Leading & Managing Occupational

Therapy Services An Evidence-Based

Approach 2nd Edition – Ebook PDF
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I am very happy to present the second edition of this
textbook, Leading & Managing Occupational Therapy
Services: An Evidence-Based Approach. The first edition
of the text was well received; however, I have both
updated information and added new content in
response to feedback and in response to changes in
the social, political, financial, legislative, and profes-
sional environments in which occupational therapy
practitioners operate. One of the challenges faced in
designing the original text was to provide students
and new managers with the breadth and depth of
information needed to support their practice while
not providing detail that might quickly become out-
dated. This challenge became even more difficult in
the second edition given the fast-changing landscape
in our health-care and organizational systems;
however, the contributors and I have done our best to
provide useful and practical information for entry-
level managers that will remain current and relevant
for quite some time.
Once again I began preparations for the text by
reviewing management literature in other fields and
disciplines and found that, regardless of the field or
discipline in which they are based, entry-level texts on
management often begin by pointing out that manag-
ers complete commonly recognized functions for
organizations. The functions most commonly identi-
fied include (a) planning, (b) organizing and staffing,
(c) controlling, and (d) directing. There are some-
times variations because some authors may pull the
function of “staffing” out from that of organizing and
present five rather than four categories. Nonetheless,
a discussion of leadership and the basic functions of
management and their relationship to leading and
4365_FM_i-xxii.indd vii
Preface
managing evidence-based practice is a logical place to
begin.
Chapters have been reordered in this edition; the
first chapter is on leadership to emphasize the impor-
tance of using leadership theory and evidence no
matter what your professional role. Other content has
been reorganized and relabeled to make the tradi-
tional management functions more easily identified.
There is increased emphasis and content on strategic
planning, business knowledge, financial planning, and
financial management. New content has been added
on interprofessional teams, interprofessional collab-
orative practice, and interprofessional competencies.
This text is now organized in four sections with
18 chapters that are as follows:
Section I: Introduction to Leadership
and Evidence-Based Management
Chapter 1: Leadership: The Art, Science, and
Evidence
Chapter 2: Engaging in Evidence-Based
Management
Section II: Leading and Managing in Context
Chapter 3: Understanding Health-Care Systems
and Practice Contexts
Chapter 4: Understanding and Working Within
Organizations
Chapter 5: Communicating Effectively in Complex
Environments
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 viii Preface
Chapter 6: Roles and Functions of Managers: Plan-
ning, Organizing and Staffing, Directing, and
Controlling
Chapter 7: Roles and Functions of Supervisors
Chapter 8: Professional Teams, Interprofessional
Education, and Collaborative Practice
Section III: Managerial Skills, Responsibilities,
and Competencies
Chapter 9: Strategic Planning
Chapter 10: Managing Change and Solving
Problems
Chapter 11: Financial Planning, Management, and
Budgeting
Chapter 12: Assessing and Promoting Clinical and
Managerial Competency
Chapter 13: Continuous Quality Improvement
Chapter 14: Marketing Occupational Therapy
Services
Chapter 15: Developing Evidence-Based Occupa-
tional Therapy Programming
Section IV: Leading Evidence-Based Practice
and Professional Considerations
Chapter 16: Introducing Others to Evidence-Based
Practice
Chapter 17: Turning Theory Into Practice: Mana-
gerial Strategies
Chapter 18: Responsible Participation in a Profes-
sion: Fostering Professionalism and Leading for
Moral Action
The focus of this text is the management of occupa-
tional therapy services. As such, every chapter within
the text relates to content, functions, or issues that lie
within the domain of concern for occupational therapy
managers. The overarching theme for this text is how
occupational therapy managers can utilize theory,
data, information, and other forms of evidence to
become more effective. For this reason, particular
4365_FM_i-xxii.indd viii
topics and content have been chosen upon which to
focus entire chapters. The topics of leadership, the
roles and functions of the manager, and the roles and
functions of the supervisor are addressed in three dif-
ferent chapters. Some occupational therapy managers
work in jobs where they are only responsible for the
oversight of occupational therapy services. However,
it is becoming more common for managers in health
care to be asked to manage several disciplines; there-
fore, the interprofessional manager has been empha-
sized throughout the text.
The key features of this text are focused on enhanc-
ing usability for the readers. A glossary has been added
at the start of each chapter to identify key terms. The
“Real-Life Management” and “Real-Life Solutions”
features remain, and case examples and vignettes are
used for emphasis. Text boxes and tables are used lib-
erally to focus on important knowledge. Each chapter
concludes with a list of additional resources to help
readers expand their knowledge base or to find addi-
tional information for class projects or for use to
support day-to-day practice. A selection of multiple-
choice questions has been added to each chapter to
stress key points and to help readers assess their
understanding.
A final comment on the content chosen for inclu-
sion in this text is warranted. As an occupational
therapy professional who has been involved in clinical
practice in some way for over three decades, I have
found that I have continually benefited from reliance
on the combination of paradigmatic occupational
therapy knowledge and related knowledge from mul-
tiple other disciplines. As a professional who has also
held leadership and management roles for much of
that same time, I have found the same benefit from
looking both within our profession and outside to
other disciplines for knowledge and insight. As a
teacher of management, I try to highlight the unique-
ness of occupational therapy while stressing the benefit
of collaborating with our peers from physical therapy,
nursing, medicine, psychology, case management,
educational administration, social work, and other dis-
ciplines. I am confident that this text will lend itself to
that approach in both the classroom and in practice.
12/30/2015 11:15:39 AM
 Contributors

Patricia Bowyer Brenda Koverman

EdD, MS, OTR, FAOTA MBA, MS, OTR/L
School of Occupational Therapy Department of Occupational Therapy
Texas Woman’s University Rush University Medical Center
Houston, Texas Chicago, Illinois

Regina F. Doherty Alanna Motzi

OTD, OTR/L, FAOTA, FNAP LCSW
Department of Occupational Therapy Department of Clinical Support Services Administration
MGH Institute of Health Professions University of Texas
Boston, Massachusetts MD Anderson Center
Houston, Texas
Marcia Finlayson
PhD, OT Reg (Ont), OTR Lauro Munoz
School of Rehabilitation Therapy OTR, MOT, CHC
Queen’s University Department of Rehabilitation Services
Kingston, ON, Canada University of Texas
MD Anderson Center
Gail Fisher Houston, Texas
MPA, OTR/L, FAOTA
Department of Occupational Therapy Julie Ann Nastasi
University of Illinois at Chicago ScD, OTD, OTR/L, SCLV, FAOTA
Chicago, Illinois Department of Occupational Therapy
The University of Scranton
Gayle Harper Scranton, Pennsylvania
MSW
Department of Clinical Support Services Administration Elizabeth W. Peterson
University of Texas PhD, OTR/L, FAOTA
MD Anderson Center Department of Occupational Therapy
Houston, Texas University of Illinois at Chicago
Chicago, Illinois

ix

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 x Contributors

Shawn Phipps Maureen Triller

PhD, MS, OTR/L, FAOTA MPA, DrPH
Chief Quality Officer & Associate Hospital Department of Clinical Support Services
Administrator Administration
Rancho Los Amigos National Rehabilitation Center University of Texas
Vice President MD Anderson Center
American Occupational Therapy Association Houston, Texas
Adjunct Assistant Professor of Clinical Occupational
Therapy
University of Southern California
USC Chan Division of Occupational Science &
Occupational Therapy
Los Angeles, California

