Finding the Right Leadership Style for Your Quality Improvement Agenda
Finding the Right Leadership Style for Your Quality Improvement Agenda ISQua Global Webinar May 6, 2014 Dr. Ben Chan, MD MPH MPA Assistant Professor, Division of Global Health & IHPME University of Toronto www.ihpme.utoronto.ca 2 Objectives Understand difference between leadership & management Learn about different leadership styles Consider pros & cons of different styles & their relationship to quality theory Reflect on the fit between your leadership style, your work context & what you want to achieve in quality improvement 3 Leadership vs Management 4 Leadership vs Management Leadership Innovates An original Inspires trust Long-range view Asks what and why Tells us where we’re going Designs Murray, 2010 Management Administers A copy Relies on control Short-term view Asks how and when Gets us there safely, on time, on budget Executes 5 What Motivates People? MacGregor’s Theory X & Y Theory X Theory Y Workers don’t like to work Workers like to work, are self-motivated Workers need constant supervision, direction Workers need creative space Workers motivated only by fear of punishment, explicit rewards Workers motivated by greater responsibility, pride in job well done & satisfaction with mastery of skill May be most applicable in Most applicable in high-skilled workers with low-skill, routine professions with complex tasks tasks requiring judgement, problem-solving 6 Emotional Intelligence viewpoint Leaders can sway emotions of group Resonant Leadership Drive emotions positively Develop connection with followers, exhibit empathy Performance soars when staff emotions pushed towards enthusiasm Goleman, 2002 7 What Quality Results Do We Want? Better outcomes Better execution of clinical best practices Better measurement More accountability Better costs More efficient use of resources Reduced waste 8 What Quality Results Do We Want? Better patient experience Courteous interaction Engagement in decision-making If this is the type of patient interaction do we want, then how does our leadership style reflect & model the behaviours we want our staff to adopt? 9 What Quality Results Do We Want? Creating a safe hospital – push to eliminate avoidable adverse events Develop a culture of safety Staff rewarded, not punished for errors Motivation based on improvement, not fear 10 Leadership Styles: Classifications 11 Lewin’s Leadership Styles Authoritarian / autocratic Democratic / participatory Laissez-Faire / delegative Lewin, K., Lippit, R. and White, R.K. (1939). Patterns of aggressive behavior in experimentally created social climates. Journal of Social Psychology, 10, 271-301 12 Blake-Moulton Leadership Grid 13 Goleman / Emotional Intelligence Commanding Affiliative Coaching Pace-setting Democratic Visionary 14 Wikipedia Authoritarian Paternalistic * Democratic Laissez-Faire Transactional * Transformational * 15 Authoritarian aka Commanding (Goleman) Leader makes key decisions Outside input into decision limited Workers told what to do & how to do it More closely aligned with Theory X Fear a key motivation 16 Authoritarian Pros Fast, efficient Cons Short-term gains outweighed by long-term dysfunction Great if you have an Loses wisdom, observations extremely smart, wise leader of other key individuals May be useful in a crisis Applicable in organizations Employees disengaged, with low-skilled workers demoralized doing routine tasks? Talent flight (some would disagree with this) 17 Pacesetting Similar to Produce or Perish (BlakeMoulton) Leader holds high standards – for self & organization Always demanding faster, better performance If poor performance, pushes staff harder or fixes problem him/herself 18 Pacesetting Pros Works with very hightalented, self-driven teams Focused on results May be useful in start-up, entrepreneurial phase Leader fixing problems for staff may get short-term results Cons Difficult to sustain pace; anxiety, burnout Obsession with results at expense of staff wellbeing Pressure for immediate results may restrict creativity, innovation Micromanagement erodes trust, stunts development 19 Visionary Aka “Transformational” leadership Leader articulates where group is heading Sets forth an inspiring vision of the future Builds excitement Resonates with values, aspirations of staff Leader helps staff see how their work will contribute to a better world 20 Visionary Pros Gives clear direction to organization Cons Conflicts if other strong individuals in organization with competing vision Motivates, excites employees If implementation weak, failure to achieve vision demotivates staff, leads to cynicism 21 Paternalistic Leader takes care of employees, gets strong loyalty in return Employees feel like part of the family 22 Affiliative Similar to “Paternalistic”, consistent with “Country Club” Promotes harmony among followers Nurture personal relationships, emotional needs of employees Helps resolve any conflict Build teams to ensure followers connected to each other 23 Affiliative / Paternalistic Pros Helpful in healing organizations with serious divisions, conflicts or broken trust May be popular in certain regions of the world Produces happier workers Cons Focus on praise, relationships at expense of results; may send message that mediocrity is tolerated Staff may not receive enough specific advice on how to improve 24 Coaching Leader aims to bring out best in key staff Invest in personal development of staff Help staff set long-term goals Identify strengths/weaknesses, help staff identify their calling Delegate challenging assignments that will let them grow 25 Coaching Pros Cons Works well if leader has staff If staff not self-motivated, who are self-motivated may not benefit from coaching experience 26 Democratic Style Seeks input from key people on important decisions Listens carefully to concerns Collective decision strengthened by buyin, commitment across organization 27 Democratic Pros Works well in organizations with broad mix of highly skilled individuals Cons May be difficult to implement in settings, cultures where staff afraid to give input Develops decisions with strong shared ownership May take too long to arrive at decisions; slow progress can affect staff morale 28 Laissez-Faire Leader trusts very talented staff to do their work, freely delegates tasks May set some general expectations for product but wide latitude on how to achieve it Key leadership task is to find the right talent in whom this level of trust can be given 29 Laissez-Faire Pros Can be useful in environments where highly creative or motivated people need space to innovate or problem-solve Cons If staff not highly motivated or talented, then organization suffers from lack of direction or guidance with implementation 30 Transactional Leadership aka task-oriented leadership Focus on completion of specific welldefined tasks Motivation through reward and punishment If tasks highly routine, consider management by exception 31 Transactional / Task-Oriented Pros Works best for basic ‘assembly-line’ type tasks Cons Not as suited to situations requiring creative problemsolving Does not focus on quality of relationships, team functioning 32 Can You Have More Than One Style? Leaders may combine different styles May have a predominant style & learn to use other styles in special circumstances 33 Cross-Reference of Styles Lewin Goleman Authoritarian Commanding Pacesetting Democratic Blake-Moulton Authoritarian Publish or Perish Democratic Affiliative Wikipedia Democratic Country Club Paternalistic Coaching Laissez-Faire Laissez-Faire Visionary Transformational Transactional 34 Leadership Styles: When to Use? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional Consider when leading highly trained, motivated individuals, professionals 35 Leadership Styles: When to Use? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional Often reserved for crises, startups, other urgent situations 36 Leadership Styles: When to Use? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional Helpful in situations with broken relationships, mistrust 37 Leadership Styles: When to Use? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional Useful in most leadership situations; often combined with other styles 38 Leadership Styles: When to Use? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional More management than leadership; consider use in stable, routine processes 39 Reflective Questions How would you describe your current leadership style? How would you describe the leadership style of the person you report to? Is there a consistent leadership style within the culture of your organization? Does the leadership style fit the context you find yourself in? 40 Poll: What Best Describes Your Management Style? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 41 Scenario 1: Crisis You have been asked by the Ministry of Health to take over a hospital in crisis, as interim CEO. Its last CEO and three of its five most senior executives have just been fired over a fraud scandal. It is suspected that others in the organization were involved in the fraud. The hospital is in the midst of a financial crisis with a deficit equal to 5% of its budget this year. 42 Scenario 1: What Leadership Style Would You Choose? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 43 Scenario 2: You are starting your first middle management position which includes housekeeping. C difficile rates are exceptionally high. Patient surveys show common complaints about frequency and quality of cleaning, especially washrooms. There are policies for this but nurses complain that the housekeeping staff are not following them. The outgoing manager says that housekeeping staff morale is poor, hours are long, pay is low and turnover is high. 44 Scenario 2: What Leadership Style Would You Choose? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 45 Scenario 3: You are the new Director of a primary care teaching centre in a low-income country. The centre very well respected for its work with the poor and its research. You have inherited a team with several highly trained physicians and researchers with good success at getting foreign-funded grants. Although there are some divisions, people generally get along. The biggest worry of the outgoing Director was that key talent was being lured to wealthier countries. 46 Scenario 3: What Leadership Style Would You Choose? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 47 Scenario 4: Westbury and Eastview hospitals have recently merged, and you are now the Chief of Staff of the new organization. There are deep divisions and mistrust between doctors in the two groups. Westside serves the inner city poor and prides itself on practical solutions & its interdisciplinary approach, while Eastview serves a more affluent neighbourhood, has more subspecialists and greater academic activities. Doctors at both sides were not consulted about the merger. 48 Scenario 4: What Leadership Style Would You Choose? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 49 Scenario 5 You are the new CEO of Safeview hospital. It has had two high-profile incidents of patient deaths, from wrong-site surgery & medication error. The previous administration relied on incident reports and issued reprimands to staff for not following policies. Staff are very afraid to flag safety issues where they were involved. You want to build a “just culture” around safety incidents and encourage everyone to report and create QI teams to fix safety issues. 50 Scenario 5: What Leadership Style Would You Choose? Visionary Affiliative/Paternalistic Coaching Democratic Laissez-Faire Authoritative Pace-setting Transactional 51 Summary Many different leadership styles exist Address people’s underlying motivation to follow you Theory X & Y, resonant leadership Develop a repertoire of different styles Select best style for where your organization is at in its quality journey 52 Recommended Readings Daniel Goleman et al. Primal Leadership: Learning to Lead with Emotional Intelligence. Harvard Business School Press, 2002. Gary Heil et al. Douglas McGregor, Revisited: Managing the Human Side of the Enterprise. Wiley & Sons, 2000. Alan Murray. Wall Street Journal Essential Guide to Management. Harper & Collins, 2010. Bass, B. M., & Bass, R. The Bass Handbook of Leadership: Theory, Research, and Managerial Applications. New York: Free Press, 2008. www.ihpme.utoronto.ca Dr. Ben Chan, MD MPH MPA Email: [email protected] Twitter: dr_benchan
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