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Directing and Leading

Dr. Thin Myat HanLecturer

Health Policy & Management Department

References:

• BM Sakharkar 2009, Principles of Hospital Administration (2nd Edit) Chapter 10. Directing and leading.

• International council of Nurses (2008), “Incentive systems for health care Professionals.”

• B S Buchbinder, NH Shanks, 2012, 2nd Edit, “Introduction to Health Care Management. “

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Discussion outline

1. Directing 2. Motivation3. Leadership4. Induction and Training5. Communication

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Directing

• Synchronizes activities and maintains momentum towards desired objectives

• Factors determine successful directing:1. Delegation2. Communication3. In-service training4. Motivation

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Work Motivation• An individual’s degree of willingness to exert and

maintain an effort towards attaining organizational goals (Kanfer 2002)

• Motivators – factors which induce an individual to perform well – e.g.

• higher pay, a prestigious title, recognition by superiors

• it can be through incentives • Financial and Non financial incentives

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Financial Incentives Salary/Wage Pension Bonuses Insurance (e.g. health) Allowances (e.g. housing, clothing, child care,

transportation) Fellowships Loans Tuition reimbursement

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Non-financial Incentives Safe and clean workplaces Vacation days Professional autonomy Sustainable employment Support for career development Flexibility in working time and job sharing Recognition of work Supervision Coaching and mentoring structures Access to/support for training and education

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Non-financial Incentives (cont.)

• Sabbatical and study leave • Planned career breaks • Occupational health and counseling services • Recreational facilities • Equal opportunity policy • Enforced protection of pregnant women against

discrimination • Parental leave

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Is everybody motivated?

• In most cases, motivation comes from some needs that leads to behavior that results in some type of rewards

• While reward may serve as incentives and those who bestow rewards may seek to use them as motivators, the real motivation to act comes from within the individual

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• Two forms rewards – intrinsic / extrinsic• Intrinsic reward- derived from within the individual –

e.g., taking pride and feeling good about a job well done

• extrinsic reward-reinforcements that are given by another person – e.g., giving bonuses to workers for a good job they have done

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Intrinsic rewards• Less tangible, are highly subjective, they represent how

the individual perceives and feels about work and its value

1. Healthy relationship – in which employees are able to develop a sense of connection with others in the workplace

2. Meaningful work – where employees feel that they make a difference in people’s lives – so manager needs to make their jobs more interesting

3. Competence – where employees are encouraged to develop skills that enable them to perform at or above standards

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Intrinsic rewards4. Choice – where employees are encouraged to

participate in the organization in various ways such as by expressing their views and opinions, sharing in decision making, participate in problem solving, goal setting

5. Progress – where managers find ways to hold employees accountable, facilitate their ability to complete assigned tasks, celebrate when progress is made

• if coupled with extrinsic rewards lead to high personal satisfaction

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Maslow’s Hierarchy of Needs

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Maslow’s Hierarchy of Needs Theory• Maslow (1954) postulated a “hierarchy of needs”

that progress from lowest, to highest level, once each level has been met, individual will be motivated by and strive to progress to satisfy the next higher level need

1. Physiological needs- e.g., food, water and other subsistence related needs;

2. Security and safety needs-shelter, safe work environment, permanency in employment, access to health care;

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Maslow’s Hierarchy of Needs Theory3. Affiliation and acceptance needs - desire for social

contact and interaction, friendship, affection; belonging to a group

4. Esteem needs – status, recognition, positive regard;

5. Self-actualization needs – desire for achievement, personal growth and development, autonomy

• “Satisfaction progression” while useful from theoretical perspective, most individuals do not view their need in this way, making this approach to motivation a bit unrealistic

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Reinforcement Theory (1953)

• Individuals are motivated when their behaviors are reinforced

1. Positive reinforcement – relates to taking action that rewards positive behavior

2. Avoidance learning (negative reinforcement) – actions are taken to reward behaviors that avoid undesirable behaviors

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Reinforcement Theory (1953)

3. Punishment – actions designed to reduce undesirable behavior by creating negative consequences for the individual

4. Extinction – removal of positive rewards for undesirable behaviors

• Criticism for this approach - Fails to account for employees’ ability to think critically and reason, may be applicable in animals

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Approaches to motivation

• Through function of leading, managers help people to realise that they can satisfy their own needs and utilise their full potential at the same time, to achieve the aims of the organization

• People have : different needs, ambitions, attitudes, desire for respect, responsibility, level of knowledge and skills, and potential

• so need to understand the complexity and individuality of people

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Assumptions1. Motivation by formal control

1. Concept of “Rational economic man” – people are motivated only by financial incentives

• it motivates only to a point, when money incentive isn’t high enough or is considered to be in equitable, it’s a de-motivator,

• Atchison (2003) calls “as soon as it predictable, it is an entitlement, not a motivator”

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Assumptions1. Motivation by formal control

2. According to Theory X, they postulated that “People are not keen to accept responsibility, cannot be trusted, needs to be controlled through fear of termination of his job and other kinds of punishments”

• Fail to motivate employees on a long-term basis

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2. Through informal organization and group dynamics

• Interpersonal dynamics of the group to a great extent influence motivation and performance of employee

• To encourage formation of cohesive informal groups and group leaders, maintaining good interpersonal relationship, and a good human relations

• Uncertain, short term approach

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3. Through encouraging full utilization of workers potential

• Satisfaction and happiness at work come from maximum utilisation of one’s potentialities and abilities

• If there is challenging opportunities at work for employees for demonstrating his performance – this will motivate him for maximum performance

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Balance view of motivation

• People are complex and variable, and have many motives which combine into a complex motivation pattern

• A part from economic rewards, they also want to develop their capabilities, their competences, their potential as well

