· 7.3 Discussion Understanding the Within-subjects Research Desig.docx

· 7.3 Discussion: Understanding the Within-subjects Research
Design
Describe an actual or suggested study using within-subjects
design and accompanying data showing one or more sources of
variation. Explain the implications of removing one of those
sources and why you would do so. Provide at least one peer-
reviewed source, other than the textbooks for this course, to
support your position. Post your observation using APA format
where applicable.
· Must demonstrate understanding of the task be able to address
the requirement using creativity and application of research
design knowledge.
· Must demonstrate understanding of within-subjects research
design, strengths and liabilities, and influences when sources of
variation are manipulated.
1
Course Learning Outcomes for Unit II
Upon completion of this unit, students should be able to:
2. Discuss effective leadership strategies used by healthcare
managers in the health services
setting to include adaptation and transformation, communication
strategies, and conflict
resolution.

Reading Assignment
Chapter 3:
Leading Health Care Change, pp. 35-44
Unit Lesson
As you think about effective leadership strategies used by
healthcare managers, what strategies come to your
mind? This unit lesson will provide practical strategies and real
world examples on four such strategies:
adaptation, transformation, communication, and conflict
resolution.
Adaptation
It is common that leaders with longevity in a company, who
have weathered changes, to be adaptable. There
is a great saying, “You bend, or you break.” We can go with the
flow and adapt, or we can be rigid and crack.
We can adapt to the ever-changing winds of health care, or we
can kick the bricks.
The ability to adapt is really marked by the maturity to accept
what we cannot change. Such maturity creates
solace (while being vehemently inflexible tends to create
discontent and disharmony). There are times when
you need to stand up for what is right, and when that happens it
is important to choose your approach wisely.
Sometimes saying nothing at all is the best course. Benjamin
Franklin, a master of diplomacy (and one who
arguably helped us win the Revolutionary War by
diplomatically gaining the involvement of the French) said,
“Best is the tongue that feels the rein; he that talks much, must
talk in vain” (Morgan, 2007, p. 25).

Being adaptable is the wisdom to hold our tongues and thoughts
on that which we cannot control, but it is also
the ability to be sagacious (to have a keen mental discernment)
in reading a person or situation, then
changing our approach as needed. Some situations may call for
your soft response and some may require a
more firm response.
This concept of tailoring and being flexible with your
leadership style is captured well in the book Situational
Leadership and the One-Minute Manager by Blanchard,
Zigarmi, and Zigarmi (1985). Blanchard is credited
with coining the term "situational leadership." You will hear
this term quite a bit in management. Blanchard
points out that a manager's style should be tailored to the
individual employee and situation, as some
circumstances call for the manager to either direct, coach,
support, or delegate.
There really is not one management style. Effective healthcare
leaders are flexible, have a keen mental
discernment, and adapt their approach to the needs of the person
or situation.
Transformation
Great material on transformational leadership is found the book
quoted by many in management, Good to
Great by Jim Collins (2001). Collins and his team studied
hundreds of companies over time that went from
good to great, and they found themes and similarities. Collins
(2001) noted that the process of
transformational change does not typically feel like drastic
change when it is happening, it is more a journey

UNIT II STUDY GUIDE
Leadership Strategies
2
UNIT x STUDY GUIDE
Title
and a process, nothing monumental, just a methodical a focus
which in times leads a company from good to
great outcomes.
The ability to transform a department or organization will be at
the forefront of your responsibilities as a
healthcare leader. Your responsibilities may include increasing
census (beds filled), increasing financial
performance, increasing employee satisfaction and engagement,
decreasing staff turnover, and increasing
regulatory compliance.
Consider the brief list below of skills for transformational
leadership:
1. Listen to your team. Understand their needs and what has
worked so far, and what has not.
2. Build relationships with your team (especially the informal
leaders and opinion leaders).
3. Ask people what resources they need and what ideas they
have.
4. Make yourself approachable, and be the example, rounding
and working alongside and leading from
the front.

