Health Management

(540163)

Lecture 3: Leadership,
team work and
cooperation
Part I
Introduction
Leadership is important in healthcare
now to address:

• Huge pressures on service provision

• New organisations and ways of working

• Failures of care
there is a need for clinicians to
be engaged in leadership and
it is no longer an optional
extra but a necessity .
Introduction
• If we want a healthcare organization to succeed,
it must be appreciated as a system, the
components of which work together to create
success.
• It is not possible to determine what each
component should be and do unless it is
examined in the light of the goals for the system
and the rest of the system’s components.

Joint Commission
 Joint Commission standards for
leadership address 3 leadership groups:
• The governing body
• The chief executive and other senior managers
• The leaders of the licensed independent
practitioners
If they work
collaboratively

high-quality, safe patient care; financial sustainability;

community service; and ethical behavior can be achieved.
Introduction
• Management and leadership are important for
the delivery of good health services.
• Good managers should strive to be good leaders
and good leaders, need management skills to be
effective.

• Good leadership is critical for the success of any

organization but also challenging.
Introduction

• Management processes are concerned with

planning, budgeting, organising, staffing,
controlling and problem-solving
• Leadership processes involve establishing
direction, aligning people, motivating and
inspiring.
(Kotter 1996)
“Leadership is a performing art – a collection of practices
and behaviours rather than a position “

Kouzes and Posner (2005)

 Leadership is the art of motivating a
group of people to achieve a common
goal

The future of leadership and management in the nhs

No more heroes Report from
The King’s Fund Commission on Leadership and Management
in the NHS
May 2011

Conclusion of the report: High-quality leadership and management

at all levels is a prerequisite for a National Health Service that delivers
both the highest possible quality of care to patients and the best
possible deal for the taxpayer.
 Leadership; change of paradigm

“There is a transition occurring from

the old paradigm in which leadership
resided in a person or a role, to a new
one in which leadership is a collective
process that is spread throughout
networks of people”.

Nick Petrie (Center for Creative Leadership),

2011, p.6
 MANAGERS AND LEADERS
Meaning shifting roles…
• From “I manage”… • To “I lead…”

• My team reports to me • We are part of a virtual

• I have a hierarchical role
• I understand what is
happening
• I have fixed objectives
• I manage by fixing things
myself
• I manage from knowledge
and experience
network
• Influencing is the way
forward
• I manage projects
• I cope with ambiguity
• I lead teams to fix things
• I lead without knowledge
and experience

Obeng and Gillet, 2008

Leaders….

• …..will have a vision of what can be achieved and

then communicate this to others and evolve
strategies for realizing the vision.
• They motivate people and are able to negotiate
for resources and other support to achieve their
goals.
Managers….
• …..ensure that the available
resources are well organized
and applied to produce the
best results.
• In the resource constrained
and difficult environments of
many low – to middle-income
countries, a manager must
also be a leader to achieve
optimum results.
Management
Matters
But

Leadership
adds value

Leaders aren't responsible for the results.

Leaders are responsible for the people who are
responsible for the results.
Leadership is viewed
as ‘doing the right
thing’

and

management as ‘doing
the thing right’
Leadership aproches: Transactional vs
Transformal
• The transactional • The transforming
leader approaches leader looks for
followers with the potential motives in
intent to exchange one followers, seeks to
thing for another, for satisfy higher needs,
example, the leaders and engages the full
may reward the hard- person of the
working teacher with follower”.
an increase in salary.
(Burns, 1978, p. 4)
“Management can get things done through others by the traditional
activities of planning, organizing, monitoring and controlling –
without worrying too much what goes on inside people’s heads.
Leadership, by contrast, is vitally concerned with what people are
thinking and feeling and how they are to be linked to the environment
to the entity and to the job/task”.(Nicholls, 1987, p. 21)
Types of leadership style
1. Autocratic
2. Democratic
 persuasive
 consultative

