1. Planning, Management and Leadership for Health IT
Welcome to Planning, Management and Leadership for Health Information Technology, Introduction to Leadership. This is Lecture A. We will start by looking at current leadership theories and principles.
Introduction to Leadership
Lecture a
This material (Comp 18 Unit 1) was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007.
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2. Introduction to Leadership Learning Objectives
Definition of leadership
An examination of leadership theories
Lecture A
Blake and Mouton’s Managerial Grid
Lecture B
Transformational Leadership
Transactional Leadership
Charismatic Leadership
Visionary Leadership
Servant Leadership
The objectives for this Unit, Introduction to Leadership, are to cover the definition of leadership and examine many of the leadership theories underlying the idea of leadership. In this first presentation you will learn about Blake and Mouton’s Managerial Grid. In the second presentation you will learn about transformational leadership, transactional leadership, charismatic leadership, visionary leadership, and servant leadership. These topics will examine the different leadership theories utilized in the healthcare industry. By examining these leadership theories, students will have the opportunity to examine the complexities and many variables that impact leadership, such as the individual behavior of the leader.

3. What is Leadership?
Leadership is a process focused on bringing people together to accomplish a set goal for the organization at the highest level of excellence
Let’s begin by trying to answer the question, “What is leadership?” Leadership is a process focused on bringing people together to accomplish a set goal for the organization at the highest level of excellence. It evolves according to the environment that the leader will be working in and the goals and objectives that are to be achieved by the organization.
Leadership focuses around the process of bringing about some type of change. The traditional mindset in healthcare is to follow predictable processes and work flow. Many leaders are often reluctant to adopt an innovative or alternative method of operation. So it’s important to study the various types of leadership styles so you can understand which theory to utilize in different situations.
Source: (Bass, 2008)

4. Leadership Values Principles that guide our behavior and our thoughts
Help an individual to analyze options, and make decisions in times of stress and difficulty
Affect how a leader perceives situations and how others perceive the leader
To understand the concept of leadership we must understand leadership values. Values are principles that guide our behavior and our thoughts. They can impact situations in a negative or a positive manner. Values can also help an individual analyze options and make decisions in times of stress and difficulty. Oftentimes, values will affect how a leader perceives a situation and how others perceive the leader, which can impact the followers and the organization.

5. Are Leaders Born or Made?
Good leaders are made, not born
If you have the desire and willpower, you can become an effective leader
Effective leaders develop their skills through the pursuit of leadership theory, approaches, concepts and experience
When discussing the idea of leadership we often are faced with the question, “Are leaders born or are they made?” You may be happy to learn that good leaders are developed, not born. If someone aspires to become a leader and has the willpower and the drive, an individual can develop into a very effective leader in a healthcare organization.
Effective leaders develop their skills through the pursuit of learning leadership theories, approaches, concepts, and experience. Leadership will occur at all management levels in an organization. Some charisma is necessary, but it is certainly not a prerequisite and it can be developed. There is no one right way to lead and we each have to develop our own type of style and the method that we will use in our environment.
As you would expect, there are both similarities and differences in the behaviors and actions that are emphasized by different theorists to determine leadership potential. So it is important for us to examine the leadership theories associated with the behavioral theories of leadership.
Source: (Bass, 2008.)

6. University of Michigan Studies
Research studies were conducted to determine the most effective style of leadership:
Utilization of an employee-centered focus, or
Utilization of a production-centered focus
In order to understand the foundations of the different leadership theories that we will discuss, we need to begin with an understanding of the University of Michigan leadership studies. These research studies were conducted to determine the most effective style of leadership. In the late 1940s, researchers at the University of Michigan were working to identify the independent dimensions of leadership behavior. The researchers focused on identifying the most effective style of leadership based on two dimensions of leadership behavior.
They focused on utilization of an employee-centered focus and utilization of a production-centered focus. In the next two slides, we’ll look at these two foci in a little more detail.
Source: (Borkowski, 2009, p. 176)

7. Employee-Centered Leaders
Emphasize interpersonal relations
Show concern for the needs of their employees
Accept personality differences
Specifically, when researchers looked at employee-centered leaders, they found that those types of leaders emphasized interpersonal relations. The employee-centered leader shows concern for the needs of his or her employees, and accepts the traits and personality differences encountered among the different employees in the organization.
Source: (Bass, 2008)

8. Production-Centered Leaders
Emphasize technical aspects
See employees as a means to achieving tasks
When they looked at leaders with a production-centered organization and focus, on the other hand, the researchers found that these types of leaders emphasize the technical aspects of the job and focus on accomplishing just that task. The employees represent a means to achieving the end of the tasks for the leader and that is their primary direction.

9. University of Michigan Studies
Non-autocratic support created highest level of productivity
Formed foundation for other leadership theories
The Michigan study showed that providing support and direction without being autocratic created the highest level of productivity than did the production centered approach.
This study has been repeated and confirmed as valid several times since the first attempt in the late 1940s. As a result, it has been a clear standard and has been a foundation underlying the other leadership theories.