5. Involve others in decision making, inviting the people to
participate who will be affected by the
decision.
As an example of involving others in decisions, in his book
Working with Emotional Intelligence, Daniel
Golemen (2000) notes that the late Nobel Prize-winning
physicist Richard Feynman recalled how people
worked on the Manhattan Project (the development of the
nuclear bomb) during WWII before and after they
knew what their effort was for. Originally, strict security meant
the whole team was kept in the dark, so they
often worked slowly and not very well. Then Feynman
convinced Robert Oppenheimer to tell the team what
they were actually working on. From that point on, Feynman
recalled that there was a complete
transformation, “They began to invent ways of doing it better.”
Feynman calculated that their team’s work
went ten times faster after they understood the goal (Goleman,
2000, pp. 227-228).
Communication
Of the skills for a successful healthcare leader, communication
is definitely at the top. Consider the
suggestions below for being an effective communicator:
1. Stick to the facts: Do not get emotionally charged up, be
cognizant of your adrenaline levels or
outward expressions (facial, tone of voice) of frustration. Be
calm. It is usually the person who
maintains composure who is respected the most.
2. Listen More, Talk Less: Always acknowledge the other
person’s points and show a genuine interest in

what the person has to say. Let others talk. It is the self-aware
person who can let the conversation
flow in a way that people feel listened to.
3. Use "yes, and" bridge statements versus "no, but" barrier
statements: Build the bridge to the person,
do not set up barriers with the "but” word. An example is, "That
is a great point you make about __; I
think we also need to consider___”
4. Ask questions: People like to have their opinions asked.
There is a saying about questions,
“Whomever is asking the questions is leading the conversation.”
Asking someone a question is a sign
you respect their opinions (versus giving them your opinion.
5. Use Anchoring Words: Use words such as "imagine” or
phrases such as “what would it look like if.”
You engage someone’s higher level thinking with such
embedded words. Passive listeners often
become active listeners when such neuro-linguistic suggestions
are used.
6. Keep ideas separate: Listen to effective communicators and
you will notice they use hard pauses and
keep separate ideas separate. A less talented communicator will
stream a diatribe in one giant
sentence of this, then that, then this. Be concise and keep ideas
separate and people will have a
much easier time listening to what you have to say.
7. Believe that what you are saying is important: That sense will
come through in how you talk, and
others will listen. The mind picks up on many things, and
thoughts are very powerful.

8. Stress key words: Stress key words of what you are saying,
and possibly put a hand motion to it for
emphasis. Watch film from President Obama’s 2008 election,
when he or Mrs. Obama used the word
change, it was usually with inflection and pause on the word
with the right hand making a slight “c”
shape. These are known as “anchor” techniques in neuro-
linguistics. Use these sparingly, as over-
use has an unintended effect.
9. Vary your tone and use pauses: Monotone is hard to listen to,
but when there is tonal variation and
pause, people listen (and it is easier on the ears). Watch former
UK Prime Minister Tony Blair in the
3
UNIT x STUDY GUIDE
Title
House of Commons and House of Lords, he is a master of
pausing and contrasting tone, going from
a fiery intense few sentences to a quiet few sentences of almost
whisper. Contrasting can also be
used to contrast someone sounding unreasonable with
heightened emotion.
10. Eye contact: Do so somewhat slowly in a large room (not
too quickly), engaging people’s eye contact
as you go. Have a smile in your eye when you look at people
and engage their attention will pick up
on this and it is an anchoring technique to let them know you

care about them, it is as if you are
speaking right to them. Be careful not to let your eyes go
upward too much or to talk above the
person or crowd (it is a natural tendency to gaze up and left
when you are pondering, but you lose
your audience when you do). Stay focused and engage others
with pleasant and positively wincing
(what our eyes do when we say hello) contact. The eyes are
powerful communicators!
11. Look into space when saying something negative: The one
time it is okay to look above or outward of
the person or crowd is if you are saying something negative (if
you look at that person, he or she may
associate what you said to them (“Why were you looking at me
when you said that?”). However, if
you want to convey your displeasure with that comment, look
directly at the person. Remember, in
the animal kingdom, such piercing eye contact means “fight.”
Diplomatic relations rarely call for this
type of eye contact or action
12. Walk around: Make deliberate eye contact with people as
you do. As you walk, you are finding the
person who is paying attention, and you engage that person with
your eye contact, holding there until
others look, then engaging them. After you have stayed in that
spot a while, move back to center,
then back to the other side. Positioning your body in the room
will engage people to you (versus
presenting from a central spot).
13. Use metaphors and images: They are easier for the mind to
associate with and they create an anchor
so that when someone thinks of that image, they think of what
you said, and vice versa. Metaphors

