Leadership

Leadership Definition 1

"My definition of a leader . . . is a man who can persuade people to do what they don't want
to do, or do what they're too lazy to do, and like it." — Harry S. Truman, 1884-1972, Thirty-
third President of the United States, Miller, More Plan Speaking

Leadership Definition 2

"You cannot manage men into battle. You manage things; you lead people." — Grace
Hopper, Admiral, U. S. Navy (retired), Nova (PBS TV), 1986

Leadership Definition 3

"The superior leader gets things done with very little motion. He imparts instruction not
through many words but through a few deeds. He keeps informed about everything but
interferes hardly at all. He is a catalyst, and though things would not get done well if he
weren’t there, when they succeed he takes no credit. And because he takes no credit, credit
never leaves him." — Lao Tse, Tao Te Ching

The Convergence of the Definition of Leadership

There are many diverse definitions of leadership. This convergence of leadership definition
outlines a few common approaches, and outlines the definition of leadership underpinning the
Leadership World. It is defined as "enabling a group to engage together in the process of
developing, sharing and moving into vision, and then living it out." It the importance of a
leader's character and integrity in building up the trust necessary for the leadership to be
exercised over a period of time. For this convergence Leadership, the importance of visioning
must be emphasized - since leadership seeks to work in partnership with his people, and
prayer is the primary channel of communication. Some of the common ideas that others
include in leadership definitions include exerting influence, motivating and inspiring, helping
others realize their potential, leading by example, selflessness and making a difference. For
perspective, we include several other common definitions:
Leadership Definition: The Collins English Dictionary. (© 1998 HarperCollins
Publishers) leadership (n) 1. The position or function of a leader. 2. the period during which a
person occupies the position of leader: during her leadership very little was achieved. 3. a. the
ability to lead. b. (as modifier): leadership qualities. 4. the leaders as a group of a party,
union, etc.: the union leadership is now very reactionary.

This dictionary definition of leadership focuses on the position (singular or collective), tenure
and ability of leaders. As such, it misses key points about the purpose and hallmarks of
effective leadership.

Leadership Definition: Peter Drucker: The forward to the Drucker Foundation's "The
Leader of the Future" sums up leadership: "The only definition of a leader is someone who
has followers." To gain followers requires influence (see John Maxwell's definition below)
but doesn't exclude the lack of integrity in achieving this. Indeed, it can be argued that several
of the world's greatest leaders have lacked integrity and have adopted values that would not
be shared by many people today.

Leadership Definition: John C Maxwell: In the 21 Irrefutable Laws of Leadership, John

Maxwell sums up his definition of leadership as "leadership is influence - nothing more,
nothing less." This moves beyond the position defining the leader, to looking at the ability of
the leader to influence others - both those who would consider themselves followers, and
those outside that circle. Indirectly, it also builds in leadership character, since without
maintaining integrity and trustworthiness, the capability to influence will disappear.

Leadership Definition: Warren Bennis: Warren Bennis' definition of leadership is focused

much more on the individual capability of the leader: "Leadership is a function of knowing
yourself, having a vision that is well communicated, building trust among colleagues, and
taking Definition of a Leader

An individual who is able to influence and inspire a group or organisational members to help
the group or organisation achieve its goals

• Management ensures that processes and procedures, staff, and other resources are used in an
effective (correct) and efficient (correctly) manner

• Leadership organizes the internal parts of the organisation to implement systems and
coordinate resources to produce reliable performance
 Management Leadership
Managers cope with complexity Leaders cope with change
Managers plan and budget Leaders set direction and shared values
Managers organize and staff a business Leaders align people with the organisation
and therefore empower them
Managers control and problem-solve Leaders motivate people, including through
networks of informal relationships
Administer Innovate
Maintain Develop
Control Inspire
Short-term view Long-term view
Ask how & when Ask what & why
Initiate Originate
Accept the status quo Challenge the status quo
Do things right Do the right things

Leadership Theories

• Great man theory

• Trait theory
• Behavioral
• Participative
• Situational
• Contingency theory
• Transactional
• Transformational
• Servant leadership
• Level 5 leadership theory
• Followership
• Working in groups, use a flip chart and make three columns. Identify leaders with
different styles of leadership, name their leadership style and list the characteristics of
their style
• Report back to the plenary
Some leadership styles

• Laissez - faire
• Autocratic
• Servants
• Transactional
• Democratic
• Bureaucratic
• Transformational

Qualities of a good leader

• Visionary and forward-looking

• Must be adaptable and change with changing circumstances
• Must be honest and sincere of purpose
• Able to see things in perspective
• Able to admit mistakes and learn from others
• Must be self-confident
• Must have a sense of humour
• Must listen to his subordinates
• Understands problems of those under him/her
• Diplomatic and humble

Students to cite other qualities

Transactional and transformational leadership

• Transactional leadership occurs when leaders and followers are in an exchange

relationship in order to get needs met
• Transformational leadership serves to change the status quo by appealing to
followers’ values and their sense of higher purpose

Transactional leadership

 Focus on the management of the organisation

 Focus on procedures and efficiency
 Focus on working to rules and contracts
  Managing current issues and problems
 More commonly a male trait
 Men tend to view job performance as a series of transactions with subordinates in
terms of exchanging rewards for services rendered or punishment for inadequate
performance
 More likely to use power that comes from organisational position and formal
authority

Transformational leadership

 Management by exception (watches for deviations)

 Keeps the system operating smoothly
 Uses reward and coercive power bases
 Recognizes what workers want and tries to deliver it
 Rewards according to worker effort
 Responsive to worker self-interests

Is transformational leadership built “on top of” transactional leadership, or is it just a

special case of charismatic leadership?

• Gives rewards in exchange for performance / services

• Manages by looking for deviations from rules
• Intervenes only if standards are not met
• Abdicates responsibilities

Transformational leadership

• More commonly a female trait

• Women tend to get subordinates to transform their own self-interest into the
interest of the group through concern for a broader goal
• Usually ascribe power to personal characteristics like charisma, interpersonal
skills, hard work, or personal contacts rather than to organisational stature

Transformational leadership is a process that changes and transforms individuals; it is

concerned with:

• Emotions
• Values
 • Ethics
• Standards
• Long-term goals
• It includes assessing followers’ motives, satisfying their needs, and treating them
as full human beings
• Transformational leadership involves an exceptional form of influence that moves
followers to accomplish more than what is usually expected of them
• It is a process that often incorporates charismatic and visionary leadership

Transactional vs. Transformational

Transactional leadership

 Refers to the bulk of leadership models, which focus on the exchanges that occur
between leaders and their followers
 Managers who offer promotions to employees who surpass their goals are exhibiting
transactional leadership
 The exchange dimension of transactional leadership is very common and can be
observed at many levels throughout all types of organizations

Transformational leadership

 Refers to the process whereby an individual engages others and creates a connection
that raises the level of motivation and morality in both the leader and the follower
 This type of leader is attentive to the needs and motives of followers and tries to help
followers reach their fullest potential
 Mahatma Gandhi is a classic example of transformational leadership. Gandhi raised
the hopes and demands of millions of his people and in the process was changed
himself
 The implication of transitional and transformational leadership for individuals, team,
and organisation development by B.M Bass and B.J Avolio 1990a, research in
organisational change and development, 4, 231-272

How does the transformational approach work?