3. Laissez-faire
(Delegative)
Leadership styles
Autocratic
• The leader makes all
decisions independently or
without consulting with
others
• Advantages: good in certain
circumstances, such as urgent
tasks or military actions
• Disadvantages: poor decisions,
poor level of employee
motivation
Leadership styles
• A leadership style
Democratic where a leader
encourages employee
participation in
decision-making
• persuasive or consultative
• Advantages: better
decisions, employee
motivation
• Disadvantages: delayed
decision, long
consultation
Leadership styles Laissez-faire

• A leadership style
where employees are
encouraged to make
their own decisions
within limits.
• Advantages: more
freedom for employees
• Disadvantages: few
guidelines, little
incentive, poor
motivation, maybe a
mess
Leadership styles
are also described by some researchers as the
following:
▫ telling leadership,
▫ selling leadership, participating
leadership,
▫ and delegating leadership.

Which one would you be?

Which one is the best?
• Comparison of Leadership Styles
Factors affecting leadership styles
• The task
• The tradition of an organization
• The type of labor force
• The leader’s personality
• The time
• Gender?
Managers as Leaders
• Which Leadership Style Is Best?
▫ Depends on function of the leader, subordinates, and
situation
▫ Some leaders can’t work well with high participation
of subordinates
▫ Some employees lack the ability or desire to assume
responsibility
▫ Participative decision making may be better when
time pressure is not acute
Being a leader

• Know yourself, be authentic

• Seek to understand others
• Be aware of your impact on others
• Reflective practice
• Emotional resilience
• Building effective relationships
Qualities of the The healthcare leader
of the future
1. will be an independent thinker who
understands the emerging healthcare market.
2. will be passionate about serving the needs of
the customer.
3. will be a change agent for their organization.
4. will have the ability to motivate and inspire.
5. will run a lean, high-quality organization.

(J. Stephen Lindsey & John W. Mitchell, 2012)

 The Nine Basics of Leadership
1. Integrity
2. Be aware of your personality type and how you
interact with others
3. Be emotionally intelligent.
4. Communicate clearly
5. Surround yourself with “good” people
6. Manage change. Don’t force it.
7. Create leaders
Hossam Al-Tatari, MD, FAAP,
8. Help them deal with failure FIDSA
9. Be ready to sacrifice Chief of Pediatric Infectious
Diseases
Former Pediatric Residency
Program Director
Adopted in part from the book of Susan Caba: Leadership Fast-Track
1. Integrity
Integrity
• The three main elements of integrity
▫ Values
▫ Insight
▫ The courage to admit limitations and mistakes
• Having integrity doesn’t mean being perfect but
rather predictable.
• Integrity  Predictability  Trust  Loyalty
Values and Integrity
• Values alone are not enough
• “The supreme quality for a leader is integrity”

US President Dwight Eisenhower

• Integrity: Complete observance of the values and

believes that guide a person’s actions and not
violate them under any circumstances.
Integrity and Admitting Mistakes
• A survey of 38000 health leaders by the Institute
for Health and Human Potential: The
Willingness to admit making a mistake is “a
single most important variable in a leader”
• In another survey:
▫ 98.6% said that they do admit their mistakes
▫ 13% only said they witnessed their colleagues do
so!
• Why is there a gap???
Integrity and Admitting Mistakes
• Ego knows it’s good to show the will of admitting
mistakes
• But Ego –unconsciously- finds it a sign of
weakness to do so
• Ego will use one of the following tactics to avoid
admitting a mistake:
▫ It’s nominal and the harm of admitting it on your
image could be bigger!!!
▫ Rationalize  convince ourselves we are right
while everyone else believes we are wrong!!!
“Everyone Else” is Not Always Right!