4365_FM_i-xxii.indd x 12/30/2015 11:15:39 AM

 Reviewers

Amanda Cline Valley O. McCurry

OTR/L MBA, OTR/L
Adjunct Faculty/Program Manager at Laclede Groves Assistant Professor
Saint Louis University and Laclede Groves University of Alabama at Birmingham
St. Louis, Missouri Birmingham, Alabama

Elizabeth DeIuliis Shirley O’Brien

OTD, OTR/L PhD, OTR/L, FAOTA
Academic Fieldwork Coordinator, Assistant Professor Professor
Duquesne University Eastern Kentucky University
Pittsburgh, Pennsylvania Richmond, Kentucky

Pamela K. Evans Debora Oliveira

OTR, MBA, DBA PhD, CRC, OTR/L
Doctor Interim Director
Brenau University Florida A&M University
Norcross, Georgia Tallahassee, Florida

Cecilia Fierro Linda L. Orr

OTR, OTD MPA, OTR/L
Clinical Assistant Professor Professor, Program Coordinator
University of Texas at El Paso Lewis and Clark Community College
El Paso, Texas Godfrey, Illinois

xi

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 xii Reviewers

Ingrid Provident Jennifer L. Womack

EdD, OTR/L MS, MA, OTR/L SCDCM, C/PH, CAPS, FAOTA
Assistant Professor Associate Professor
Chatham University University of North Carolina–Chapel Hill
Pittsburgh, Pennsylvania Chapel Hill, North Carolina

Charlotte Brasic Royeen

PhD, OTR/L, FAOTA
Professor
Saint Louis University
St. Louis, Missouri

4365_FM_i-xxii.indd xii 12/30/2015 11:15:39 AM


I would like to thank the following persons for their
support, consultation, and guidance in conceptualiza-
tion of this text and in my daily practice as an occupa-
tional therapy leader and manager:
Christopher Bluhm
Chief Operating Officer
American Occupational Therapy Association
Christina Metzler
Chief Public Affairs Officer
American Occupational Therapy Association
Virginia Stoffel, PhD, OT, BCMH, FAOTA
Associate Professor
University of Wisconsin, Madison
Frank Tortorella, MBA, JD, FACHE
Vice President of Clinical Support Services
University of Texas
MD Anderson Cancer Center
4365_FM_i-xxii.indd xiii
Acknowledgments
I also wish to extend thanks to the following who are
directors at the University of Texas MD Anderson
Cancer Center Division of Clinical Support Services:
• Carol Frankmann, Clinical Nutrition
• Gayle Harper, Clinical Support Services
Administration
• Gale Kennebrew, Chaplaincy and Pastoral
Education
• Daniel Kowalczyk, Dining Services
• Connie Longuet, Patient Access
• Margaret Meyer, Social Work
• Pamela Douglas-Ntagha, Patient Resources
• Cesar Palacio, Language Assistance
• Donna Ukanowicz, Case Management
xiii
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4365_FM_i-xxii.indd xiv 12/30/2015 11:15:39 AM

SECTION I
Introduction to Leadership
and Evidence-Based Management, 1
CHAPTER 1
Leadership: The Art, Science, and Evidence,
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 3
Critical Thinking Questions, 4
Glossary, 4
Introduction, 5
Leadership Versus Management, 6
Understanding Leadership, 6
Leadership Theories: An Overview, 7
Leadership Theories, 10
Servant Leadership, 21
Gender and Leadership, 24
Real-Life Solutions, 28
Chapter Summary, 28
Study Questions, 28
Resources for Learning More About Leadership, 30
Associations That Are Concerned With Leadership, 31
Useful Websites on Leadership, 31
Reference List, 31
CHAPTER 2
Engaging in Evidence-Based Management,
Marcia Finlayson, PhD, OT Reg (Ont), OTR
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 35
Critical Thinking Questions, 36
Glossary, 36
Introduction, 37
Evidence-Based Practice and Evidence-Based
Management: Reviewing the Basics, 37
The Need for Evidence-Based Management
of Occupational Therapy Services, 39
4365_FM_i-xxii.indd xv
Contents
Types of Evidence Used by Occupational Therapy
Managers, 41
Process of Finding, Evaluating, and Using Evidence
in Occupational Therapy Management, 41
Challenges of Using an Evidence-Based Approach, 53
Chapter Summary, 54
Useful Resources for Applying Evidence-Based Practice
3 to Management of Occupational Therapy
Services, 54
Real-Life Solutions, 55
Study Questions, 55
Resources for Learning More About Evidence-Based
Practice, 56
Professional Organizations Relevant to Management
of Occupational Therapy Services, 57
Reference List, 58
SECTION II
Leading and Managing in Context, 59
CHAPTER 3
Understanding Health-Care Systems
and Practice Contexts, 61
Gail Fisher, MPA, OTR/L, FAOTA
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 61
Critical Thinking Questions, 62
Glossary, 62
35 Introduction, 63
Health-Care Systems and Occupational Therapy Service
Delivery Settings, 63
Evidence, Health Systems, and the Occupational
Therapy Manager, 67
Common Types of Data, Information, and Other
Forms of Evidence Used by Occupational Therapy
Managers, 68
Legislation, 72
Clinical Practice Requirements, 78
Data, Information, and Other Forms of Evidence
on Personnel, 81
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 xvi Contents

Licensure and Certification, 81 Real-Life Solutions, 153

Trend Data and Future Forecasts, 82 Study Questions, 154
Chapter Summary, 84 Resources for Learning More About
Real-Life Solutions, 84 Communication, 155
Study Questions, 85 Associations Concerned With Communication, 155
Resources for Learning More About Health-Care Resources for Learning More About Writing Grant
Systems and Practice Contexts, 87 Proposals, 155
Professional Associations Concerned With Health-Care Reference List, 155
Systems and Practice Contexts, 87
Website Resource List, 88
Reference List, 90 CHAPTER 6
Roles and Functions of Managers:
CHAPTER 4 Planning, Organizing and Staffing, Directing,
Understanding and Working and Controlling, 159
Brent Braveman, PhD, OTR/L, FAOTA
Within Organizations, 93 Real-Life Management, 159
Brent Braveman, PhD, OTR/L, FAOTA
Critical Thinking Questions, 160
Real-Life Management, 93
Glossary, 160
Critical Thinking Questions, 94
Introduction, 160
Glossary, 94
Planning, 161
Introduction, 95
Operational Planning Versus Strategic Planning, 162
A Brief History of Organizations and Organizational
Theory, 95 Organizing and Staffing, 168
Organizations as Systems, 97 Human Resources Planning, 168
Organizational Environments, 101 Recruitment and Hiring, 169
Types of Organizations, 106 Training, Education, and Development, 172
Common Types of Private Business Organizations, 108 Discipline and Separation, 173
Organizations by Societal Sector, 111 Directing, 175
Organizational Structure, 112 Controlling, 176
Trends in Organizational Development, Behavior, Information Management, 179
and Function, 116 Chapter Summary, 180
Chapter Summary, 119 Real-Life Solutions, 181
Real-Life Solutions, 121 Study Questions, 182
Study Questions, 121 Resources for Learning More About the Roles
Resources for Learning More About Organizations, 122 and Functions of Managers, 182
Professional Organizations and Associations Concerned Associations That Are Concerned With Management
With the Study of Organizations, 123 and Management Issues, 183
Reference List, 124 Miscellaneous Resources Related to Management, 183
Reference List, 183