10. Blake and Mouton’s Managerial Grid
Five types of leaders:
Authoritarian
Team Leader
Country Club
Impoverished
Middle-of-the-Road
Let’s begin our study of the various leadership theories by looking at Blake and Mouton’s managerial grid. Blake and Mouton define five types of leaders:
- Authoritarian
- Team
- Country Club
- Impoverished and
- Middle-of-the-Road
Source: (Borkowski, 2009, p. 176) 

11. Managerial Grid Diagram
Blake and Mouton (2009) represent each type of leader on what they call a managerial grid. On this slide, you can see the managerial grid as a whole. It is founded on two types of axes (pronounced ax-ees). "Concern for people" is located on the vertical axis, while "Concern for production" is located on the horizontal axis. The range on each of the axes goes from 1-9, with a 1 signifying low and a 9 signifying high. You can see where each of the types of leaders falls on the grid.
Represented in the center is the Middle of the Road leader. In the top left corner, you find the Country Club leader. In the top right corner is the Team Leader. And in the lower right corner, we find the Authoritarian Leader. Down in the lower left corner, we find the Impoverished Leader.
In the next slides, we’ll look at the style of leadership associated with each type.  
(Image adapted from Borkowski, 2009)

12. Authoritarian Leader 9 on production, 1 on people
Difficult to work with
Task oriented at the expense of relationships
Credited with increased productivity, but over time followers become resentful of autocratic style
If we begin by looking at authoritarian leaders, these would be leaders who are high task and low relationship, represented by the number 9 on the production level and by 1 on the focus for people. People who get this rating are very much task oriented and are very difficult to work with and are hard on their workers, meaning that they are an autocratic type.
As stated by Bernard Bass in the Handbook of Leadership, the authoritarian approach can contribute to increased productivity levels in the workforce but over extended periods of use it has an adverse reaction on individuals because of the autocratic style.
Source: (Bass, 2008)

13. Team Leader 9 on production, 9 on people
Maintains high level of relationship
Fosters strong bond among team members
Encourages collaboration
Leads some of the most productive teams
When looking at the team leader type of leader, we are looking at a 9 on the production scale and a 9 on the people scale. This is a very high task-oriented leader who is also very focused on maintaining a high level of relationships. This type of person leads with a sense of purpose creating “a perfect infusion of concern for people and concern for task.”
Team leaders work to accomplish “interdependence through a common stake in the organization [which builds] relationships of trust and respect” among followers. By doing this it is expected that followers will “internalize goals and objectives: which will increase productivity and quality.”
Source: (Borkowski, 2009, p. 178
Bass, 2008, p. 512)

14. Country Club Leader 1 on production, 9 on people
Encourages friendly atmosphere
Does not like to punish
When focusing on the Country Club Leader, we see that this type is represented by the number 1 on production and 9 on people. A country club leader scores very low on task, but very high on relationships. This type of leader is “concerned with ensuring that employees’ needs are met and that the work environment is comfortable and friendly.” Since the focus is centered on people rather than on productivity this type of leader often falls short in achieving production goals.
Source: (Borkowski, 2009, p.178)

15. Impoverished Leader 1 on production, 1 on people
Puts forth minimal effort toward accomplishing assigned goals
Is detached. Team will have opportunity to complete tasks they desire, but leader detached from team process
Is available to save the day when trouble arises
When discussing the impoverished leader, we see that it is represented by a 1 on production and a 1 on people. This means low task and low focus on relationships. This type of leader puts forth minimal effort toward accomplishing assigned goals and tasks. An impoverished leader focuses on only completing the amount of work that is absolutely required to sustain a leadership position within an organization. The group of individuals working with this type of leader will have the opportunity to complete the assigned task as they desire. However, in allowing a team to do whatever it wishes, the impoverished leader may appear to come in and “save the day” when trouble arises.
Source: (Borkowski, 2009, p. 177)

16. Blake and Mouton’s Managerial Grid 2
Authoritarian Leader
Team Leader
Country Club Leader
Impoverished Leader
Middle of Road Leader
“Perfect Politician”
If we look in the very center of the grid, we notice that there is an area of 5, 5, meaning 5 on production and 5 on people. We refer to this type of leader as a middle-of-the-road leader.
The individual who demonstrates this leadership style will “balance the concern for task and the concern for people” in a fashion that improves morale, productivity, and increases satisfaction among the group members. This type of leader will often be viewed as the “perfect politician” for their ability to adapt to the various situational factors that may be encountered.
(Image adapted from Borkowski, 2009)

17. Managerial Grid Diagram 2
Here again is a diagram of the managerial grid. The most “prescribed” place on the grid is focused on a 9, 9. As we just discussed, that would be referred to as a Team Leader. This type of leader demonstrates “openness, trust, and commitment” and becomes involved with the followers.
Every leader has a particular managerial style he or she will utilize but it will often be supported “by other styles” on the Blake and Mouton grid. “For instance, the 1, 9 leader may begin a meeting in a casual, friendly way but quickly become a tough, no-nonsense 9, 1” because it is more in line with the individual’s managerial style.   
(Image adapted from Borkowski, 2009)

18. Introduction to Leadership Summary – Lecture a
Definition of leadership
An examination of leadership theories
This concludes Lecture a of Introduction to Leadership. In this lecture we defined leadership and focused on Blake and Mouton’s managerial grid.

19. Introduction to Leadership References – Lecture a
Bass BM, Bass R. The Bass handbook of leadership: theory, research, and managerial applications. 4th ed. New York: Free Press; 2008.
Borkowski N. Organizational behavior, theory, and design in health care. Sudbury, MA: Jones and Bartlett; 2009.
Images
Slides 11, 16, 17: Image adapted from Borkowski N. Organizational behavior, theory, and design in health care. Sudbury, MA: Jones and Bartlett; 2009.
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20. Planning, Management and Leadership for Health IT Introduction to Leadership Lecture a
This material was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007.
No Audio.
Health IT Workforce Curriculum Version 4.0