The transformational approach to leadership is a broad-based perspective that encompasses
many facets and dimensions of the leadership process In general, it describes how leaders
can:

 Initiate, develop, and carry out significant changes in organizations

 Transformational leaders set out to empower followers and nurture them in change
 They attempt to raise the consciousness of individuals and get them to transcend their
own self-interests for the sake of others

To create change, transformational leaders become strong role models for their followers

 It is common for transformational leaders to create a vision

 The vision emerges from the collective interests of various individuals and units
within an organisation
 Transformational leaders also act as change agents who initiate and implement new
directions within organizations
 The transformational approach also requires that leaders become social architects
 This means they make clear the emerging values and norms of the organisation
 They involve themselves in the culture of the organisation and help shape its meaning

Transformational leader

• Charismatic/Inspirational
• Focuses on vision
• Is not as concerned with day-to-day issues

Kouzes-Posner leadership model of Transformational leadership

• Challenging the process

• Inspiring a shared vision
• Enabling others to act
• Modeling the way
• Encouraging the heart

Guidelines for becoming a transformational leader

Develop a vision that is both clear and a clear vision will guide followers highly appealing to
followers toward achieving organisational goals and make them feel good about doing
 • Articulate a strategy for bringing the vision into reality
• State the best path towards achieving the mission
• Visions must not only be clear, but show confidence and optimism about the
organizations future
• If a leader lacks confidence about the organizational vision and success, followers
will not try very hard to achieve successful implementation of the organizational and
country strategic plans and global health commitments.
• The leader needs to express confidence in followers’ capacity and followers must
believe that they are capable of carry out the strategy
• Leaders need to build the confidence and capacity of followers by recognizing the
groups and organizational early experiences of success
• Follower’s accomplishments toward the group and organizational goals will be
motivated to continue working hard
• Celebrate successes through formal or informal ceremonies; these are useful to
building optimism and commitment
• Leaders take dramatic action to symbolize key visions reinforced by organisational
values
• Leaders need to set an examples; actions speak louder than words
• We praise leaders too much when organizations succeed, and blame them too much
when organizations fail

Levels of Leadership

• Level 1 – Highly Capable Individual – Makes productive contributions through talent,

knowledge, skills, and good work habits

• Level 2 – Contributing team member – contributes to the achievement of group objectives;

works effectively with others in a group setting

• Level 3 – Competent manager - organizes people and resources toward the effective and
efficient pursuit of predetermined objectives
• Level 4 – Effective leader - catalyses commitment to and vigorous pursuit of a clear and
compelling vision; stimulates the group to high performance standards

• Level 5 – Executive - Builds enduring greatness through a paradoxical combination of

personal humility plus professional will

Level 5 leadership -People generally assume that transforming from good to great
organizations’ requires charismatic, larger than-life leaders. Not the case in study of many
successful health care organizations and companies.

The level 5 leadership is an essential factor for taking a health care organisation from good to
great, but it’s not the only one

• Sits on top of a hierarchy of capabilities

• Four other layers lie beneath it

• Each one is appropriate in its own right, but none with the power of Level 5

• We do not need to move sequentially through each level of the hierarchy to reach the
top

• But to be a fully-fledged Level 5, we need the capabilities of all the lower levels, plus
the special characteristics of level 5

• The highest level in a hierarchy of leadership capabilities

• Leaders at the other four levels in the hierarchy can produce high levels of success but
not enough to elevate organizations’ from mediocrity to sustained excellence

• Good-to-great transformations don’t happen without Level 5 leadership

• The key to an organisation becoming great is having a Level 5 leader

• Level 5 leader is an individual who blends extreme personal humility with intense
professional will.

• Hence, the equation HUMILITY + WILL = LEVEL 5

• Level 5 leaders are the ones who takes companies/ organizations from good results to
great results
 • Level 5 leader should possess capabilities of all lower levels along with Level 5
characteristics

• An individual can show Level 5 Leadership and it is not necessary to move from one
level to another

• There are other “drivers”, combined with Level 5 - the combined package which takes
the organisation beyond unremarkable success.

• The drivers are – First Who, Stockdale Paradox, the Flywheel, Flywheel, The
Hedgehog Concept and A Culture of Discipline

Level 5 leadership is a study in duality

• Modest and willful

• Shy and fearless, do not talk about themselves
• They would talk about the organisation, about the contribution of others and
instinctively deflect discussion about their own role

The characteristic of the level 5 hierarchy

 Personal Humility
 Professional Will
 Demonstrates compelling modesty, shunning public adulation; never boastful
 Creates superb results, a clear catalyst in the transition from good to great
 Acts with quiet, calm determination; relies principally on inspired standards, not
inspiring charisma, to motivate
 Demonstrates an unwavering resolve to do whatever must be done to produce the best
long-term results, no matter how difficult
 Channels ambition into the organisation, not the self; sets up successors for even more
greatness in the next generation
 Sets the standard of building an enduring great organisation; will settle for nothing
else
 Looks in the mirror, not out the window, to apportion responsibility for poor results,
never blaming other people, external factors, or bad luck
 Looks out the window, not in the mirror, to apportion credit for the success of the
organisation – other people, external factors, and good luck
  An unwavering resolve
• Besides extreme humility, Level 5 leaders also display tremendous professional will
• They possess inspired standards, cannot stand mediocrity in any form, and utterly
intolerant of anyone who accept the idea that good is good enough

Succession planning

Level 5 leaders have ambition not for themselves but for their organizations’

• They routinely select superb successors

• They want to see their organizations become even more successful in the next
generation
• Comfortable with the idea that most people won’t even know that the roots of that
success trace back to them

Level 4 leaders often fail to set up the organisation for enduring success – what better
way to demonstrate your personal greatness than that the place falls apart after you leave

Born or bred? Can Level 5 be developed?

