LEADERSHIP AND MANAGEMENT

DEFINITION OF KEY CONCEPTS

LEADERSHIP
IS THE ABILITY TO INFLUENCE OTHER
PEOPLE TO MOVE “IN THE SAME
DIRECTION, TOWARD THE SAME
DESTINATION, AT THE SAME SPEED, NOT
BECAUSE THEY HAVE BEEN FORCED TO,
BUT BECAUSE THEY WANT TO” (Lansdale,
2002).
FOLLOWERS - is a skilled, self-directed
employee, one who participates actively in setting
the group’s direction, invest his or her time and
energy in the work of the group, thinks critically,
and advocates for new ideas
MANAGEMENT
as planning, organizing, commanding,
coordinating, and controlling the work of a
given set of employees as defined by henri
fayol in 1916 (wren, 1972).
THREE PRIMARY TASKS OF
A LEADER

1. Set direction: mission, goals,

vision, purpose

2. Build commitment: motivation,

spirit, teamwork

3. Confront challenges: innovation,

change, turbulence
CHARACTERISTICS OF A GOOD
FOLLOWER
If you discover a problem, inform your team
leader or manager right away. Even better, include
a suggestion for solving the problem in your
report.
Freely invest your interest and energy in your
work.
Be supportive of new ideas and new directions
suggested by others.
When you disagree, explain why you do not
support an idea or suggestion.
Listen carefully and reflect on what your leader
or manager says.
Continue to learn as much as you can about your
specialty area.
Share what you learn with others.
An effective follower will not only make you a
more valuable employee but also can increase the
meaning and satisfaction you get from your work.
Definition of Terms:
1. RESPONSIBILITY – refers to obligation,
“what must be done.”

2. AUTHORITY – power to make final

decision and give commands.

3. ACCOUNTABILITY – refers to liability.

4. SUPERVISION – refers to overseeing the

activities of others.
Purpose of Supervision
1. Inspect, evaluate and improve worker’s
performance.

2. Provide suitable working conditions for the

staff.

3. Orient, train and guide the individual staff

member.
LEADERSHIP THEORIES

TRAIT THEORIES - leaders are

distinguish from non leader to a leader
through their identified traits, or qualities.

QUALITIES :
 Intelligence
- Knowledge, judgment, decisiveness,
oral fluency.
Personality
- Adaptability, creativity,
cooperativeness,
alertness, self-confidence, personal
integrity, emotional balance and control,
independence.
Abilities
- Able to enlist cooperation, interpersonal
skills, tact, diplomacy, prestige, social
participation.
BEHAVIORAL THEORIES

THREE STYLES :

1. AUTHORITARIAN LEADERSHIP -
(also called autocratic, directive, controlling) gives
orders, makes decisions for the group as a whole,
and bears most of the responsibility for the
outcomes.
Characteristics:
• Strong control is maintained over the work
group.
• Others are motivated by coercion.
• Others are directed with commands.
• Communication flows downward.
• Decision making does not involve others.
• Emphasis is on difference in status (“I”
and You”).
• Criticism is punitive.
2. DEMOCRATIC LEADERSHIP - (also called
participative) shares the planning, decision-making,
and responsibility for other members of the group.
participate, either.

Characteristics:

• Less control is maintained.

• Economic and ego awards are use to motivate.
• Others are directed through suggestions
and guidance.
• Communication flows up and down.
• Decision making involve others.
• Emphasis is on “we” rather than “I” and
“you”.
• Criticism is constructive.
3. LAISSEZ-FAIRE LEADERSHIP (also
called permissive, nondirective) “let it alone” does
very little planning or decision-making and fails to
encourage others to participate, either.

Characteristics:
• Is permissive, with little or no control.
• Motivates by support when requested by the
group or individuals.
• Provides little or no direction.
• Uses upward and downward communication
between members of the group.
• Disperses decision making throughout the
group.
• places emphasis on the group.
• does not criticize.
DIFFERENCE
DEMOCRATIC -the leader tries to move
the group toward its goals.

AUTOCRATIC - the leader tries to move

the group towards the leader’s goals.

