Introduction to management

INTRODUCTION TO MANAGEMENT. BASIC CONCEPTS OF MANAGEMENT. HISTORICAL DEVELOPMENT OF MANAGEMENT THEORY

 

 

 

 

. . . management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.

—Stephen R. Covey

 

. . . no executive has ever suffered because his subordinates were strong and effective.

—Peter Drucker

 

 

 

 

LEARNING OBJECTIVES

 

The students shall:

•                     discuss the evolution of management theory in relationship to changing society

•                     correlate management theorists with their appropriate theoretical contributions

•                     discuss the need for healthcare managers to have highly integrated, well-developed management skills

•                     define the components of the management process

•                     differentiate between leadership roles and management functions

•                     identify common leadership styles and describe situations in which each leadership style could be used appropriately

•                     describe the differences between interactional and transformational leadership theories

•                     analyze the historical development of leadership theory

•                     differentiate between authoritative, democratic, and laissez-faire leadership styles

•                     identify contextual factors impacting the relationship between leaders and followers, based on full range leadership theory

•                     delineate variables suggested in situational and contingency theories

 

The relationship between leadership and management continues to prompt some debate, although there clearly is a need for both. Leadership is viewed by some as one of management’s many functions; others maintain that leadership requires more complex skills than management and that management is only one role of leadership; still others delineate between the two. Others argue that management emphasizes control—control of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies—whereas leadership increases productivity by maximizing workforce effectiveness.

But if a manager guides, directs, and motivates and a leader empowers others, then it could be said that every manager should be a leader. Similarly, leadership without management results in chaos and failure for both the organization and the individual executive. Yet, we are all aware of individuals in leadership positions who cannot manage and individuals in management roles who caot lead. This topic will first artificially differentiate between management and leadership, focusing on how theory development in each field of study has changed over time and then conclude with a discussion of how closely integrated the two roles must actually be for individuals in contemporary leadership or management roles.

 

 

MANAGERS

 

Encarta World English Dictionary (2009, para 1) defines management as “the act of handling or controlling something successfully” or “the skillful handling or use of something such as resources.” Both definitions imply that management is the process of leading and directing all or part of an organization, often a business, through the deployment and manipulation of resources. The act, manner, or practice of managing, handling, supervision, or control is another description of management.

 

Managers then typically:

•           have an assigned position within the formal organization

•           have a legitimate source of power due to the delegated authority that accompanies their position

•           are expected to carry out specific functions, duties, and responsibilities

•           emphasize control, decision making, decision analysis, and results

•           manipulate people, the environment, money, time, and other resources to achieve organizational goals

•           have a greater formal responsibility and accountability for rationality and control than leaders

•           direct willing and unwilling subordinates

 

Management is the process of leading and directing all or part of an organization through the deployment and manipulation of resources.

 

 

LEADERS

Although the term leader has been in use since the 1300s, the word leadership was not known in the English language until the first half of the 19th century. Despite its relatively new addition to the English language, leadership has many meanings. From Chapin’s (1924) technical definition of leadership as “a point of polarization for group cooperation” to Ward’s (2009, para 1) definition of leadership as “the art of motivating a group of people to act towards achieving a common goal,” it becomes clear that there is no single definition broad enough to encompass the total leadership process.

 

Leadership Roles

 

 

A job title alone does not make a person a leader. Only a person’s behavior determines if he or she occupies a leadership position. The manager is the person who brings things about — the one who accomplishes, has the responsibility, and conducts. A leader is the person who influences and guides direction, opinion, and course of action. Display 2.1 includes a partial list of common leadership roles.

Other characteristics of leaders include the following:

•                     leaders often do not have delegated authority but obtain their power through other means, such as influence.

•                     leaders have a wider variety of roles than do managers.

•                     leaders may or may not be part of the formal organization.

•                     leaders focus on group process, information gathering, feedback, and empowering others.

•                     leaders emphasize interpersonal relationships.

•                     leaders direct willing followers.

•                     leaders have goals that may or may not reflect those of the organization.

 

To examine the word leader, however, is to note that leaders lead. “Put even more simply, the leader is the inspiration and director of the action. He or she is the person in the group who possesses the combination of personahty and skills that makes others want to follow his or her direction” (Ward, 2009, para 2).

 

Leaders are in the front, moving forward, taking risks, and challenging the status quo.

 

LEARNING EXERCISE

Leadership Roles and Management Functions

In small or large groups, discuss your views of management and leadership. Do you believe they are the same or different? If you believe that they are different, do you think that they have the same importance for the future of nursing? Do you feel that one is more important than the other? How caovice nurse-managers learn important management functions and develop leadership skills?

 

 

It is important then to remember that all it takes to stop being a leader is to have others stop following you. Leadership then is more dynamic than management and leaders do make mistakes that can result in the loss of their followers. For example, Zenger and Folkman (2009), using 360-degree feedback data from more than 450 Fortune 500 executives, identified 10 fatal flaws that derail leaders (see Display 2.2). Although these flaws seem fairly obvious, many ineffective leaders are unaware that they exhibit these behaviors.

 

Ten Fatal Leadership Flaws

1.                  A lack of energy and enthusiasm

2.                  Acceptance of their own mediocre performance

3.                  Lack of a clear vision and direction

4.                  Having poor judgment

5.                  Not collaborating

6.                  Not walking the talk

7.                  Resisting new ideas

8.                  Not learning from mistakes

9.                  A lack of interpersonal skills

10.               Failing to develop others

Source: Zenger, J., & Folkman, J. (2009). Ten fatal flaws that derail leaders. Harvard Business Review. 18.

 

 

HISTORICAL DEVELOPMENT OF MANAGEMENT THEORY

 

Management science, like nursing, develops a theory base from many disciplines, such as business, psychology, sociology, and anthropology. Because organizations are complex and varied, theorists’ views of what successful management is and what it should be have changed repeatedly in the last 100 years.

 

Theorists’ views of what successful management is and what it should be have changed repeatedly in the last 100 years.

 

 

Scientific Management (1900-1930)

 

Frederick W. Taylor, the “father of scientific management,” was a mechanical engineer in the Midvale and Bethlehem Steel plants in Pennsylvania in the late 1800s. Frustrated with what he called “systematic soldiering,” where workers achieved minimum standards doing the least amount of work possible, Taylor postulated that if workers could be taught the “one best way to accomplish a task,” productivity would increase. Borrowing a term coined by Louis Brandeis, a colleague of Taylor’s, Taylor called these principles scientific management. The four overriding principles of scientific management as identified by Taylor (1911) are:

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 that workers can be hired, trained, and promoted based on their technical competence and abilities. Taylor thought that each employee’s abilities and limitations could be identified so that 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 a sharing of the organizational mission. One way Taylor thought that this could be accomplished was by the use of financial incentives as a reward for work accomplished. Because Taylor viewed humans as “economic animals” motivated solely by money, workers were reimbursed according to their level of production rather than by an hourly wage.

4.           The relationship between managers and workers should be cooperative and interdependent, and the work should be shared equally. Their roles, however, were not the same. The role of managers, or functional foremen as they were called, was to plan, prepare, and supervise. The worker was to do the work.

What was the result of scientific management? Productivity and profits rose dramatically. Organizations were provided with a rational means of harnessing the energy of the industrial revolution. Some experts have argued that Taylor lacked humanism and that his scientific principles were not in the best interest of unions or workers. However, it is important to remember the era in which Taylor did his work. During the Industrial Revolution, laissez-faire economics prevailed, optimism was high, and a Puritan work ethic prevailed. Taylor maintained that he truly believed managers and workers would be satisfied if financial rewards were adequate as a result of increased productivity. As the cost of labor rises in the United States, many organizations are taking a new look at scientific management with the implication that we need to think of new ways to do traditional tasks so that work is more efficient.

 

 

LEARNING EXERCISE

Strategies for Efficiency

In small groups, discuss some work routines carried out in healthcare organizations that seem to be inefficient. Could such routines or the time and motion involved to carry out a task be altered to improve efficiency without jeopardizing quality of care? Make a list of ways that nurses could work more efficiently. Do not limit your examination to only nursing procedures and routines, but examine the impact that other departments or the arrangement of the nurse’s work area may have on preventing nurses from working more efficiently. Share your ideas with your peers.