CHAPTER 5
Communicating Effectively in Complex CHAPTER 7
Environments, 127 Roles and Functions of Supervisors, 185
Brent Braveman, PhD, OTR/L, FAOTA Brenda Koverman, MBA, MS, OTR/L
Real-Life Management, 127 Brent Braveman, PhD, OTR/L, FAOTA
Critical Thinking Questions, 127 Real-Life Management, 185
Glossary, 128 Critical Thinking Questions, 186
Introduction, 128 Glossary, 186
A Short History of Communication Theory, 128 Introduction, 186
Theories of Communication, 129 Supervision, 187
Cybernetics and Information Theory, 131 The Roles and Functions of Supervisors, 187
Dramatism and Narrative, 132 Becoming an Effective Supervisor, 189
Proxemics and Expectancy Violations Theory, 134 Models of Supervision, 193
Pragmatic Strategies for Improving Management Approaches to Supervision, 195
Communication, 137 Occupational Therapy Perspectives on Supervision, 196
Paralinguistics and Nonverbal Communication, 137 Theories of Motivation, Employee Satisfaction,
Effective Written Communication, 141 and Retention of Employees, 197
Communicating in Virtual Meetings and Social Employee Retention, 203
Media, 150 Performance Appraisal, 207
SBAR Communication in Medical Settings, 152 Chapter Summary, 211
Chapter Summary, 152 Real-Life Solutions, 211

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 Contents xvii

Study Questions, 212 CHAPTER 10

Resources for Learning More About Supervision, 212
Associations That Are Concerned With Supervision, 213
Miscellaneous Resources, 213
Reference List, 214
CHAPTER 8
Professional Teams, Interprofessional Education,
and Collaborative Practice, 215
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 215
Critical Thinking Questions, 216
Glossary, 216
Introduction, 217
The History of Interprofessional Education
and Interprofessional Teams, 219
What Are Interprofessional Teams?, 222
Core Competencies for the Interprofessional Team, 222
Effectiveness of Interprofessional Education, 224
Collaborative Practice, 226
Leadership and Interprofessional Teams, 227
Chapter Summary, 228
Real-Life Solutions, 228
Study Questions, 229
Resources for Learning More About Professional
Teams, Interprofessional Education,
and Interprofessional Competencies, 230
Associations and Organizations Related to Professional
Teams, Interprofessional Education,
and Interprofessional Competencies, 231
Reference List, 231
SECTION III
Managerial Skills, Responsibilities,
and Competencies, 233
CHAPTER 9
Strategic Planning, 235
Brent Braveman, PhD, OTR/L, FAOTA
Shawn Phipps, PhD, MS, OTR/L, FAOTA
Real-Life Management, 235
Critical Thinking Questions, 236
Glossary, 236
Introduction, 237
Operational Planning Versus Strategic Planning, 237
Strategic Planning Across the Decades, 238
Why Plan Strategically?, 240
How Do You Prepare for Strategic Planning?, 240
The Steps of Strategic Planning, 241
Chapter Summary, 248
Real-Life Solutions, 250
Vision 2021, 250
Study Questions, 251
Resources for Learning More About Strategic
Planning, 252
General Resources on Strategic Planning, 252
Associations Concerned With Strategic Planning, 252
Reference List, 253
Managing Change and Solving Problems, 255
Shawn Phipps, PhD, MS, OTR/L, FAOTA
Real-Life Management, 255
Critical Thinking Questions, 256
Glossary, 256
Introduction, 257
Layers of Change, 258
Chapter Summary, 271
Real-Life Solutions, 271
Study Questions, 272
Resources for Learning More About Change
and Solving Problems, 273
Associations That Are Concerned With Change
or Solving Problems, 273
Other Resources, 274
Reference List, 274
CHAPTER 11
Financial Planning, Management,
and Budgeting, 277
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 277
Critical Thinking Questions, 278
Glossary, 278
Introduction, 279
The Relationship of Financial Planning and Management
and Strategic Planning, 279
Basic Accounting Principles, 280
The Financial Planning Process, 280
Capital Equipment and Improvements, 289
Coding and Billing, 291
Payment Models, 292
Chapter Summary, 293
Real-Life Solutions, 293
Study Questions, 293
Resources for Learning More About Financial Planning,
Management, and Budgeting, 294
Organizations Related to Financial Planning,
Management, and Budgeting, 295
Networks and Newsletters Related to Financial
Planning, Management, and Budgeting, 295
Reference List, 295
CHAPTER 12
Assessing and Promoting Clinical
and Managerial Competency, 297
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 297
Critical Thinking Questions, 298
Glossary, 298
Introduction, 299
Why Do We Need to Worry About Competency?, 300
Key Terms, Concepts, and Players, 300
Competency, Skill Acquisition, and Theory, 303
Assessment of Competencies and Other Functions
of the Occupational Therapy Manager, 304
Professional Development and Portfolios, 306
Staffing Plans, Including Per Diem or Registry Staff, 307

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 xviii Contents

Agency Accreditation and Licensure, 308 Organizations Concerned With Marketing Health
Outcomes Evaluation and Management, 309 Services, 374
Domains of Knowledge, Competency, and Assessment Reference List, 374
of Competencies, 309
Examples of Types of Competencies, 309 CHAPTER 15
Documenting Assessment of Competencies, 312
Methods of Assessing Competencies, 313
Developing Evidence-Based Occupational Therapy
Synthesizing Assessment of Competencies Programming, 375
and Documentation, 313 Brent Braveman, PhD, OTR/L, FAOTA
Managerial Competencies, 314 Real-Life Management, 375
Specialty and Advanced (Board) Certifications, 317 Critical Thinking Questions, 376
Chapter Summary, 318 Glossary, 376
Real-Life Solutions, 318 Introduction, 377
Study Questions, 319 How Is Knowledge Organized in Occupational Therapy?
Resources for Learning More About Assessment Paradigms, Theories, Conceptual Practice Models,
of Competencies and Continued Competency, 320 and Related Knowledge, 377
Organizations and Associations Concerned Program Development Models, 380
With Assessment of Competencies and Continued What Are the Relationships Between Theory
Competence, 321 and a Program Development Model?, 382
Reference List, 321 Overview of Evidence on Select Related Knowledge
Relevant to Program Development, 382
Choosing Conceptual Practice Models and Related
Knowledge for the Development of Occupational
CHAPTER 13 Therapy Programming, 389
Continuous Quality Improvement, 327 Case Example 1: Developing an Occupational
Maureen Triller, MPA, DrPH Therapy Program Using Evidence—The Enabling
Alanna Motzi, LCSW Self-Determination (ESD) for Persons Living With
HIV/AIDS Program, 394
Gayle Harper, MSW
Case Example 2: Developing a Theory-Based Approach
Real-Life Management, 327 to Occupational Therapy Oncology
Critical Thinking Questions, 328 Rehabilitation, 401
Glossary, 328 Chapter Summary, 405
Introduction, 329 Real-Life Solutions, 405
A Short History of Continuous Quality Study Questions, 406
Improvement, 330 Resources for Learning More About Developing
History of Quality Improvement in Health Care, 332 Programs, 407
CQI as a Management Philosophy, 334 Associations That Are Concerned With Program
Plan-Do-Study-Act (PDSA), 339 Development, 407
Chapter Summary, 350 Useful Websites on Program Development, 407
Real-Life Solutions, 352 Reference List, 408
Study Questions, 352
Resources for Learning More About Continuous Quality
Improvement, 353 SECTION IV
Professional Organizations Concerned With CQI
or Quality, 354 Leading Evidence-Based Practice
Miscellaneous Resources, 354 and Professional Considerations, 411
Reference List, 355
CHAPTER 16
Introducing Others to Evidence-Based
CHAPTER 14
Practice, 413
Marketing Occupational Therapy Services, 357
Marcia Finlayson, PhD, OT Reg (Ont), OTR
Brent Braveman, PhD, OTR/L, FAOTA Brent Braveman, PhD, OTR/L, FAOTA
Julie Ann Nastasi, ScD, OTD, OTR/L, SCLV, FAOTA Real-Life Management, 413
Real-Life Management, 357 Critical Thinking Questions, 414
Critical Thinking Questions, 358 Glossary, 414
Glossary, 358 Introduction, 415
Introduction, 359 Creating an Environment to Support Evidence-Based
Target Populations, 360 Practice, 415
Components of the Marketing Process, 360 Fieldwork and Entry Into a Profession, 417
Chapter Summary, 370 Evidence-Based Practice Competencies, 419
Real-Life Solutions, 372 Teaching and Training Basics, 419
Study Questions, 373 Strategies for Teaching Each Step of the Evidence-
Resources Related to Marketing Health Services, 373 Based Practice Process, 421