LAISSEZ-FAIRE - makes no attempt to

move the group.
Contingency Leadership Theory
1. Fiedler’s contingency – proposed that a
leader is most effective when he or she
matches leadership styles (relationship-
oriented or task-oriented) to situational
factors.
3 Situational Factors:
1. Manager-follower relationship (good to
poor) – reflect the degree to which the
leader enjoys the loyalty and support of the
subordinates.
2. Task structure (high to low)
is the degree to which the task or results is
clearly described and or standard operating
procedures guarantee successful completion
and evaluation of the quality of the task.
3. Manager power (strong to weak)
is the degree to which leaders are able to
administer rewards and punishment by
virtue of their position (legitimate power).
Situational Leadership Theory – considered the
followers’ readiness and willingness to perform the
tasks.
Four Situational leadership styles:
1. Telling style (TELLING, DIRECTING OR
GUIDING)
- use with followers who are unable and unwilling or
insecure about performing the task.
2. Selling style (SELLING, COACHING or
EXPLAINING)
- use with followers who are unable but are willing or
confident in performing the task.
3. Participating styles (PARTICIPATING,
FACILITATING or COLLABORATING)
 use with followers who are able but unwilling
or lacking in confidence in performing the task.

4. Delegating styles (PARTICIPATING,

FACILITATING or COLLABORATING)
use in followers who are both able and willing
and have confidence in performing the task.
Vroom-Yetton Expectancy Model
- prescriptive model for determining the amount
of participation leaders should seek from
employees in decision making.

Five Leadership Styles

1. Telling
- assess a problem, make a decision
independently, and inform followers.
2. Selling
- to gather information from followers about a
problem, make a decision independently, and
persuade followers to implement it.
3. Consultative
- to seek advice from followers individually,
make the decision independently, and inform
the followers.
4. Joining
- to join the group, seek suggestion,
independently make a decision, inform.
5. Delegation
- to work with followers in developing
solutions to the problem and facilitate
consensus-building toward a group
solution, which generally is accepted and
implemented as the group wishes.
PATH GOAL THEORY (ROBERT
HOUSE, 1971)
concerned with motivation and productivity.
an effective leader or manager clarifies the path
to the goal. This is done through structuring the
work, planning, organizing, directing, and
controlling.
the leader facilitates task accomplishment by
minimizing obstructions to the goals and
rewarding followers for completing their tasks.
Quantum Leadership

outcome oriented, it matters little what you

did; it only matters what outcome you
produced.
 employees directly involved in decision
making as equitable and accountable partners.
 managers assume more of an influential
facilitative role, rather than one of control.
Charismatic Leadership
based on personal qualities such as charm,
persuasiveness, personal power, self-
confidence, extraordinary ideas, and strong
convictions.

Transactional Leadership
 based on the principles of social exchange
theory.
 individuals engage in social interactions
expecting to give and receive social,
political, psychological benefits or rewards.
Transactional Leadership
focuses on merging the motives, desires,
values, and goals of leaders and followers
into a common cause.
 generate employees’ commitment to the
vision or ideal rather than to themselves
 fosters followers’ inborn desires to pursue
higher values, humanitarian ideals, moral
missions, and causes.
 inspires followers and uses power to instill
a belief that followers also have the ability
to do exceptional things.
Relational Leadership
values collaboration and teamwork;
interpersonal skills are used to promote
collegiality in achieving organizational goals.

Process of developing relationship and creating

connections
Identify actual and potential collaborators
Communicate and sell a potential shared vision
to those in varied settings and under disparate
conditions
 Describe the value each collaborator could
bring to the endeavor, both to the individual
and others
 Facilitate communication by sharing
information, preparing for interactions, and
following up communications exchanges
 build and maintain social interaction and
comfort
Shared Leadership
 an organizational structure in which several
individuals share the responsibility for
achieving the organization’s goal
Servant Leadership
premise that leadership originates from a
desire to serve and that in the course of
serving, one may be called to lead.
MOTIVATION
as the force within the individual that influence
or directs behavior.
the action people take to satisfy unmet needs.
it is the willingness to put effort into achieving a
goal or reward to decrease the tension caused by
the need.

Intrinsic Motivation
comes from within the person, driving him
or her to be productive.
 It is directly related to a person’s level of aspiration.

Factors that influence Intrinsic Motivation

 Parents and peers influence in shaping a person’s
values about what she or he wants to do and be.
 cultural background; some cultures value career
mobility; job success, and recognition more than
others.

Extrinsic Motivation
 is motivation enhanced by the job environment or
external rewards.
MOTIVATIONAL THEORY
Maslow’s hierarchy
• Physiological needs

• Security/Safety
• Social/Love
• Esteem
• Self Actualization
Herzberg Two-Factor Theory
Hygiene Factors:
• positive working conditions
• salary
• status
• job security
• supervision
• Personal life
• IPR and peers
• company policy
Motivator Factors:

achievement
recognition
satisfaction from work itself
responsibility
advancement
possibility for growth
Reinforcement Theory
B.F. Skinner
operant conditioning and behavior modification
demonstrated that people could be conditioned
to behave in a certain way based on a consistent
reward or punishment system.