• There are two categories of people

• Those who don’t have the level 5 seed within them and those who do not

First category

• Will never bring themselves to subjugate their own needs to the greater ambition of
something larger and more lasting than themselves
• Work will always be first and foremost of what they get – fame, fortune, power,
adulation, etc.
• Work will never be about what they build, create and contribute
• The great irony is that the personal ambition that often drives people to become a
Level 4 leader stands at odds with the humility required to rise to level 5

Second category

• Could evolve to level 5

• Capability resides in them, perhaps buried or ignored
 • Under the right circumstances – with self-reflection, a mentor, a significant life
experience, loving parents, or other factors the seed can begin to develop “I believe
you are in this category”
• Discussion to follow at the end of this module; Examples of great leaders and
leadership skills: Martin Luther King – Dream , Martin Luther King – Last Speech

Reflection

• How do you assess your leadership style?

• Include some action points in your concept, project/research proposal and Thesis

Effective Leadership and Strategic Direction

Characteristics of effective leadership

• Know yourself and seek self-improvement

• Helping employees (health workers) understand the health care organizations,
Ministry of Health, Public Sanitation/ company's overall business strategy
• In order to know yourself, you have to understand your "be", "know," and "do"
attributes
• This is possible by continually strengthening your attributes by reading and self-study
• Be technically proficient
• As a leader, you must know your job and have a solid familiarity with your health
workers/employees' jobs
• Seek responsibility and take responsibility for your actions. Search for ways to guide
your organisation to new heights. And when things go wrong, do not blame others
• Make sound and timely decisions. Use good problem solving, decision-making, and
planning tools
• Set the example. Be a good role model for you employees. They will believe what
they see - not what they hear
• Know your people and look out for their wellbeing
• Know human nature and the importance of sincerely caring for your workers
• Keep your people informed. Know how to communicate with your people, seniors,
and other key people within the organisation
• Ensure tasks are understood, supervised, and accomplished. Communication is the
key to this responsibility
 • Develop a sense of accountability, ownership and responsibility in your people
• Train your people as a team
• By developing team spirit, you will be able to employ your organisation, department
• These traits will help them carry out their responsibilities with professionalism

Challenges of leadership in health in Kenya and the African Region

Discuss the key leadership challenges in health in your Health Care Organization, County,
Ministry of Health and Country and the African Region?

Student’s reflection on what extent

• Is care comprehensive, integrated, continuous and effective?

• Is access guaranteed and are people aware of what they are entitled to?
• Are people protected against the economic consequences of ill-health?
• Are authorities effective in ensuring protection against exclusion from care?
• Are they effective in ensuring protection against exploitation by commercial
providers?

Visionary leadership: mission and vision

• What is the vision of your institution?

• What is your mission?
• Critique the mission and vision of your organisation
• What challenges do you experience in actualizing this vision?
• How can a leader obtain buy in into their vision and mission?

What is a vision statement and why have one?

A vision statement

• Reflects desired impact of the health care organization in the out in the future

• Is achievable, even if far

• Provides a clear picture of

• Describes future the future aspirations

• Helps track the mission of the organization

 • Defines the dream, the long term big picture of the organization

• Helps organisational focus on its direction

• Has a possible team heading in building effect

• Is inspirational, motivational, hopeful

What is a mission statement?

• Expresses organisation’s identity and over-riding purpose

• Outlines contribution organisation will make and outcomes it seeks to deliver

• Captures interest of key stakeholders and motivates them in a common direction

What are values?

• Principles or commitments that organisational members stand for

• Qualities and behaviors most highly regarded by organisation as a whole

• Define the ethical guidelines and standards that direct the organisation

• Typically limited to 3-5

• Deeply embedded

• Withstand test of time

Value based leadership

• Integrity

• Commitment

• Humility

• Respect

• Trust

• Courage to take risks

 • Continuous learning

Strategic direction

The strategic direction of a Health Institution is informed by Global Health direction such the
MDGs and the National Health Systems Strategic Plan (NHSSP), Millennium Development
Goals (MDGs), The United Nations Millennium Development Goals are eight goals that all
191 UN member states have agreed to try to achieve by the year 2015. The United Nations
Millennium Declaration, signed in September 2000 commits world leaders to combat
poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against
women. The MDGs are derived from this Declaration, and all have specific targets and
indicators.

Source: http://www.who.int/topics/millennium_development_goal28th May 2011

National Health Strategic Plan

Medium Term Strategic Objectives, System Investments, Programs description, Malaria

Strategy Child Health Strategy, HR Strategy (Roadmap), EPI Strategy, ECD Strategy and
Others

• Includes policy, strategy, budget, and operational plans

• Links priorities with budgets

• All plans inter-linked

• Country led in all processes

• Developed inclusively

Millennium Development Goals (MDGs)

MDG1: Eradicate extreme poverty and hunger

MDG2: Achieve universal primary education

MDG3: Promote gender equality and empower women

MDG4: Reduce child mortality

MDG5: Improve maternal health

MDG6: Combat HIV/AIDS, malaria and other diseases

MDG7: Ensure environmental sustainability

MDG8: Develop a global partnership for development

National health priorities

As leaders in Health care, you need to be aware of your country’s national health priorities
and to align your goals and actions accordingly

Example of Malawi

• It is important to know the mission and vision statements of your Ministry of Health (MOH)

• MOH Mission Statement for Malawi “ to stabilize and improve the health status of
Malawians by improving access, quantity, cost-effectiveness and quality of the EHP and
related services so as to alleviate the suffering caused by illness, and promoting good health,
thereby contributing to poverty reduction.”

• Share the vision and mission statement of your organisation

Using the Challenge Model

Using the Challenge Model to develop a County, National or Regional Health Leadership
concept, proposal and project to strengthen health systems management

STEP 1 Review your organisational, national, regional mission and strategic priorities

STEP 2 Create a shared vision

STEP 3 Agree on one measurable result

What is Change?

Organizational change is defined as any alteration in people, structure, or technology. Change

is ever present in organizations and cannot be eliminated. Instead, we need to look at the
key issues related to managing change.

Forces of Change

There are external and internal forces that create the need for change.
External forces that create the need for change come from various sources.

• The marketplace
• Government laws and regulations
• Technology
• Labor markets
• Economic changes

Internal forces tend to originate primarily from the internal operations of the
organization or from the impact of external changes.

• Changes in strategy
• Changes in the workforce
• New equipment
• Change in employee attitudes

Stimulating Innovation

Innovation is important to organizational success in the marketplace.

Creativity versus Innovation.

There is a difference between creativity and innovation.

Creativity is the ability to combine ideas in a unique way or to make unusual associations
between ideas. Innovation is the process of taking a creative idea and turning it into a useful
product, service, or method of operation.

How can health care leaders foster innovation?

• Organic structures positively influence innovation.