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Creating the Tools to Support Evidence-Based
Practice, 427
Transferring Knowledge and Translating Research
to Practice: A New Global Focus, 427
Chapter Summary, 428
Real-Life Solutions, 429
Study Questions, 430
Resources for Learning More About Introducing Others
to Evidence-Based Practice, 431
General Information on Finding and Evaluating
the Literature, 432
Occupational Therapy–Specific Resources on Evidence-
Based Practice, 432
Professional Organizations Relevant to Administration
and Management of Health-Care Services, 432
Reference List, 433
CHAPTER 17
Turning Theory Into Practice: Managerial
Strategies, 439
Lauro Munoz, OTR, MOT, CHC
Patricia Bowyer, EdD, MS, OTR, FAOTA
Brent Braveman, PhD, OTR/L, FAOTA
Real-Life Management, 439
Critical Thinking Questions, 440
Glossary, 440
Introduction, 441
Communities of Practice Structures, 442
Managing Practice: Roles, Rules, and Tools, 443
How Do I Start to Gain the Trust of the Staff,
Which Will Be Necessary to Build Better
Practice?, 443
How Should We Decide What Constitutes Best
Practice?, 445
What Are Management Approaches to Maintain
Gains After You Define Best Practices in Your
Setting?, 449
What Are the Implications of Changes in Practice
on Staff Roles, Productivity, and Billing?, 455
How Can We Communicate the Nature and Value
of Our Services?, 457
How Will We Know If All This Is Working
for the Patients as Well as for the Staff?, 458
Chapter Summary, 459
Real-Life Solutions, 459
Study Questions, 459
FM.indd xix
Contents xix
Resources for Learning More About Turning Theory
Into Practice, 460
Associations That Are Concerned With Occupation-
Based Practice or Communities of Practice, 461
Other Resources, 461
Reference List, 461
CHAPTER 18
Responsible Participation in a Profession: Fostering
Professionalism and Leading for Moral Action, 467
Regina F. Doherty, OTD, OTR/L, FAOTA, FNAP
Elizabeth W. Peterson, PhD, OTR/L, FAOTA
Real-Life Management, 467
Critical Thinking Questions, 468
Glossary, 468
Introduction, 469
What Does It Mean to Be a Professional?, 469
Occupational Therapy Professional Associations, 470
Ethics, 474
Applying Ethics Knowledge and Skills, 475
Case Example 1: Erin, Ray, and Cross-Coverage
Competency, 478
How Can Managers Actively Support Ethical Practice
Within a Department?, 480
Case Example 2: Linda and the Not-So-Smart
Smartphone, 483
Regulation of Occupational Therapy Practice, 485
Case Example 3: Miguel—An Ounce
of Prevention, 486
Some Final Thoughts on Occupational Therapy
Managers and Ethics, 487
Chapter Summary, 487
Real-Life Solutions, 488
Study Questions, 489
Resources for Learning More About Participating
in a Profession, 490
Professional Organizations Concerned
With the Profession of Occupational Therapy, 490
Professional Organizations Concerned with
Interprofessional Collaboration and Education, 491
Useful Resources on Ethics, 492
Reference List, 492
Answer Key to Chapter Study Questions, 495
Index, 499
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4365_FM_i-xxii.indd xx 12/30/2015 11:15:40 AM
 About the Author

Dr. Brent Braveman is the director of the Department Dr. Braveman has a long history of volunteer
of Rehabilitation Services at the University of Texas service in state and national association activities,
MD Anderson Cancer Center. The department including serving as a state association president,
employs nearly 100 occupational therapy and physical a member of American Occupational Therapy Asso-
therapy practitioners, treats 20,000 patients each year, ciation’s (AOTA’s) Roster of Accreditation Evaluators,
and had a gross revenue of over $24 million in fiscal the chairperson of AOTA’s Administration and Man-
year 2015. agement Special Interest Section, the AOTA Special
Dr. Braveman earned his BS in Occupational Interest Section Council Chairperson, speaker of the
Therapy in 1984 from the University of New Hamp- AOTA Representative Assembly, and secretary of
shire, an MA in Education and Human Development AOTA. Dr. Braveman has a passion for occupational
from the George Washington University in 1992, and therapy, leadership development, and social justice; he
a PhD in Public Health from the University of Illinois is committed to the promotion of the profession and
at Chicago in 2002. to helping occupational therapy practitioners to meet
He has been an author on 38 refereed journal arti- society’s occupational needs.
cles and book chapters, has presented at numerous
national and international conferences, and is the
author of two occupational therapy textbooks, Leading
& Managing Occupational Therapy Services: An Evidence-
Based Approach and Work: Occupational Therapy Inter-
vention to Promote Participation and Productivity.
He has served on multiple national expert panels
providing consultation on issues related to work dis-
ability and employment, HIV and AIDS, and oncol-
ogy rehabilitation for groups including the American
Cancer Society, the Institute of Medicine, and the
National Institutes of Health. He has been a coinves-
tigator on $1.2 million of federally funded research
grants.

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4365_FM_i-xxii.indd xxii 12/30/2015 11:15:40 AM
 SECTION I

