UTA NURS 4223 – Leadership & Management

The process of influencing people to accomplish goals
What influences people
character and integrity
Framework for most leadership research prior to mid-1940s
Great Man & Trait Theories: “Some people are born to lead” and a certain set of personality traits of great leaders could be described
Great Man & Trait Theories
“Some people are born to lead” and a certain set of personality traits of great leaders could be described
Behavioral Theories
Autocratic or Authoritarian; Democratic, Participative or Shared; Laissez-Faire, Permissive or Free Rein
Autocratic or Authoritarian Leader
Task-oriented, control over group, downward communication, decisions made by leader, emphasis on status, punitive
Democratic Leader
less emphasis on control, motivate by ego and economic rewards, direction by suggestions, foster 2-way communication, group decision-making, emphasis on “we”
Laissez-Faire Leader
permissive, little control, little or no direction, emphasis on people, free communication, dispersed decision-making, no criticism
Transformational Leadership
ability to look at what the group has in common; identifies common values, is committed, has long-term vision, inspires others with vision, and empowers others
Law of situation
developed by Mary Follet; Leadership style should vary based on situation/individuals involved. Situation should determine directives given after problem known by everyone.
Leadership process (defined by Hersey)
a function of the leader, the followers, and situational variables.
Management (defined by Marquis-Huston)
the process of leading and directing all or part of an organization through the deployment and manipulation of resources
Scientific Management theory
developed by Taylor; uses the scientific method to organize work—one best way to complete tasks; emphasis on productivity; workers viewed as “economic animals” and did not consider “human element”
Classical management theory (Bureaucracy)
developed by Weber; formal authority, chain of command, consistent rules and regulations, “structure”; presumed >efficiency was achieved through rules/regs
Hawthorn Effect
identified by Mayo in study on workplace physical and environmental influences on workers’ productivity and motivation; demonstrated that workers are more productive when they know they are being observed
The Management Process
developed by Fayol; Planning > Organizing > Staffing > Directing > Controlling
Planning stage of management process
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
Organizing stage of management process
establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals.
Staffing stage of management process
recruiting, interviewing, hiring, orienting staff, scheduling, staff development, employee socialization, and team building.
Directing stage of management process
human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration
Controlling stage of management process
performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control
Human Relations Management
developed the concepts of participatory and humanistic management, emphasizing people rather than machines
Theory X and Theory Y
developed by McGregor; assume that managers role is to gather the necessary resources (including people) to meet organization goals
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
Contingency approach
developed by Fred Fieldler; relationship between followers and leaders influenced by manager’s ability to lead well
Interactional leadership theory
leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation
Theory Z
consensus decision making, fitting employees to jobs, job security, slower promotions, examining long-term consequences, quality circles, guarantee lifetime employment, establishment of strong bonds of responsibility, and holistic concern for workers
Transformational leadership vs. Transactional
transactional leaders focus on tasks and getting the work done. Transformational leaders focus on vision and empowerment.
Full-range leadership theory
suggests that there are nine factors impacting leadership style and its impact on followers; five transformational, three transactional, and one nonleadership
Servant Leadership
developed by Greenleaf; to be a great leader, one must be a servant first
Principal Agent Theory
interactive leadership theory that suggests that not all followers (agents) are inherently motivated to act in the best interest of the principal (leader or employer)
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 further payoff
Human capital vs. social capital
human capital represents the capability of the individual. Social capital represents what a group can accomplish together.