• The easy availability of organizational resources provides a critical building block for
innovation.
• Frequent inter unit communication helps break down barriers to innovation.
• Human resources variables are indicative of the important role that people play in
innovative organizations.
• Innovative organizations actively promote the training and development of their
employees so their knowledge remains current.
• Innovative organizations offer employees high job security.
 • Innovative organizations encourage individuals to become idea champions—
individuals, who actively and enthusiastically support a new idea, build support,
overcome resistance, and ensure that the innovation is implemented.

Change management

• Change is inevitable in today's complex environment. It has been said that change is
the only constant

• A leader would learn change practices that produce results

Definition of Change Management

• Change management is a structured approach to shifting/transitioning individuals or

teams from a current state to a desired future state

• An organisational process aimed at helping employees to accept and embrace change

in their current work environment

All leaders and health care leaders must be prepared for changes by being flexible, positive
and proactive in their approach

Leadership and Motivation

The nature of motivation

Being able to effectively motivate employees is a challenge that health care leaders face in all
types and sizes of organizations. “Everything that we give to our workers gets returned to us
in terms of efficiency, quality, loyalty, and innovation.”

What is motivation?

• Motivation is the willingness to exert high levels of effort to reach organizational

goals, conditioned by the effort’s ability to satisfy some individual need.
• Effort is a measure of intensity or drive.
• High levels of effort are unlikely to lead to favorable job performance unless the
effort is channeled in a direction that benefits the organization.
• A need is an internal state that makes certain outcomes appears attractive.
• An unsatisfied need creates tension that stimulates drives within an individual.
 • These drives generate a search behavior to find particular goals that, if attained, will
satisfy the need and reduce the tension.
• Hence motivation is the force that energizes behavior, gives direction to behavior, and
underlies the tendency to persist.
• A person’s motivation is not directly measurable, but must be inferred from
behavior.
• Performance is a function of ability, motivation and working conditions.
• Besides hiring individual with ability to do the work, health care leaders have the
challenge to provide working conditions that nurture and support individual
motivation to work toward organization goals.

The main elements of motivation have been identified based on numerous studies. A
simplified model of motivation has been developed.

• Inner needs and cognitions lead to behaviors.

• Appropriate behaviors may result in rewards, which reinforce the behaviors, fulfill
needs, and provide cognitive input regarding the future association of behaviors and
rewards.
• Lack of rewards may lead to unfulfilled needs, un-reinforced behaviors, and cognitive
input in the form of expectations about the future.

Intrinsic Motivators: A person’s internal desire to do something for his/her satisfaction,

respect, prestige or loyalty.

Extrinsic Motivators: Factors of motivation that comes from outside (environment) or

organization like pay, bonuses, tangible benefits etc.

From Theory to Practice: Suggestions for Motivating Employees

Several suggestions for motivating employees are given and are based on what is currently
known about motivation.

• Recognize individual differences in terms of needs, attitudes, personality,

and other important individual factors.
• Match people to jobs by identifying what needs are important to individuals and
trying to provide jobs that allow them to fulfill those needs.
 • Use goals because the literature on goal setting suggests that health care leaders
should ensure that employees have hard, specific goals and feedback on
how well they’re doing in pursuit of those goals.
• Ensure that goals are perceived as attainable. Employees who see goals as
unattainable will reduce their levels of effort
• Individualize rewards. Because employees have different needs, what is a
reward and reinforce to one may not work for another.
• Link rewards to performance by making rewards contingent on desired levels of
performance.
• Check the system for equity. Employees should perceive that the rewards or outcomes
are equal to the inputs given.
• Don’t ignore money. The allocation of performance-based increases, piecework
bonuses, and other pay incentives is important in determining employee motivation.

Maslow’s Needs Theory and Its Analysis

Maslow’s Need Theory

According to Abraham Maslow’s hierarchy of needs theory, one of the most widely known
theories of motivation, individual needs form a five-level hierarchy. Maslow’s hierarchy of
needs from the most basic to the highest.

• Physiological needs are basic and include needs for food, water, and
shelter.
• Safety needs pertain to the desire to be safe, secure and free from threats to our
existence.
• Belongingness needs involve the desire to affiliate with and be accepted by others.
• Esteem needs are related to the two-pronged desire to have a positive self-image
and to have our contributions valued and appreciated by others.
• Self-actualization needs pertain to the requirement of developing our
capabilities and reaching our full potential.

Needs at one level do not have to be completely fulfilled before the next
level becomes relevant. As needs on one level are fulfilled, they cease to act as
motivators and tension develops to fulfill needs at the next level. Recent studies have
raised questions as to whether the hierarchical aspect of Maslow’s theory is
applicable to everyone and whether there might be fewer than five levels of needs.

Analysis and Weakness of Theory

• Five levels of need are not always present.

• Order of needs and hierarchy may not be the same for all employees.
• There are certainly cultural differences which the theory did not take care.
• Analyzing the theory in country and cultural context, for example in China, the
hierarchy of needs found was different than Maslow’s theory.

Other Need and Cognitive Theories of Motivation

McGregor’s Theory X and Theory Y; were developed by Douglas McGregor and

describes two distinct views of human nature. Theory X was the assumption that employees
dislike work, are lazy, seek to avoid responsibility, and must be coerced to perform. Theory
Y was the assumption that employees are creative, seek responsibility, and can exercise self-
direction.

Theory X assumed that lower-order needs (Maslow’s) dominated individuals, and Theory Y
assumed that higher-order needs dominated.

Motivation-hygiene theory; is the theory developed by Frederick Herzberg that suggests

that intrinsic factors are related to job satisfaction and motivation, and extrinsic factors are
associated with job dissatisfaction. The basis of Hertzberg’s theory is that he believed that
the opposite of satisfaction was not dissatisfaction. Removing dissatisfying characteristics
from a job would not necessarily make the job satisfying. Frederick Hertzberg’s two-factor
theory states that there are only two categories of needs.

Hygiene factors are factors that eliminate dissatisfaction. They include things such as
supervision, company policy, salary, working conditions, security and so forth—extrinsic
factors associated with job context, or those things surrounding a job. Hygiene factors are
necessary to keep workers away from feeling dissatisfied. There are several hygiene factors.
Pay, working conditions, supervisors, company policies and benefits

Motivators are factors that increase job satisfaction and hence motivation. They include
things such as achievement, recognition, responsibility, advancement and so forth—intrinsic
factors associated with job content, or those things within the job itself.
Motivator factor can only lead workers to feel satisfied and motivated

• Achievement
• Responsibility
• Work itself
• Recognition
• Growth and achievement

Clayton Alderfer’s ERG theory combines Maslow’s five needs into three need levels:
existence, relatedness and growth. Existence needs include the various forms of material and
physiological desires, such as food and water, as well as such work-related forms as pay,
fringe benefits and physical working conditions.

