change agent is motivated by
the need to create change. Affected nurses are made aware of this need.

The problem is identified or diagnosed, and the best solution is selected. One of
three possible mechanisms provide input to the initial change:

a. Individual expectations are not being met ( lack of confirmation)

b. The individual feels uncomfortable about some action or lack of action (guilt-
anxiety)
c. Former obstacle of change no longer exists (psychologic safety)

The unfreezing stage occurs when disequilibrium is introduced into the system,
creating a need for change.

2. The moving stage. The nurse manager gathers information. A knowledgeable,

respected, or powerful person influences the change agent in solving the
problems (identification). A variety of sources give a variety of solutions
(scanning) and a detailed plan is made. People examine, accept and try out the
innovation.

3. The refreezing stage. Changes are integrated and stabilized as part of the value
system. Forces are at work to facilitate the change (driving forces). Other forces
are at work to impede change (restraining forces). The change agent identifies
and deals with these forces, and change is established homeostasis and
equilibrium.

24
 ROGERS’ THEORY

Everette Rogers modified Lewin’s change theory. Antecedent included the

background of the change environment. Rogers’ theory has five phases:

PHASE 1: awareness, correspond to Lewin’s unfreezing stage

PHASE 2: interest
PHASE 3: evaluation
PHASE 4: trial, correspond to Lewin’s moving phase
PHASE 5: adoption, corresponds to the refreezing stage; the change is either
accepted or rejected. If accepted, it requires interest and commitment.

Rogers’ theory depends on 5 factors of success, these are:

1. The change must have the relative advantage of being better than the existing
methods.
2. It must be compatible with the existing values.
3. It must have complexities – more complex ideas persist even though simple ones
get implemented easily
4. It must have divisibility – change is introduced on a small scale
5. It must have communicability - the easier the change is to describe, the
more likely it is to spread.

25
 HAVELOCK’S THEORY

Havelock’s theory is another modification of Lewin’s theory, expanded to

six elements. The first three corresponds to unfreezing, the next two to moving,
and the sixth to refreezing.

1. Building a relationship.
2. Diagnosing the problem.
3. Acquiring the relevant resources.
4. Choosing the solution.
5. Gaining acceptance.
6. Stabilization and self-renewal.

LIPPITT’S THEORY

Lippitt added 7th phase to Lewin’s original theory.

PHASE 1: Diagnosing the problem.

PHASE 2: Assessing the motivation and capacity for change.

PHASE 3: Assessing the change agent’s motivation and resources.

PHASE 4: Selecting progressive change objectives.

PHASE 5: Choosing the appropriate role of change agent.

PHASE 6: Maintaining the change.

PHASE 7: Terminating the helping relationship.

26
 SPRADLEY’S THEORY

Spradley has developed and eight-step model based on Lewin’s theory.

She indicates that planned the change must be constantly monitored to develop
a fruitful relationship between the change agent and the change system.

1. Recognize the symptoms.

2. Diagnose the problem.
3. Analyze alternative solutions.
4. Select the change.
5. Plan the change.
6. Implement the change.
7. Evaluate the change.
8. Stabilize the change. 9

9 Burke, W. W. (2014). Organization Change: Theory and Practice: Theory and Practice. LA: SAGE
Publications Inc.

27
RULES OF EFFECTIVE CONFLICT RESOLUTION

Phase 1: Facilitate Listening and Speaking. Listening and speaking are the
basic elements of a conversation. Too often we do one without the other. In the
early phase of conflict resolution, you and your partner need to be able to be as
nondefensive and nonjudgmental as possible. Don’t rush to a solution, because
it’s only by seeing the situation in all its complexity that you’ll be able to
“untangle the strands.”

1. Don’t hear attack. Listen for what is behind the words. If you assume
you’re under attack, you’ll hear attack. Instead of hearing “attack,” try to hear
“information.”

2. Resist the urge to attack—change the conversation from the inside.

If you can avoid hearing “attack,” this principle will be easier to follow. For
example, your partner may be asking you to clean the dishes up earlier after a
meal than you would care to do. Rather than complain angrily about this night
after night, you can instead express the way you feel about the situation. Here’s
where an “I” statement (“I feel disappointed because I like a clean kitchen”) is
preferable to a “you” statement (“You’re a lazy slob.”) As a general rule, this
sentence can give you language to help you frame this statement: “When [this
event] happened, I felt [this feeling] because [my need or interest] is really
important to me.”