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Motivating professionals

• More committed to their profession rather than to the organization, like to have freedom to provide self-direction, technical competence

• Want opportunities where they can show achievement, can grow in their profession and get feeling of accomplishment

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Leadership

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Leadership• Key to effective managing• Induces people to strive not only willing but also with

enthusiasm• Leaders need to understand what motivates

employee• Not all leaders are executives or administrators • but administrators must have leadership qualities

because they have to deal with people for creating better attitudes, arousing enthusiasm, improving morale, and develop spirit of cooperation

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Leadership styles

• Theory X and Y styles of leadership by McGregor

• Four basic leadership stylesDirectingCoachingSupportingDelegating

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Theory X type of leadership(Autocratic and authoritative)

• Based on the traditional negative assumption (of manager) viz.– Average human beings have an inherent dislike of

work and will avoid it– Most people must be coerced, controlled and

directed– wish to avoid responsibility, and want security

above all• Can be effective where task is simple in nature the

employees are unskilled

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Theory Y type of leadership(participated and consultative)

• Based on an assumptions that people– want to exercise self-direction and self-control in

achieving goals to which they are committed– under proper conditions want to accepts

responsibility– The intellectual and inner potentialities of the

average human being are only partially utilized

• More effective in managing the human resources

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Four basic leadership styles

1. Directing

2. Coaching

3. Supporting

4. Delegation

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Directing style

Managers are: • highly authoritative, • have little trust in subordinate, • motivate people through fear and punishment with

occasional rewards, • engage only in downward communication, and • limit decision making to the top

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Coaching style• Managers :• Have confidence and trust in subordinates• Motivate with reward, some fear and punishment• Permit some upward communication, solicit some

ideas and opinions from subordinates• Allow some delegations of decision making but with

close control

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Supporting style• Managers:• Have substantial confidence and trust in subordinates, • Try to make constructive use of subordinates’ ideas

and opinions• Use motivation rewards and some participation• Engage in communication both down and up• Make broad policy decisions at the top with specific

decision at lower levels and act consultatively in other ways

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Delegation style• Managers:• Have complete trust and confidence in subordinates

in all matters• Invite ideas and opinions from subordinates and

constructively use them• Engage in communication down and up and with

peers,• Encourage decision making throughout the

organization and operate as a group

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Emotional Intelligence (EI)• A concept made famous by Daniel Golemen in late

1990s• Suggests that there are certain skills (intra and

interpersonal) that a person needs to be well adjusted in today’s world, include

1. Self-awareness – a deep understanding of one’s emotions and drives

2. Self-regulation – adaptability to changes and control over impulses

3. Motivation – ability to enjoy challenges and being passionate toward work

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Emotional Intelligence (EI)4. Empathy – Social awareness skill, putting yourself

in another’s shoes

5. Social skills – supportive communication skills, abilities to influence and inspire

• Leaders have needed to be more understanding of their subordinates’ world outside of the work environment

• Suggests a more caring, confident, enthusiastic boss who can establish good relations with workers

• EI can distinguish outstanding leaders and strong organizational performance

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Induction and Training

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Induction and Training

• Induction - A new worker needs at least to be introduced to his colleagues and shown around the layout of his department

• to understand how his job fits into the pattern of the whole organization – to have sense of belonging to an organization and interest in his job

• Training – to adopt their knowledge and skills to the special requirements of the new job (organization)

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Communication

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Communication• Important in the function of leading• The transfer of information from the sender to the

receiver with information being understood by the receiver

• Means by which social inputs are fed into social system

• Behavior is modified, change is affected• Information is made productive• Force for influencing - staff direction, group activity

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Purpose of communication• For both internal and external functioning• Internal1. To disseminate goals and develop plans for their

achievement2. To organize resources in the most effective and

efficient manner3. To appraise and develop members of the

organization4. To lead, direct, motivate and create a climate in

which people want to contribute

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Purpose of communication

• External• Information exchange to become aware of the needs

of patients (clients) and the concerns of the community

• Leaders have major responsibility to set the right direction and tone for effective communication

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Communication process

1. Sender of message2. Transmission of message3. Receiver of message4. Feedback

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Communication flow• Downward –comes down the chain of command,

time consuming, oral and written• Upward – tendency to be hindered,

e.g., reports and return, suggestion system, appeal procedure, complaint system, group meeting, open-door-policy

• Crosswise - horizontal flow - Diagonal flow

• One way – ineffective in long run, but speedy, no fear of disagreement, impressive, protect one power, makes work life simpler

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Communication models

Written Oral Nonverbal

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Written communication

• Can be read by large audience• Promote uniformity• Provide record• No immediate feedback• Take long time to know whether a message has been

properly understood• A lot of effort is required for effective writing

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Oral communication

• 70% of communication• Speedy interchange with immediate feedback• Effect can be noted• Face to face meeting –time consuming and costly

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Non-verbal communication

• Can reinforce verbal communication• Through gestures, facial expression and body

language• Attentive eye contact, active listening, a show of

confidence – mature person

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Art of listening

1. Physically show that you are ready to listen2. Ignore the speaker’s appearance or manner of

delivery3. Watch your nonverbal communication4. Keep your mind on what the speaker is saying5. Allow for your own bias

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Art of listening (cont.)

6. Visualize the situation from the speaker’s point of view

7. Do not interrupt immediately if you hear an apparently wrong statement

8. Evaluate the logic and credibility of what you hear9. Do not give your last word

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Guideline for effective communication

• Clarify ideas before attempting to communicate• Eliminate unnecessary details• Plan the organizational communications in

consultation with all• Establish two way communication• Understand the other party’s frame of reference• Follow-up• Be a good listener

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Thank You