Relatedness needs address our relationships with significant others, such as families,
friendship groups, work groups and professional groups.

Growth needs impel creativity and innovation, along with the desire to have a productive
impact on our surroundings. ERG needs differ in concreteness, (i.e. the degree to which their
presence or absence can be verified).

The satisfaction-progression principle is a principle that states that satisfaction of one level of
need encourages concern with the next level. Besides disagreeing as to the number of
need levels that might exist, the ERG theory differs from Maslow’s hierarchy of needs
theory in three other significant ways: Although the general notion of a hierarchy is retained,
Alderfer’s theory argues that we can be concerned with more than one need category at the
same time.

ERG theory is more flexible in acknowledging that some individuals’ needs may
occur in a somewhat different order than the posited by the ERG framework. ERG theory
incorporates a frustration regression principle which states that if we are continually
frustrated in our attempts to satisfy a higher- level need, we may cease to be concerned about
that need.

McClelland’s acquired-needs theory argues that our needs are acquired or learned on the
basis of our life experience.

• The Thematic Apperception Test (TAT) measures the needs for achievement,
affiliation, and power.
 • The need of achievement (nAch) is the desire to accomplish challenging tasks and
achieve a standard of excellence in one’s work.
• The need for affiliation (nAff) is the desire to maintain warm, friendly relationships
with others.
• The need for power (nPow) is the desire to influence others and control one’s
environment.
• Personal power is the need for power in which individuals want to dominate others for
the sake of demonstrating their ability to wield power.
• Institutional power is the need for power in which individuals focus on what they can
do to solve problems and further organizational goals.
• The need profile of successful health care leaders in competitive environments
appears to include: A moderate-to-high need for institutional power, a moderate need
for achievement to facilitate individual contributions early in one’s career and a
desire for the organization to maintain a competitive edge as one moves to higher
levels, at least a minimum need for affiliation to provide sufficient sensitivity for
influencing others, need for achievement may actually be more important than need
for power in running small or large, decentralized companies. It may be possible to
foster the needs for achievement and for institutional power through training.

Significance for Health care leaders

• Many aspects of need theories are of value to health care leaders. Need theories are
compatible in pointing out the importance of higher-level needs as a source of
motivation.
• Research indicates that it is more likely that individuals differ in the
makeup of their need structures than that the need structures of individuals are
basically the same.
• The frustration-regression aspect of ERG theory may have serious
implications for organizations.

Cognitive Perspectives

Equity Theory; developed by J. Stacey Adams, says that an employee perceives what he or
she got from a job situation (outcomes) in relation to what he or she put into it (inputs) and
then compares the inputs- outcomes ratio with the inputs-outcomes ratios of relevant others
and finally corrects any inequity.

• The referents are the persons, systems, or persons against which individuals compare
themselves to assess equity.
• Equity theory recognizes that individuals are concerned with their absolute rewards as
well as the relationship of those rewards to what others receive.

What will employees do when they perceive an inequity?

• Distort either their own or others’ inputs or outcomes.

• Behave in some way to induce others to change their inputs or outcomes.
• Behave in some way to change their inputs or outcomes.
• Choose a different comparison person.
• Quit their job

Expectancy, Goal Setting and Re-Enforcement Theories

Expectancy Theory; is the theory that an individual tends to act in a certain way based on
the expectation that the act will be followed by a given outcome and on the attractiveness of
that outcome to the individual.

Three relationships are important to this theory

Effort-performance linkage (expectancy) is the probability perceived by the individual that

exerting a given amount of effort will lead to a certain level of performance.

Performance-reward linkage (instrumentality) is the degree to which an individual

believes that performing at a particular level is instrumental in, or will lead to, the attainment
of a desired outcome.

Attractiveness of the reward (valence) is the importance that the individual places on the
potential outcome or reward that can be achieved on the job.

There are four features inherent in the theory

• What perceived outcomes does the job offer the employee?

• How attractive do employees consider these outcomes to be?
• What kind of behavior must the employee exhibit to achieve these outcomes?
 • How does the employee view his or her chance of doing what is asked?

The key to understanding expectancy theory is understanding an individual’s goal and the
linkage between effort and performance, between performance and rewards, and between
rewards and individual goal satisfaction.

Goal-Setting Theory; says that specific goals increase performance, and difficult goals,
when accepted, result in higher performance than easy goals. What do we know about goals
as motivators? Intention to work toward a goal is a major source of job motivation. Specific
and challenging goals are superior motivating forces. Specific hard goals produce a
higher level of output than do generalized goals. Is there a contradiction between
achievement motivation and goal setting? No, and here’s why. Goal-setting theory deals with
people in general; achievement theory is based only on people who have a high need for
achievement. Difficult goals are still recommended for the majority of employees.

The conclusions of goal-setting theory apply to those who accept and are committed to the
goals.

Difficult goals will lead to higher performance only if they are accepted

1. Will employees try harder if they participate in the setting of goals?

2. We can’t say that participation is always desirable.
3. However, participation is probably preferable to assigning goals when the
manager expects resistance.
4. Will people do better when they get feedback on how well they’re progressing toward
their goals?

Feedback acts to guide behavior, self-generated feedback has been shown to be a more
powerful motivator than externally generated feedback, what contingencies exist in goal-
setting theory? There are four contingencies we need to know about; feedback influences the
goal-performance relationship.

Goal commitment is another contingency. Commitment is most likely to occur

when goals are made public, when the individual has an internal locus of control, and when
the goals are self-set rather than assigned.
Self-efficacy is another contingency and refers to an individual’s belief that he or she is
capable of performing a task. The higher your self-efficacy, the more confidence you have in
your ability to succeed in a task.

The last contingency that affects goal setting is national culture.

The conclusion about motivation from goal-setting theory is that intentions, as defined by
hard and specific goals, are a powerful motivating force. In the proper conditions, they can
lead to higher performance. However, there’s no evidence that such goals are associated with
increased job satisfaction.

Reinforcement Theory is counter to goal-setting theory. It proposes that behavior

is a function of its consequences. Reinforcement theory argues that behavior is
externally caused. What controls behavior are reinforcers, which are consequences
immediately following a response that increase the probability that the behavior will be
repeated. Reinforcement theory ignores factors such as goals, expectations, and needs. It
focuses solely on what happens when a person takes some action. How can the concept of
reinforcement be used to explain motivation?

• People will most likely engage in a desired behavior if they are rewarded for doing so.
• These rewards are most effective if they immediately follow a desired response.
• Behavior that isn’t rewarded or is punished is less likely to be repeated.

Health care leaders can influence employees’ behavior by reinforcing the work behaviors
they desire.