3. Talk to the other person’s best self. According to this principle (and its
antithesis- provoke the other person’s worst self) you are best off approaching a
conflict by appealing to your partner’s higher nature. Just as a sports team will
“play down” to an inferior opponent, you and your partner can devolve into a
shouting match if you each appeal to the other person’s worst impulses. Try to

28
find the good in other people, and their good side will be more likely to show
through.

4. Differentiate needs, interests, and strategies. People have basic needs

(such as autonomy) interests (such as seeking to be educated), and strategies
(such as applying to school). Caspersen puts it succinctly. “Every strategy is an
attempt to meet a need or interest.” If you try to come up with a strategy before
figuring out which needs or interests are being addressed, your approach will
come up short. Asking yourself what’s so important about the conflict will help
you identify your needs and interests.

5. Acknowledge emotions—see them as signals. This is perhaps the crux of

the first set of principles. We often act on our emotions without recognizing that
they're telling us something important. Emotions can help you understand what’s
driving the conflict. If you take the time to identify the emotions, you’ll be better
able to get to the root of the problem. Pretending you don’t have those emotions
will only ensure that they continue to get in your way.

6. Differentiate between acknowledgement and agreement. Let your partner

know that he or she is “being heard,” as the saying goes. Don’t assume you and
your partner do, or should, agree on every occasion. You can use phrases such
as “It sounds like,” or “I hear you say that,” perhaps followed up with “Is that
right? What are your concerns?”

7. When listening, avoid making suggestions. No matter how obvious the

“solution” seems to you, it’s important that you hear the other person out. Not
only may your partner be going in a completely different direction than you
imagined, but by waiting, you also communicate an air of respect. You can ask

29
clarifying questions (“Is this what you mean?”) that show you’re interested, but
don’t try to jump-start a solution out of your own discomfort or impatience.

8. Differentiate between evaluation and observation. Create a “no-judgment”

zone for your partner in which you make observations (“You came home at 6 pm
instead of 5 pm, three times this week”) rather than evaluate or judge (“Why are
you always so late?”). By noting a behavior instead of evaluating it, you avoid
putting the other person on the defensive, which, as shown in the previous
principles, can create continued resentment and misunderstandings.

9. Test your assumptions—and relinquish them if they prove false. Being a

good scientist involves being willing to make hypotheses that you can test
empirically. Similarly, in a conflict, simply state your observation (“You came
home at 6 pm…”) along with a question to make sure your observation is correct
(“Is that right?”). In this way, you are able to show that you’re open to being
proven wrong rather than insisting that no matter what, you’re always right.

Phase 2: Facilitate Listening and Speaking. To change the conversation, you

have to get inside it. The open mind is fine to get the conflict resolution process
underway, but then you need to maintain it as you work it through with your
partner.

10. Develop curiosity in difficult situations. You may not always like the
answers that you get during a conflict, such as the infamous question “Is it me or
is it you?” but you still need to maintain an open mind to be able to hear what
your partner has to say.

11. Assume useful dialogue is possible, even when it seems

unlikely. Opponents who are the opposite end of a bargaining table often make
dire predictions about the likelihood of reaching agreement. However, if you
assume the best can happen, perhaps it will. Try to find out what’s keeping you

30
from having that useful dialogue occur, such as asking yourself “What is making
it difficult for us to talk in a productive manner?”

12. If you are making things worse, stop. As people’s emotions escalate in a
conflict, it becomes increasingly difficult to pull away. Have an open mind toward
recognizing that you may be the one preventing you and your partner from
reaching a positive outcome. This doesn’t mean that you always have to give up
in every situation, but you can benefit from recognizing your own contribution to a
conflict, especially if it’s the kind of conflict you have time and time again.

13. Figure out what’s happening, not whose fault it is. Finger-pointing is one
of the most destructive conflict resolution strategies there is. Everyone in a
conflict plays a role in keeping it going, no matter how large or small. Rather than
try to assign blame, try to take the long view to understand what got you to the
position you and your partner are now occupying.

Phase 3: Look For Ways Forward. Planning for the future, and the possibility of
future conflict, is the last phase of conflict resolution. As you'll see, though, it's
not the "end."

14. Acknowledge conflict. Identify your needs and interests as well as those of
your partner, recognize that they’re at odds, and then try to come up with a
workable strategy to resolve those differences. You may find that there are
multiple issues involved. Make a “to do” list of the ones that seem most vital,
along with workable steps for tackling them.

15. Assume undiscovered options exist. You may feel at your wit’s end, but if
you take the positive viewpoint that change is possible, you may be able to come
up with creative solutions to which your partner agrees. Thinking “outside the
box,” perhaps by taking a little break (as in Principle 12) may allow you and your
partner to refocus on a solution you can both live with.

31
 16. Be explicit about agreements. Any good resolution will involve some type
of agreement; rather than make assumptions about what that agreement is, be
sure that both you and your partner are clear. It may seem strange, but by putting
those agreements in writing, you can reduce the chances of misunderstandings
in the future. Similarly, if situations change (such as your partner gets new work
hours), you need to revisit your prior agreements.

17. Expect and plan for future conflict. It would be nice if we settled arguments
once and for all and they never appeared again. However, certain themes are
likely to recur over time, particularly in your closest relationships. The better you
can listen, speak, delve into a conflict, and then come up with an agreement, the
less likely a conflict will come back to haunt you. However, the reality is that our
needs and interests will never completely coincide with others, even those who
you hold nearest and dearest.10

10

Barsky, A. (2014). Conflict Resolution for the Helping Professions. : Oxford University Press.

32
 HOW TO CONDUCT AN EFFECTIVE GROUP MEETING

The success of group or team depends on the active involvement of all

the members. Members should participate fully in all meetings. The following are
guidelines to assist the group or team in conducting an effective meeting.

Brainstorm ideas. Review the focus statement and write your ideas of
everything you know about the focus.

Evaluate what you know. Start with the ideas you brainstormed and
gather any additional information you may need. Analyze the information trying
to determine the specific opportunity, problem or root cause.

Formulate alternatives. Generate a list of alternatives to accomplish

the focus.

Orient toward one alternative. Determine one alternative you can

support. This is your starting position based on the information you know. During
the meeting, you may change the alternative based on additional information
provided by other group members.

Review the agenda. Ensure that you are prepared with information,
status, or assignments.

Ensure that you complete any assignments. The group depends

on you to accomplish your specific actions. Even if you cannot make the
meeting, try to make sure your assignments are on time.
11

11

Pedler, M. (2010). A Manager's Guide To Leadership: An Action Learning Approach 2nd Edition.
Berkshire, England: McGraw-Hill Publishing Company.

33
 CATEGORIES ON HOW TO DEVELOP AND EVALUATE EVIDENCE

ACCDG TO STETLER, et. al

USING THE STETLER MODEL

The basic “how to” of EBP using Stetler Model is divided into the following five
progressive categories or phases of activities.

1. Preparation: Getting started by defining and affirming priority need, reviewing

the context in which use would occur, organizing the work if more than one
individual practitioner is involved, and systematically initiating a search for
relevant evidence, especially research.
2. Validation: Assessing a body of evidence by systematically critiquing each study
and other relevant documents, with a utilization focus in mind, then choosing
and summarizing the collected evidence that relates the identified needs.
3. Comparative evaluation/decision making: Making decisions about use after
synthesizing the body of summarized evidence by applying a set of utilization
criteria, then deciding whether and, if so, what to use in light of identified need.
4. Translation/application: Converting findings into the type pf change to be
made/ recommended, planning application as needed for formal use, putting the
plan into action by using operational details of how to use acceptable findings,
and then enhancing adoption and actual implementation with an evidence-based
change plan.
5. Evaluation: Evaluating the plan in terms of the degree to which it was
implemented and whether the goals for using the evidence were met.12

12 Melnyk, B. M., & Overholt, E. F. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice.

PA: Lippincott Williams & Wilkins.

34
 DIFFERENCE BETWEEN QUALITY ASSURANCE AND QUALITY
IMPROVEMENT
QUALITY ASSURANCE
(QA)
Performance Goal Perform to standards
(controls) across
multiple parts of the
system
Measurement Periodic inspection of
past events (large set of
measures of inputs
and/or processes)
Data Tracking Before and after change
Data System External (e.g. inspection
tools)
Changes Standards driven;
normative; can be linked
to frontline system
analysis
Motivation for change Management led;
compliance; incentives;
competition
13
13
Burke, W. W. (2014). Organization Change: Theory and Practice: Theory and Practice. LA: SAGE
Publications Inc.
QUALITY IMPROVEMENT
(QI)
Aspire to a best
performance of goals for
focused improvement
area
Continuous tracking or
current activity (few key
processes linked to
outcome)
Continuous (e.g. run
charts)
Internal (e.g. registers
and tally sheets)
Theory driven; adaptive
always linked to frontline
system analysis
Shared governance;
internal motivation; “all
teach all learn”
35
 HOW TO EFFECTIVELY DETERMINE STAFFING NEEDS

One of the most frustrating responsibilities of a nurse is determining the

staffing numbers needed to deliver safe and appropriate nursing care. Hospital
administrators and governing bodies often believe that there is “magic” number
of nursing staff needed to care for any given population. This leads to a quest to
find the right answers so that care can be appropriately given.