Expectancy Theory
Vroom’s Expectancy theory
Expectancy Effort Performance
Reward Valence Motivation
McClelland Motivational theory
Motivated by 3 basic needs
1.Achievement-oriented
people focus on improving what is; they transform
ideas into action, judiciously and wisely, taking risks
when necessary.

2. Affiliation-oriented
 people focus their energies on families and friends;
their overt productivity is less because they view their
contributions to society in a different light than those
who are achievement-oriented.
3. Power-oriented
 people are motivated by the power that can be
gained as a result of specific action.

Gellerman Motivational theory

Methods in motivating people positively

1. Stretching
 involves assigning tasks that are more difficult
than what the person is used to doing.
2. Participation
 entails actively drawing into decisions affecting their
work.

Creating a Motivating Work Climate

 Have a clear expectations for workers, and
communicate these expectations effectively.
 Be fair and consistent when dealing with all
employees.
 Be a firm decision maker using an appropriate
decision-making style.
 Develop the concept of teamwork. Develop group
goals and projects that will build a team spirit.
 Integrate the staff’s needs and wants with the
organization’s interests and purpose.
 Know the uniqueness of each employee. Let
each know that you his or her uniqueness.
 Remove traditional blocks between the
employee and the work to be done.
 Provide experiences that challenge or “stretch”
the employee and allow opportunities for
growth.
 When appropriate, request participation and input
from all subordinates in decision-making.
 Whenever possible, give subordinates recognition
and credit.
 Be certain that employees understand the reasons
behind the decisions nad actions.
 Reward desirable behavior; be consistent in how you
handle undesirable behavior.
 Let employee exercise individual judgment as much
as possible.
 Create a trustful and helping relationship
with employees.
 Let employees exercise as much control
as possible over their work environment.
 Be a role model for employees.
POWER
may be defined as that which enables one to
accomplish goals.
As the capacity to act or the strength and
potency to accomplish something.
TYPES OF POWER
1. REWARD POWER – is obtained by the ability to
grant favors or reward others with whatever they
value.
2. PUNISHMENT OR COERCIVE POWER – the
opposite of reward power, is based on fear of
punishment if the manager’s expectations are not met.
3. LEGITIMATE POWER – is position power. It is
gained by a title or official position within an
organization.
4. EXPERT POWER – is gained through knowledge,
expertise, or experience. This type of power is limited to a
specialized area.

5. REFERENT POWER – is a power a person has because

others identify with that leader or with what that leader
symbolizes
It also occurs when one gives another person feelings of
personal acceptance or approval.
it may be obtained through association with powerful.
it may develop because others perceive them as
powerful.
6. INFORMATIONAL POWER – is obtained
when people have information that others must
have to accomplish their goals.

7. CONNECTION POWER – comes from

association with a powerful figure.
EMPOWERMENT
is an interactive process that develops,
builds, and increases power through
cooperation, sharing, and working
together.
Decentralization of power.
3 components of empowerment
1. All practitioners must have professional
traits, including responsibility for
continuing education, participation in
professional organizations, and political
activism, and must have a sense of value
about their work.
2. The nurse must work in an environment
that encourages empowerment.
3. The process must include an effective
leadership style.

7 Impediments to Empowerment
1. Authoritarian
2. Rigid control
3. Inertia
4. Internal competition
5. Employee mix
6. Lack of staff accountability
7. Managerial incompetence
ADVOCACY
helping others to grow and self-actualize
by informing others of their rights and
ascertaining that they have sufficient
information on which to base their
decisions.
Strategies in Advocacy
1. Creates a climate where advocacy and its
associated risk- taking are valued.
2. Seeks fairness and justice to individuals who
are unable to advocate for themselves.
3. Seeks to strengthen patient and subordinate
support system to encourage autonomous,
well-informed decision making.
4. Influences others by providing information
necessary to improve them to act
autonomously.
5. Assertively advocates on behalf of patients and
subordinates when an intermediary is
necessary.
6. Participates in professional nursing
organizations and other groups that seek to
advance the profession of nursing.
7. Role models proactive involvement in health
care policy through both formal and informal
interactions with the media and legislative
representatives.
Principles of Advocacy
1. Each individual has a right to autonomy in
deciding what course of action is most
appropriate to meet his or her goals.
2. Each individual has a right to hold personal
values and to use those values in making
their own health care decisions.
3. All individuals should have access to the
information they need to make informed
decisions and choices.
4. The nurse must act on behalf of patients who
are unable to advocate for themselves.
5. Empowerment of patients and subordinates to make
decisions and take action on their own is the essence
of advocacy.