Open Book Management; Open-book management is a motivational approach in which an

organization’s financial statements (the “books”) are opened to and shared with all
employees. The goal of open-book management is to get employees to think
like an owner by seeing the impact their decisions and actions have on financial results.
To be effective, employees have to be taught the fundamentals of financial statement analysis
and what the numbers show. The style of management demands for involvement of
employees in all decision making for organization involving the transparency of financial
statements.

Employees may be treated as business partners so productivity and profitability is enhanced.

Pay-for-performance programs are compensation plans that pay employees on the basis
of some performance measure. Performance-based compensation is probably most
compatible with expectancy theory. The increasing popularity of pay-for-performance
programs can be explained in terms of both motivation and cost control. Do pay-for-
performance programs work? Studies seem to indicate that they do.

Integrating Contemporary Theories of Motivation

The basic foundation is the simplified expectancy model. The model also considers the
achievement-need, reinforcement and equity theories. Rewards also play an important role in
the model.

Motivating Knowledge Professionals

Leadership Trait Theories

Motivating the “New Workforce i.e. Knowledge Professionals.” Another current motivation
issue revolves around motivating the “new workforce.” These special groups present unique
motivational challenges to health care leaders. These professionals possess specialty
knowledge of markets, of customers, of supplier, of software, of hardware, of technology and
are very important to run the organizations smoothly in 21st century. Motivating
professionals is one of these special challenges. Professionals are different from
nonprofessionals and have different needs.

Money and promotions are typically low on the motivation priority list for professionals. Job
challenge is usually ranked high as is support and the feeling that they’re working on
something important.

Special challenges in motivating professionals include their long-term commitment to

their field of expertise, with greater loyalty to their profession than to their
employer. Money and promotions are typically low on professionals’ priority list.
Contingent workers lack the security that permanent employees have and do not identify with
or display much commitment to the organization. Temporary workers also typically lack
benefits such as health care and pensions. Low-skilled minimum-wage workers typically
have limited education and skills; offering higher pay is usually not an option.

Leadership
The recognition of the important role that leadership plays in a health care organizational
performance is widely acknowledged by health care leaders everywhere. Leadership is what
makes things happen in organizations.

Managers versus Leaders

There are distinctions between Managers and leaders. Health care managers are appointed
and have legitimate power within the organization. Leaders are those persons who are able to
influence others and who possess managerial authority. Leadership, then, is the ability to
influence a group toward the achievement of goals.

How leaders influence others

Leadership, the foundation of the management function of leading, and a critical element of
the health systems management building blocks is the process of influencing others toward
the achievement of health care organizational goals (better health outcomes).

Power is the capacity to affect the behavior of others.

There are different types of power depending upon their sources originally identified by
French and Raven;

• Legitimate power stems from a position’s placement in the managerial hierarchy and
the authority vested in the position.
• Reward power is based on the capacity to control and provide valued rewards to
others.
• Coercive power is based on the ability to obtain compliance through fear of
punishment.
• Expert power is based on the possession of expertise that is valued by others.
• Information power result from access to and control over the distribution of important
information about organizational operations and future plans.
• Referent power results from being admired, personally identified with, or liked by
others.

The different types of power can engender different levels of subordinate motivation

With commitment, employees respond enthusiastically and exert a high level of

effort toward organizational goals.
 • Commitment is the most common outcome of referent power and expert power.
• Commitment is least likely to result from the use of coercive power.
• With compliance, employees exert at least minimal efforts to complete directives, but
are likely to deliver average, rather than stellar, performance.
• Compliance is the most likely outcome of the use of legitimate power,
information power, and reward power.
• Compliance is a possible outcome of coercive power if used in a helpful way or of
referent power of expert power when some element of apathy is present.
• With resistance, employees may appear to comply, but actually do the
absolute minimum, possibly even attempting to sabotage the attainment of
organizational goals.
• Resistance is a likely outcome of coercive power.
• Resistance is a possible outcome of other types of power if used inappropriately.
• The effective manager is one who does not have to rely on a single power base but
rather, has high levels of power in several (all if possible) of these six power types.

Searching for Leadership Traits

Researchers began to study leadership in the early part of the 20th century. These early
theories focused on the leader (trait theories) and how the leader interacted with his/her group
members (behavior theories).

Trait Theories

Research in the 1920s and 1930s focused basically on leader traits with the intent to isolate
one or more traits that leaders possessed, but that non leaders did not.

Identifying a set of traits that would always differentiate leaders from non leaders proved
impossible.

Traits are distinctive internal qualities or characteristics of an individual such as physical

characteristics (e.g., height, weight, appearance, energy), personality characteristics
(e.g., dominance, extroversion, originality), skills and abilities (e.g., intelligence, knowledge,
technical competence), and social factors (e.g., interpersonal skills sociability, and
socioeconomic position).
A number of the early research attempts were reanalyzed in the 1950s and concluded that
there is no set of traits which consistently distinguish leaders from non leaders.

Recent efforts suggest that the trait approach may have been abandoned prematurely. More
sophisticated statistical techniques are now available. Several rather predictable traits have
now been suggested such as intelligence, dominance, aggressiveness and decisiveness

The question of whether traits can be associated with leadership remains open.
Recent research work has looked at communication skills, human relations skills, resistance
to stress, tolerance of uncertainty, and others.

Behavioral and Situational Models of Leadership

Identifying Leader Behaviors

A number of researchers have focused on the question of whether specific

behaviors, rather than traits, make some leaders more effective than others. If behavior
studies turned up critical behavioral determinants of leadership, people could be trained to be
leaders.

Four main leader behavior studies are carried out

University of Iowa Studies—Kurt Lewin and associates—studied three leadership styles:

autocratic, democratic, and laissez-faire.

The Ohio State Studies identified two important dimensions of leader behavior—initiating
structure and consideration.

University of Michigan Studies identified two dimensions of leader behavior—employee

oriented and production oriented.

The Managerial Grid is a two-dimensional grid for appraising leadership styles using
“concern for people” and “concern for production” as dimensions. Predicting leadership
success involved more than isolating a few leader traits or behavior. This
“failure” to attain consistent results led to a focus on situational influences.

University of Iowa researcher, Kurt Lewin, conducted some of the earliest

attempts to identify effective leadership behaviors.
Three types of leadership behavior styles were identified.

Autocratic leaders tend to make unilateral decisions, dictate work methods, limit worker
knowledge about goals to just the next step to be performed, and sometimes give feedback
that is punitive.

Democratic leaders tend to involve the group in decision making, let the group determine
work methods, make overall goals known, and use feedback as an opportunity for helpful
coaching.

Laissez-faire leaders generally give the group complete freedom, provide necessary
materials, participate only to answer questions, and avoid giving feedback.