Introduction
to Leadership
and Evidence-Based
Management

4365_Chapter 1_0001-0034.indd 1 12/30/2015 11:14:42 AM

4365_Chapter 1_0001-0034.indd 2 12/30/2015 11:14:43 AM

Leadership: The Art,
Science, and Evidence
Brent Braveman, PhD, OTR/L, FAOTA
■ Real-Life Management
Christi recently relocated from a large city to a
smaller suburban town after accepting a position at
an acute care facility that is also associated with a
skilled nursing facility. The facility employs 14
occupational therapy and physical therapy practi-
tioners and one rehabilitation technician. Christi
has 14 years of experience and is commonly recog-
nized as a clinical expert in a number of areas by
many of her peers. Christi was originally asked to
act as interim director for the position of director
of rehabilitation, which has been vacant for several
months; now she has been offered the position on
a permanent basis. She is excited about the promo-
tion and the opportunity but is also nervous about
moving into the role of department director. She is
questioning her leadership skills because she feels
comfortable interacting on a one-on-one basis but
is not as comfortable when leading groups.
Christi shared her reservations about taking on
a formal leadership role with Carole, the division
director who would be her new boss. Carole was
empathetic to Christi’s concerns and committed to
her that, if Christi accepted the position, she would
4365_Chapter 1_0001-0034.indd 3
CHAPTER 1
mentor her to develop her leadership skills. Christi
appreciated the offer but now has the following
questions:
1. Can an individual develop skills as a leader, or
are leadership skills something with which
one is born?
2. What sort of leader does Christi want to be?
She respects both Carole and her former
boss, Steve, but they seem to have very dif-
ferent styles of leadership.
3. If it is possible to develop skills as a leader,
what specific steps can she take to do so?
Christi decided to go to the local bookstore to see
if there were any resources on leadership skills that
would be helpful. She was surprised to find a large
number of books, and they seemed to approach
leadership from many different perspectives. After
scanning a few books, she also noted that a number
of different theories and models were mentioned.
She decided to make a visit to the local university
library and do some more investigation to find out
if any of the theories or models mentioned in the
“popular press” books in the bookstore had been
validated by research.
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 4 SECTION 1 Introduction to Leadership and Evidence-Based Management
Critical Thinking Questions
As you read this chapter, consider the following
questions:
• Are leadership skills innate traits with which
we are born or are they skills that can be
learned and developed over time?
• How can an understanding of theories of lead-
ership and the evidence on these theories
assist in examining your current skills and
Glossary
• 360-degree feedback: receiving feedback on
performance from subordinates, peers, and
supervisors or those higher in an organizational
structure.
• Charisma: ability to instill pride, faith, and
respect in subordinates by transmitting a sense of
mission that is effectively articulated.
• Contingent rewards: rewards and recognition
exchanged for accomplishment of assigned work
duties or reaching organizational objectives.
• Individualized consideration: delegates proj-
ects to stimulate the learning and growth of
employees, coaches and teaches employees, and
treats each employee with respect.
• Intellectual stimulation: arousing followers to
think in new ways and emphasizing problem-
solving and the use of reason before acting.
• Leadership: a process of creating structural
change wherein the values, vision, and ethics of
individuals are integrated into the culture of a
community as a means of achieving sustainable
change.
• Management: the process of guiding an orga-
nization by planning for future work obligations,
4365_Chapter 1_0001-0034.indd 4
interpersonal tendencies in order to identify
areas for development?
• How can leadership theories classified as
supervisory or as strategic be used in combina-
tion to be most effective as a leader?
• What is the relationship of leadership to tra-
ditionally recognized management functions
such as planning, organizing, directing, and
controlling?
organizing employees into functional units,
directing employees in the process of completing
daily work tasks, and controlling work processes
and systems to assure adequate quality of work
output.
• Management by exception: type of manage-
ment in which leaders follow work performance
closely to identify mistakes and intervene or give
directions to correct actions during the work
process (active management by exception) or
may wait until work is completed and provide an
employee with a negative evaluation, hoping that
future performance will be improved (passive
management by exception).
• Mindfulness: approaching communication in a
thoughtful and conscious manner in each inter-
action and avoiding the appearance that com-
munication and leader behavior have become
routine.
• Transaction: in Transactional Leadership The-
ory, occurs whenever the leader promises rewards
and benefits to subordinates for their fulfillment
of agreements and their contributions to goal
achievement.
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Introduction
Occupational therapy practitioners have the opportu-
nity to take on various formal leadership roles in both
paid and volunteer positions. Examples include the
roles of supervisor, department director, or elected
volunteer leader in state professional associations or
at the national level in the American Occupational
Therapy Association (AOTA). Practitioners also have
the opportunity to assume informal leadership roles
such as acting as a resource person for less experienced
students or practitioners, functioning as a thought
leader on a task force or committee (e.g., as an expert
or authority leading innovations) as it completes its
work, or being a lead voice in a community of practi-
tioners. Peter Northouse (2013), the author of a widely
read text on leadership, refers to people who are
leaders because of their formal position in an organiza-
tion as “assigned leaders” and those who are leaders
because of the way others respond to them as “emer-
gent leaders.” Whether you are in a formal assigned
leadership role or lead others because of a natural
affinity to share your knowledge, skills, and experi-
ences with them, you can benefit from learning and
applying theory and evidence on leadership. Just as
you would use an “evidence-based” approach to apply-
ing any clinical skill set with your clients and patients,
using an evidence-based approach to leadership will
help you be more effective.
Leadership is a topic that permeates every aspect of
management. Whether we are involved in planning a
new program, organizing staff for daily work, direct-
ing personnel on how to complete their assignments,
or controlling output and services by measuring and
improving quality, we can function as leaders and have
an impact on how others in the organization view the
organization and their work.
Leadership has been a topic of interest and scien-
tific investigation in sociology, psychology, organiza-
tional development, and business administration—and
in the popular press—for decades. Much of the litera-
ture has focused on the qualities of effective leaders,
including in-depth explorations of what has made
some of our most notable public figures effective as
leaders. Examples include biographies of famous
public figures such as Eleanor Roosevelt and Mahatma
Gandhi, politicians such as William Jefferson Clinton
and George Walker Bush, and successful business
leaders such as Steve Jobs, Bill Gates, and Warren
4365_Chapter 1_0001-0034.indd 5
1 Leadership: The Art, Science, and Evidence 5
Buffet (Bush, 2010; Clinton, 2004; Gerber & Burns,
2002; Isaacson, 2011; Loomis, 2012; Rogak, 2012;
Rudolph & Rudolph, 1983). Leadership has also
become a topic of great interest in health care as the
costs of providing care have skyrocketed. In addition,
there has been wider political debate about health
care surrounding the adoption of the Patient Protec-
tion and Affordable Care Act in 2010 (U.S. Depart-
ment of Health and Human Services, 2013). Books
on the application of leadership have been written in
the fields of nursing, case management, and occupa-
tional therapy (Dunbar, 2009; Gilkeson, 1997;
Grohar-Murray & Dicroce, 2002; Marshall, 2011;
Powell, 2000).
Health-care organizations today are in a constant
state of flux and are influenced by rapidly evolving
government policies such as the Patient Protection
and Affordable Care Act (e.g., Obamacare), economic
conditions, shrinking reimbursement, increased com-
petition, and heightened scrutiny by consumers who
have become more sophisticated in managing their
own health care. Because of an increase in managed
care, tighter compliance regulations for payment, and
increased competition for both public and private
funding, the management structure of most health-
care organizations and community-based organiza-
tions has “flattened.” As a result of this flattening,
many managers who used to lead discipline-specific
departments have been asked to accept formal mana-
gerial responsibility for other disciplines. It is com-
monplace today for directors of rehabilitation or
similar departments to have responsibility for over-
sight of multiple disciplines, including occupational
therapy, physical therapy, and speech-language pathol-
ogy, as well as technical staff, including transportation
or business staff.
It is clear that the topic of leadership has war-
ranted much attention, but it is easy to understand
how, as an occupational therapy student or entry-level
practitioner, you might ask, “I just want to treat my
patients so why should I care about leadership at this
point?” It is easy to appreciate that new practitioners
might be most concerned with the patient care issues
that they expect to confront on a day-to-day basis.
However, given the dynamic health-care environ-
ment, occupational therapy students and new gradu-
ates may find themselves in both formal and informal
leadership roles much sooner than they expect or
perhaps desire.
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 6 SECTION 1 Introduction to Leadership and Evidence-Based Management
Leadership Versus Management
It is helpful to begin a practical discussion of leader-
ship by differentiating between the concepts of leader-
ship and management. One conceptualization of the
relationship between leadership and management is
that the leader’s role is to guide change, whereas the
manager’s role is to maintain stability. For example,
Zaleznik described leaders as developing fresh
approaches to long-standing problems and open issues
to new options but described managers as acting to
limit choices to solve problems (Zaleznik, 2004). He
further stated, “A managerial culture emphasizes
rationality and control. Whether his or her energies
are directed toward goals, resources, organization
structure, or people a manager is a problem-solver.
The manager asks: ‘What problems have to be solved
and what are the best ways to achieve results so that
people will continue to contribute to this organiza-
tion?’ ” (Zaleznik, 2004, p. 75). Similarly, Beech (2002)
suggested that managers tend to rely primarily on
strategy, structure, and systems, whereas leaders are
inclined to use style, staff, skills, and shared goals to
yield desired results.
These conceptualizations of the relationship
between leadership and management may be unneces-
sarily narrow, however. In fact, one may be a leader, a
manager, or both. As noted by Schruijer and Vansina
(2002, p. 872), “Such splitting obscures the complexity
of life. Leaders often face environmental change
and stability simultaneously; organizations may need
change in some domains yet stability in others.” Dis-
tinguishing between leadership and management has
a functional implication for new managers and is not
simply an academic exercise. By thoughtfully distin-
guishing between the constructs of leadership and
management, we may more successfully identify the
skills and behaviors associated with each so that they
can more easily be practiced and incorporated into our
daily behavior. To this end, the following definitions
of leadership and management will be used:
• Leadership is a process of creating structural
change wherein the values, vision, and ethics of
individuals are integrated into the culture of a
community as a means of achieving sustainable
change.
• Management is the process of guiding an orga-
nization by planning for future work obligations,
organizing employees into functional units,
4365_Chapter 1_0001-0034.indd 6
directing employees in the process of completing
daily work tasks, and controlling work pro-
cesses and systems to assure adequate quality of
work output.
Understanding Leadership
To begin to understand leadership, it is important to
distinguish between the act or process of leading (i.e.,
leadership) and the individuals who are in the position
of guiding others (i.e., leaders). It is problematic to
attempt to define and investigate leadership, and in
particular strategies for developing skills in the process
of leading others, by solely focusing on descriptions
of effective leaders. If leadership is a process, then it,
like all processes, will have results. Reflecting on the
definition of leadership provided, leadership is a
process of change whereby we hope to impact others
in some sustainable manner and have lasting impact
on the function of a department or organization. The
definition of leadership provided also implies that the
focus of this process of change is specifically on indi-
viduals and that these individuals are part of a larger
community. This means that when examining the
process of leading, we must consider the impact
on individual workers and on the larger work com-
munity (e.g., the occupational therapy department,
our clients, members of other departments in our
organization).
Theory and evidence on leadership has greatly
evolved and is still evolving. The majority of research
can be found in the business and psychology literature,
although some can be found in the health-care litera-
ture as well. In a review of health and business litera-
ture from 1970 to 1999, only 4.4% of 6,629 articles
reviewed were data based, indicating the continued
need for evidence-based research on the topic of lead-
ership effectiveness (Vance & Larson, 2002). By 2009
Avolio, Walumbwa, and Weber noted that,
Today, the field of leadership focuses not only on the
leader, but also on followers, peers, supervisors, work
setting/context, and culture, including a much broader
array of individuals representing the entire spectrum of
diversity, public, private, and not-for-profit organiza-
tions, and increasingly over the past 20 years, samples of
populations from nations around the globe. Leadership is
no longer simply described as an individual characteristic
12/30/2015 11:14:43 AM

