LEADERSHIP AND MANAGEMENT

HAND OUTS
INTRODUCTION
Leadership vs Management
Leadership: taking risks, achieving shared goals, inspiring others
Management: directing organization through manipulation of resources
Roles
Leader Manager
Power through influence Legitimate power by authority
(Directs willing followers) (Directs willing and unwilling
subordinates)
May not be part of formal org Position in formal organization
(Job title)
Focus: inspiring others Focus: getting work done
Greater roles Expected duties

Leadership Theories
1) Great Man/ Trait Theory
- Leaders are born, not made
- Leaders arise when situation demands.

2) Leadership Styles
- Authoritarian
- Strong control through commands.
- Downward communication
- Sole decision-making
- Emergency situations
- e.g. armed forces
- Democratic
- Control through guidance.
- Upward and downward communication
- Collective decision making
- Takes longer time
- Laissez-faire
- Little/no control and direction
- Communication and decision making among members
- Reqts: (1) highly motivated, (2) self-directed members

3) Situational/Contingency Leadership
- Leadership style based on situation

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Management Theories

1) Scientific Management (Frederick Taylor)

- One best way to do task, increase productivity

2) Bureaucracy (Max Weber)

- Strict rules and regulations, increase efficiency

3) Management Functions (Henri Fayol)

- POSDC (Planning, Organizing, Staffing, Directing, Controlling)

PLANNING
- Deciding in advance
- Choosing among alternatives
- Failing to plan, planning to fail.

Strategic Planning
- Long-term (3 to 5 years), complex

Operational Planning
- Short-term (< 3 years), less complex
- Daily basis/ Per shift

SWOT analysis
- Strengths: internal advantage
- Weakness: internal disadvantage
- Opportunities: external advantage
- Threats: external disadvantage

Planning Hierarchy

1) Vision: future aims

- “What do you want to be?”
- e.g., “By 2020, Hospital X will be the leading center for cancer in the Philippines.”

2) Mission: reason for existence

- “What do you want to do?”
- e.g. “Hospital X is a tertiary care facility that provides evidence-based, holistic care to all patients.”

3) Philosophy: set of values and beliefs

- “What do you believe in?”
- e.g. “Hospital X believes that…”
Goals and Objectives
Desired result
Goal: general, Objectives: specific
“What do you want to happen?”

4) Policies: Guide for decision-making

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- “How should you behave?”
- Expressed: written policies
- Implied: expected

5) Procedures: Step-by-step plan for doing specific tasks

- “How should you do it?”

6) Rules: Do’s and don’ts

- Allows organizational structure
- “Should you do it?”

Fiscal Planning
- Budget
o Cost-effectiveness: good value for money

o Fixed vs Variable budget

 Fixed: does not change, e.g. building mortgage
 Variable: changes, e.g. supplies, water bill
o Direct vs Indirect Costs
 Direct: for production goods/service
 Indirect: for expenses not related to product

- Types of budget
o Personnel
 Salary of staff
 Largest budget: health care is labor-intensive
o Operating
 Day-to-day costs
 Maintenance, bills, supplies
o Capital
 Equipment and real property
 Long-term, expensive
o Petty cash
 Emergency, repairs

ORGANIZING

- Establishing a structure that improves coordination to achieve objectives

- Organizational Structure
o Formal vs Informal
 Formal: positions and power
 Informal: employee relationships

- Components
o Chain of Command
 Formal paths of communication and authority
 Line positions: legitimate authority (solid lines)
 Staff positions: advisory positions, no legit authority, (broken lines)

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 o Unity of Command: employees report to 1 boss only (vertical solid line)

o Span of Control
 No. of people directly reporting to manager
 Higher span, flatter structure
 Lower span, taller structure
o Managerial Levels
 Top-level
 Strategic planner
 Policy making
 Chief nurse
 Middle-level
 Facilitate communication between top and first-level
 Nursing supervisor
 First-level
 Operational planner
 Day-to-day operations
 Head nurse

- Types of Organizational Structures

o Bureaucratic/ Line
 Tall
 Centralized
 Decision making at top
 Narrower span of control
 Flat
 Decentralized
 Decision making where work is done
 Wider span of control
o Ad Hoc
 Temporary
 Project-based

- Power
o Effect based on how it is used.
o Types of Power
 Reward: granting favors/rewards
 Coercive: fear of punishment
 Legitimate
 Formal position/title
 Authority is source of power
 Authority =/= Power
 Limit commands
 Expert: knowledge, expertise
 Referent: association with powerful people
 Charismatic: personal influence
 Informational: knowledge that others do not have

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- Patient Care Delivery Methods
o Total Patient Care or Case Method Nursing
 Nurse is responsible to meet all needs of assigned patients
 Oldest, common
 Reqt: Highly skilled staff
o Functional Method
 Based on tasks, not patients
 E.g. BP monitoring, Medications, Hygiene
o Team Nursing
 Staff follow the team leader (nurse)
 Max. 5 per team
 Reqt: Team leader is efficient and organized
o Modular Nursing
 Mini-team (3 members)/ Care pairs (2 members)
 Smaller teams
o Primary Nursing
 24-hour care
 Admission to discharge
 Associate nurse: substitute when primary nurse is off-duty
 Reqt: Primary nurse is self-directed
o Case Management
 Collaborative: Multidisciplinary action plan (MAP)
 Goal: Cost-effective outcomes
 Reqt: Case manager

STAFFING

- Healthcare as labor-intensive
- First step: Determine staffing needs

- Staffing Functions (ReSePI)

o Recruitment
 Active search for applicants
 Ongoing process
 Turnover: replacement of new staff
 No turnover: stagnation
 Low turnover: retention, staff development
 High turnover: expensive, decreased patient safety

o Selection
 Requirements
 Minimal Criteria: minimum
 Preferred Criteria: ideal
 Interview
 Evaluates suitability for the position.

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  Evaluation
 JOB DESCRIPTION: avoid under/overqualified applicants
 NEVER ask discriminatory questions.
o Age, race, marital status, sexual preference, etc.
 Background Check: Check references, verify credentials
 Preemployment Testing: Personality and psychiatric tests
 Physical Examination: physical reqts for the job

o Placement
o Assignment to department
o Proper placement   efficiency

o Indoctrination: Adjustment of employee to organization

(IOS)
o Induction
 General information
 Employee handbooks
o Orientation
 Specific information for position
 Promote belongingness of employee
 Personnel policies: first-level manager (head nurse)
o Socialization
 Learning the behaviors associated with role

- Scheduling Options
o 8hrs or 12hrs/shift, 40 hrs/week

o Float pools
 Per diem employees
 Flexible: Higher pay, no benefits
 Reqt: Orientation to unit, Core competencies

o Flextime
 Time schedules based on staff

o Self-scheduling
 Daily schedules based on staff

DIRECTING (THE “DOING” PHASE)

- Communication: exchange of thoughts through speech or signals.

o Communication Process

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 o Verbal vs Nonverbal
 Verbal: use of words (written or spoken)
 Non-verbal: body language

- Verbal communication
o Assertive: direct, honest, acceptable. “I” statements
o Passive: silence, avoids conflict
o Aggressive: threatening, bullying
o Passive-aggressive: aggressive message conveyed passively.

- Nonverbal Communication
o Silence: use therapeutically
o Space (Proxemics)
o Appearance and posture
o Eye contact
o Gestures and facial expressions
o Note: verbals and non-verbals must be congruent.

- Channels of Communication
o Upward: subordinate to superior
o Downward: superior to subordinate
o Horizontal: peer to peer
o Diagonal: different levels and jobs
o Grapevine: informal, random, source of rumor

- ISBAR: communication tool to  patient safety (Used in referrals)

o Introduction: name, ward
o Situation: chief complaint
o Background: patient info
o Assessment: other findings
o Recommendation: suggested action

- Listening skill
o Best communication skill
o Communication failure: common cause of medical error

- Delegation
o Getting work done through others
o Accountability: retained
o Responsibility: transferred
o Pros: (1) productivity, (2) Can handle more complex problems, (3) empowers staff
o Cons: risk for improper/ overdelegating

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 o 5 Rights of Delegation
 Right task
 Right circumstance
 Right person
 Right direction
 Right level of supervision

o Delegation to LVN and UAP

Do’s 
LVN/LPN
- Administering medications except via intravenous, intrathecal, intraosseous, or
endotracheal route
- Enteral or tube feedings
- Ostomy care
- Inserting and removing Foley catheters
- Oral suctioning
- Non-complex sterile procedures
- UAP tasks

UAP:
- Routine vital signs (No admission)
- Hygiene
- Feeding without oral/swallowing problems
- Basic life support
- Postmortem care
- ADLs, Ambulation, turning
- Elimination, Monitoring I&O
- Obtaining specimens

Don’ts X
- ADPE, except routine assessment
- Baseline/Admission assessment
- Health teaching/Discharge Planning
- Nursing judgment
- Not within scope of practice

 Conflict resolution strategies (Goal: Win-win solution)

 Collaborating: set aside differences and work together, win-win
 Compromising: parties give up something, lose-lose
 Competing: one party intends to win. win-lose
 Accommodating: one party sacrifices. Win-lose
 Smoothing: reducing the severity of problem, temporary
 Avoiding: no resolution, temporary

CONTROLLING

- Tasks: (1) Performance measured against standards, (2) Praise/Correct actions

- Performance Appraisal vs Nursing Audit

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 o Criteria: Job description
o Performance appraisal: nurse-centered
o Nursing Audit: patient-centered, chart

- Evaluation
o Structure: resources, e.g. environment, staffing (human resources)
o Process: how care is delivered, e.g. medications
o Outcome: end-result, e.g. health status

- Quality Assurance vs Quality Improvement

o Quality Assurance: maintaining quality
o Quality Improvement: upgrading quality

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