Ch-4 Leadership For MPH

Leadership Function
By;
Zemichael Wg.
1 Department Public Health, AU 09/18/2020
Leadership
“Trust men and they will be true to you;

treat them greatly and they will show
themselves to be great.”
Ralph Waldo Emerson

Objectives
At the end of this session, you will be able to:
define leadership;

describe the links between management and
leadership and improving health outcomes;

explain the differences between leadership and
management;

Describe the different leadership theories and
models
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09/18/2020 Department Public Health, AU
Presentation outlines
Introduction to leadership
Definitions of leadership
Who are leaders
Leadership and management
Dimensions of leadership
Leadership at different level
Leadership, authority and power
Leadership trait and skill
The role of leadership in HSO/HS

Why do we need to develop Medical
Leadership?
History of…
Low levels of medical engagement in management and
leadership
Tensions between doctors and managers
Acknowledgment that…
o ALL health care staff require management and leadership
competences to be effective; SOME take on service leadership
roles

Why do we need to develop Medical
Leadership?
Growing evidence of a link between…
Medical engagement and organisational performance
(Ham and Dickinson, 2008).

Medical engagement and patient safety (Firth-Cozens
and Mowbary, 2001).

National Drivers
The NHS Next Stage Review Report (2014/15)
highlights a commitment to improving leadership

within the NHS
Taken as One transformation agenda of the current
years
Enhancing Engagement in Medical Leadership
Project-improving leadership and Good

governance!!!
How important is a leader?
In most cases, people will perform at about
60% of their potential with no leadership at
all
Thus, an additional 40% can be realized if
effective leadership is available

capability
utilization
Contribution due to leadership 40%

ability of manager
Default contribution due to

60%
need for a job, peer pressure, etc.

Leadership - definition
Leadership is not domination, but the art of
persuading people to work toward a common goal
(Goleman and Daniel,1995).
Cart Wright and Zander(1968) defined leadership as
the act and activities of one person that contribute
to performance by others.
Fiedler and Chemers(1974) defined it as “unequal
influence and power relationship” in which
followers accept the leaders right to make certain
decisions for them.

Leadership…
Bass(1990) “leadership occurs when one group
members modifies the motivation or competencies
of others in the group.”
Management sciences for health (2006) defines
Leadership is Enabling Groups to Make Progress
in Complex Conditions.
It is helping groups of people to identify their
critical challenges, and mobilizing them to learn
and take effective action.
Leadership is an activity that takes place at all
levels, not a position of authority

Definitions cont’d….
“Influencing/persuading people so that they will strive
willingly towards the achievement of group
goals/organizational goals” Koontz, H. and C. O’Donnell. “Management:
A System of Contingency Analysis of Managerial Functions”. McGraw-Hill, New York, 1976.

Who is a leader?
As Bass stated “ leaders are agents of change,

persons whose acts affect other people more than
other people's acts affect them.”
View leadership as a process of one individual
influencing another individual or group to
achieve particular objectives.
Influence Achieve
Leaders Exercise
followers’ objectives
leadership
behavior
behavior
Fig : The process of leadership (Longest,etal,2000)

Who is a leader?...
A leader is someone who has a vision, and
ability to see it through to reality, while keeping
everyone else concerned on board.
A good leader is always ready to learn and be

led.
A leader is essentially someone who at a point in

time is able to direct or influence certain types of
activities when there is a definite goal that we are
working towards.

Who is a leader?...
Innovates
Develops new system
Inspires people
Longer range view
Asks what and why
Challenges it
Does the right thing
Could you tell us world class leaders????

Who are leaders?...

Great leaders
We can all think of great leaders who have
changed history, Gandhi, Nelson Mandela,
mother Teresa, Abraham Lincoln and Martin
Luther King and Meles Zenawi.
These are people who inspired millions to

challenge their existing conditions and to take
action.

Abraham Lincoln
Vision
“ No man will be a
slave. Everyone man
is created equal.”
Initial reaction
“You are going to break
the nation apart!”
Price paid
His life

Mother Teresa
Vision
“Care for the dying.”
Initial reaction
“You will die yourself!”
Price paid
Life of sacrifice

Mahatma Gandhi
Vision
“An independent
India”
Initial reaction
“ But that will never
happen!”
Price paid
His life

Nelson Mandela
Vision
“A democratic South
Africa, Free of
apartheid.”
Initial reaction
“You are crazy!”
Price paid
27 years in prison

Everyday leaders
But what about those leaders in our midst,
those people who enable groups to make
progress at the local and district levels. What
can we learn from those who lead others
everyday, in difficult conditions.