 

 

About the same time that Taylor was examining worker tasks, Max Weber, a well-known German sociologist, began to study large-scale organizations to determine what made some workers more efficient than others. Weber saw the need for legalized, formal authority and consistent rules and regulations for personnel in different positions; he thus proposed bureaucracy as an organizational design. His essay “Bureaucracy” was written in 1922 in response to what he perceived as a need to provide more rules, regulations, and structure within organizations to increase efficiency. Much of Weber’s work and bureaucratic organizational design are still evident today in many healthcare institutions. His work is discussed further in Topic 12.

 

 

Management Functions Identified (1925)

 

Henri Fayol (1925) first identified the management functions of planning, organization, command, coordination, and control. Luther Gulick (1937) expanded on Fayol’s management functions in his introduction of the “seven activities of management”—planning, organizing, staffing, directing, coordinating, reporting, and budgeting—as denoted by the mnemonic POSDCORB. Although often modified (either by including staffing as a management function or renaming elements), these functions or activities have changed little over time. Eventually, theorists began to refer to these functions as the management process.

 

 

The Management Process

 

The management process is this book’s organizing framework. Brief descriptions of the five functions for each phase of the management process follow:

1.          Planning encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of action; and managing planned change.

2.            Organizing includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals. Other functions involve working within the structure of the organization and understanding and using power and authority appropriately.

3.           Staffing functions consist of recruiting, interviewing, hiring, and orienting staff. Scheduling, staff development, employee socialization, and team building are also often included as staffing functions.

4.           Directing sometimes includes several staffing functions. However, this phase’s functions usually entail human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration.

5.           Controlling functions include performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

 

 

Human Relations Management (1930-1970)

 

During the 1920s, worker unrest developed. The Industrial Revolution had resulted in great numbers of relatively unskilled laborers working in large factories on specialized tasks. Thus, management scientists and organizational theorists began to look at the role of worker satisfaction in production. This human relations era developed the concepts of participatory and humanistic management, emphasizing people rather than machines.

Mary Parker Follett (1926) was one of the first theorists to suggest basic principles of what today would be called participative decision making or participative management. In her essay “The Giving of Orders,” Follett espoused her belief that managers should have authority with, rather than over, employees. Thus, solutions could be found that satisfied both sides without having one side dominate the other.

The human relations era also attempted to correct what was perceived as the major shortcoming of the bureaucratic system—a failure to include the “human element.” Studies done at the Hawthorne Works of the Western Electric Company near Chicago between 1927 and 1932 played a major role in this shifting focus. The studies, conducted by Elton Mayo and his Harvard associates, began as an attempt to look at the relationship between light illumination in the factory and productivity.

 

 

Management Theory Development 1900-1970

 

 

 

Mayo and his colleagues discovered that when management paid special attention to workers, productivity was likely to increase, regardless of the environmental working conditions. This Hawthorne effect indicated that people respond to the fact that they are being studied, attempting to increase whatever behavior they feel will continue to warrant the attention. Mayo (1953) also found that informal work groups and a socially informal work environment were factors in determining productivity, and Mayo recommended more employee participation in decision making.

Douglas McGregor (1960) reinforced these ideas by theorizing that managerial attitudes about employees (and, hence, how managers treat those employees) can be directly correlated with employee satisfaction. He labeled this Theory X and Theory Y. Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs. Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

Chris Argyris (1964) supported McGregor and Mayo by saying that managerial domination causes workers to become discouraged and passive. He believed that if self-esteem and independence needs are not met, employees will become discouraged and troublesome or may leave the organization. Argyris stressed the need for flexibility within the organization and employee participation in decision making.

The human relations era of management science brought about a great interest in the study of workers. Many sociologists and psychologists took up this challenge, and their work in management theory contributed to our understanding about worker motivation, which will be discussed in Topic 18. Table 2.1 summarizes the development of management theory up to 1970. By the late 1960s, however, there was growing concern that the human relations approach to management was not without its problems. Most people continued to work in a bureaucratic environment, making it difficult to always apply a participatory approach to management. The human relations approach was time consuming and often resulted in unmet organizational goals. In addition, not every employee liked working in a less structured environment. This resulted in a greater recognition of the need to intertwine management and leadership than ever before.

 

 

HISTORICAL DEVELOPMENT OF LEADERSHIP THEORY (1900-PRESENT)

 

Because strong management skills were historically valued more than strong leadership skills, the scientific study of leadership did not begin until the 20th century. Early works focused on broad conceptualizations of leadership, such as the traits or behaviors of the leader. Contemporary research focuses more on leadership as a process of influencing others within an organizational culture and the interactive relationship of the leader and follower. To better understand newer views about leadership, it is necessary to look at how leadership theory has evolved over the last century.

Like management theory, leadership theory has been dynamic; that is, what is “known” and believed about leadership continues to change over time.

 

 

The Great Man Theory/Trait Theories (1900-1940)

 

The Great Man theory and trait theories were the basis for most leadership research until the mid-1940s. The Great Man theory, from Aristotelian philosophy, asserts that some people are born to lead, whereas others are born to be led. It also suggests that great leaders will arise when the situation demands it.

Trait theories assume that some people have certain characteristics or personality traits that make them better leaders than others. To determine the traits that distinguish great leaders, researchers studied the lives of prominent people throughout history. The effect of followers and the impact of the situation were ignored. Although trait theories have obvious shortcomings (e.g., they neglect the impact of others or the situation on the leadership role), they are worth examining. Many of the characteristics identified in trait theories (Display 2.3) are still used to describe successful leaders today.

Contemporary opponents of these theories argue that leadership skills can be developed, not just inherited. Avolio, Walumbwa, and Weber (2009) suggest, however, that very little work has been done in the last 100 years to determine whether leadership can actually be developed. A recent meta-analytic review suggested that only about one third of the 201 interventional leadership studies focused on developing leadership skills rather than manipulating it for impact.

 

 

LEARNING EXERCISE

Effective Leadership

In groups or individually, list additional characteristics that you believe an effective leader possesses. Which leadership characteristics do you have? Do you believe that you were born with leadership skills, or have you consciously developed them during your lifetime? If so, how did you develop them?

 

 

Behavioral Theories (1940-1980)

 

During the human relations era, many behavioral and social scientists studying management also studied leadership. For example, McGregor’s (1960) theories had as much influence on leadership research as they did on management science. As leadership theory developed, researchers moved away from studying what traits the leader had and placed emphasis on what he or she did—the leader’s style of leadership.

 

 

Characteristics Associated with Leadership

 

A major breakthrough occurred when Lewin (1951) and White and Lippitt (1960) isolated common leadership styles. Later, these styles came to be called authoritarian, democratic, and laissez faire.

 

The authoritarian leader is characterized by the following behaviors:

•                     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.

 

 

Authoritarian leadership results in well-defined group actions that are usually predictable, reducing frustration in the work group and giving members a feeling of security. Productivity is usually high, but creativity, self-motivation, and autonomy are reduced. Authoritarian leadership is frequently found in very large bureaucracies such as the armed forces.

In addition, Amar, Hentrich, and Hlupic (2009) suggest that in chaotic times, leaders often become more autocratic in an effort to increase efficiency and achieve greater control. Amar et al. argue, however, that relinquishing authority and giving employees more autonomy may actually boost innovation and success, even during crises. This is because organizations can begin to miss opportunities and not respond to market demands when employees feel confined by excessive authority and oversight.

 

 

The democratic leader exhibits the following behaviors:

•                     Less control is maintained.

•                     Economic and ego awards are used to motivate.

•                     Others are directed through suggestions and guidance.

•                     Communication flows up and down.

•                     Decision making involves others.

•                     Emphasis is on “we” rather than “I” and “you.”

•                     Criticism is constructive.

 

Democratic leadership, appropriate for groups who work together for extended periods, promotes autonomy and growth in individual workers. This type of leadership is particularly effective when cooperation and coordination between groups are necessary.

 

Studies have shown, however, that democratic leadership is less efficient quantitatively than authoritative leadership.

Because many people must be consulted, democratic leadership takes more time and, therefore, may be frustrating for those who want decisions made rapidly.

 

 

The laissez-faire leader is characterized by the following behaviors:

•                     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.