or difference but rather is depicted in various models as
dyadic, shared, relational, strategic, global, and a complex
social dynamic. (Avolio et al, 2009, p. 422)
New models, theories, and methods of examining
leadership such as servant leadership continue to be
introduced. In fact, the number and variety of leader-
ship theories is such that not all can be discussed in
this chapter. Leadership scholars most consistently
agree upon one thing: Leaders are supposed to moti-
vate followers to accomplish organizational goals.
How leaders accomplish this task can be explained and
may depend on the theory or theories of leadership on
which they base their behavior.
Leadership Theories: An Overview
An Early Focus on Traits
Early studies of leadership focused on identification of
the common traits of effective leaders, or what Thomas
Carlyle referred to as “Great Men” or natural leaders
in the 19th century (Carlyle, 1888). Smith and Kreuger
(1933) provided an early review of the literature and
organized traits into the categories of personality traits
(e.g., alertness), social traits (e.g., sociability), and
physical traits (e.g., height). Stogdill (1948, 1974) con-
ducted two surveys of leadership traits that contrib-
uted much to the relationship between individuals’
traits and how they became and performed as leaders.
Other researchers, including Kirkpatrick and Locke
(1991), completed various studies later that identified
a considerable range of traits and characteristics that
contribute to effective leadership. Many of the traits
commonly thought to be associated with effective
leaders are presented in Box 1-1.
BOX 1-1
Traits Commonly Associated With Being an Effective Leader
Intelligence Persistence
Integrity Dominance
Openness Initiative
4365_Chapter 1_0001-0034.indd 7
1 Leadership: The Art, Science, and Evidence 7
However, as early as the mid-20th century, some
challenged the trait approach and questioned the uni-
versality of leadership traits (Northouse, 2013). Trait
identification can contribute to understanding how a
particular leader might be perceived, but there has
been relatively little recent research to validate Trait
Theory as effective in linking leaders with leadership
outcomes; therefore, these theories will not be
addressed further in this chapter.
Early research on leadership also often sought to
answer the question, “Are great leaders born or made?”
Answering this question provides much insight into
whether or not training in leadership is effective and
a valuable investment of resources. However, little
emphasis is placed on this question today because evi-
dence now seems to support that many factors may
influence the effectiveness of leaders, including skills,
knowledge, work experience, and personality. Although
we may not be able to change some of our basic per-
sonality traits, it seems clear that over time, we can
seek the types of experiences (e.g., practice in solving
novel problems and working with different sorts of
groups in various environments) that may contribute
to becoming a more effective leader.
Knowledge and skills may be gained over time, and
the problems encountered by leaders often become
more complex and long term as these individuals rise
higher in organizations, which allows for the existence
of leaders at all levels of organizations. Leadership
development initiatives often attempt to address intra-
personal competence through efforts that include
training in self-awareness (e.g., emotional awareness),
self-regulation (e.g., self-control, trustworthiness),
self-motivation (e.g., commitment, initiative, opti-
mism), social awareness (e.g., empathy, service orien-
tation), and social skills (e.g., collaboration and
cooperation, conflict management) (Day, 2001;
Lussier, 2010).
Drive Honesty
Self-Confidence Cognitive Ability
Sociability Achievement
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 8 SECTION 1 Introduction to Leadership and Evidence-Based Management
Leadership in the Occupational
Therapy Literature
A review of the occupational therapy literature reveals
attention to the topic of leadership in most occupa-
tional therapy textbooks on management and, to a
more limited extent, in the research literature. For
example, a chapter of the 2011 edition of The Occupa-
tional Therapy Manager, Fifth Edition, is devoted to
leadership development. In this text, Snodgrass (2011)
compared the responsibilities of leaders and managers,
identified the two main types of leaders as transforma-
tional and transactional, and presented a review of the
evidence on leadership. Several recent articles describe
the perception of, or self-perception of, various lead-
ership groups in occupational therapy, including
managers and directors of academic programs. For
example, Fleming-Castaldy and Patro (2012) exam-
ined the leadership characteristics of 53 occupational
therapy clinical managers. A demographic measure
and a self-inventory of leadership behaviors were col-
lected in a nonexperimental survey. No significant
associations were found between the demographics
and the scores on the inventory. Snodgrass, Douthitt,
Ellis, Wade, and Plemons (2008) conducted a study
that investigated the relationship between faculty per-
ceptions of occupational therapy program directors’
leadership styles and outcomes of leadership and the
effects of moderating demographic and institutional
characteristics. They reported that, in general, trans-
formational leadership had a significant ( p < 0.001)
positive predictive relationship with the leadership
outcomes, whereas transactional leadership had a sig-
nificant ( p < 0.001) negative predictive relationship.
Findings from this study indicated that overall, trans-
formational and transactional leadership styles are
associated with leadership outcomes. More recently,
leadership development has been a focus of AOTA,
which has implemented programs for academic leaders,
middle managers, and emerging leaders (AOTA,
2014). AOTA President Virginia Stoffel made leader-
ship the focus of her 2013 Inaugural Presidential
Address titled, “From Heartfelt Leadership to Com-
passionate Care” (Stoffel, 2013).
Categorizing Theories on Leadership
Boal and Hooijberg (2001) differentiated between
what they described as theories of leadership within
4365_Chapter 1_0001-0034.indd 8
organizations (supervisory leadership theories) and
theories of leadership of organizations (strategic lead-
ership theories). Supervisory leadership theories,
including the Path-Goal Theory of Leadership and
the Transactional Leadership Theory, draw from
Expectancy Motivation Theory. Expectancy Motiva-
tion Theory supposes that a subordinate’s performance
is related to the extent to which he or she believes that
his or her actions will lead to specific outcomes. Stra-
tegic leadership theories, including the Charismatic
Leadership Theory, Transformational Leadership
Theory, and Situational Leadership Theory, draw
from the study of organizational behavior and the
notion that leaders are able to motivate followers to
commit to and realize performance that exceeds their
own expectations. Leadership within these latter theo-
ries has been likened to the process of empowerment.
The end result of empowerment is a change in orga-
nizational culture that helps subordinates generate
a sense of meaning in their work and a desire to
challenge themselves to experience success (Bennis
& Nanus, 1985). Servant leadership, which is also
described in this chapter, does not fit neatly into either
the supervisory or strategic category of theories. Nort-
house (2013, p. 219) described servant leadership as a
“paradox—an approach to leadership that runs counter
to common sense” and asked, “How can leadership be
both service and influence?”
Table 1-1 provides a brief overview of the classifica-
tion of six theories of leadership chosen for presenta-
tion in this chapter and their major foci. These theories
were chosen because of their inclusion in the occupa-
tional therapy literature and because of their applica-
bility to leadership in health-care settings.
A Few Words About Leadership
Theories and Evidence
Before beginning an exploration of the theories of
leadership to be discussed in this chapter and the evi-
dence related to each theory, it will be helpful to make
a few comments about the nature of empirical inves-
tigations in this area. In Chapter 2 you will be intro-
duced to the process of conducting a search for
evidence; a critical step in this process is to develop
a question to guide selection of evidence. In regard
to leadership theory and corresponding behavior of
leaders who adopt a particular theory, what we might
be most interested in knowing is whether behaviors
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 1 Leadership: The Art, Science, and Evidence 9