Leadership at All Levels
When people think of leaders they often think
about highly placed public figures in governments
or organizations who are admired for their
extraordinary, and often charismatic qualities.
The assertion, however, is that there are people at

all levels in both the public and private sectors who
are leading their teams, large or small, towards the
realization of a specific vision.
We call these people "managers who lead."

Leadership at All Levels
A nurse at a rural health post in Egypt
commented on how her views on leadership
have changed: “When we first came to attend
the leadership development meeting, we
thought that the clinic director will be the
leader, but we realized that every one of us is
a leader.”

Differences b/n leadership &MGT
Managers and leaders (Bennis,1989)
No. The Manager The Leader
1 Administers Innovates
2 Maintains Develops
3 Relies on control Inspires people
4 Shorter range view Longer range view
5 Asks how and when Asks what and why
6 Accepts the status quo Challenges it
7 Does things right Does the right thing

Differences cont’d

What do good leaders do?
SCAN their environment for challenges and
opportunities
 FOCUS their attention around the critical
challenges
 ALIGN and MOBILIZE their organizations to
make progress
 INSPIRE those around them to learn and create
effective solutions

Leading and Managing at All Levels
Sustainable Performance
Leading Managing
 PLANNING
 SCANNING Outcome - Organization results
defined and resources assigned
Outcome - Awareness of  ORGANIZING
conditions
 FOCUSING Outcome - Functional
structures, systems, and
Outcome - Clarity of direction processes for efficient operations
 ALIGNING/MOBILIZING  IMPLEMENTING
Outcome - The whole is greater Outcome - Individuals at all
than the sum of the parts: levels are able to carry out the
synergy and complementarity organizational direction
 INSPIRING  MONITORING &
Outcome - A culture that EVALUATING
encourages commitment and Outcome - Improved information
creativity and knowledge

Dimensions of Leadership

There are many articles and books on leadership.
Authors write that:
 Leadership involves not just "doing," but "being.“

Effective leaders have a high level of self-awareness.
"Leadership involves the discipline of continually

clarifying and deepening our personal vision, of
focusing our energies, of developing patience, and
of seeing reality objectively…." (Senge 1994:7,8)

Leadership is exercised with others.
Organizations that face challenges in their
environments must adapt and change.
Leaders get people to face the challenge, the
change, and the learning. "Solutions to adaptive
challenges reside in the collective intelligence of
employees at all levels. Often the toughest task
for leaders in effecting change is mobilizing
people throughout the organization to do
adaptive work." (Heifetz and Laurie 1997:33)

Leadership is responsibility.
"Leadership is responsibility, not rank, title,

privilege, or money… [Leaders] did not start out
by asking themselves, 'What do I want?' but
'What should be done?' Then they ask
themselves, 'What should I do and what must I
do to make a difference?'" (Drucker in Hesselbein
et al. 1996:xii–xiii)

Leadership happens at all levels.
"Students of management and mid-level
managers in the organizations often ask,
'How can we lead the organization and make the
changes we are talking about if we are not in the
upper ranks?'
Tell them, 'You can start right where you are; it
doesn't matter what your job is. You can
contribute your new judgment, new leadership,
to your team or your group.'" (Hesselbein
1997:83)

Leadership and management are both necessary.
"Leadership and management are two

distinctive, complementary systems of action,
each having its own characteristic practice and
activities, but both are necessary for success in an
increasingly complex and volatile setting."
(Kotter 1990:85)

Leadership, Authority, & Power

We have said that leadership can—and
should be—exercised at all levels, not just at
the top, whether one is a nurse in a
rural health unit responsible for some people,
or a minister of health responsible for the
performance of an entire health system.

This notion of 'leadership at all levels' often
surprises people. That is because they confuse
leadership with authority.
Leadership is not about position.
Leadership is about enabling people to face
challenges.
Facing a challenge means change in the way
things are done.
Leadership helps an organization to be
successful and create the future it wants.

Authority is a role that people take on because of
the position they are in.
Authority is the power vested in a person by
virtue of their role to expend resources (financial,
material, technical and human).
Sometimes people in positions of authority are
also leaders, but not necessarily so.
Conversely, some people without authority can
be very effective leaders. We need both.