Emotional intelligence
the understanding and recognition of oneself and others’ abilities, perception and attitudes
5 components of emotional intelligence
self-awareness, self-regulation, motivation, empathy, social skills
Authentic leadership
in order to lead, leaders must be true to themselves and their values and act accordingly
Congruent leadership
a match between the activities, actions, and deeds of the leader and the leader’s values, principles, and beliefs
5 distinguishing characteristics of the Authentic Leader
purpose, values, heart, relationships, self-discipline
Thought leadership
a person who is recognized among their peers for innovative ideas and who demonstrates the confidence to promote those ideas
Quantum leadership
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
Cultural bridging
seeks out and respects other view points and creates a work environment where cultural differences are recognized and valued
Industrial age leadership vs. relationship age leadership
industrial age focused primarily on traditional hierarchical management structures, skill acquisition, competition, and control. Relationship age focused primarily on the relationship between the leader and followers.
Leaders vs. Managers
leaders not always formal, have wider variety of roles, and people focused. Managers are always assigned formal position, have legitimate source of power, have specific role responsibilities, and focus on control/use of resources
Integrated Leader/Managers
developed by Gardner; think longer term; look outward; influence others beyond own group; emphasize vision, values, and motivation; politically astute; think in terms of change and renewal; empower others
Baby Boomers vs. Generations X and Y
boomers view long hours as evidence of loyalty and hard work, Gen X and Y try to have more work/life balance (flexible hours, more vacation time, continuous training, and telecommuting options) by leveraging technology to work more efficiently
Two keys areas of personal growth and development that are fundamental to leadership success
self-confidence, and a positive attitude
Lateral transfer
one staff person moving to another unit, to a position with a similar scope of responsibilities, within the same organization
Downward transfer
someone takes a osition within the organization that is below his/her previous level
Accommodating transfers
allow someone to receive a similar salary but with a reduction in energy expenditure
Inappropriate transfer
solving unit personnel problems by transferring problem employees to another unsuspecting department
Steps to Personal Goals Setting
create “big picture” and identify large-scale goals; break goals down into smaller and smaller targets; then start working on achieving goals
S – Specific (or Significant); M – Measurable (or Meaningful); A – Attainable (or Action-Oriented); R – Relevant (or Rewarding); T – Time-bound (or Trackable)
ANA/NCSBN definition of delegation
the process for a nurse to direct another person to perform nursing tasks and activities
Delegation process
identify task, indentify skills and levels, select most capable/appropriate person, communicate goal, empower the delegate, set deadlines, monitor progress, provide guidance, evaluate performance, reward accomplishment
5 rights to delegation
right task, right circumstance, right person, right direction/communication, right supervision/evaluation/follow-up
Criteria for delegation
must assess, task must be delegated using sound nursing judgment, can be performed safely, instructed UAP or verified competency, doesn’t require licensed person, adequately supervise, periodically evaluate
Ineffective delegation
under delegation, over delegation, improper delegation, reverse delegation
Causes of under delegation
false assumption that delegation may be interpreted as a lack of ability; desire to complete the whole job personally due to lack of trust in subordinates; lack of experience; failure to anticipate the help needed; difficulty assuming the manager role
Causes of over delegation
poor time management; insecurity in ability to perform task
Causes of improper delegation
delegating at the wrong time, to the wrong person, or for the wrong reason; delegating tasks and responsibilities beyond the capability of the person being delegated to or that should be done by the manager
Causes of resistance to delegation
failure to see subordinate’s perspective; lack of knowledge, information, skill or ability; fear of failure; resistance to authority; over-delegation of tasks; lack of positive incentives for motivation
Nationally established standards for UAPs
there are none
Problem-Solving and Decision-Making Process Similarities
define the problem, gather information, analyze information and explore alternatives, develop solutions, make a decision, implement, and evaluate
Problem-Solving and Decision-Making Strategies
trial and error; experimentation; past experience; intuition
Problem solving styles
Adaptation-Innovation Theory; Adaptors; Innovators
Adaptation-Innovation Theory
problem solving strategy that suggests two types of problem solvers: Adaptors and Innovators.
use tried and accepted ways, rarely challenge rules, methodical efficient, and less risk-taking
seek solutions in creative and challenging ways; think ‘outside the box’; promote change; higher risk-taking
Creative Problem Solving principles
deferred judgment (suspending bias, judgment, and evaluation) and divergent-convergent thinking (being open to exploring possibilities)
Intuitive Problem Solving Novice Nurses vs. Experts
Novice nurses rely more on deliberate thinking while experts rely more on instinct and “gut” feelings and looking for patterns.
“thin slicing” (Gladwell, 2005)
how experts draw on years of experience and a deep knowledge of their field to make rapid decisions using the thinnest slice of information
Group Problem Solving Disadvantages
can become so stagnant that they don’t allow new ideas and generate change
Risky Shift
a group is willing to take greater risks than individuals would do on their own (e.g., mob mentality)
Frequent Errors in Decision Making & Problem Solving
failing to consider possible outcomes; lacking a clear objective or goal; faulty data gathering (information withheld or not ample); limiting options; faulty logic (over-generalizing); excessive delay; refusal/failure to act
Satisficing vs. Maximizing
satisficing is ‘good enough for now’ while maximizing must be done well initially
Types of decisions
routine (well-defined, common issues), adaptive (need modifications to usual methods), innovative (unusual problems needing creative solutions)
Rational or Normative Decision-Making Model
have good information and anlysis-allows for logical decision making
Descriptive or Bounded Rationality Decision-Making Model
fairly complete info but limited by time, energy, and or money or other resources
Political Decision-Making Model
considers needs of stakeholders and ‘Power Brokers’
Critical Thinking
aka reflective thinking; “a set of cognitive skills” including “interpretation, analysis, evaluation, inference, explanation, and self-regulation”
the complex exchange of thoughts, ideas, or information on at least two levels: verbal and nonverbal
Goal of communication
to approach as closely as possible a common understanding of the message sent and the message received
Variables affecting organizational communication
spatial distance; different subgroups or subcultures; differing authority and status; work structure; organizations in a constant state of flux
Channels of communication
downward (primarily directive), upward (allows employee input), lateral/horizontal (between individuals or departments at same level), and diagonal (between individuals or departments at different levels)
Assertive communication
allows people to express themselves in direct, honest, and appropriate ways that DO NOT INFRINGE ON ANOTHER PERSON’S RIGHTS
Passive communication
occurs when a person suffers in silence, although he or she may feel strongly about the issue; a nonassertive and manipulative way to send a message
Aggressive communication
expressing oneself in a direct and often hostile manner that infringes on another person’s rights; generally oriented to a “winning at all costs” mentality
Passive-Aggressive communication
an aggressive message presented in a passive way; limited verbal behavior with incongruent nonverbal behavior
a technique used to improve the communication between members of the health care team: Situation, Background, Assessment, Recommendations
Communication process
the person who is the source of the communication encodes it into a message, and transmits it through a channel. The receiver decodes the message, and, in one way or another, feeds back understanding or a lack of understanding to the source.
KISS principle
Keep It Simple and Straightforward
helping others to grow and fulfill their potential
Nursing values central to advocacy
right to autonomy, right to hold personal values, access to information, act on behalf of clients who are unable to advocate for themselves, empowerment of patients and subordinates to make their own decisions
Advocacy vs. Paternalism
advocacy is assisting patient choices (allowing freedom) vs. Paternalism is controlling patient choices (domination and dependence)
Subordinate advocacy
manager helps resolve ethical and job related problems and live with the solutions at the unit level
Workplace advocacy
part of subordinate advocacy; ensuring the work environment is both safe and conducive to professional and personal growth for subordinates
Failure to Rescue
poor outcome of care that occurs when staff fail to identify potential complications early and take appropriate actions
What is needed to rescue patients
competent staff (critical thinkers); enough staff to spend time with patients; ability to mobilize resources
Interacting with the media
respect/meet deadlines; assume will be fair/ accurate; have key facts/figures ready; limit key points to 2-3 bullet points; avoid technical jargon; speak confidently and truthfully; avoid inflammatory arguments or blame setting; provide contact info
Formal dimensions of power
Relational Aspect, Dependency Aspect, Sanctioning Aspect
Relational aspect of power
suggests power related to relationships between 2 or more individuals
Dependency aspect of power
particularly evident in organizations; interdependence between units/staff
Sanctioning aspect of power
direct manipulation of another’s outcome (rewards, punishments, peer pressure)
Reward power
giving something of value (praise, pay raise, promotion)
Punishment (coercive) power
force against the will; ability to threaten punishment and deliver penalties
Legitimate power
position power; right to command; authority; most common source of power
Expert power
unique skills/personal abilities
Referent power
subtle; based on admiration or respect for an individual or association with powerful others; comes from others
Referent power vs. charismatic power
referent power is gained only through association with powerful others whereas charisma is a more personal type of power
Informational power
obtained when people have information that others must have to accomplish their goals
Most common source of organizational conflict
communication problems, organizational structure, and individual behavior within the organization
Categories of Conflict
intrapersonal, interpersonal, intergourp
Stages of Conflict
Antecedent/Latent, Perceived, Felt, Manifest, Aftermath
Antecedent/latent conflict stage
conditions exist (short staffing, poor pay, inadequate support)
Perceived conflict stage
conflict recognized by individual (may be able to be resolved at this stage
Felt conflict stage
emotionalized (anger/fear/mistrust)
Manifest conflict stage
action is taken
Conflict aftermath stage
positive or negative feelings linger (may be worse than original conflict if handled poorly
Competition strategy to resolve conflict
One party pursues what it wants regardless of the cost to other person
Accommodation strategy to resolve conflict
One party sacrifices his or her beliefs and wants, to allow the other party to win
Smoothing strategy to resolve conflict
an individual attempts to reduce the emotional component of the conflict
Avoidance strategy to resolve conflict
parties are aware of a conflict but choose not to acknowledge it or attempt to resolve it
Compromise strategy to resolve conflict
each party gives up something it wants
Collaboration strategy to resolve conflict
an assertive and cooperative means of conflict resolution whereby all parties set aside their original goals and work together to establish a common priority goal
When to intervene in a conflict
the conflict gets to a place where it is creating a distraction, interference in workflow, or becomes a threat to patient safety or unit function
Alternative Dispute Resolution (ADR)
mediation, fact finding, arbitration, due process hearings, and use of ombudsperson
that which enables one to accomplish goals
Power vs. authority
power is the capacity to act whereas authority is the right to command
Power-building strategies
personal energy, powerful persona, pay entry fee, determine powerful, learn culture, use org. priorities, increase skills/knowledge, broad vision, use experts/seek counsel, be flexible, be visible/have voice, toot own horn, sense of humor, empower others
Authority-power gap
gap that sometimes exists between a position of authority and subordinate response
Planned change
deliberate, intentional effort by change agent to create something new
Unplanned change or change by drift
haphazard; random; unexpected; occurs over time as people enter/leave the system
Good reasons for change
to solve some problem; to make work procedures more efficient; and to reduce unnecessary workload
Change agent
persons skilled in the theory and implementation of planned change
Managers vs. Leaders
managers continue the status quo while leaders embrace change
Lewin’s Rules for Implementing Change
should only be implemented for good reason; always be gradual; be planned and not sporadic or sudden; and all individuals who may be affected should be involved in planning for the change
Lewin’s Change Theory steps
unfreezing, movement, freezing
Lewin’s Change Theory unfreezing stage
must by pass defense mechanisms to change existing mind-set (assessment)
Lewin’s Change Theory movement stage
period when change happens; may be confusing and unsettling as old habits are challenged (planning and implementation)
Lewin’s Change Theory freezing stage
new mindset and habits stabilized; comfort levels return (evaluation/implementation)
Lewin’s Force Field Model
describes change as a dynamic balance of forces working in opposing directions within a field, such as an organization; for change to occur, forces (driving and restraining) must be altered
Driving forces
facilitate change
Restraining forces
impede change
Roger’s Theory of Planned Change
described 5 factors that determine successful planned change: relative advantage, compatibility, complexity, trialability, observability
Roger’s relative advantage
degree to which change is deemed preferable to status quo
Roger’s compatibility
degree to which change is compatible with groups existing values
Roger’s complexity
degree to which change is perceived as difficult to use/understand
Roger’s trialabilty
degree to which change can be tested on a limited basis
Roger’s observability
degree to which the results of a change are visible to others
reason people resist change
lack of trust; also vesting interest in status quo, fear of failure, loss of status or income, misunderstanding, rigidity
Pesut responses to change
individuals are either crusaders (innovators and early adopters) or tradition bearers (prefer status quo and/or may resist) in response to their propensity to seek change
Porter-O’Grady’s single most important factor in how people accept change
the manager’s behavior
systematic exam of a record, process, structure, environment or account to evaluate performance
Types of audits
retrospective, concurrent, prospective (how future performance will be affective), outcome, process, and structure
Most common audits
outcome, process, structure
Outcome audit
what results occurred as a result of specific interventions (e.g., patient falls, hospital-acquired infections, pressure ulcers, restraints, patient satisfaction)
Process audit
measures how nursing care was provided (e.g., efficient, best practice, how being carried out, policies/procedures being followed)
Structure audit
looking at the patient care environment: structure (e.g., lighting, beds, flooring) and environment of care (e.g., staffing ratios, staffing mix, ED wait times)
Quality improvement
target ongoing and continually improving quality
Quality assurance
target currently existing quality
Total quality management
never ending process, everyone can improve
the degree to which services for individuals and populations increase the likelihood of desired healthcare outcomes and are consistent with current professional knowledge
Quality control
activities that evaluate, monitor, or regulate services rendered to customers
Quality control vs. Risk management
moved health care from a model of identifying failed standards, problems, and “problem people” (risk management) to Proactive organizations where problems are prevented and care improvements are continuously made (quality control)
Leapfrog Group standards
CPOE system, evidence-based hospital referral, ICU physician staffing, Leapfrog safe practices
Number one cause of Sentinel Events
poor communication
Workplace violence
incident that leads one to believe that he/she has been harmed by the experience (e.g., favoritism, verbal abuse, abusive correspondence, bullying, pranks)
5 steps to handling patient complaints
acknowledge the incident and apologize; quick follow-up; personal contact; immediate restitution; document facts
Organizational structure
the way in which a group is formed, its lines of communication, and its means for channeling authority and making decisions
Span of control
number of people reporting to one manager; optimal range is 3-50 depending on manager’s expertise
Line Organizational Structure
Bureaucratic designs found frequently in healthcare organizations
Ad hoc Organizational Structure
modification of bureaucratic design sometimes used temporarily to facilitate project completing
Matrix Organizational Structure
focused on both product and function; formal vertical and horizontal chain of command
Flat Organizational Structure
more authority and decision making occurs where work is done
Organizational Climate
system of symbols and interactions unique to each organization; ways of thinking, behaving, and believing that members of a unit have in common
Organizational Culture
how employees perceive the organizations; how it feels to be part of the unit or organization; perceptions may differ and may be accurate or inaccurate
Organizational Climate vs. Culture
Climate is the system of symbols and interactions unique to each organization (how the organization thinks, behaves, and believes) while Culture is how employees perceive the organization (how it feels to be part of the organization)
Shared Governance
innovative and idealistic organizational structure that empowers employees within the decision-making system (giving nurses more authority and control over nursing practice)
Participatory Management
implies that others are allowed to participate in decision making over which someone has control
Shared Governance vs. Participatory Management
Shared governance empowers employees to make decisions while participatory management allows employees to participate in decision making, but still has someone who has control and makes final decisions

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