Common Areas Requiring Nurse-Patient

Advocacy
1. End of life decisions
2. Technological advances
3. Healthcare reimbursement
4. Access to health care
5. Provider-patient conflicts regarding expectations and
desired outcomes.
6. Withholding of information or blatant lying to
patients.
7. Insurance authorizations, denials, and delays
in
coverage.
8. Medical errors.
9. Patient grievance and appeals processes.
10. Patient information disclosure (privacy and
confidentiality).
11. Cultural and ethnic diversity and sensitivity
12. Respect for patient dignity.
13. Informed consent.
14. Incompetent healthcare providers.
15. Complex social problems including AIDS,
teenage pregnancy, violence, poverty.
16. Aging population.
Patient advocacy
refers to speaking on behalf of a patient in order
to protect their rights and help them obtain
needed information and services. The role of
patient advocate is frequently assumed by nurses,
social workers, and other healthcare providers.
Some hospitals, health insurance companies, and
other healthcare organizations employ people
specifically to assume this role.
Patient advocacy is fundamental to nursing.
The American Nurses Association (ANA)
includes advocacy in its definition of nursing
as "the protection, promotion, and
optimization of health and abilities,
prevention of illness and injury, alleviation of
suffering through the diagnosis and treatment
of human response, and advocacy in the care
of individuals, families, communities, and
populations."
The role derives from healthcare ethics. For
instance, the ANA's Code of Ethics for Nurses
includes language relating to patient
advocacy:
• The nurse's primary commitment is
to the patient, whether an individual,
family, group, or community.
• The nurse promotes, advocates for,
and strives to protect the health,
safety, and rights of the patient.
Subordinate Advocacy – situation in which
managers assist subordinates to resolve ethical
problems and live with the solutions at the unit
level.
Things to consider:
• recognize what subordinates are striving for
and the goals and values subordinates consider
appropriate.
• consider the workplace environment.
protect the whistle-blowers.
Professional Advocacy – involves a personal
and public promise to serve others with the
special expertise that a profession can provide
and that society legitimately expects it to
provide.
 Concepts of Management
Scientific Management (1900 – 1930)
Frederick Taylor – “father of scientific
management.”
he postulated that if workers could be
taught the “one best way to accomplish
a task,” productivity would increase.
4 Overriding Principles of Management
identified by Taylor.
1. Traditional “rule of thumb” means of
organizing work must be replaced with
scientific methods. In other words, by using
time and motion studies and the expertise of
experienced workers, work could be
scientifically designed to promote greatest
efficiency of time and energy.
2. A scientific personnel system must be
established so workers can be hired, trained,
and promoted based on their technical
competence and abilities. Taylor thought that
employee’s abilities and limitations could be
identified so the worker could be best
matched to the most appropriate job.
3. Workers should be able to view how they
“fit” into the organization and how they
contribute to overall organizational productivity.
This provides common goals and and a sharing
of organizational mission. One way in which
Taylor thought this could be accomplished was
by the use of financial incentives as a reward for
work accomplished. Because he viewed humans
as “economic animals” motivated solely by
money, workers were paid according to their
level of production, rather than by an hourly
wage.
4. The relationship between managers and
workers should be cooperative and
independent, and the work should be shared
equally. Their roles, however, were not the
same. The role of managers, or “functional
foreman” as they were called, was to plan,
prepare, and supervise. The worker was to
do the work.
THEORY X AND THEORY Y (DOUGLAS
McGREGOR, 1960.)
• theory X assumes that people dislike work
and must be directed and controlled.
Organizational goals are emphasized.