TABLE 1-1
Overview of Leadership Theories

Supervisory Theories of Leadership

Theory Primary Focus

Path-Goal Leaders increase personal payoffs for subordinates for goal attainment and make the path to these payoffs
easier to travel by reducing obstacles, thereby improving performance.

Transactional Leaders promise rewards and benefits to subordinates for meeting work goals, and leaders and subordinates
agree through transactions on what will lead to reward and how to avoid punishment.

Strategic Theories of Leadership

Theory Primary Focus

Charismatic Stresses the personal identification of followers with the leader, who formulates an inspirational vision and
impression that the leader’s mission is extraordinary.

Transformational Leaders achieve change by expressing the value associated with outcomes and by articulating a vision of the
future resulting in commitment, effort, and improved performance on the part of subordinates.

Situational Leaders should adopt a leadership style that best fits the developmental level of their subordinates’
competence and commitment.

Servant Leadership: Supervisory or Strategic?

Leaders should be attentive to the concerns of followers and empathize and nurture them by first empowering them and helping
them to develop their personal capacities.

guided by one theory result in better performance on
the part of subordinates than when a leader uses
behavior guided by a different theory. In other words,
“Do behaviors guided by a particular leadership theory
result in higher perceived effectiveness as measured by
indicators of subordinate perception or by organiza-
tional measures of leader performance (e.g., peer
reviews or performance appraisals)?” These questions
may be difficult to answer because well-designed
empirical investigations of the direct impact of leader
behavior on subordinate performance and results are
relatively rare. This dynamic exists primarily for two
reasons. First, outside of contrived laboratory situa-
tions (i.e., studies of leader behavior with college
students who volunteer for a study), relatively few
experimental studies examine leaders in real-time and
real-life situations. It is easy to appreciate that not
many organizations are going to allow their employee
leaders to be manipulated (e.g., to change their style
of leadership for the purpose of study) because of
worry over financial and performance costs to the
organizations. Second, when we try to answer the
question of whether a particular approach to leader-
ship results in improved subordinate performance,
things get cloudy very quickly. This is true because so
many other things besides leadership behavior can
influence performance of subordinates, such as the
organization’s culture, the subordinates’ skills and
experiences, and the relationship of subordinates or
work units to other subordinates or work units in the
organization.
Recent research on issues such as the mediating
effects of subordinate trust in leaders or the congru-
ence of subordinates’ values with a leader’s values may
shed valuable light on why some leaders are effective
(Zhu, Newman, Miao, & Hooke, 2013). However,
such research is not as well developed as that related
specifically to the direct impact of leader behavior. For
this reason, evaluating evidence in regard to leadership
theory and behavior may be a sticky situation.