 

Because it is nondirected leadership, the laissez-faire style can be frustrating; group apathy and disinterest can occur. However, when all group members are highly motivated and selfdirected, this leadership style can result in much creativity and productivity. Laissez-faire leadership is appropriate when problems are poorly defined and brainstorming is needed to generate alternative solutions.

 

A person’s leadership style has a great deal of influence on the climate and outcome of the work group.

 

 

LEARNING EXERCISE

What’s Your Leadership Style?

Define your predominant leadership style. Ask those who work with you if in their honest opinion this is indeed the leadership style that you use most often. What style of leadership do you work best under? What leadership style best describes your present or former managers?

 

 

For some time, theorists believed that leaders had a predominant leadership style and used it consistently. During the late 1940s and early 1950s, however, theorists began to believe that most leaders did not fit a textbook picture of any one style but rather fell somewhere on a continuum between authoritarian and laissez faire. They also came to believe that leaders moved dynamically along the continuum in response to each new situation. This recognition was a forerunner to what is known as situational or contingency leadership theory.

 

 

Situational and Contingency Leadership Theories (1950-1980)

 

The idea that leadership style should vary according to the situation or the individuals involved was first suggested almost 100 years ago by Mary Parker Follett, one of the earliest management consultants and among the first to view an organization as a social system of contingencies. Her ideas, published in a series of books between 1896 and 1933, were so far ahead of their time that they did not gain appropriate recognition in the literature until the 1970s. Her law of the situation, which said that the situation should determine the directives given after allowing everyone to know the problem, was contingency leadership in its humble origins.

Fiedler’s (1967) contingency approach reinforced these findings, suggesting that no one leadership style is ideal for every situation. Fiedler felt that the interrelationships between the group’s leader and its members were most influenced by the manager’s ability to be a good leader. The task to be accomplished and the power associated with the leader’s position also were cited as key variables.

In contrast to the continuum from autocratic to democratic, Blake and Mouton’s (1964) grid showed various combinations of concern or focus that managers had for or on productivity, tasks, people, and relationships. In each of these areas, the leader-manager may rank high or low, resulting iumerous combinations of leadership behaviors. Various formations can be effective depending on the situation and the needs of the worker.

Hersey and Blanchard (1977) also developed a situational approach to leadership. Their tridimensional leadership effectiveness model predicts which leadership style is most appropriate in each situation on the basis of the level of the followers’ maturity. As people mature, leadership style becomes less task focused and more relationship oriented.

Tannenbaum and Schmidt (1958) built on the work of Lewin and White, suggesting that managers need varying mixtures of autocratic and democratic leadership behavior. They believed that the primary determinants of leadership style should include the nature of the situation, the skills of the manager, and the abilities of the group members.

Although situational and contingency theories added necessary complexity to leadership theory and continue to be applied effectively by managers, by the late 1970s, theorists began arguing that effective leadership depended on an even greater number of variables, including organizational culture, the values of the leader and the followers, the work, the environment, the influence of the leader-manager, and the complexities of the situation. Efforts to integrate these variables are apparent in more contemporary interactional and transformational leadership theories.

 

 

Interactional Leadership Theories (1970-Present)

 

The basic premise of interactional theory is that leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation. Schein (1970), an interactional theorist, was the first to propose a model of humans as complex beings whose working environment was an open system to which they responded. A system may be defined as a set of objects, with relationships between the objects and between their attributes. A system is considered open if it exchanges matter, energy, or information with its environment. Schein’s model, based on systems theory, had the following assumptions:

•           People are very complex and highly variable. They have multiple motives for doing things. For example, a pay raise might mean status to one person, security to another, and both to a third.

•           People’s motives do not stay constant but change over time.

•           Goals can differ in various situations. For example, an informal group’s goals may be quite distinct from a formal group’s goals.

•           A person’s performance and productivity are affected by the nature of the task and by his or her ability, experience, and motivation.

•           No single leadership strategy is effective in every situation.

To be successful, the leader must diagnose the situation and select appropriate strategies from a large repertoire of skills. Hollander (1978) was among the first to recognize that both leaders and followers have roles outside of the leadership situation and that both may be influenced by events occurring in their other roles.

With leader and follower contributing to the working relationship and both receiving something from it, Hollander (1978) saw leadership as a dynamic two-way process. According to Hollander, a leadership exchange involves three basic elements:

•           The leader, including his or her personality, perceptions, and abilities

•           The followers, with their personalities, perceptions, and abilities

•           The situation within which the leader and the followers function, including formal and informal group norms, size, and density

Leadership effectiveness, according to Hollander, requires the ability to use the problemsolving process; maintain group effectiveness; communicate well; demonstrate leader fairness, competence, dependability, and creativity; and develop group identification.

Ouchi (1981) was a pioneer in introducing interactional leadership theory in his application of Japanese style management to corporate America. Theory Z, the term Ouchi used for this type of management, is an expansion of McGregor’s Theory Y and supports democratic leadership. Characteristics of Theory Z include consensus decision making, fitting employees to their jobs, job security, slower promotions, examining the long-term consequences of management decision making, quality circles, guarantee of lifetime employment, establishment of strong bonds of responsibility between superiors and subordinates, and a holistic concern for the workers (Ouchi, 1981). Ouchi was able to find components of Japanese-style management in many successful American companies.

In the 1990s, Theory Z lost favor with many management theorists. American managers are unable to put these same ideas into practice in the United States. Instead, they continue to boss-manage workers in an attempt to make them do what they do not want to do. Although Theory Z is more comprehensive than many of the earlier theories, it too neglects some of the variables that influence leadership effectiveness. It has the same shortcomings as situational theories in inadequately recognizing the dynamics of the interaction between worker and leader.

 

One of the pioneering leadership theorists of this time was Kanter (1977), who developed the theory that the structural aspects of the job shape a leader’s effectiveness. She postulated that the leader becomes empowered through both formal and informal systems of the organization. A leader must develop relationships with a variety of people and groups within the organization in order to maximize job empowerment and be successful. The three major work empowerment structures within the organization are opportunity, power, and proportion. Kanter asserts that these work structures have the potential to explain differences in leader responses, behaviors, and attitudes in the work environment.

Nelson and Burns (1984) suggested that organizations and their leaders have four developmental levels and that these levels influence productivity and worker satisfaction. The first of these levels is reactive. The reactive leader focuses on the past, is crisis driven, and is frequently abusive to subordinates. In the next level, responsive, the leader is able to mold subordinates to work together as a team, although the leader maintains most decision-making responsibility. At the proactive level, the leader and followers become more future oriented and hold common driving values. Management and decision making are more participative. At the last level, high- performance teams, maximum productivity and worker satisfaction are apparent.

Brandt’s (1994) interactive leadership model suggests that leaders develop a work environment that fosters autonomy and creativity through valuing and empowering followers. This leadership “affirms the uniqueness of each individual,” motivating them to “contribute their unique talents to a common goal.” The leader must accept the responsibility for quality of outcomes and quality of life for followers. Brandt states that this type of leadership affords the leader greater freedom while simultaneously adding to the burdens of leadership. The leader’s responsibilities increase because priorities cannot be limited to the organization’s goals, and authority confers not only power but also responsibility and obligation. The leader’s concern for each worker decreases the need for competition and fosters an atmosphere of collegiality, freeing the leader from the burden of having to resolve follower conflicts.

Wolf, Boland, and Aukerman (1994) also emphasized an interactive leadership model in their creation of a collaborative practice matrix. This matrix highlights the framework for the development and ongoing support of relationships between and among professionals working together. The “social architecture” of the work group is emphasized, as is how expectations, personal values, and interpersonal relationships affect the ability of leaders and followers to achieve the vision of the organization.

Kanter (1989) perhaps best summarized the work of the interactive theorists by her assertion that title and position authority were no longer sufficient to mold a workforce where subordinates are encouraged to think for themselves, and instead managers must learn to work synergistically with others.

 

 

Transactional and Transformational Leadership

 

Similarly, Burns (2003), a noted scholar in the area of leader-follower interactions, was among the first to suggest that both leaders and followers have the ability to raise each other to higher levels of motivation and morality. Identifying this concept as transformational leadership, Burns maintained that there are two primary types of leaders in management. The traditional manager, concerned with the day-to-day operations, was termed a transactional leader. The manager who is committed, has a vision, and is able to empower others with this vision, however, was termed a transformational leader.