Research on the comparative effectiveness of the three leadership styles was inconclusive.
The laissez-fair style was ineffective. The effectiveness of the autocratic and democratic
leaders varied, although satisfaction levels tended to be higher in the democratically led
groups.

Michigan Studies

The Michigan studies compared leadership within groups already identified as effective or as
ineffective. A continuum was developed from employee-centered to job-centered approaches.
With the employee-centered approach, health care leaders channel their main attention to the
human aspects of subordinates’ problems and to the development of an effective work
group dedicated to high performance goals. With the job-centered approach (or production-
centered approach), leaders divide the work into routine tasks, determine work methods,
and closely supervise workers to ensure that the methods are followed and productivity
standards are met.

The outcomes of the study were mixed, but they sometimes showed that the high-producing
work units tended to have job-centered supervisors.

Ohio State Studies

Researchers at the Ohio State University developed a questionnaire to measure leaders’

behaviors and to correlate them with group performance and satisfaction. Two behaviors
were identified as particularly important.

• Initiating structure is the degree to which a leader defines his or her own role and the
roles of subordinates in terms of achieving unit goals.
 • Consideration is the degree to which a leader builds mutual trust with subordinates,
respects their ideas, and shows concern for their feelings.

In contrast to the Iowa and Michigan studies, the two behaviors were considered to be
independent variables and are best illustrated with separate continuums rather than the single
continuum developed in the Iowa and Michigan studies. The leader who is high in both
initiating structure and consideration was thought to be the most effective, but further
research indicated that such a generalization was too simplistic.

The Mouton-Blake Managerial Grid uses concern for people and concern for production as
its two axes. Used a training device; the grid enables health care leaders to understand their
own styles. The manager high in concern for people and concern for production
is the theoretical ideal.

Research into male-female stereotypes of management styles do not hold. Most

studies indicate that male and female leaders are similar in the amounts of interpersonal and
task behaviors exhibited.

Situational Theories

Lack of success in identifying an effective leadership style generalize-able to all situations

led to consideration of situational factors—i.e., any particular style of leadership could be
effective depending on the situation. Situational theories are theories that emphasize
situations. Contingency theories are theories of leadership because they hold that appropriate
leader traits or behaviors are contingent, or dependent, on relevant situational
characteristics.

Fielder’s contingency model is a situational approach originally developed by Fred Fielder

and his associates. A leader’s LPC orientation is a personality trait measured by the least
preferred coworker (LPC) scale. The LPC scale is a 1 to 8 rating by the leader of “the person
with whom the leader can work least well.” The interpretation of the scale has been
controversial, but there is an orthodox interpretation at present.

Low-LPC leaders describe a least-preferred coworker in relatively negative terms and are
likely to be task-motivated. High-LPC leaders describe a least-preferred coworker in
relatively positive terms and are likely to be people-motivated.
Fielder maintains that management style or LPC orientation is difficult to change, so it is
important to carefully match the leader’s personality to situational factors that favor the
leader’s prospects for success. The situation should be assessed to determine the
degree of situational control for the leader. The most important situational variable
is leader-member relations, i.e., the extent to which the leader has the support of
group members.

Task structure is the extent to which a task is clearly specified with regard to
goals, methods, and standards of performance. Position power is the amount of power
that the organization gives the leader to accomplish necessary tasks. Leadership style
should be matched with situation.

Low-LPC leaders do best in situations of either high favorability or extremely low

favorability. High-LPC leaders do best in situations of moderate favorability.

Recent analyses are tending to support Fielder’s original research do suggest that there are
additional factors at work that are not accounted for in the contingency model.

The normative leadership model is a model that helps leaders assess important situational
factors that affect the extent to which they should involve subordinates in particular
decisions.

Five types of management method for solving group problems are delineated

Autocratic I (AI): You solve the problem or make the decision yourself using present
information. Autocratic II (AII): You obtain necessary information from subordinates,
without involving them in the decision, and make the decision yourself.

Consultative I (CI): You share the problem with the relevant subordinates individually, then
you make a decision which may or may not be influenced by subordinates.

Consultative II (CII): You obtain ideas and suggestions from subordinates in a group session,
but make the decision yourself.

Group II (GII): You share the problem with your subordinates as a group and coordinate their
efforts to devise a solution.

A decision about which method to use is guided by the answer to eight questions

• How important is the technical quality of this decision?

 • How important is subordinate commitment to this decision?
• Do you have sufficient information to make a high-quality decision?
• Is the problem well structured?
• If you were to make the decision by yourself, is it reasonably certain that your
subordinates would be committed to the decision?
• Do subordinates share the organizational goals to be attained in solving this problem?
• Is conflict among subordinates over preferred solution likely?
• Do subordinates have sufficient information to make a high-quality decision?

The revised normative leadership model can be used in either of two variations: when
developing subordinates is more important than conserving time in decision making or when
minimizing time is more important.

The situational leadership theory; developed by Paul Hersey and Ken Blanchard, is on the
premise that leaders need to alter their behaviors depending on the readiness of
followers.

Two leader behaviors are considered to be independent dimensions

• Task behavior is the extent to which the leader engages in spelling out the duties and
responsibilities of an individual or group.
• Relationship behavior is the extent to which the leader engages in two-
way or multi-way communication

The four levels of readiness defined along a continuum from low to high readiness
prescribe the appropriate leadership style.

• Telling is used in situations of low readiness, when followers are unable and also
unwilling or too insecure to take responsibility for a given task.
• Selling is used for low to moderate readiness, when followers are unable to take
responsibility, but are willing or feel confident to do so.
• Participating is used with moderate to high readiness, when followers are able to take
responsibility, but are unwilling or too insecure to do so.
• Delegating is used for high readiness, when followers are able and willing or
confident enough to take appropriate responsibility.
Leaders should help increase the task-related readiness of their followers as quickly as
feasible by adjusting their own leadership styles. Studies have found the situational theory of
leadership particularly effective with newly hired employees and employees in new jobs.

Recent analyses are tending to support Fielder’s original research do suggest that there are
additional factors at work that are not accounted for in the contingency model.

The path-goal theory of leadership attempts to explain how leader behavior impacts the
motivation and job satisfaction of subordinates. The theory gets its name from the fact that it
focuses on how leaders influence the way that subordinates perceive work goals and
possible paths to reaching both work goals (performance) and personal goals (intrinsic
and extrinsic rewards). Path-goal theory relies heavily on the expectancy theory of
motivation.

Four major leader behaviors can be used to affect subordinate perceptions

of paths and goals.

Directive leader behavior involves letting subordinates know what is expected of

them, providing guidance about work methods, developing work schedules, identifying
work evaluation standards, and indicating the basis for outcomes or rewards.