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 10 SECTION 1 Introduction to Leadership and Evidence-Based Management
However, as a student or new occupational therapy
practitioner who may be assuming his or her first lead-
ership role, you may be perfectly happy to find an
answer to the question, “If I adopt behaviors guided
by a particular leadership theory, am I more likely to
be perceived as effective?” The next section of this
chapter presents four well-established theories of
leadership and two less researched—but often cited—
leadership theories, as well as a summary sample of
evidence on each theory.
Leadership Theories
Path-Goal Theory of Leadership
The genesis of the Path-Goal Theory of Leadership
lies in the work of the Institute for Social Research at
the University of Michigan. The theory was developed
primarily to reconcile prior research findings on the
effects of leader–task orientation (the extent to which
leaders focused on completing work tasks) and leader–
person orientation (the extent to which leaders focused
on the emotional and psychological needs of subordi-
nates) on subordinate satisfaction and performance
(House, 1996). The initiation of research on the Path-
Goal Theory represented a shift in research from a
focus on task and person orientation to a focus on
leader effectiveness.
The Path-Goal Theory was initially developed as a
dyadic theory of supervision concerning relationships
between formally appointed supervisors and subordi-
nates in their day-to-day functioning. As such, it did
not address leadership of groups, leadership of change,
or leadership related to strategic planning or whole
organizations; rather, it dealt with the effect of leader
behavior on individuals. However, in 1996, R. J. House
presented a “reformulated” theory that he described
as a theory of work unit leadership addressing the
effects of leaders on the motivation and abilities of
immediate subordinates and the effects of leaders on
work unit performance. This reformulated theory
included a focus on “unconscious” motives of subor-
dinates and the “valence” of leadership behaviors (i.e.,
the strength of the attractiveness of outcomes to the
followers). The primary propositions of the Path-Goal
Theory are included in Box 1-2.
The function of a leader as explained in the Path-
Goal Theory is to “use a leadership style that best
meets subordinates’ motivational goals” (Northouse,
4365_Chapter 1_0001-0034.indd 10
BOX 1-2
Primary Propositions of Path-Goal Theory
of Leadership
• Leader behavior is viewed as positive to the
extent that subordinates see the behaviors as
an immediate source of satisfaction or key to
future satisfaction.
• Leader behavior will improve employee per-
formance to the extent that it
• Enhances the motivation of members of
work units, enhances the relevant abilities
of employees, provides guidance, and
removes obstacles and provides resources.
• Makes satisfaction of employee needs and
employee rewards contingent on per-
formance, makes work tasks and goal
attainment intrinsically satisfying, and com-
plements the work environment by provid-
ing structure, support, and rewards necessary
for good performance.
• Enhances employee work tasks in a way that
promotes collaborative working relation-
ships among employees and between
employees and the organization, ensures
that the requisite resources are available to
work units, and enhances the need for the
work unit in the eyes of the rest of the
organization.
• Serves as a role model for learning relevant
task behavior.
Based on concepts from House, R. J. (1996). Path-Goal Theory of Leader-
ship: Lessons, legacy and a reformulated theory. Leadership Quarterly,
7, 323–352.
2013, p. 137). This is done by increasing personal
payoffs to subordinates for achieving the workplace
goals, targets, and outcomes established by manage-
ment. Leaders make the paths to these payoffs easier
to travel by reducing roadblocks and helping subordi-
nates choose behaviors that are most appropriate for
the situation and problems at hand. The Path-Goal
Theory is basically a “functional” approach to leader-
ship, calling for a diagnosis of functions that need to
be fulfilled in subordinates’ work environments for
them to be motivated, perform at high levels, and be
satisfied (Schriesheim & Neider, 1996).
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 1 Leadership: The Art, Science, and Evidence 11

The reformulated 1996 Path-Goal Theory of
Leadership identifies 10 classes of leader behaviors
that are theoretically acceptable, satisfying, and moti-
vational for employees. These behavior classes and
examples of each are listed in Table 1-2.
In addition to a leader’s characteristics, the Path-
Goal Theory also considers characteristics of the sub-
ordinates and of the task. Subordinate characteristics
include needs for affiliation, preferences for structure,
desires for control, and self-perceived level of task

TABLE 1-2
Classes and Examples of Leadership Behavior According to Path-Goal Leadership Theory

Leader
Behavior Examples

Clarifying • Setting clear performance goals and how to achieve them

• Setting clear standards for performance in job descriptions and everyday assignments
• Clarifying from whom the employee should and should not take direction
• Using rewards and punishment with restraint and only in response to work performance

Supportive • Expressing concern about the welfare of employees

• Creating a friendly work environment
• Listening to employees’ complaints

Participative • Asking for suggestions on how to proceed

• Including employees in decision-making using formal and informal means

Achievement • Setting challenging goals

oriented • Showing confidence in the ability of employees to perform well
• Emphasizing excellence in performance

Work facilitation • Planning, scheduling, and organizing work tasks effectively to promote employee performance
• Mentoring, guiding, and coaching employees
• Assisting employees to develop needed knowledge and skills

Interaction • Assisting employees to resolve conflicts

facilitation • Assuring that minority opinions are heard
• Using team-building activities to promote close and satisfying relationships

Group-oriented • Encouraging all members of the work unit to participate in discussions

decision • Preventing individuals from dominating discussions
process • Waiting to select options until the entire team has had the opportunity to give input

Representation • Advocating for the work unit throughout the organization

and • Presenting a positive view of the work unit to superiors
networking • Obtaining resources to facilitate work
• Participating in organization-wide social functions

Value-based • Use of “envisioning” activities with employees

behavior • Showing passion and self-sacrifice to achieve a described vision
• Frequent positive evaluation of employees as a group
• Communicating high performance expectations and confidence in employee ability to meet the expectations

Shared • Promoting interdependence among employees

leadership • Delegating leadership visibly to various employees for different tasks

Based on concepts from House, R. J. (1996). Path-Goal Theory of Leadership: Lessons, legacy and a reformulated theory. Leadership Quarterly, 7,
323–352.

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 12 SECTION 1 Introduction to Leadership and Evidence-Based Management

ability. Characteristics of the task include the design
of the subordinate’s task, the formal authority system
of the organization, and the primary work group of
subordinates.
Evidence for the Path-Goal
Theory of Leadership
The Path-Goal Theory of Leadership has been the
focus of considerable research; however, most leader-
ship scholars agree that the theory still has not been
adequately tested and that empirical validation of the
theory as a whole has proved difficult (Knight, Shteyn-
berg, & Hanges, 2004). Some hypotheses of the theory
have been well supported, whereas others have not.
For instance, relationships between leader behavior
and follower performance are more consistently found
than are relationships between leader behavior and
follower satisfaction. Several early meta-analyses
found support for the basic propositions of the Path-
Goal Theory, including strong support for the role
that leaders may play in developing organizational
structures that promote goal attainment by employees
and an overall positive relationship between leader
consideration and subordinate job satisfaction (Fisher
& Edwards, 1988; Indvik, 1986; Wofford & Liska,
1993). Most research on the Path-Goal Theory has
relied on various versions of the Leader Behavior
Description Questionnaire (LBDQ) to measure leader
behaviors. Yet, scholars have repeatedly noted the
inappropriateness of this instrument in investigating
the relationships posited by the Path-Goal Theory,
arguing that the scale does not adequately tap the
proposed constructs. Ayman and Adams (2012) recently
provided an overview of the Path-Goal Theory con-
sistent with the mixed findings about the theory. They
noted that, “Path-Goal Theory can be seen as an
important development in leadership theory that
encouraged the evolution of new leadership conceptu-
alizations” and that “although the empirical support
for the model is mixed, it helped drive new thinking
about leadership” (Ayman & Adams, 2012, p. 227).
Table 1-3 summarizes selected evidence on the
Path-Goal Theory of Leadership.

TABLE 1-3
Summary of Selected Evidence on Path-Goal Theory of Leadership

Level of
Author Study Type N (Sample Size) Evidence Results

Dixon & Hart (2010) Survey 260 manufacturing Fair Path-Goal leadership styles have significant
workers in positive relationships with diverse work group
20 work groups effectiveness.

Schriesheim, Castro, Questionnaire 295 state social Good Main element of theory contradicted because no
Zhou, & services agency evidence found that contingent reward
DeChurch (2006) employees negatively moderates the relationship between
transformational leadership and outcomes (job
satisfaction and performance).

Wofford & Liska Meta-analysis 120 studies Strong Positive relationship between leader consideration
(1993) (behaviors aimed at increasing subordinate job
satisfaction) and job satisfaction.

Fisher & Edwards Meta-analysis 12 studies Strong Positive relationship between leader consideration
(1988) and job satisfaction.

Indvik (1986) Meta-analysis 48 studies with Strong Analyzed prior “mixed” results and found overall
11,862 sufficient support for basic propositions of the
respondents theory to warrant continued investigation.

4365_Chapter 1_0001-0034.indd 12 12/30/2015 11:14:43 AM

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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN