Presentation on theme: "Finding the Right Leadership Style for Your Quality Improvement Agenda"— Presentation transcript:
1 Finding the Right Leadership Style for Your Quality Improvement Agenda ISQua Global WebinarMay 6, 2014Dr. Ben Chan, MD MPH MPAAssistant Professor,Division of Global Health & IHPMEUniversity of Toronto
2 Objectives Understand difference between leadership & management Learn about different leadership stylesConsider pros & cons of different styles & their relationship to quality theoryReflect on the fit between your leadership style, your work context & what you want to achieve in quality improvement
4 Leadership vs Management InnovatesAdministersAn originalA copyInspires trustRelies on controlLong-range viewShort-term viewAsks what and whyAsks how and whenTells us where we’re goingGets us there safely, on time, on budgetDesignsExecutesMurray, 2010
5 What Motivates People? MacGregor’s Theory X & Y Theory YWorkers don’t like to workWorkers like to work, are self-motivatedWorkers need constant supervision, directionWorkers need creative spaceWorkers motivated only by fear of punishment, explicit rewardsWorkers motivated by greater responsibility, pride in job well done & satisfaction with mastery of skillMay be most applicable in workers with low-skill, routine tasksMost applicable in high-skilled professions with complex tasks requiring judgement, problem-solving
6 Emotional Intelligence viewpoint Leaders can sway emotions of groupResonant LeadershipDrive emotions positivelyDevelop connection with followers, exhibit empathyPerformance soars when staff emotions pushed towards enthusiasmGoleman, 2002
7 What Quality Results Do We Want? Better outcomesBetter execution of clinical best practicesBetter measurementMore accountabilityBetter costsMore efficient use of resourcesReduced waste
8 What Quality Results Do We Want? Better patient experienceCourteous interactionEngagement in decision-makingIf 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 eventsDevelop a culture of safetyStaff rewarded, not punished for errorsMotivation based on improvement, not fear
11 Lewin’s Leadership Styles Authoritarian / autocraticDemocratic / participatoryLaissez-Faire / delegativeLewin, K., Lippit, R. and White, R.K. (1939). Patterns of aggressive behavior in experimentally created social climates. Journal of Social Psychology, 10,
14 Wikipedia Authoritarian Paternalistic * Democratic Laissez-Faire Transactional *Transformational *
15 Authoritarian aka Commanding (Goleman) Leader makes key decisions Outside input into decision limitedWorkers told what to do & how to do itMore closely aligned with Theory XFear a key motivation
16 Authoritarian Pros Cons Fast, efficient Short-term gains outweighed by long-term dysfunctionGreat if you have an extremely smart, wise leaderLoses wisdom, observations of other key individualsMay be useful in a crisisApplicable in organizations with low-skilled workers doing routine tasks?(some would disagree with this)Employees disengaged, demoralizedTalent flight
17 Pacesetting Similar to Produce or Perish (Blake-Moulton) Leader holds high standards – for self & organizationAlways demanding faster, better performanceIf poor performance, pushes staff harder or fixes problem him/herself
18 Pacesetting Pros Cons Works with very high-talented, self-driven teams Difficult to sustain pace; anxiety, burnoutFocused on resultsObsession with results at expense of staff wellbeingMay be useful in start-up, entrepreneurial phasePressure for immediate results may restrict creativity, innovationLeader fixing problems for staff may get short-term resultsMicromanagement erodes trust, stunts development
19 Visionary Aka “Transformational” leadership Leader articulates where group is headingSets forth an inspiring vision of the futureBuilds excitementResonates with values, aspirations of staffLeader helps staff see how their work will contribute to a better world
20 Visionary Pros Cons Gives clear direction to organization Conflicts if other strong individuals in organization with competing visionMotivates, excites employeesIf implementation weak, failure to achieve vision demotivates staff, leads to cynicism
21 PaternalisticLeader takes care of employees, gets strong loyalty in returnEmployees feel like part of the family
22 Affiliative Similar to “Paternalistic”, consistent with “Country Club” Promotes harmony among followersNurture personal relationships, emotional needs of employeesHelps resolve any conflictBuild teams to ensure followers connected to each other
23 Affiliative / Paternalistic ProsConsHelpful in healing organizations with serious divisions, conflicts or broken trustFocus on praise, relationships at expense of results; may send message that mediocrity is toleratedMay be popular in certain regions of the worldStaff may not receive enough specific advice on how to improveProduces happier workers
24 Coaching Leader aims to bring out best in key staff Invest in personal development of staffHelp staff set long-term goalsIdentify strengths/weaknesses, help staff identify their callingDelegate challenging assignments that will let them grow
25 CoachingProsConsWorks well if leader has staff who are self-motivatedIf staff not self-motivated, may not benefit from coaching experience
26 Democratic Style Seeks input from key people on important decisions Listens carefully to concernsCollective decision strengthened by buy-in, commitment across organization
27 DemocraticProsConsWorks well in organizations with broad mix of highly skilled individualsMay be difficult to implement in settings, cultures where staff afraid to give inputDevelops decisions with strong shared ownershipMay take too long to arrive at decisions; slow progress can affect staff morale
28 Laissez-FaireLeader trusts very talented staff to do their work, freely delegates tasksMay set some general expectations for product but wide latitude on how to achieve itKey leadership task is to find the right talent in whom this level of trust can be given
29 Laissez-Faire Pros Cons Can be useful in environments where highly creative or motivated people need space to innovate or problem-solveIf staff not highly motivated or talented, then organization suffers from lack of direction or guidance with implementation
30 Transactional Leadership aka task-oriented leadershipFocus on completion of specific well-defined tasksMotivation through reward and punishmentIf tasks highly routine, consider management by exception
31 Transactional / Task-Oriented ProsConsWorks best for basic ‘assembly-line’ type tasksNot as suited to situations requiring creative problem-solvingDoes not focus on quality of relationships, team functioning
32 Can You Have More Than One Style? Leaders may combine different stylesMay have a predominant style & learn to use other styles in special circumstances
33 Cross-Reference of Styles LewinGolemanBlake-MoultonWikipediaAuthoritarianCommandingPacesettingPublish or PerishDemocraticCountry ClubAffiliativePaternalisticCoachingLaissez-FaireVisionaryTransformationalTransactional
34 Leadership Styles: When to Use? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactionalConsider when leading highly trained, motivated individuals, professionals
35 Leadership Styles: When to Use? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactionalOften reserved for crises, start-ups, other urgent situations
36 Leadership Styles: When to Use? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactionalHelpful in situations with broken relationships, mistrust
37 Leadership Styles: When to Use? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactionalUseful in most leadership situations; often combined with other styles
38 Leadership Styles: When to Use? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactionalMore management than leadership; consider use in stable, routine processes
39 Reflective QuestionsHow 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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
41 Scenario 1: CrisisYou 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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
49 Scenario 5You 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? VisionaryAffiliative/PaternalisticCoachingDemocraticLaissez-FaireAuthoritativePace-settingTransactional
51 Summary Many different leadership styles exist Address people’s underlying motivation to follow youTheory X & Y, resonant leadershipDevelop a repertoire of different stylesSelect best style for where your organization is at in its quality journey
52 Recommended ReadingsDaniel 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.