 

 

Examining the Evidence 2.1

Source: Mielnicki, M., Murphy, P., & Globel, B. (2009, May). Transformational leadership: Successful merging of a hematology/oncology unit with a palliative care/oncology unit. Oncology Nursing Forum, 36(3), 69-70.

This case study reported on the merger of two medical oncology units; a hematology/oncology unit and a palliative care/oncology unit. Although the units were geographically located near one another and shared a unit secretary, each unit had a separate leadership team, a unique culture, and individual staffing guidelines. The units were slated to merge into one staff with dual competencies and one leadership team to care for the combined patient population. Issues identified related to the merger, which needed to be addressed were identified as: staff scheduling, education, workflow, and team building.

Following a 4-hour leadership retreat, which emphasized idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation (four factors of transformational leadership principles), the leadership team of both units began working together to identify team-building activities and to propose a new workflow plan. All unit staff were kept involved in the process through weekly communication meetings, questionnaires, team building activities, and e-mails. In less than 3 months, a new unit scheduling procedure was created, palliative care and telemetry education were completed, team-building activities were accomplished, and a new workflow was rolled out. Turnover following the merger fell to 3%, well below the hospital and national averages. The authors concluded that transformational leadership can facilitate change, encourage innovation and creativity, and result in more successful, cohesive clinical units.

 

 

Transactional leaders focus on tasks and getting the work done. Transformational leaders focus on vision and empowerment.

 

Similarly, Bass and Avolio (1994) suggested that transformational leadership leads followers to levels of higher morals because such leaders do the right thing for the right reason, treat people with care and compassion, encourage followers to be more creative and innovative, and inspire others with their vision. This new shared vision provides the energy required to move toward the future. This clearly was the case in a case study reported by Mielnicki, Murphy, and Globel (2009) when transformational leadership principles were used to guide the merger of two distinct clinical units into one (Examining the Evidence 2.1).

McIntosh and Tolson (2009) also suggest that transformational leadership also encompasses acting as mediator and champion and exerting control over complex change initiatives. A composite of the two different types of leaders is shown in Table 2.2.

 

Vision is the essence of transformational leadership.

 

Although the transformational leader is held as the current ideal, many management theorists sound a warning about transformational leadership. Although transformational qualities are highly desirable, they must be coupled with the more traditional transactional qualities of the day-to-day managerial role. In addition, both sets of characteristics need to be present in the same person in varying degrees. The transformational leader will fail without traditional management skills. Indeed, Avolio et al. (2009, p. 428) note that much of the disillusionment with leadership theory and research in the early 1980s was related to “the fact that most models of leadership and measures accounted for a relatively small percentage of variance in performance outcomes such as productivity and effectiveness.”

 

 

Although transformational qualities are highly desirable, they must be coupled with the more traditional transactional qualities of the day-to-day managerial role or the leader will fail.

In addition, Badaracco cautions that “because we admire heroes, it is easy to overlook the inconvenient fact that some leaders are effective without being either visionary or very inspiring. There must be a place for leading by example and other forms of quiet leadership” (McCrimmon, n.d., para 2). Similarly, the North Carolina Center for Student Leadership in Ethics & Public Service (2009) warns that transformational leaders must be careful not to mistake passion and confidence for truth and reality. “Whilst it is true that great things have been achieved through enthusiastic leadership, it is also true that many passionate people have led the charge right over the cliff and into a bottomless chasm. Just because someone believes they are right, it does not mean they are right” (para 14).

Avolio et al. (2009) also warns that boundary conditions exist causing transformational leadership to be more or less effective in predicting follower attitudes and behaviors. For example, there are contextual variables that mediate or moderate the relationships transformational leaders have with their followers. Examples would be social and structural distance, perceived environmental uncertainty, social networks, the use of technology to support group decision making, and cultural orientations such as collectivism (Avolio et al., 2009).

 

 

Full-Range Leadership Theory

 

It is this idea that context is an important mediator of transformational leadership, that led to the creation of full-range leadership theory early in the 21st century. This theory, originally developed by Antonakis, Avolio, and Sivasubramaniam (2003), suggests that there are nine factors impacting leadership style and its impact on followers; five are transformational, three are transactional, and one is a nonleadership or laissez-faire leadership factor (Rowold & Schlotz, 2009) (see Display 2.4).

In describing these factors, Rowold and Schlotz (2009) suggest that the first factor, inspirational motivation, is characterized by the leader’s articulation and representation of vision. Idealized influence (attributed), the second factor, relies on the charisma of the leader to create emotional ties with followers that build trust and confidence. The third factor, idealized influence (behavior), results in the leader creating a collective sense of mission and values and prompting followers to act upon these values. With the fourth factor, intellectual stimulation, leaders challenge the assumptions of followers’ beliefs as well as analyze subordinates’ problems and possible solutions. The final transformational factor, individualized consideration, occurs when the leader is able to individualize his or her followers, recognizing and appreciating their unique needs, strengths, and challenges.

 

 

Nine Factors of Full Range Leadership Theory

The first transactional factor, as described by Rowold and Schlotz (2009) is contingent reward. Here, the leader is task oriented in providing followers with meaningful rewards based on successful task completion. Active management-by-exception, the second transactional factor, suggests that the leader watches and searches actively for deviations from rules and standards and takes corrective actions wheecessary. In contrast, the third transactional factor, management-by-exception passive, describes a leader who intervenes only after errors have been detected or standards have been violated. Finally, the ninth factor of full range leadership theory is the absence of leadership. Thus, laissez faire is a contrast to the active leadership styles of transformational and transactional leadership exemplified in the first eight factors.

 

 

INTEGRATING LEADERSHIP AND MANAGEMENT

 

Because rapid, dramatic change will continue iursing and the healthcare industry, it has grown increasingly important for nurses to develop skill in both leadership roles and management functions. For managers and leaders to function at their greatest potential, the two must be integrated.

 

Gardner (1990) asserted that integrated leader-managers possess six distinguishing traits:

1.    They think longer term. They are visionary and futuristic. They consider the effect that their decisions will have years from now as well as their immediate consequences.

2.     They look outward, toward the larger organization. They do not become narrowly focused. They are able to understand how their unit or department fits into the bigger picture.

3.     They influence others beyond their own group. Effective leader-managers rise above an organization’s bureaucratic boundaries.

4.     They emphasize vision, values, and motivation. They understand intuitively the unconscious and often nonrational aspects that are present in interactions with others. They are very sensitive to others and to differences in each situation.

5.     They are politically astute. They are capable of coping with conflicting requirements and expectations from their many constituencies.

6.     They think in terms of change and renewal. The traditional manager accepts the structure and processes of the organization, but the leader-manager examines the ever-changing reality of the world and seeks to revise the organization to keep pace.

 

Leadership and management skills can and should be integrated as they are learned. Table 2.3 summarizes the development of leadership theory through the end of the 20th century. Newer (21st century) and emerging leadership theories are discussed in Topic 3.

 

 

In examining leadership and management, it becomes clear that these two concepts have a symbiotic or synergistic relationship. Every nurse is a leader and manager at some level, and the nursing role requires leadership and management skills. The need for visionary leaders and effective managers iursing preclude the option of stressing one role over the other. Highly developed management skills are needed to maintain healthy organizations. So too are the visioning and empowerment of subordinates through an organization’s leadership team. Because rapid, dramatic change will continue iursing and the healthcare industry, it continues to be critically important for nurses to develop skill in both leadership roles and management functions and to strive for the integration of leadership characteristics throughout every phase of the management process.

 

 

KEY CONCEPTS

 

•                    Management functions include planning, organizing, staffing, directing, and controlling. These are incorporated into what is known as the management process.

•                    Classical, or traditional, management science focused on production in the workplace and on delineating organizational barriers to productivity. Workers were assumed to be motivated solely by economic rewards, and little attention was given to worker job satisfaction.

•                    The human relations era of management science emphasized concepts of participatory and humanistic management.

•                    Three primary leadership styles have been identified: authoritarian, democratic, and laissez-faire.

•                    Research has shown that the leader-manager must assume a variety of leadership styles, depending on the needs of the worker, the task to be performed, and the situation or environment. This is known as situational or contingency leadership theory.

•                    Leadership is a process of persuading and influencing others toward a goal and is composed of a wide variety of roles.

•                    Early leadership theories focused on the traits and characteristics of leaders.

•                    Interactional leadership theory focuses more on leadership as a process of influencing others within an organizational culture and the interactive relationship of the leader and follower.

•                    The manager who is committed, has a vision, and is able to empower others with this vision is termed a transformational leader, whereas the traditional manager, concerned with the day-to-day operations, is called a transactional leader.

•                    Integrating leadership skills with the ability to carry out management functions is necessary if an individual is to become an effective leader-manager.

 

 

ADDITIONAL LEARNING EXERCISES AND APPLICATIONS

 

LEARNING EXERCISE

When Culture and Policy Clash

You are the nurse-manager of a medical unit. Recently, your unit admitted a 16-year-old East Indian boy who has beeewly diagnosed with insulin-dependent diabetes. The nursing staff has been interested in his case and has found him to be a delightful young man—tvery polite and easygoing. However, his family has been visiting in increasing numbers and bringing him food that he should not have.

The nursing staff has come to you on two occasions and complained about the family’s noncompliance with visiting hours and unauthorized food. Normally, the nursing staff on your unit has tried to develop a culturally sensitive nursing care plan for patients with special cultural needs, so their complaints to you have taken you by surprise.

Yesterday, two of the family members visited you and complained about hospital visitor policies and what they took to be rudeness by two different staff members. You spent time talking to the family, and when they left, they seemed agreeable and understanding.

Last night, one of the staff nurses told the family that according to hospital policy only two members could stay (this is true) and if the other family members did not leave, she would call hospital security. This morning the boy’s mother and father have suggested that they will take him home if this matter is not resolved. The patient’s diabetes is still not controlled, and you feel that it would be unwise for this to happen.

ASSIGNMENT: Leadership is needed to keep this situation from deteriorating further. Divide into groups. Develop a plan of action for solving this problem. First, select three desired objectives for solving the problem and then proceed to determine what you would do that would enable you to meet your objectives. Be sure that you are clear as to who you consider your followers to be and what you expect from each of them.

 

 

LEARNING EXERCISE

Delineating Leadership Roles and Management Functions

Examine the scenario in Learning Exercise 2.5. How would you divide the management functions and leadership roles in this situation? For example, you might say that having the nurse-manager adhere to hospital policy was a management function and that counseling staff was a leadership role.

ASSIGNMENT: List at least five management functions and five leadership roles that you could also delineate in this scenario. Share these with your group.

 

 

LEARNING EXERCISE

What’s Your Management Style?

Recall times when you have been a manager. This does not only mean a nursing manager. Perhaps you were a head lifeguard or an evening shift manager at a fast-food restaurant. During those times, do you think you were a good manager? Did you involve others in your management decision making appropriately? How would you evaluate your decision-making ability? Make a list of your management strengths and a list of management skills that you felt you were lacking.

 

 

LEARNING EXERCISE

What Decision-Making Style Should Be Used?

ASSIGNMENT: In the following scenarios, determine whether an autocratic, democratic, or laissez-faire decision-making style would be most appropriate. Provide rationale for your choice that includes a discussion of the individuals involved, the environment, and the task to be completed.

1.        You are the evening shift charge nurse of the intensive care unit. Your supervisor is sending two nurses from each shift to an upcoming critical care conference in a nearby city. The supervisor wants each charge nurse to submit names of the selected nurses in 2 weeks. All of the 12 fulltime evening shift nurses would like to go. From a staffing standpoint, there is no reason why any of them could not go. All are active in the local critical care organization. Financial resources, however, limit your choice to two. How do you resolve this situation? Select the most appropriate decision style.

2.        You are the day shift charge nurse on a surgical unit. Because of your related expertise, your supervisor has asked you to select a new type of blood-warming unt. You want to be sure that you select the right one. Several companies have provided your staff with trial units. You have not received much feedback from the staff regarding their preferences, however, and you must submit your equipment request by 4 pm tomorrow. Select the most appropriate decision style.

3.        You are the manager of a 30-bed medical unit. After consultation, you recently implemented a system for incorporating nursing diagnoses on the patient care plans. Although the system was expected to reduce report time between shifts and improve the quality of patient care, to everyone’s surprise, including your own, you find that the system is not working. You do not think that there is anything wrong with your idea. Many other hospitals in the areas are using nursing diagnoses with success. You had a consultant come from another hospital and give an update to your nurses on use of the system. The consultant reported that your staff seemed knowledgeable and appeared to understand their responsibilities in implementing the system.

You suspect that a few nurses might be sabotaging your efforts for planned change, but your charge nurses do not agree. They believe that the failure may be lack of proper incentives or poor staff morale. Your nursing administrator is anxious to implement the system in other patient care units but wants it to be working well in your unit first. You have just come from a manager’s meeting where your administrator told you to solve the problem and report back to her within 1 week regarding the steps you had taken to solve your problem. You share your administrator’s concern, but how should you solve this problem? Select the most appropriate decision style.

 

 

Throughout history, nursing has been required to respond to changing technological and social forces. In the last two decades alone, the proliferation of managed care, a renewed impetus for health care reform, changing federal and state government reimbursement strategies, and new quality imperatives resulted in major redesign of most healthcare organizations. In addition, the locus of care shifted from acute-care hospitals to community and outpatient settings, innovation and technological advances transformed the workplace, and organizational cultures increasingly shifted to safety-driven, customer-focused care. All of these changes brought about a need for leader-managers to learn new roles and develop new skills.

The new managerial responsibilities placed on organized nursing services call for nurse administrators who are knowledgeable, skilled, and competent in all aspects of management. Now more than ever, there is a greater emphasis on the business of healthcare, with managers being involved in the financial and marketing aspects of their respective departments. Managers are expected to be skilled communicators, organizers, and team builders and to be visionary and proactive in preparing for emerging new threats such as terrorism, biological warfare, and global pandemics.

In addition, the need to develop nursing leadership skills has never been greater. At the national level, nurse-leaders and nurse-managers are actively involved in greatly needed healthcare reform and in addressing a persistent, and likely growing, international nursing shortage. At the organizational and unit levels, nurse-leaders are being directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, growing trends toward unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime, while maintaining cohesive and productive work environments. Moreover, ensuring successful recruitment, creating shared governance models, and maintaining high-quality practice depend on successful team building, another critical leadership skill in contemporary healthcare organizations. This challenging and changing healthcare system requires leader-managers to use their scarce resources appropriately and to be visionary and proactive in planning for challenges yet to come.

In confronting these expanding responsibilities and demands, many leader-managers turn to the experts for tools or strategies to meet these expanded role dimensions. What they have found is some new and innovative thinking about how best to manage organizations and lead people as well as some reengineered interactive leadership theories from the later 19 th century. This topic explores this contemporary thinking about leadership and management, with specific attention given to emergent 21st-century thinking.

 

 

NEW THINKING ABOUT LEADERSHIP AND MANAGEMENT

 

Zinni and Koltz (2009) suggest there is a profound leadership crisis in America in the 21st century and that contemporary leaders have failed to change with the times. They argue that this has occurred because the world is changing quickly and the traditional top-down hierarchical leadership approach has not evolved quickly enough to match the complexity of the 21st-century world. Zinni and Koltz also suggest that single, directive approaches to leading no longer work and that participatory enterprise models, which are not easy to develop, must replace them. Osborn and Marion (2009) agree, suggesting that new research on leadership, including full range leadership theory, is rediscovering the importance of organizational context, levels of analysis, and potential boundary conditions on transformational leadership.

Many recent leadership and management concepts focus on the complexity of the relationship between the leader and the follower. Indeed, much of the leadership research emerging as we enter the second decade of the 21st century builds upon the interactive leadership theories developed in the latter part of the 20th century. As a result, concepts such as servant leadership, principal agent theory, human and social capital theory, emotional intelligence, authentic leadership, quantum leadership, thought leadership, and cultural bridging have emerged as part of the leader-manager’s repertoire for the 21st century.

 

 

Servant Leadership

 

Although Greenleaf (1977) developed the idea of servant leadership more than 30 years ago, it continues to greatly influence leadership thinking in the 21st century. In more than four decades of working as director of leadership development at AT&T, Greenleaf noticed that most successful managers lead in a different way from traditional managers. These managers, which he termed servant leaders, put serving others, including employees, customers, and the community, as the number-one priority. In addition, servant leaders foster a service inclination in others that promotes collaboration, teamwork, and collective activism.

 

Greenleaf argued that to be a great leader, one must be a servant first.

 

Sutton (2009) agrees, noting that many individuals placed in positions of authority become less mindful of others’ feelings and needs. Meanwhile, their subordinates devote tremendous energy to watching and interpreting the actions of their leaders and the end result is a toxic tandem where employees feel underappreciated and overcontrolled. Sutton suggests that good leaders find ways to provide employees with more predictability, understanding, control, and compassion and the reward is long-term employee loyalty.

In fact, Takaba (2009), building on Greenleaf’s work, suggests that servant leadership is one of the top 10 characteristics of an agile organization today. Takaba says that servant leaders have a greater sense of goal setting than traditional leaders; that their listening skills are enhanced; and that they are tolerant of imperfection, recognizing that sometimes things just need to be “good enough.” Takaba also notes that acceptance and empathy are greater in servant leadership than in traditional leadership.

Research done by Sturm (2009) also found that servant leadership behaviors can be sorted into three thematic categories: respect and valuing of one as a unique individual, affirmation of professional judgment and fair treatment regarding workload, and collaboration with supervisors and administrators in a spirit of willingness. Sturm concluded that a servant-leadership model can support personal and professional growth, empowering nurses to play a leadership role and thereby increasing nurse collaboration, satisfaction, and retention. Other defining qualities of servant leadership are shown in Display 3.1.

 

 

 

LEARNING EXERCISE

Creating a Service Inclination

An important part of servant leadership is the servant leader’s ability to create a service inclination in others. In doing so, more leaders are created for the organization.

ASSIGNMENT: Identify servant leaders who you have worked with. Did they motivate followers to be service oriented? If so, what strategies did they use? Does servant leadership result in a greater number of leaders within an organization? If so, why do you think that this happens?

 

 

LEARNING EXERCISE

Servant Leadership in Nursing and Medicine

In a recent study, Garber, Madigan, Click, and Fitzpatrick (2009) found that registered nurses had both a higher level of collaboration and servant leadership than did physicians and medical residents. There was a weak positive correlation between collaboration and servant leadership in the registered nurse group and no significant correlation between the two variables in the physician/resident group.

ASSIGNMENT: What factors might account for these differences? Write a one-page essay that addresses the following:

1.        Both nursing and medicine are helping, service-oriented professions. Do you believe there are inherent differences in service inclination between individuals who choose nursing for a profession rather than medicine?

2.        Do you believe that nursing education fosters a greater service inclination than medical education?

3.        Do you believe the female majort (gender) of the nursing profession influences these findings?

 

 

 

New Thinking About Leaders and Followers

 

Many contemporary scholars have expanded on Greenleaf’s work, particularly in terms of how followers influence the actions of the leader. While the positive effect of followers on leaders has been fairly well described in most discussions of transformational leadership, less has been said about potential negative impacts. For example, followers can and do mislead leaders, whether intentionally or not. Leaders can counteract this, however, by focusing on vision, cultivating truth telling, and making sure followers feel they can disagree.

 

Followers can and do mislead leaders, both intentionally and unintentionally.

 

Avolio, Walumbwa, and Weber (2009) also suggest there are interesting omissions in theory and research about followership and its impact on leadership. For example, Avolio et al. point out that many leadership researchers treat follower attributes as outcomes of the leadership process as opposed to inputs, even though the dynamics of the relationship are not fully understood.

 

 

Principal Agent Theory

 

Principal agent theory, which first emerged in the 1960s and 1970s, is another interactive leadership theory being actively explored in the 21st century. This theory suggests that not all followers (agents) are inherently motivated to act in the best interest of the principal (leader or employer). This is because followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal’s preferences. The risk then is that agents will pursue their own objectives or interests instead of that of their principal.

Principals then must identify and provide agents with appropriate incentives to act in the organization’s best interest. For example, consumers with good health insurance and small out-of-pocket expenses may have little motivation to act prudently in accessing healthcare resources, since payment for services used will come primarily from the insurer. The insurer then must create incentives for agents who access only needed services.

Another example might be end-of-shift overtime. While most employees do not intentionally seek or want to work overtime after a long and busy shift, the reality is that doing so typically results in financial rewards. Employers then must either create incentives that reward employees who are able to complete their work in the allotted shift time or create disincentives for those who do not.

 

 

LEARNING EXERCISE

The Agent’s Motives

You are a team leader for 10 patients on a busy medical unit. Your team includes Lori, a Licensed Vocational Nurse (LVN), passing medications and assisting with patient treatments, and Tom, an experienced Certified Nurses Aid (CNA), who provides basic care such as monitoring vital signs, ambulating patients, and assisting with hygiene. On several occasions in the past, Tom has failed to report significant changes in patients’ vital signs to you until some time had elapsed or you discovered them yourself. Despite confronting Tom about the need to report these changes and the specific vital sign parameters that need to be reported, this behavior has continued. You have become concerned that patient harm might occur if this pattern of behavior is allowed to continue.

ASSIGNMENT: Identify possible motives that Tom (the agent) may have for failing to share this information with you (the principal). What incentives might you employ to modify his behavior?

 

 

Human and Social Capital Theory

 

Human capital refers to the attributes of a person that are productive in some economic context, although it is normally measured and conceived of as a private return to the individual as well as a social return (About.com-Economics, 2009). For example, the term human capital is often used when examining formal educational attainment, “with the implication that education is an investment whose returns are in the form of wage, salary, or other compensation” (About.com-Economics, para 1). Human capital can be viewed, however, from an organizational perspective as well. In this case, human capital would refer to the collective group knowledge or experience.

 

Human capital can refer to a group’s collective knowledge, skills, and abilities.

 

Human capital theory suggests that individuals and/or organizations will invest in education and professional development if they believe that such an investment will have a future payoff. For example, a healthcare organization that provides tuition reimbursement for nurses to go back to school to earn higher degrees is likely doing so in anticipation that a more highly educated nursing staff will result in increased quality of care and higher retention rates- of which should translate into higher productivity and financial return.

This was certainly the case in a landmark 2003 study by Dr. Linda Aiken and her colleagues at the University of Pennsylvania, which found that “surgical patients have a ‘substantial survival advantage’ if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level and that a 10% increase in the proportion of nurses holding Bachelor’s of Science (BSN) degrees decreased the risk of patient death and failure to rescue by 5%” (American Association of Colleges of Nursing, 2009, para 12). Research by Dr. Aiken and colleagues also showed that hospitals with better care environments, the best nurse staffing levels, and the most highly educated nurses had the lowest surgical mortality rates. In fact, the researchers found that every 10% increase in the proportion of nurses on the hospital staff, with a Bachelors of Science (BSN) degree iursing, was associated with a 4% decrease in the risk of death (Aiken, Clarke, Sloane, Lake, & Cheney, 2008).

 

 

Emotional Intelligence

 

Another leadership theory gaining prominence in the 21st century is that of emotional intelligence (EI, also known as EQ). Broadly defined, emotional intelligence refers to the “understanding and recognition of oneself and others’ abilities, perception and attitudes” (Momeni, 2009, p. 35). Van Wagner (2009) suggests it can be defined simply as the ability to perceive, control, and evaluate emotions.

 

In their original work on EI in 1990, Mayer and Salovey (1997) suggested that EI develops with age and that it consists of three mental processes:

•           Appraising and expressing emotions in the self and others

•           Regulating emotion in self and others

•           Using emotions in adaptive ways

 

In 1997, they further refined EI into four mental abilities: perceiving/identifying emotions, integrating emotions into thought processes, understanding emotions, and managing emotions.

Goleman (1998), in his 1995 best seller Emotional Intelligence, built upon this work in his identification of five components of EI: self-awareness, self-regulation, motivation, empathy, and social skills (Display 3.2). Goleman argued that all individuals have a rational thinking mind and an emotional feeling mind and that both influence action. The goal, then, in EI is emotional literacy—being self-aware about one’s emotions and recognizing how they influence subsequent action. Unlike Mayer and Salovey, however, Goleman argued that EI could be learned, although he too felt that it improves with age.

 

Source: Adapted from Goleman, D. (1998). Working with emotional intelligence. New York: Bantam Books.

 

 

Examining the Evidence

Source: Momeni, N. (June, 2009). The relation between managers’ emotional intelligence and the organizational climate they create. Public Personnel Management, 38(2), 35-48.

 

In this study, emotional intelligence (EI) was measured in a random sample of 30 managers from similar organizations in Iran, using a 360-degree feedback approach. Organizational climate was assessed by a questionnaire. The managers’ results were then compared with those of 140 supervisors and peers of the managers.

Regression analyses demonstrated positive correlations between the managers’ EI and organizational climate. In fact, regression indicated that 55% of organizational climate was caused by the EI of the managers. Among EI factors, self-awareness and social awareness had the greatest impact on organizational climate. Credibility was also strongly influenced by the managers’ EI. The researchers concluded that organizations should consider EI when recruiting, especially for management positions, and for staff whose jobs require social skills. This should result in greater efficiency and productivity in the organization.

 

In addition, most theorists studying EI agree that EI is critical for building a cooperative and effective team. Indeed, Momeni (2009, p. 38) suggests that “more than 70% of employees’ perceptions of organizational climate are directly formed by managers’ style of leadership and behavior, particularly how managers work to improve employees’ performance and reward them.” Indeed, research done by Momeni found that emotional behaviors are the primary factor in creating organizational climate and concluded that highly emotional intelligent managers can create highly positive organizational climates (Examining the Evidence 3.1).

 

 

 

LEARNING EXERCISE

Emotions and Decision Making

Think back on a recent decision you made that was more emotionally laden than usual. Were you self-aware about what emotions were influencing your thinking and how your emotions might have influenced the course(s) of action you chose? Were you able to objectively identify the emotions that others were experiencing and how these emotions may have influenced their actions?

 

 

Authentic Leadership

 

Another emerging leadership theory for the contemporary leader-manager’s arsenal is that of authentic leadership. Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly. Stanley (2008) calls this phenomenon congruent leadership and defines it as a match (congruence) between the activities, actions, and deeds of the leader and the leader’s values, principles, and beliefs.

It is important to remember that authentic or congruent leadership theory differs somewhat from more traditional transformational leadership theories, which suggest that the leader’s vision or goals are often influenced by external forces and that there must be at least some “buy-in” of that vision by followers. In authentic leadership, it is the leaders’ principles and their conviction to act accordingly that inspire followers. Thus, authentic followers realize their own true nature.

 

In authentic leadership, it is the leaders’ principles and their conviction to act accordingly that inspire followers.

 

 

Authentic leadership is not easy. It takes great courage to be true to one’s convictions when external forces or peer pressure encourages an individual to do something he or she feels morally would be inappropriate. For example, there is little doubt that some nurse leaders experience intrapersonal values conflicts between what they believe to be morally appropriate and a need to deliver results in a healthcare system increasingly characterized by pay for performance and rewarded by cost containment (Huston, 2008). This was supported in research done by O’Neil, Morjikian, and Cherner (2008), which found that funding and budgeting were identified as the greatest leadership challenge by nurse executives. In contrast, it was ranked at the bottom of the top 5 by nonnursing leaders assessing what they saw as the most critical leadership challenge facing nurses in senior leadership roles. This dichotomy points out the personal conflict nurse executives may face in attempting to meet the differing expectations and priorities of organizational stakeholders.

A number of theorists have attempted to further define the theoretical construct of authentic leadership in the past decade. Shirey (2006) suggests there are five distinguishing characteristics of authentic leaders: purpose, values, heart, relationships, and self-discipline. (See Display 3.3). Avolio et al. (2009) suggest, however, that the general agreement in the literature is that there are four factors that cover the components of authentic leadership: balanced processing, internalized moral perspective, relational transparency, and self-awareness. Balanced processing refers to analyzing data rationally before making decisions. Internalized moral perspective suggests that the authentic leader is guided by internal moral standards that then guide his or her behavior. Relational transparency refers to openly sharing feelings and information appropriate to a situation, and self-awareness alludes to a knowing of self so as to make sense of the world (Avolio et al.). Avolio et al. suggest, however, that work on defining and measuring authentic leadership is in its early stages of development and that further research is needed to assess the validity of this construct

 

 

Source: Shirey, M. R. (2006). Fostering leadership through collaboration. Reflections on Nursing Leadership (third quarter). Sigma Theta Tau International. Retrieved October 2, 2006, from http://www.nursingsociety.org/RNL/3Q_2006/features/ feature5.html.

 

 

LEARNING EXERCISE

Inconsistency in Word and Action

There are many examples of internationally or nationally recognized leaders who have lost their followers because of their actions being inconsistent with personally stated convictions. An example might be a world-class athlete and advocate for healthy lifestyles who is found to be using steroids to enhance physical performance. Or it might be a political figure who preaches morality and becomes involved in an extramarital affair or a religious leader who promotes celibacy and then becomes involved in a sex scandal.

ASSIGNMENT: Think of a leader who espoused one message and then acted in a different manner. How did it affect the leader’s ability to be an effective leader? How did it change how you personally felt about that leader? Do you feel that leaders who have lost their “authenticity” can ever regain the trust of their followers?

 

 

Finally, one must not be so idealistic as to assume that all leaders strive to be authentic. Indeed, many are flawed, at least at times. Leaders may be deceitful and trustworthy, greedy and generous, cowardly and brave. To assume that all good leaders are good people is foolhardy and makes us blind to the human condition. Future leadership theory may well focus on why leaders behave badly and why followers continue to follow bad leaders.

 

 

Thought Leadership

 

Another relatively new leadership theory to emerge in the 21st century is that of thought leadership, which applies to a person who is recognized among his or her peers for innovative ideas and who demonstrates the confidence to promote those ideas. Thus, thought leadership refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things.

Thought leaders challenge the status quo and attract followers not by any promise of representation or empowerment, but by their risk taking and vision in terms of being innovative.

The ideas put forth by thought leaders typically are future oriented and make a significant impact. In addition, they are generally problem-oriented, which increases their value to both individuals and organizations. Dyer, Gregersen, and Christensen (2009) suggest that what actually makes thought leaders so successful is something called creative intelligence, which enables them to use both sides of their brain in generating new ideas. In fact, Dyer et al. suggest that there are five “discovery skills” that separate true innovators from the rest of us: associating, questioning, observing, experimenting, and networking. Innovators actively and consistently engage in these discovery skills. As a result, they gain confidence in their creative abilities and eventually become defined by them. “Innovative entrepreneurship is not a genetic predisposition. It is an active endeavor” (Dyer et al., p. 67).

Organizations can also be thought leaders. For example, Blue Cross and Blue Shield were early thought leaders in the development of private health insurance in the late 1920s. Johnson and Johnson launched the Discover Nursing campaign earlier this decade to champion the nursing profession and promote the recruitment and retention of nurses. It is interesting, however, that Dyer et al. (2009) found that at most companies, top executives did not feel personally responsible for being thought leaders. Instead, they felt responsible for facilitating the innovation process. In contrast, senior executives of the most innovative companies (only about 15% in Dyer et al.’s study) do the creative work themselves.

Thought leaders in the coming decade will likely focus on enduring issues that continue to be of critical importance to nursing and healthcare, and address new, emerging problems of significance. For example, thought leadership is still greatly needed in identifying and adopting innovative safety and quality improvement approaches that actually reduce the risk of harm to patients and healthcare workers. In addition, the international nursing shortage continues to loom and an inadequate number of innovative solutions have been suggested for addressing the dire nursing faculty shortage that is expected to occur in the next 5 to 10 years.

 

 

LEARNING EXERCISE

Technological Innovation and Thought Leadership

Technological innovations continue to change the face of healthcare, and the pace of such innovations continues to increase exponentially. For example, wireless communication, computerized charting, and the barcode scanning of medications have all greatly affected the practice of nursing.

ASSIGNMENT: Choose at least one of the following technological innovations, and write a one-page report on how this technology is expected to impact nursing and healthcare in the coming decade. See if you can identify the thought leader(s) credited with developing these technologies, and explore the process that they used to both develop and market their innovations.