and images create anchors of association.
14. Use stories: If you can use a small story to illustrate, or
ideally engage a story from your audience,
you create not just an association, but something more,
something personal. Great stories are
remembered much more than great words. Cater your
metaphors, images and stories to your
audience (to what you know they will readily associate with).
15. Be pleasant and avoid unreasonable emotion: Even if you
are using great communication techniques,
you must yourself be pleasant and reasonable for people to want
to listen to you. Be objective and
reasoning, personable and kind.
16. Be agreeable: (Not argumentative). People get too charged
up these days in the way they think,
moving themselves too quickly into positions and putting other
people on the other side of the fence.
Our modern media and our politicians tend to divide us more
than unite us. Old school debate and
dialogue were always maintained with a profound respect for
the person, and though we may
disagree with their points of view, we respect their reasons and
most of all, we respect their right to
their opinion and we celebrate our diversity. Shake hands after a
disagreement. Acknowledge the
other person’s point of view. Stay calm and collected. Show
respect for others (even if they are being
belligerent). There will always be different points of view, and
it is how we respect others’
communication that reflects our character and ability to reason.
17. Use the same words: If someone uses a word as a descriptor,
use the same word back; this is known

as “matching” or “mirroring.”
18. Do not repeat yourself: It is a sign you do not respect their
intelligence.
19. Be concise: Show value for people’s time by being as
concise as possible, this includes writing. Less
is more, and in fact, you engage someone’s neurology more
when you leave out the obvious (their
mind will fill that in and thereby increase the anchor to your
message).
20. Be authentic and be yourself: People can sniff out fake,
canned, or forced posing. The more you are
yourself, the easier communication flows. Do not delay to find
the perfect word, just speak! Take the
ideas above and customize them to you. If you are humoristic,
use humor and go with it. If you are
the sincere type, use sincerity and go with it. You are believable
when you are yourself.
21. If someone is not listening, consider these techniques: A)
Ask the person a question; B) Use “the
pause” ….you will see his/her head lift up; C) Vary your tone;
D) Stand by the person not paying
attention.
22. Remember names: Nothing says I care about what you have
to say more than greeting and
addressing the person by name. There are many techniques for
this, including associating the person
or his or her name with something you will remember. Another
technique is to use his or her name
right away.
23. Include others: If you notice someone hanging back or not

included in a conversation, ask their
opinion. This creates a connective and inclusive bridge and
shows respect for that person.
4
UNIT x STUDY GUIDE
Title
24. Think positively: Think positively about the person or what
he or she is saying as you are listening,
and that will be picked up by the person’s mind. We send many
signals outside of verbal. This goes
for writing, too. If you come from a positive position, your
positive words and actions will flow in that
direction.
25. Use positive plantings: For example, if you must do a
corrective action for an employee, use positive
writing such as will, and express confidence in the person.
People tend to perform to the level they
think others think they can, so the power of a parent, coach, or
manager is a tremendous
responsibility
26. Begin with the end in mind: This was a concept taught by
the great teacher Steven Covey (1989),
author of “7 Habits of Highly Effective People.” It is said that
90% of conversations end the way they
started. If you are not ready to have a positive or constructive
conversation, wait. Words matter and
feelings take time to heal, it is best to say nothing at all and just

ask for some time to sort things
through. When you do approach the person, make sure you have
the best interest of your long-term
relationship at heart. If you come from a pure position, your
words and actions will flow in that
direction.
Communication is both a science (we can learn more about,
there are so many books and techniques
including neuro-linguistics, public speaking, etc.), and an art
(having a natural feel for a situation and knowing
how to act).
Conflict Resolution
Conflict avoiders generally do not make for excellent managers,
yet on the other hand, managers who brashly
approach any little thing too strongly (intimidation, etc.) also
do not make for excellent managers. There is a
good middle ground in managing conflict with following up
with what is needed and doing so with tact.
It is important to follow up on big issues in a timely manner. To
use a medical analogy, when a skin boil
manifests, if it is not attended to, infection can grow, which will
continue to fester and cause underlying issues
such as breakdown of tissue and bone, and often the untreated
boil will burst. The intervention for conflict is
similar to treating a boil, give it timely and caring attention.
You will also manage patients upset about their care. Below are
some tips for effectively managing upset
patients.
1. Put yourself in their shoes: Bear in mind that they are in pain
and likely feeling vulnerable. Do not take

things personally, just focus on the patient’s concerns and get to
the heart of the matter.
2. Timely follow-up: Conflict is best dealt with at the time it
happens, be sure to follow-up that shift or
same day if possible.
3. Self-control: Keep your emotions in check, the calmer you
can be, the quicker and more effectively
you will come to a solution.
4. Do not admit guilt: This is a technique taught to medical
students, it is the art of saying “I am sorry
you had that experience” or “I am sorry you feel that way,” but
not admitting wrongdoing or guilt.
5. Frontline staff: Understand that upset patients tend to be
harder on your frontline staff than on you as
the manager, perhaps because they feel you can do something
for them.
6. Frontline solutions: Find ways in your organization to have
issues solved at the front-most line
possible, so patient concerns are taken care of as soon as
possible. For example, The Ritz-Carlton
allows their staff to make decisions up to $2000, so problems
can be solved expeditiously for the
customer (Reiss, 2009).
7. Listen: Let the patient fully relate his or her concern. Usually
80% of solving someone’s problem is for
them to feel heard. As Steven Covey (1989), author of “7 Habits
of Highly Effective People” put it,
when customers are upset, they are seeking to be understood,
not to usually to understand.

8. Humility: Be humble and ask questions like, “Can you please
help me better understand.”
9. Keep an open mind: Be open to what happened, even if you
think you know. For example, a patient
did not feel listened to when she conveyed her concern to the
agent, then asked to speak to the
supervisor who abruptly said, "My agent has already told me
about this situation, what can I do for
you?" The patient felt like the supervisor was already
predisposed and had a “Let’s get this over with”
approach. Be sincere in listening and keep an open mind to the
patient’s concerns.
10. Do not bring logic to an emotional conversation: Patients or
families can sometimes be upset and not
in a good state of mind, so reasoning or bringing logic to them
in that state is not always a good idea.
Often it is best to listen, express concern (“I am so sorry you
had that experience”); let him or her
5
UNIT x STUDY GUIDE
Title
know their concern is important to you and you want him or her
to have the best experience possible,
and ask if you can follow-up on the details and then do it. When
you speak with the person next, he or
she will likely be in a better state to listen.
Here is a summary of how it can look when resolving a patient’s
concern:

DO SAY
Apologize generally
(do not admit guilt)
Mr.__, I am very sorry you had that experience.
Show Empathy I can understand why you are upset.
State the Goal I want you to know your concern is very
important
to me, and I want you to have the best patient
experience possible.
Restate the Concern If I understand your concern correctly
___(restate
the concerns, being careful not to overly-simplify
what was said).
Offer a
Solution
&
Ask Permission
Mr.___, would it be acceptable with you if I ____
(offer the solution).
Many times, you will not immediately have a
solution, and it is best to just to say, “I would like

to look into the details more closely, would it be
okay with you if I give you a call tomorrow
afternoon with my follow-up?”
Stay Positive What I can do is___... (Do not say: No, we
cannot do ___) Ask the person if his or her
concern has been addressed to his or her
satisfaction and if there is anything further you can
do .
Summary
Being adaptable, being a great transformational leader, having
advanced communication skills, and having
great conflict resolution skills will serve you well as a
healthcare leader.
References
Blanchard, K., Zigarmi, P., & Zigarmi, D. (1985). Leadership
and the one minute manager: Increasing
effectiveness through situational leadership. New York, NY:
HarperCollins.
Collins, J. (2001). Good to great. New York, NY:

HarperCollins.
Covey, S. R. (1989). The 7 habits of highly effective people,
powerful lessons in personal change. New York,
NY: Simon & Schuster.
Goleman, D. (2000). Working with emotional intelligence. New
York, NY: Bantam Books.
Morgan, E. S. (Ed.). (2007). Not your usual founding father:
Selected readings from Benjamin Franklin. New
Haven, CT: Yale University Press.
Reiss, R. (2009). How Ritz-Carlton stays at the top. Forbes.
Retrieved from
http://www.forbes.com/2009/10/30/simon-cooper-ritz-
leadership-ceonetwork-hotels.html

· 7.3 Discussion Understanding the Within-subjects Research Desig.docx

More Related Content

Similar to · 7.3 Discussion Understanding the Within-subjects Research Desig.docx

More from gerardkortney

Recently uploaded

· 7.3 Discussion Understanding the Within-subjects Research Desig.docx