THREE STAFFING MODELS

The three main models of nurse staffing are:

 budget based, in which nursing staff is allocated according to nursing hours per
patient day
 nurse-patient ratio, in which the number of nurses per number of patients or
patient days determines staffing levels
 patient acuity, in which patient characteristics are used to determine a shift’s
staffing needs

According to ANA, no single staffing model—patient acuity, budget-based,

or nurse-patient ratio—is best for all settings and situations. Most organizations
use a combination of methods and tailor the overall staffing approach to their
specific needs. Concerns about safe staffing may arise when a purely financial
approach is taken without considering such factors as acuity, outcomes, or
research.

36
Budget-based staffing

Commonly, the number of nursing hours per patient day (HPPD) or

nursing hours divided by total patient days is used to determine staffing levels
based on national or regional benchmarks. On a medical unit, total patient days
reflects the average number of patients for a 24-hour period. Nursing hours
refers to the total number of hours worked by all nurses on that unit for a given
time period. This staffing model provides a snapshot of the overall day and shift,
without concern for “churn” within the shift.

Staffing by nurse-patient ratio

The nurse-patient ratio model is based solely on the number of patients

on a unit. A pure nurse-patient ratio approach to staffing might not take into
account individual patient needs or nursing judgment. A hospital might use this
model in conjunction with HPPD, where HPPD is converted to a ratio.

Be aware that although a nursing unit can stop admitting patients if it hits
the maximum nurse-patient ratio, the hospital’s emergency department (ED)
can’t stop accepting patients. Federal laws require hospitals to provide medical
screening for patients who present to the ED. However, ED patients who need to
be admitted to the hospital may have to remain in the ED if additional staff aren’t
available on the unit. With a ratio-only staffing model, the minimum staffing level
would then become the maximum staffing level.

37
 Staffing by patient acuity

Acuity-based staffing considers patients’ level of care complexity.

However, those responsible for staffing must consider more than just how long it
takes to do certain nursing tasks, such as administer medication, perform
assessment, or take vital signs. Breaking down nursing into these tasks runs the
risk of undermining the full scope of nursing practice. Instead, acuity-based
staffing should take into account the scope of nursing and the time needed to
maintain standards of practice. It must give nurses time to perform all functions
within their scope. A nurse who focuses only on assessments and interventions
might underestimate the total amount of nursing care she needs to provide.
Instead, she should consider each element within that scope so she can plan
appropriately for the time needed to perform each element for every patient.14

14

Reid, W. H., & Silver, S. B. (2013). Handbook of Mental Health Administration and Management. NYC:
Taylor and Francis Books, Inc. .

38
 NURSES’ ASSOCIATION IN THE PHILIPPINES

1. NARS (Nagkakaisang Narses sa Adhikaing Reporma sa Kalusugan ng

Sambayanan)

MISSION:
Empower the community health nurses and
people’s health advocates to uphold and protect the people’s right to health and
development.

VISSION:
A healthy society of empowered communities where there is social justice and
equity and a people-centered health care system that is responsive, relevant and
accessible.

Its mission and vision helps nursing leaders to exercise their leadership power by
acting as a change agent for the common good of the nursing profession
especially those who are assigned to the community. This also hones leaders’
ability on how to properly implement fairness and equality in providing health
care to the common people.

39
2. RENAL NURSES ASSOCIATION OF THE PHILIPPINES

MISSION:
To advance the professional development of the registered nurses practicing and
interested in nephrology, transplantation and related therapies and to promote
the highest standards of patient care.

VISION
To represent a professional atmosphere through teamwork, support, dedication,
communication, leadership and pride of members.

The RNAP’s mission and vision help leader practice their skill in communication
which is a very vital element of leadership. It also emphasizes teamwork within
the organization. Which is also a big factor that can contribute to the success of
the organization. 15

15
"Brief History". Philippine Nurses Association. Retrieved 3 April 2015

40
 EXTERNAL FORCES THAT INFLUENCES HEALTH CARE

Society is composed of various system that form part of the greater

structure, or the social system. The health system is one of these systems within
the greater social system. The healthcare industry is an open system, which
means that it is affected by many external factors. In the quest to deliver optimal
patient care, health care services must be cognizant of the influencing factors
that impact on their health care provision.

