Leadership PDF

BRANDON M. B. | BSN 4 B | REVIEWER MANAGEMENT Four overriding principles of scientific management: From an old French, mesnagement (or ménagement),...

BRANDON M. B. | BSN 4 B | REVIEWER MANAGEMENT Four overriding principles of scientific management: From an old French, mesnagement (or ménagement), 1. Traditional “rule of thumb” means of organizing work meaning the art of conducting, directing. must be replaced with scientific methods. From Latin “manu agere”, to lead by the hand. 2. A scientific personnel system must be established so The organization and coordination of the activities of that workers can be hired, trained, and promoted a business in order to achieve defined objectives. based on their technical competence and abilities. It is the process of leading and directing all or part of 3. Workers should be able to view how they “fit” into an organization, through the deployment and the organization and how they contribute to overall manipulation of resources. organizational productivity. 4. The relationship between managers and workers LEADERS should be cooperative and interdependent, and the Those individuals who are out front, taking risks, work should be shared equally. attempting to achieve shared goals, and inspiring others to action. BUREAUCRACY Those individuals who choose to follow a leader do Max Weber (1922): Theory of Social and Economic so by choice, not because they have to. Organization advocated Bureaucracy. Need for legalized, formal authority and consistent rules and regulations for LEADERSHIP VS. MANAGEMENT personnel in different positions. LEADERSHIP MANAGEMENT MANAGEMENT FUNCTIONS The act of influencing and The process of leading and Henri Fayol (1925), first identified the management motivating a group of directing an organization to functions of planning, organization, command, coordination, people to act in the same meet its goals through the and control. direction towards achieving use of appropriate resources. a common goal. Do not have delegated Legitimate source of power authority but obtain their due to the delegated power through other means, authority. such as influence. Focus on group process, Emphasize control, decision ACTIVITIES OF MANAGEMENT information gathering, making, decision analysis Luther Gulick (1937) expanded on Fayol’s management feedback, and empowering and results. functions in his introduction of the “Seven Activities of others. Management” – planning, organizing, staffing, directing, coordinating, reporting and budgeting. Have goals that may or may Greater formal 1. PLANNING determines the philosophy, goals, not reflect those of the responsibility and objectives, policies, procedures, and rules; carrying organization. accountability for rationality out long- and short-range projections; determining a and control than leaders. fiscal course of action; and managing planned change. 2. ORGANIZING establishes the structure to carry out...management is efficient in climbing the ladder of success; plans, determining the most appropriate type of leadership determines whether the ladder is leaning against the patient care delivery, and grouping activities to meet right wall. unit goals. - Stephen R. Covey 3. STAFFING consists of recruiting, interviewing, hiring, and orienting staff. Scheduling, staff SCIENTIFIC MANAGEMENT development, employee socialization, and team Frederick W. Taylor, the “Father of Scientific Management” building. Work should be studied scientifically to determine the method 4. DIRECTING consists of motivating, managing of task performance that would yield maximum work output conflict, delegating, communicating, and facilitating with minimum work expenditure. collaboration.  BRANDON M. B. | BSN 4 B | REVIEWER 5. CONTROLLING functions include performance THEORY X AND Y appraisals, fiscal accountability, quality control, legal Douglas McGregor (1960), X and Theory Y, posited that and ethical control, and professional and collegial managerial attitudes about employees can be directly control. correlated with employee satisfaction. Theory X managers believe Theory Y managers believe PRINCIPLES OF MANAGEMENT (14) that their employees are that their workers enjoy 1. Division of work: allows specialization basically lazy, need constant their work, are 2. Authority: right to command balanced with supervision and direction, self-motivated, and are responsibility and accountability and are indifferent to willing to work hard to meet 3. Discipline: employees will only obey orders if organizational needs. personal and organizational management plays their part by providing good goals. leadership. 4. Unity of command: there should only be one boss with no conflicting lines of command. 5. Unity of direction: people engaged in the same kind of activities must have the same objectives in a single plan. 6. Subordination of individual interest to general interest: the goals of the firms are always paramount. 7. Remuneration: payment is an important motivator. 8. Centralization or Decentralization: depends on the condition of business and the quality of its personnel. 9. Scalar chain/line of authority: refers to the number of levels in the hierarchy. 10. Order: both material order (minimizes lost time and useless handling of materials) and social order (organization and selection) are necessary. EMPLOYEE PARTICIPATION 11. Equity: employees should be treated well to achieve Chris Argyris (1964), managerial domination causes workers equity. to become discouraged and passive. If self-esteem and 12. Stability of tenure of personnel: job security and independence needs are not met, employees will become career progress are important for employees to work discouraged and troublesome or may leave the organization. better. 13. Initiative: allow personnel to show their initiative, it THEORIST THEORY may be a source of strength for the organization. 14. Esprit de corps: management should foster the moral Taylor Scientific Management of employees. Weber Bureaucratic Organizations PARTICIPATIVE MANAGEMENT Fayol Management functions Mary Parker Follet (1926) was one of the first theorists to suggest participative decision making or participative Gulick Activities of managements management. Managers should have authority with, rather Follet Participative management than over, employees. Mayo Hawthorne effect Theory ILLUMINATION STUDIES Mc Gregor X and Y Elton Mayo and his Harvard associates (1927-1932), look at the relationship between light illumination in the factory Argyris Employee participation and productivity. Hawthorne effect indicates that people respond to the fact that they are being studied, attempting to increase whatever behavior.  BRANDON M. B. | BSN 4 B | REVIEWER DEVELOPMENT OF LEADERSHIP THEORIES Disperses decision making throughout the group. GREAT MAN THEORY Places emphasis on the group. The Great Man Theory, from Aristotelian philosophy, asserts Does not criticize. that some people are born to lead, whereas others are born to be led. Great leaders will arise when the situation demands it. CONTINGENCY APPROACH TRAIT THEORY Fiedler’s (1967), Contingency Approach, suggests that no Trait Theories assume that some people have certain one leadership style is ideal for every situation. characteristics or personality traits that make them better Interrelationships between the group’s leader and its members leaders than others. were most influenced by the manager’s ability to be a good Intelligence Knowledge leader. Judgment Decisiveness Oral fluency Emotional intelligence Independence Personable SITUATIONAL APPROACH Adaptability Hersey and Blanchard (1977), developed Situational Creativity Approach to leadership. Tridimensional leadership Cooperativeness effectiveness model predicts which leadership style is most Alertness appropriate in each situation based on the level of the Self-confidence Personal integrity followers’ maturity. As people mature, leadership style Emotional balance and control risk-taking becomes less task focused and more relationship oriented. Ability Able to enlist cooperation interpersonal skills Tact Diplomacy TRANSACTIONAL AND TRANSFORMATIONAL Prestige LEADERSHIP Social participation charisma Burns (2003), suggests that both leaders and followers can raise each other to higher levels of motivation and morality. LEADERSHIP STYLES There are two primary types of leaders in management. Democratic Leader exhibits the following behaviors: The traditional manager, concerned with the Less control is maintained. day-to-day operations, was termed a transactional Economic and ego awards are used to motivate. leader. Others are directed through suggestions and guidance. The manager who is committed, has a vision, and can Communication flows up and down. empower others with this vision was termed a Decision making involves others. transformational leader. Emphasis is on “we” rather than “I” and “you”. Criticism is constructive. EXEMPLARY LEADERSHIP Authoritarian Leader characterized by the following behaviors: Kouzes and Posner’s Five Practices of Exemplary Leadership Strong control is maintained over the work group. 1. Modeling the way: requires value clarification and Others are motivated by coercion. self awareness so that behavior is congruent with Others are directed with commands. values. Communication flows downward. 2. Inspiring a shared vision: Entails visioning which Decision making does not involve others. inspires followers to want to participate in goal Emphasis is on difference in status (“I” and “you”) attainment. Criticism is punitive. 3. Challenging the process: Identifying opportunities and taking action. Laissez-faire leader characterized by the following behaviors: 4. Enabling others to act: Fostering collaboration, Is permissive, with little or no control. trust, and the sharing of power. Motivates by support when requested by the group. 5. Encouraging the heart: recognize, appreciate, and Provides little or no direction. celebrate followers and the achievement of shared Uses upward or downward communication between goals. members of the group.  BRANDON M. B. | BSN 4 B | REVIEWER INTEGRATING LEADERSHIP AND MANAGEMENT MANAGEMENT PROCESS: Gardner (1990) asserted that integrated leader-managers PLANNING possess six distinguishing traits: Is defined as pre-determining a course of action in order to 1. They think longer term. arrive at a desired result. A continuous process of assessing, 2. They look outward, toward the larger organization. establishing goals and objectives, implementing and 3. They influence others beyond their own group. evaluating them, and subjecting these to change as new facts 4. They emphasize vision, values, and motivation. are known. 5. They are politically astute. 6. They think in terms of change and renewal. PRINCIPLES OF PLANNING 1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization. THEORIST THEORY 2. It is a continuous process. Provision for proper Aristotle Great Man Theory analysis would indicate a revision or flexibility to be done to make it more effective. Lewin and White Leadership Styles 3. It should be pervasive within the entire organization Fiedler Contingency Leadership covering the various departments, services, and the various levels of management to provide maximal Hersey and Situational Leadership Theory cooperation and harmony. Blanchard 4. It utilizes all available resources. 5. It should be precise in its scope and nature. It should Burns Transactional and Transformational Leadership be realistic and focused on its expected outcomes. 6. It should be time-bound, i.e., with short- and Gardner The integrated leader-manager long-range plans. 7. Projected plans must be documented for proper dissemination to all concerned for implementation POWER and evaluation as to the extent of its achievement. Power is defined as the capacity to act or the strength and potency to accomplish something. The manager who is WHY MANAGERS FAIL TO PLAN EFFECTIVELY? knowledgeable about the wise authority, power, and political They may either lack knowledge of the philosophy, strategy is more effective at meeting personal, unit, and goals and objectives of the agency or lack organizational goals. understanding of the significance of the planning process. They may not know how to manage their time to TYPES OF POWER devote to planning. Reward power is obtained by the ability to grant They may lack confidence in formulating plans or favors or reward others with whatever they value. fear that planning may bring about unwanted changes Punishment or coercive power is based on fear of that they are unwilling to undertake or are unable to punishment if the manager's expectations are not met. cope with. Legitimate power is the power gained by a title of official position within an organization. SCOPE OF PLANNING Expert power is gained through knowledge, Top management or the Nursing Directors, Chief expertise or experience. Nurses or Directors of Nursing and their assistants set Referent power is power that a person has because the over-all goals and policies of an organization. others identify with that leader or with what that Middle management or Nursing Supervisors direct leader symbolizes. Charismatic power is the activities to actually implement the broad distinguished by some from referent power. operating policies of the organization such as staffing Informational power is obtained when people have and delivery of services to the units. information that others must have to accomplish their At the lower or first-level management, the Head goals. Nurses or Senior Nurses (including Charge Nurses or  BRANDON M. B. | BSN 4 B | REVIEWER team leaders) do the daily and weekly plans for the administration of direct patient care in their respective units. FOUR PLANNING MODES Modes of Description Planning Reactive Occurs after a problem exists Inactivism Seek the status quo Preactivism Utilize technology to accelerate change and are future oriented Interactive or Attempt to plan the future of their Proactive organization rather than react to it. FORECASTING Forecasting involves trying to estimate how a condition will be in the future. Takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes. STRATEGIC PLANNING Strategic planning examines an organization’s purpose, mission, philosophy, and goals in the context of its external environment. Complex organizational plans that involve a long period (usually 3 to 10 years) are referred to as THE PLANNING HIERARCHY long-range or strategic plans. SWOT ANALYSIS SWOT Analysis, also known as TOWS Analysis, was developed by Albert Humphrey at Stanford University in the 1960s and 1970s. SWOT definitions: Strengths are those internal attributes that help an organization to achieve its objectives. Weaknesses are those internal attributes that VISION challenge an organization in achieving its objectives. Vision statements are used to describe future goals or Opportunities are external conditions that promote aims of an organization. achievement of organizational objectives. It conjures up a picture for all group members of what Threats are external conditions that challenge or they want to accomplish together. threaten the achievement of organizational objectives. An organization will never be greater than the vision that guides it.  BRANDON M. B. | BSN 4 B | REVIEWER MISSION EXAMPLE OF NURSING SERVICE POLICIES The mission statement is a brief statement identifying 1. Accidents – care, reporting, precautions to prevent the reason that an organization exists. occurrence It identifies the organization’s constituency and 2. Admissions – receiving, consent, notifying doctor, addresses its position regarding ethics, principles, and care of patients standards of practice. 3. Autopsies – obtaining informed consent 4. Breakage – classification, responsibility, reporting GOALS AND OBJECTIVES 5. Committees – types, memberships, functions Goals and objectives are the ends towards which the 6. Bulletin boards – location, posting of information organization is working. 7. Complaints – how handled, action taken Objectives are similar to goals in that they motivate 8. Consent – informed consent taken by whom, from people to a specific end and are explicit, measurable, whom, shared decision-making with patient and observable or retrievable, and obtainable. family and/or significant others together with members of the health team 9. Death – notification, care and identification, care of POLICIES personal belongings, death certificate. Policies are plans reduced to statements or 10. Discharge – time, clearances, discharge planning, instructions that direct organizations in their decision accompaniment of patient making. 11. Doctor’s order – written, verbal, by telephone These explain how goals will be met ang guide the 12. Equipment and supplies – list of expendable general course and scope of organizational activities. and-expendable items, care, lending, requesting, Policies can also be implied or expressed: repairing Implied policies, neither written nor expressed 13. Fire Regulations – drills, prevention verbally, have usually developed over time and follow 14. Nursing Care a precedent. a. Administration and preparation of – oral ○ For example, a hospital may have an implied meds, IV infusions, BT policy that employees should be encouraged b. Charting – forms used, use of various colors and supported in their activity in community, of ink, format regional, and national health-care c. Emergency Drug Supply – Contents, organizations. responsibility, location Expressed policies are delineated verbally or in d. Meds – card system, responsibility, checking, writing dosages, errors: reporting, correction ○ Expressed policies may include a formal e. Daily assignment dress code, policy for sick leave or vacation f. Kardex – use, sample form time and disciplinary procedures. g. Private Duty Nurses – Engaging, obligations to hospital, supervision, evaluation, remuneration NURSING SERVICE POLICY MANUAL h. Reasonable and Due Care – definition, Departmental policies must reflect the policies of the explanation, legal implications hospital; hence it should be carefully made to define i. Referrals – within and outside of agency j. the scope of departmental responsibility within the Safety devices – siderails, restraints hospital. 15. Meetings – frequency, purpose, types, membership, The manual is an effective tool for orienting new minutes employees, a reference when unexpected problems 16. Reports – forms, responsibilities arise, a basis for developing administrative 17. Reporting On or Off Duty – when leaving the unit procedures, and a firm basis for discussions when differences occur. INTERDEPARTMENTAL POLICIES Are developed in keeping with overall hospital policies, thus ensuring unity and harmonious relationships among departments. This requires a  BRANDON M. B. | BSN 4 B | REVIEWER clear understanding of how these services can be It usually has a general format which includes carried out smoothly for the betterment of all definition, purpose, materials needed, proper concerned. requisitioning of supplies, proper disposal of used Coordination of all activities in obtaining the same equipment, etc. final goal may be made through the use of written Procedure manuals are reviewed, updated and/or policies. revised with the maximum involvement of the unit’s nursing staff. Examples: Examples: ❖ Admissions – type of patient, time, reservation, ❖ Admission of patients signing consents ❖ AM care ❖ Pharmacy – ordering of drugs, narcotics and ❖ Bath: Bed bath, TSB barbiturate regulations, inspection of stock drugs ❖ Bed Making-Occupied or unoccupied ❖ X- ray – requests, preparation of patient, transporting ❖ Bladder, catheterization of of patient ❖ Blood, administration of ❖ Personnel Dept. – request for additional employee, ❖ Chest, closed drainage interview, record keeping, counseling, grievances, ❖ Medication training RULES ❖ Transfers – requests, departments to be notified Rules and regulations are plans that define specific ❖ Discharges – notification, against medical discharge, action or non-action. conduction, clearances Existing rules should be enforced to keep morale ❖ Blood bank – how obtained, checking information from breaking down and to allow organizational (type/cross-match), reactions, replacement structure. ❖ Cashier – safekeeping of valuables, clearances. ❖ Dietary – requisition (diet list, new diets, therapeutic), CHANGE THEORY discharge planning with nutritionist Kurt Lewin (1951) identified three phases through which the ❖ Laboratory – requests (routine, emergency), change agent must proceed before a planned change becomes record-keeping part of the system. ❖ Social-services – referrals from various departments Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety or concern can be elicited. PROCEDURES Movement, the change agent identifies, plans and Procedures are plans that establish customary or implements appropriate strategies, ensuring that acceptable ways of accomplishing a specific task and driving forces exceed restraining forces. delineate a sequence of steps of required action. Refreezing phase, the change agents assists in Identify the process or steps needed to implement a stabilizing the system change so that it becomes policy and are generally found in manuals at the unit integrated into the status quo. level of the organization. Are specific directions for implementing written Stages of change and responsibilities of the change agent: policies. Two areas where procedures are needed are STAGE 1 – UNFREEZING those that are related to job situations such as 1. Gather data reporting complaints and those involving patient care. 2. Accurately diagnose the problem Procedures that involve patient care should consider 3. Decide if change is needed. the safety of the patient. 4. Make others aware of the need for change; do not Nursing procedure manuals should be available in proceed until the status quo has been disrupted and each unit for familiarization. the need for change is perceived by others. NURSING PROCEDURES STAGE 2 – MOVEMENT Procedure manuals can be an effective tool in 1. Develop a plan. ensuring that a procedure will be done according to 2. Set goals and objectives. the agency’s protocol. 3. Identify areas of support and resistance.  BRANDON M. B. | BSN 4 B | REVIEWER 4. Include everyone who will be affected by the change other leaves, holidays and the average number of in its planning. absences per staff member per year. 5. Set target dates. The next step is to ascertain the amount and kind of 6. Develop appropriate strategies. supplies needed for the operation of each nursing unit. 7. Implement the change. A review of past expenses and consumption provides 8. Be available to support others and offer data for planning. Requests for the replacement of encouragement through the change. capital equipment must be supported with document 9. Use strategies for overcoming resistance to change. justification. 10. Evaluate the change. The Chief Nurse compiles and completes the final 11. Modify the change, if necessary. draft of the budget and presents this to the Budget Officer of the Hospital Administrator. A carefully STAGE 3 – REFREEZING planned budget presentation usually reflects favorable 1. Support others so that the change continues. action from the administrator. CHAOS THEORY Edward Lorenz (1960s), discovered that even tiny changes in variables often dramatically affected outcomes. Even small changes in conditions can drastically alter a system’s long-term behavior (butterfly effect) BUDGET A budget is a financial plan that includes estimated expenses as well as income for a period. Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. TYPES OF BUDGET Workforce or personnel budget – largest of the budget expenditures because healthcare is labor intensive. Operating budget – reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs and maintenance, and supplies. Capital budgets – plan for the purchase of buildings or major equipment, which includes equipment that has a long life (usually greater than 5 to 7 years). BUDGETARY PROCESS To assure an orderly and timely development of the budget, the budget committee must be well defined. This committee can assist the budget officer in budget preparation, and in monitoring the budget. The Chief Nurse or his/her assistant is usually a member of the Budget Committee. Within the Nursing service the chief Nurse with supervisors and head nurses in preparing the budget for the nursing service The estimation of staff for each unit should be based on the number of patients, the number of nursing care hours needed, the provision of vacation, sick and