Supportive leader behavior entails showing concern for the status, well- being, and needs
of subordinates; doing small things to make the work more pleasant; and being
friendly and approachable.

Participative leader behavior is characterized by consulting with subordinates, encouraging

their suggestions, and carefully considering their ideas when making decisions.

Achievement-oriented leader behavior involves setting challenging goals, expecting

subordinates to perform at their highest level, and conveying a high degree of confidence
in subordinates.

Situational factors must be taken into account when choosing a leader behavior.

• Subordinate characteristics include personality traits, skills, abilities, and needs.

• Context characteristics include the task itself, the work group, and the organization’s
formal authority system.
Diagnosis in terms of expectancy theory leads to a choice of appropriate leader behavior and
involves three steps.

• Think in terms of the elements used in expectancy theory to diagnose various

situational factors in terms of their effects on the three expectancy-theory elements
(the path).
• Effort-performance is the probability that our efforts will lead to the required
performance level.
• Performance-outcome expectancy is the probability that our successful
performance will lead to certain outcomes or rewards.

Valence is the anticipated value of the outcomes or rewards.

• Diagnose situational factors that can be changed to enhance the expectancy

theory elements are targeted.
• Appropriate leader behaviors are initiated to change the situational factors.

Path-goal theory encompasses multiple leader behaviors and a potentially large number of
situational variables. Its flexibility provides a useful framework about likely impacts of leader
behavior on subordinate motivation, goal attainment, and job satisfaction.

Strategic Leadership Models

Cutting-Edge Approaches to Strategic Leadership

The most current approaches to looking at leadership are discussed. The research we’ve
discussed has described transactional leader.

What is the difference between transactional and transformational leaders?

• Transactional leaders are leaders who guide or motivate their followers in the
direction of established goals by clarifying role and task requirements.
• Transformational leaders are leaders who provide individualized
consideration and intellectual stimulation and possess charisma.
• Transformational leadership is built on top of transactional leadership.

The evidence supporting the superiority of transformational leadership over the transactional
variety is overwhelmingly impressive. Transformational leaders motivate subordinates to
perform at expected levels by helping them recognize task, responsibilities, identify goals,
acquire confidence about meeting desired performance levels, and understand how their
needs and the rewards that they desire are linked to goal achievement.

Transformational leaders motivate individuals to perform beyond normal expectations by

inspiring subordinates to focus on broader missions that transcend their own
immediate self- interests, to concentrate on intrinsic higher-level goals (such as safety and d
security), and to have confidence in their abilities to achieve the extraordinary missions
articulated by the leadership. Transformational leadership is not a substitute for transactional
leadership; it is an enhancement.

Charisma is the leader’s ability to inspire pride, faith, and respect; to recognize
what is really important, and to articulate effectively a sense of mission, or vision, that
inspires followers. Charisma was once thought to be an inborn personality trait.

Recent research attempts to identify behaviors which cause people to view a person as
charismatic.

Charismatic-Visionary Leadership

Charismatic leadership theory is an extension of attribution theory and suggests

that followers make attributions of heroic or extraordinary leadership abilities when they
observe certain behaviors.

Five personal characteristics of charismatic leaders have been identified

• Have a vision
• Are able to articulate that vision
• Are willing to take risks to achieve that vision
• Are sensitive to both environmental constraints and follower needs
• Exhibit behaviors that are out of the ordinary

An increasing amount of research shows impressive correlations between

charismatic leadership and high performance and satisfaction among followers. Most
experts think that individuals can be trained to exhibit charismatic behaviors. Charismatic
leadership may not always be needed to achieve high levels of employee performance. It may
be most appropriate when an employee’s job has a lot of ideological content.
Visionary leadership is described as going beyond charisma with the ability to
create and articulate a realistic, credible, attractive vision of the future for an organization
or organizational unit that grows out of and improves on the present.

If the vision is properly selected and implemented, it can be so energizing that it incites
individuals to use their skills, talents, and resources to make it happen.

A vision differs from other forms of organizational direction in that it uses compelling
imagery, taps into people’s emotions and energy, and creates the enthusiasm that
people need to bring energy and commitment to the workplace.

The key properties of a vision are that it has inspirational possibilities that are value centered,
are realizable, have superior imagery, and are well articulated.

What skills do visionary leaders have?

• The ability to explain the vision to others.

• The ability to express the vision not just verbally but through behavior.
• The ability to extend or apply the vision to different leadership contexts.

Another important contemporary issue for leaders is creating a culture of trust and
credibility.

• Credibility is the degree to which followers perceive someone as honest, competent,

and able to inspire.
• Trust is the belief in the integrity, character, and ability of a leader.

Research has identified five dimensions that make up the concept of trust.

• Integrity (honesty and truthfulness)

• Competence (technical and interpersonal knowledge and skills)
• Consistency (reliability, predictability, and good judgment in handling situations)
• Loyalty (willingness to protect a person, physically and emotionally)
• Openness (willingness to share ideas and information freely)

Given the fact that many organizations have moved to self-managed work teams, trust is
extremely important because many of the traditional control mechanisms have been removed.
How should leaders build trust? Here are eight suggestions.
 • Practice openness.
• Be fair.
• Speak your feelings.
• Tell the truth.
• Show consistency.
• Fulfill your promises.
• Maintain confidences.
• Demonstrate competence.

Team Leadership

As the usage of work teams grows, the role of team leader becomes increasingly important.
The challenge for most health care leaders is learning how to become an effective team
leader. Effective team leaders have mastered the difficult balancing act of
knowing when to leave their teams alone and when to get involved.

There are two priorities for a team leader.

• Managing the team’s external boundaries

• Facilitating the team process

These priorities can be broken down into four specific leadership roles.

• Liaisons with external constituencies

• Troubleshooters
• Conflict management
• Coaches

Gender and Leadership

The next contemporary leadership issue we want to discuss is gender and leadership. This
topic is one that still creates controversy! What, if any, differences exist between
male and female leaders and what implications would these differences have?

The evidence generally has found that males and females do use different leadership styles.

• Women tend to adopt a more democratic or participative style and a

less autocratic or directive style than men do.
 • Women are more likely to encourage participation, share power and information, and
attempt to enhance followers’ self-worth.
• Men are more likely to use a directive, command-and-control style.
• Men rely on the formal authority of their position for their influence base.
• Men use transactional leadership, handing out rewards for good work and punishment
for bad.

Is different better? The best managers (leaders) listen, motivate, and provide
support to their people. They inspire and influence rather than control. Generally
speaking, women seem to do these things better than men. However, gender
doesn’t imply destiny. Which leadership style is effective depends on the
situation. Gender simply provides a behavioral tendency in leadership style.