The following are the external factors that influence health care:

1. Product Issues – the healthcare personnel depends highly on the

performance of its equipment. When the quality of hospital equipment
is poor, the quality of care will also descend. And this should be
resolve by nursing leaders and other medical leaders by providing
good quality equipment.

2. Human Factor Issues

The human factor is also a very important factor to healthcare quality.
The nurses’ knowledge and skills influence the quality of health care
given.

3. Social Issues
Healthcare is really composed of a team. Each health care member has
the responsibility and accountability to a certain patient receiving the
care. So it is a challenge to a leader to properly delegate task suited
for each member of the team.

41
 4. Political Issues
There are many political changes in healthcare. Hospitals have to
publish their annual clinical results. Health care quality is a very
important factor on the over-all quality factor of the hospital. Patients
are reluctant to go to a hospital with bad annual result. This poses as a
challenge to medical leaders to improve quality of care every year.

5. Environment Issues
The physical condition of the hospital or of the health care setting such
as lights and ventilation determines the work environment within the
setting.

6. Technological Issues
Technology is a dynamic field and the speed of technology is high.
Leaders should therefore make sure that their staff is very flexible, so
that new technologies can be integrated easily. 16

16
Duffy, V. G. ( 2010). Advances in Human Factors and Ergonomics in Healthcare. NW: CRC
Press.

42
HOW TO ADDRESS GRIEVANCES OR DISPUTES IN WOKPLACE

Many so-called grievances are informational in nature, resulting from a

lack of breakdown in communication; for example, the employee misreads the
rule, the clause, or policy. Others result from a dissatisfaction from with the rule,
clause or policy – they are gripes. However, whether they are gripes, complants
or bona fide grievances. They must be addressed. A large majority of grievances
result from a decision made and/or communicated by first-line supervisors.
Therefore, if a theory of due process is to prevail, it becomes necessary to
permit an employee to contest an immediate supervisor’s decision and to have
an avenue of recourse beyond that ruling.

The major purpose of the grievances procedure is to dispose of the

grievances fairly and equitably and, where possible reach an agreement. To do
so facts must be obtained and evaluated objectively; fact finding is at the heart
of the grievance procedure. The most effective grievance handling, which results
in fair and equitable resolution of employee disputes, requires:

1. Energetic pursuits of all the facts

2. Omission from the hearing procedures of preconceived ideas about the
validity of the grievance
3. A desire to dispose of the grievance by protecting the rights of the
institution and of the employee
4. A willingness to admit that management is wrong, if that is the case. 17

17

Barsky, A. (2014). Conflict Resolution for the Helping Professions. : Oxford University Press.Moffit, L., M., & Bordone, R.
C. ( 2012). The Handbook of Dispute Resolution. NYC: John Wiley & Sons.

Moffitt, M. L., & Bordone, R. C. (2012). The Handbook of Dispute Resolution. NYC: John Wiley & Sons.

43
 HOW TO DELEGATE TASK EFFECTIVELY

Delegation, much like leadership, is the art of accomplishing work through

others. Nursing has become so multifaceted that it is difficult for one person to
complete every task. Delegation is a skill that is learned, and it is essential in
fulfilling that daily responsibilities of the professional nurse.

For effective delegation, a nurse should:

 Identify the task: Know whether the task is legal to delegate.

You retain responsibility for assessment of the patient’s nursing
care needs.
 Analyze the skill and knowledge needed to accomplish the task:
Consider whether the task is within the scope of the assignee’s
education and ability, whether the circumstances are
appropriate to delegate the specific task, whether directions and
other communications have been sufficient, and how much
direct supervision is needed. Know whether the person is able
to properly and safely perform the task without jeopardizing the
patient’s welfare and whether the task requires professional
nursing judgment. Validate the person’s understanding.
 Assign the task: Provide clear and concise details about the
task, including the time frame and the expected outcome, the
purpose of the task, and any limitations in responsibility or
authority for accomplishing the task.
 Periodically evaluate the delegations of tasks: Let the assignee
complete the task with occasional follow up and feedback.
Adequately supervise the performance of the delegated nursing
task. DO NOT delegate a task if you feel uncomfortable about
someone else having control over how it will be completed.

44
Furthermore, the nurse should also consider the 5 rights of delegation:

1. Right Task
2. Right Circumstances
3. Right Person
4. Right Direction (Communication)
5. Right Supervision18

18

Christensen, B. L., & Kockrow, E. O. (2013). Foundations of Nursing. Missouri: Elsevier Health
Sciences.

45