•Theory Y assumes that people are self directed

and will accept responsibility under favorable
conditions. Individual goals are emphasized.
THEORY Z (WILLIAM OUCHI, 1981.)
• promotes a relationship-oriented, democratic
leadership style.
• participative management approach is utilized.
characterized by shared authority, responsibility
and accountability.
• promotes a relationship-oriented, democratic
leadership style.
•participativemanagement approach is utilized.
• characterized by shared authority, responsibility and
accountability.
•
FIVE DIFFERENT FORMS OF POWER THAT A
LEADER MAY POSSES.
1. LEGITIMATE POWER
- given to a manager by virtue of his position in the organization.
Ex. H.N.
2. REWARD POWER
- based on the ability of the manager to administer rewards to
others.
3. COERCIVE POWER
- founded on the managers ability to use punishment on others
for non compliance with order.
4. EXPERT POWER
- derived from some special ability, skill or knowledge
demonstrated by the individual.
5. REFERENT POWER
- based on attractiveness or appeal of one person to another.
Similarities & Differences Between
Leaders & Managers
Leaders:
• May or may not have official
appointment to the position
• Power & authority: depends on the
willingness of the followers
• Influence others toward goal setting, either
formally or informally
• Interested in risk taking and exploring new
ideas.
• Relate to people personally in an intuitive
and empathetic manner
• Feel rewarded by personal achievements
• May or may not be successful as managers
Managers:
• Officially appointed to the position
• Have power and authority to enforce
decisions
• Carry out predetermined policies, rules and
regulations
•Maintain an orderly, controlled, rational
and equitable structure
• Relate to people according to their roles
• Feel rewarded when fulfilling
organizational mission or goals
• Managers as long as the appointment
holds.
Management: the process of working with
and through others to achieve
organizational objectives in a changing
environment.

Nursing management : the process of

working through the staff members to
provide care, cure and comfort to patients.
The Nurse Management Process:
Planning
- an intellectual, continuous process of
assessing, establishing goals and
objectives; implementing and evaluating
them if changes are needed.

Importance of planning:
1. It leads to the achievement of goals and
objectives.
2. It gives meaning to work.
3. Provides for effective use of available
resources and facilities.
4. Helps in coping with crises.
5. Promotes efficiency and cost
effective.
6. Reduces recurrence of problems.
7. Leads to the realization of the need
for change.
8. Necessary for effective control.
Scope of Planning:
1. Top managers:
> responsible for the overall planning of
nursing services; establish objectives ,
policies and strategies; represents the
organization in community affairs, business
arrangements and negotiations.
2. Middle managers:
coordinates the nursing activities of several
units; receive broad, overall strategies and
policies from top managers and translate them
into specific objectives and programs.

3. First-line managers: Directly responsible for

the actual production of nursing services; Acts
as links between higher level managers and
non-managers.
Elements of Planning:
1. Forecasting
2. Setting the vision, mission, Philosophy,
Goal and Objectives
3.Time management
4. Preparing the budget
- a financial road map: estimates the costs
and a plan for utilization of manpower,
material and other resources to cover capital
projects in the operating programs.
a. Nursing Budget: a financial plan for
allocation resources based on preconceived
needs.
b. Hospital Budget: a financial plan to meet
future service expectations
Budget Components:
a. Revenue Budget: summary of the income
expected
b. Expense Budget: describes the expected
activities in operational and financial terms.
c. Capital budget: outlines the
programmed acquisitions, disposals
and improvements in the
institution’s physical capacity.
d. Cash budget: represents the planned
cash receipts and disbursements.
Benefits:
1. Planning: anticipates future opportunities
Types of services to be rendered and
revenues derived
Stimulates interaction; organizational
thinking process.
2. Coordination: balancing effect: quantity
& quality of service should equal to the
expected revenue.
3. Comprehensive Control: Comparison
between actual expenditures and budgeted
standards can be made.
Budget Factors:
1. Types of patients
2. Bed capacity & hospital size
3. Physical lay-out of the hospital
4. Personnel policies
a. Salaries paid to various types of
personnel
b. Extent of Leaves
c. staff development programs
5. Standards of nursing care.
6. Amount & quality of
supervision
available/provided
7. Method of patient assignment
8. Reports required by
Administration
9. Affiliation of nursing student
5. Establishing Nursing Standards,
Policies and Procedures

Policies: broad guidelines that

govern the action of workers and
supervisors at all levels and are
intended to achieve pre-
determined goals.
Characteristics:
a. written and understood by those
who will be affected by it.
b. comprehensive in scope; flexible
c. consistent and realistic
Nursing Procedures: specific directions
for implementing written policies.
a. Job situations
b. Patient Care
DECISION MAKING:
The commitment to a particular course of
action for the purpose of achieving a
desired result.
Process:
1. Definition of the problem
2. Analysis of the problem
3. Development of an alternative solution
4. Selection of the solution
5. Implementation and follow-up