• Great leaders throughout history were deemed

wrong by “Everyone Else”
• Your “Everyone Else” could be different than
their “Everyone Else”
• Did “Everyone Else” listen equally to both
parties?
Why is “Admitting Mistakes” So
Important?
• Human err. But error becomes a mistake only
when you refuse to admit it and correct it.
• It’s a sign of having full control over the Ego 
Sign of strength and not weakness
• It allows one to have a deeper insight
• It encourages learning and growth in you and
your colleagues
• It’s a sign of integrity which makes you
more predictable and trustworthy.
2. Personality Types
 Marston Personality Types
• Personality = The way we think, feel and behave
• William Mounton Marston (Harvard University. 1928)
defined four personality types depending on
▫ Extrovert Vs Introvert
▫ People-focused Vs Task-focused
• The type will define how a leader would
▫ Response to challenges
▫ Ability to influence others
▫ Preferred pace of environment
▫ Compliance with rules and regulations
• People may have a bit of each or change their personality
according to the challenges
The Anxious Coach
Task-Focused Extroverts
• Who are they?
▫ Strong personality who likes to be in charge.
▫ Direct, decisive and wants to move fast
▫ Competitive and self-confident
• What’s bad about them?
▫ They believe that everyone should think like them
▫ Their confidence often become overconfidence
▫ Don’t like constructive feedback. i.e: Super Egos
▫ Can’t work with other personality types
 The Silent Micromanager
Task-Focused Introverts
• Who are they?
▫ Very analytical, systematic and obsessed with details
▫ Very formal and silent most of the time
▫ They live in the fear of a flaw or failure  May become
paranoid
▫ Therefore, they like to micromanage
• What’s bad about them?
▫ Easily gets stress/paralyzed
▫ Not open for suggestions or constructive feedback
▫ Not personable and may loose credit due to their silence
 The Social Optimistic
People-Focused Extrovert
• Who are they?
▫ Charismatic
▫ Believes in every one and trusts all  Beloved
▫ They always see the bright side and help others to see it
▫ Fast-paced and hates routines, details and schedules
• What’s bad about them?
▫ They could miss a lot by not looking at details
▫ They may drop projects to please their followers
▫ They are often miss-understood as self-promoters
 The Ninja Turtles
People-Focused Introverts
• Who are they?
▫ Slow but steady
▫ Flexible and emotional
▫ Avoids challenges and problems to maintain harmony
▫ They lead by “relationships” and not by “drama”
• What’s bad about them?
▫ They don’t like change. Like turtles, if pushed they stop
▫ Because they don’t like to show-off, they may come
across as careless
▫ Can’t work with the anxious coach
How do they react to stress?
• The anxious coach: Explodes and tries to find
someone to blame
• The silent micromanager: Will have a sleepless
night saying “I need to fix this issue right away
and I don’t need help from anyone!”
• The social optimistic: Minimize the issue and
tries to keep everyone happy
• The ninja turtle: Hides in the closet
Which type is the best?
• None is perfect !
• Don’t fix your personality to one form or the
other  Be flexible
▫ At the beginnings be The Social Optimistic
▫ When things are established and need to move
faster, be the Anxious Coach.
▫ When things are established and need to be
stabilized, be the Ninja Turtle
▫ When there are problems, be the silent
micromanager
Is it Important to Know the Types?
• Know your type to
– Have insight and self-knowledge
– Have control over ones Ego
– Improve emotional intelligence
– Continue to develop and grow

• Know the type of others to

– Predict and understand their actions and behaviors
– Communicate better
 • Why Can’t Introverts Be Leaders?
▫ By Ronald E Riggio Ph.D. Cutting-Edge
Leadership

• Research has shown a consistent positive

relationship between extraversion and leadership

• There is also a positive relationship (although a

weaker one) between extraversion and leader
effectiveness

• Our research has suggested that key elements

such as good interpersonal, or social, skills are
typically not outstanding among introverts
https://www.psychologytoday.com/blog/cutting-edge-leadership/201210/why-can-t-introverts-be-leaders.
Accessed on November 2016
Can Introverts
Become Real
Distinguished
Leaders?
Can Introverts Become Real
Distinguished Leaders?
• They could become very successful in professions
that require “lots of thinking”
• They could succeed in “a project –big or small-” with
flying colors
• Beware of the “selective” introverts
• Introverts will not typically become distinguished
leaders:
▫ It’s hard to know how they think  It’s hard to predict what
they would do  It’s hard to trust them
▫ Typically have strong “Ego”  It’s hard for them to admit
mistakes, apologize or accept constructive feedback
▫ Due to lack of transparency, they can’t produce leaders
Can Introverts Become Real
Distinguished Leaders?

• Examples of famous
introverted leaders:
Abraham Lincoln,
Gandhi, and in
business, Bill Gates
and Warren Buffett.