•                    Biometrics to ensure patient confidentiality

•                    Computerized physician order entry (CPOE)

•                    Point of care testing (POC)

•                    Bluetooth technology

•                    Electronic health records

•                    Nursebots (prototype nurse robots)

 

 

Quantum Leadership

 

Quantum leadership is another relatively new leadership theory that is being used by leader- managers to better understand dynamics of environments, such as healthcare. This theory, which emerged in the 1990s, builds upon transformational leadership and suggests that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur. This is especially true during periods of rapid change and needed transition.

Building on quantum physics, which suggests that reality is often discontinuous and deeply paradoxical, quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity. The theory also suggests that change is constant. Today’s workplace is a highly fluid, flexible, and mobile environment, and this calls for an entirely innovative set of interactions and relationships as well as the leadership necessary to create them (Porter-O’Grady & Malloch, 2007).

Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.

Because the healthcare industry is characterized by rapid change, the potential for intraorga– nizational conflict is high. Porter-O’Grady and Malloch (2007) suggest that because the unexpected is becoming the normative, the quantum leader must be able to address the unsettled space between present and future and resolve these conflicts appropriately, creating a better healing environment for both the providers and consumers of healthcare. In addition, they suggest that “the ability to respond to the dynamics of crisis and change is not only an inherent leadership skill, it must now be inculcated within the very fabric of the organization and its operation” (p. 161).

 

 

Cultural Bridging

 

The final emerging leadership theory to be presented in this topic is that of cultural bridging. The new role of the leader-manager as a cultural bridge has become a requirement as our society becomes more diverse.

As society becomes more diverse, a new role of the leader-manager as a cultural bridge has become a requirement.

Increasing ethnic diversity, both in the population as a whole and in the workforce, has resulted in an increased need for nurse-leaders and nurse-managers to be cultural bridges. Indeed, current demographic data show that the U.S. population continues to diversify ethnically, with minority populations increasing at a faster rate than the white non-Hispanic population (Huston, 2010). This is also true in the nursing workforce itself with the increasing global migration of nurses and international recruitment to solve the current nursing shortage.

Some individuals have suggested that patient care cannot be culturally sensitive if the nursing workforce is not as culturally diverse as the population it serves. Others have suggested that culturally competent care is possible if the nurse understands his or her own world views as well as those of patients and coworkers, and if he or she avoids stereotyping and misapplication of scientific knowledge (“Cultural diversity iursing,” 2009). No matter what, serving as a cultural bridge requires the nurse-leader to seek out and respect other view points and to create a work environment where cultural differences are recognized and valued.

Finally, generational diversity is occurring in all healthcare organizations. With four generations working side by side in the nursing workforce, there has never been a greater need for generational team building and conflict resolution. Generational values and expectations are not universal. As a result, unquestioned assumptions often result in generational misinterpretation. Few organizations, however, have directly confronted the implications of how to deal with this diversity or to examine the impacts that it has on the quality of care provided (Huston, 2010).

 

 

TRANSITION FROM INDUSTRIAL AGE LEADERSHIP TO RELATIONSHIP AGE LEADERSHIP

 

In considering all of these emerging leadership theories, it becomes apparent that a paradigm shift has taken place early in the 21st century—a transition from industrial age leadership to relationship age leadership (Scott, 2006).

Scott contends that industrial age leadership focused primarily on traditional hierarchical management structures, skill acquisition, competition, and control. These are the same skills traditionally associated with management. Relationship age leadership focuses primarily on the relationship between the leader and his or her followers, on discerning common purpose, working together cooperatively, and seeking information rather than wealth (Table 3.1). Servant leadership, authentic leadership, human and social capital, EI, and cultural bridging are all relationship-centered theories that address the complexity of the leader-follower relationship.

 

 

Source: Adapted from Scott (2006). © KiThoughtBridge, LLC 2000. Author, Katherine Taylor Scott. All rights reserved. Permission for use in this publication granted by KiThoughtBridge.

 

Yet the leader-manager in contemporary healthcare organizations cannot and must not focus solely on relationship building. Ensuring productivity and achieving desired outcomes are essential to organizational success. The key, then, likely lies in integrating the two paradigms. Scott (2006) suggests that such integration is possible (Fig. 3.1).

1t1t A paradigm shift is taking place early in the 21st century—a transition from industrial age leadership to relationship age leadership.

Technical skills and competence seeking must be balanced with the adaptive skills of influencing followers and encouraging their abilities. Performance and results priorities must be balanced with authentic leadership and character. In other words, leader-managers must seek the same tenuous balance between leadership and management that has existed since time began.

 

Figure 3.1 Integrated model of leadership.

 

 

LEARNING EXERCISE

Balancing the Focus Between Productivity and Relationships

You are a top-level nursing administrator in a large, urban medical center in California. As in many acute-care hospitals, your annual nursing turnover rate is more than 25%. At this point, you have many unfilled licensed nursing positions, and local recruitment efforts to fill these positions have been largely unsuccessful. The problem has been exacerbated by the recent passage of legislated minimum licensed staffing ratios in your state.

During a meeting with the CEO today, you are informed that the hospital vacancy rate for licensed nurses is expected to rise to 35% with the implementation of the new minimum staffing ratios in 3 months. The CEO states that you must reduce turnover or increase recruitment efforts immediately or the hospital will have to consider closing units or reducing available beds when the new ratios take effect.

You consider the following “industrial leadership” paradigm options:

1.                  You could aggressively recrut international nurses to solve at least the immediate staffing problem.

2.                  You could increase sign-on bonuses and offer other incentives for recruiting new nurses.

3.                  You could expand the job description for unlicensed assistive personnel and LVNs to relieve the RNs of some of their duties.

4.                  You could make newly recruited nurses sign a minimum 2-year contract upon hire.

You also consider the following “relationship leadership” paradigm options:

1.                  You could hold informal meetings with current staff to determine major variables affecting their current satisfaction levels and attempt to increase those variables that increase worker satisfaction.

2.                  You could develop an open-door policy in an effort to be more accessible to workers who wish to discuss concerns or issues about their work environment.

3.                  You could implement a shared governance model to increase worker participation in decision making on the units in which they work.

4.                  You could make daily rounds on all the units in an effort to get to know your nursing staff better on a one-to-one basis.

ASSIGNMENT: Decide which of the options you would select. Rank order them in terms of what you would do first. Then look at your list. Did it reflect more of the industrial leadership paradigm or a relationship leadership paradigm? What inferences might you draw from your rank ordering in terms of your leadership skills? Do you think that your rank ordering might change with your age? Your experience?

 

 

 

LEADERSHIP AND MANAGEMENT FOR NURSING’S FUTURE

 

Seemingly insurmountable problems, a lack of resources to solve these problems, and individual apathy have been and will continue to be issues that contemporary leader-managers face. Effective leadership is absolutely critical to organizational success in the 21st century. Becoming a better leader-manager begins with a highly developed understanding of what leadership and management are and how these skills can be developed. The problem is that these skills are dynamic, and what we know and believe to be true about leadership and management changes constantly in response to new research and visionary thinking.

Contemporary leader-managers, then, are challenged not only to know and be able to apply classical leadership and management theory but also to keep abreast of new insights, new management decision-making tools, and new research in the field. It is more important than ever that leader- managers be able to integrate leadership roles and management functions and that some balance be achieved between industrial age leadership and relationship age leadership skills. Leading and managing in the 21st century promises to be more complex than ever before, and leader-managers will be expected to have a greater skill set than ever before. The key to organizational success will likely be having enough highly qualified and visionary leader-managers to steer the course.

 

 

KEY CONCEPTS

 

•       Many new leadership and management theories have emerged in the 21st century to explain the complexity of the leader-follower relationship and the environment in which work is accomplished and goals are achieved.

•       Servant leadership is a contemporary leadership model that puts serving others as the first priority.

•       Followers can and do influence leaders in both positive and negative ways.

•       Principal agent theory suggests that followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from those of the principal. This may lead to a misalignment of goals.

•       Human capital represents the capability of the individual. Social capital represents what a group can accomplish together.

•       Emotional intelligence refers to the ability to use emotions effectively and is required by leader-managers in order to enhance their success.

•       Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly.

•       Thought leadership refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things.

•       Thought leaders attract followers not by any promise of representation or empowerment but by their risk taking and vision in terms of being innovative.

•       Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.

•       Leader-managers must adopt the role of cultural bridge in an increasingly diverse society and workplace.

•       A transition has occurred in the 21st-century industrial age leadership to relationship age leadership.

 

 

 

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