Leadership in an organization
 The quality of leadership in a health services
organization/health systems (HSO/HS) affects
how work is done, how well the organization
or system perform, and whether its objectives
are achieved.
 Burns(1978) established that leadership in an

organization is of two types:
1. Transactional
2. Transformational

occurs through out a
Transactional leadership
HSO/HS; as managers directly supervise people,
which establishes ”supervisor-subordinate
relationship”
The needs of followers are met if they perform to

the leader’s expectations
Leaders and followers undertake transactions

through which each receives some thing of value

Transactional…
Directs appeals for performance through a
clearly defined reward system
Four key behaviors:
Making rewards contingent on performance
Correct problems actively when performance is
lacking
Refraining from interruptions of performance
when it does not need altering
A laissez-faire approach to organizational change

Transformational leadership –more likely to be
practiced in HSO/HS by senior managers- the
purpose is significant change in status quo.
In this role managers will focus on changes that are
organization or system wide in scope.
In practicing transformational leadership,
managers are more focused on creating change
rather than exchange.
They lead by providing strategic directions and
vision to HSO/HS to achieve mission and
objectives
Why the difference?
What makes leaders role of managers different
at different levels?
1.Diversity and homogeneity of those who
must be led.
Transactional leaders lead homogenous
group
Transformational leaders lead heterogeneous
group
2. The amount and sources of power available
to them.
Core Leadership Theories
1. Trait Theories – What Type of Person
Makes a Good Leader?
2. Behavioral Theories – What Does a
Good Leader Do?
3. Contingency Theories – How Does the
Situation Influence Good Leadership?
4. Power and Influence Theories – What
is the source of leader’s power?

Trait Theories
Trait theories argue that effective leaders
share a number of common personality
characteristics, or "traits.“
Trait theories help us identify traits and

qualities (for example, integrity, empathy,
assertiveness, good decision-making skills,
and likability) that are helpful when leading
others.
Behavioral Theories
Behavioral theories focus on how leaders
behave.
In the 1930s, Kurt Lewin developed a

framework based on a leader's behavior.
Autocratic
Democratic
Laissez-faire
Further developed into spectrum…

consultative, participatory, etc

Contingency theories
The best leadership style depends on
the situation.
These theories try to predict which

style is best in which circumstance.

Power and Influence Theories
Take an entirely different approach –ways
that leaders use power and influence to
get things done, look at the leadership
styles that emerge as a result.
French and Raven's Five Forms of Power

Legitimate power
Reward power
Coercive power
Expert power
Referent power

Sources of power cont’d…
Legitimate power: is power derived from a
person’s position in an organization. It is also
called formal power or authority and exists
because organizations find it advantageous to
assign certain powers to individuals so that
they can do their job.
Reward power: emanates from the leaders
ability to reward desirable behavior. It stems
partly from the legitimate power. Reward
includes pay increase, promotions, work
schedule, recognitions of accomplishment, etc

Coercive power: is the opposite of reward power
and is based on the leader’s ability to punish or
prevent them from obtaining desired rewards.
Expert power: derives from having knowledge

valued by the HSO/HS, such as expertise in
problem solving, critical tasks, etc.
Expert power is personal to the individual who
possess the required knowledge or expertise.
In organizations in which work is highly technical
or professional, expert power alone makes some
people very powerful.
Referent power: Results when individuals engender
admiration, loyalty, and emulation to the extent that
they gain the power to influence others.
It is some times called charismatic power.
Charismatic leaders typically have a vision for the
groups or organizations that they lead.
They are perceived by their followers as agent of
change
It is rare for leader whether transactional or
transformational, to gain sufficient power to heavily
influence followers simply from referent or
charismatic power.
As with expert power, referent power can not be
given by the HSO/HS.
The five bases of power are not necessarily
independent, in fact can be complementary.
Leaders who use reward power can strengthen
their referent power.
Leaders who abuse their coercive power will
quickly weaken their referent power.
Effective leaders are those who can translate
power into influence.
Effective leaders understand the cost, risks and
benefits of using each kind of power and are
able to recognize which to draw on in different
situations and with different people.
Sources of power in organization
Position power: formal authority, control over
rewards, control over punishments, control over
information,
Personal power: expertise, friendship/loyalty,

charisma.
Political power: control over decision processes,

coalitions, co-optation, institutionalization (By
Yukl, in leadership in organizations,1998).

Blake and McCanse’s leadership grid
Developed by Blake and Mouton initially

Uses two variables of leadership orientation
“Concern for production” and “concern for
people”
Identified five distinct leadership styles:
9,9……Team management
9,1…..Authority compliance
1,9….Country club management
1,1…Impoverished management
5,5….Middle of the road management

The Role Of Leadership In
Effective Health Services
Delivery

The world is faced with enormous health
problems, leading to ill health and premature
deaths
Over 70% of diseases causing deaths in Africa
are due to preventable conditions
These health conditions call for cost-effective
interventions
Good leadership plays a crucial role in effective
health service delivery
This presentation gives highlights of the
importance of leadership in effective health
service
Why is Leadership Important?
To provide overall policy direction and
guidance on health programs
Good policies Vs bad policies
Priority setting
To advocate for the necessary support
Good advocacy if health seen as priority by leaders
To mobilize and make resources available for
health programs
Allocation of funds

Why cont’d…
To monitor and evaluate health programmes
Concept of all stakeholders participating in M&E
Support for using lessons learnt for improvement
To enforce accountability by service
providers, to the population
Accountability by leaders themselves

The Need for Leadership At All Levels
For effective health service delivery,
leadership is needed in all sectors and
different levels, for example:
Political leadership (President, Ministers,)
Professional leadership by health professionals
Leadership at central and local levels
Household and community level leadership so
that communities and households take charge
of their health programs
Leadership by partners that collaborate in
health service delivery

Professional Leadership
Professionals must be leaders in their fields.
To be good leaders, these professionals need
to be trained and equipped with skills
Training and equipping the professionals

with skills promotes leadership , e.g.,
leadership training
In addition, these professionals need to be

placed in positions of influence

Leadership By Partners
Health service delivery is provided through
partnerships of the public sector, private sector
and civil society organizations
Government leadership is important in bringing
together the partners
At international level, an organization such as the
World Health Organization (WHO) is important
in providing leadership and support needed to
address health problems
Leadership is also needed at regional level to
engage partners

Leadership at Community and Household
Level
Involvement of communities and households
promotes effective health service delivery
Involve communities/households in:
Planning health programmes
Monitoring and evaluation of health programmes
Involvement of communities leads to
confidence building and better service
utilization by communities

Evidence of Good Leadership
When those in leadership are showing political
commitment
When the political commitment is translated into
adequate resource allocation for health programs
When good policies are formulated
When leaders lead by example
When people begin to see leaders as role models
When there is good governance and there is
accountability to the public

References
 Stoner J.A.F, Freeman R.E., Gilbert Jr. D.R.
Management. 6th edition, 1996.
 Kerzner H. Project Management: A Systems
Approach to Planning, Scheduling and
Controlling, 2nd edition. 1984.
 Rakich, J.S. Managing Health Services
Organizations, 2nd edition, 1985.
 Rao V.S.P and Narayana P.S. Principles and
Practices of management, 1st edition (1987),
Konark Publishers.

References
 Hersey P., Blanchard K.H. and Johnson D.E.
Management of organizational behavior:
Utilizing human resources, 7th edition
(1996), Prentice Hall.
 Kreitner R. Management. 7th edition (1998),
Arizona State University, Houghton Mifflin
Company, New York.
 Shortell S. M. and Kaluzny A.D. (2000).
Essentials of Health Care Management,
Delmar Publishers

Thank you

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Leadership Function

“Trust men and they will be true to you;

2 Department Public Health, AU 09/18/2020

4 Department Public Health, AU 09/18/2020

5 Department Public Health, AU 09/18/2020

(Ham and Dickinson, 2008).

and Mowbary, 2001).

6 Department Public Health, AU 09/18/2020

highlights a commitment to improving leadership

Project-improving leadership and Good

8 Department Public Health, AU 09/18/2020

Contribution due to leadership 40%

Default contribution due to

9 Department Public Health, AU 09/18/2020

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11 Department Public Health, AU 09/18/2020

“Influencing/persuading people so that they will strive

willingly towards the achievement of group

goals/organizational goals” Koontz, H. and C. O’Donnell. “Management:

A System of Contingency Analysis of Managerial Functions”. McGraw-Hill, New York, 1976.

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As Bass stated “ leaders are agents of change,

Fig : The process of leadership (Longest,etal,2000)

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A good leader is always ready to learn and be

A leader is essentially someone who at a point in

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These are people who inspired millions to

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The assertion, however, is that there are people at

We call these people "managers who lead."

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 Leadership involves not just "doing," but "being.“

"Leadership involves the discipline of continually

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"Leadership is responsibility, not rank, title,

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"Leadership and management are two

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 Burns(1978) established that leadership in an

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The needs of followers are met if they perform to

Leaders and followers undertake transactions

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