Health Policy and Administration 201

objectives
Gain an understanding of leadership
Explore the concepts of leadership Summarize the factors related to leadership

effectiveness Compare a leader and a manager Enumerate the roles and functions of a leader and a manager Identify features of good leader and good manager Improve leadership knowledge and skills

LEADERSHIP vs management
A manager is an individual who holds an

office to which multiple roles are attached

Leadership is one of the roles attached to

the office of the manager.

Manager vs Leader
The manager administrates; the leader

innovates

The manager is a copy; the leader is an

original

The manager maintains; the leader

develops

 The manager accepts reality; the leader

investigates it

The manager focuses on systems and

structures; the leader focuses on people

The manager relies on control; the leader

inspires trust

Manager vs leader
The manager has a short range of view; the leader has a long range of perspective The manager asks how and when; the leader asks what and why The manager has his eye always on the bottom line; the leader has his eye on the horizon

The manager imitates; the leader

originates

The manager accepts the status quo; the

leader challenges it

The manager does things right; the leader

does the right thing

Leadership role of manager

PUBLIC HEALTH ORGANIZATIONS

Leading and Managing for Results Model

Leading

Managing
plan organize implement

scan focus align/mobilize

inspire

monitor and evaluate

improved work climate improved management systems

Improved capacity to respond to change

Results Improved Services Improved Health Outcomes

To lead and manage better you need to

apply the eight(8) leading and managing practices consistently To manage your organization well, you and other managers need to continuously pay attention to the services that the organization provides to make sure they are effective (the right services), efficient (services delivered in the right way), and of consistently high quality to meet clients needs Your performance as manager rests on these three(3) goals

 Plan

how to achieve results by assigning resources, accountabilities and timelines Organize people, structures, systems, and processes to carry out the plan Implement activities efficiently, effectively and responsively to achieve defined results

 Monitor and evaluate achievement

results against plans, and continuously update information and use feedback to adjust plans, structures, systems and processes for future results

 Managers who lead well can adapt

to changing conditions in the environment and lead others to adapt as well By using adaptive skills, they are able to achieve results despite complex conditions and scarce resources They are well informed about opportunities and threats

Their direction is clear to staff

People and resources are aligned

around a common shared vision

Because of their commitment , work

groups deliver the results that managers promised

When you lead well , you and other managers:

Scan up-to-date knowledge about yourself (how your behavior and values affect others), your work group, your organization, and your environment

Focus staff work on achieving the organizational mission, strategy, and priorities Align and mobilize stakeholders and staff time and energies as well as the material and financial resources to support organizational goals and priorities inspire staff to be more committed and continuously learn how to adapt and do things better

Leading and managing do not form distinct sequential processes that you complete separately

They are not independent of each

other
Accomplished managers move fluidly

between leading and managing to support their teams to face challenges and achieve results

This is leadership that our health personnel do not wait for instructions from the highest levels, but rather make decisions to do what they need to do to serve their communities -- Margarita Gurdian Minister of Health, Nicaragua

COMPETENCY Master yourself

APPLICATION Reflect on yourself Be aware of your impact on others Manage your emotions effectively Use your strengths and work on your shortcomings See the big picture Look beyond a narrow focus to take into account conditions outside your immediate area of work

 Create a shared

vision

Work with others to envision a better future utilize the vision to focus efforts Know your own values and what is most important to accomplish

Clarify purpose

and priorities

 Communicate

effectively

Hold dialogues focused on outcomes Clarify assumptions, beliefs, and feelings within yourself and others Create the environment of recognition and trust to lead teams to high performance that can be sustained over time

Motivate

committed teams

 Negotiate conflict Both sides should

benefit from agreements

Lead change

Enable team to own challenges, enlist stakeholders and navigate through conflicts/ unstable situations

Leadership
process through which an individual

attempts to intentionally influence another individual or group in order to accomplish a goal

Leadership is also

Creativity in action

The ability to see the present in terms of the future while maintaining respect for the past
Public health leadership includes a commitment to the community and the values for which it stands
--Public Health Leadership: Putting Principles to Practice by Louis Rowitz

Moving Up the Organizational Hierarchy

We turn out to realize our greatest

potentialities by viewing our own individual crises as opportunities to let go of who we have been and to set forth on the journey toward becoming something more --- William Bridges

The Way of Transition

When someone moves to a higher position

in an organization, the progression is called leadership transition

Leadership Transition
People tend to think of transition as those that occur at the top level of an organization, when the chief leaves and a new person steps in But leadership transitions take place at all levels of an organization , every time people move from one level to the next Transitions increase the persons scope of responsibility and

accountability Roles change as one moves up the organizational hierarchy

 Builds on the skills needed to develop a

positive work climate and encourage strong team performance 4 Typical levels of transition are explored: becoming a first time manager who leads: Level One moving from managing a team to managing other managers: Level Two becoming a senior manager: Level Three leading and managing at the top: Level Four

Building a Pipeline
The major job of leaders is to develop

other leaders

---Noel Tichy The Leadership Engine More commonly we call these transitions promotions Technical expertise is not enough It is the task of managers who lead to help those who get stuck to move on (up or out) and make room for others

 As a manager who leads, any problem affecting your staff is also your problem

To be successful as first level manager you will need to incorporate the leading and managing practices that address the elements of time horizon, priorities, relationships, tasks, and skills
These can be organized according to the key practices of the Leading and Managing for Results Model

First Practices Scanning Focusing Planning

Level Manager What to Do Pay attention to what is going on inside and outside your team; See the relationship between yourself and your team as part of the larger management structure

. Talk with people to identify health needs, and assess team to address those needs; . Help team identify their challenges and responsibilities in meeting those challenges as a team; . Help people prioritize their tasks

Aligning Mobilizing

Organizing Implementing

Provide opportunities for your team to see how their work fits together to serve organization goals; partnering with other teams

. Align with others outside the team about desired goals, vision, gaps, expectations , priorities and deadlines;

. Match staff skills and motivation to jobs

. Facilitate performance of team by removing obstacles

Inspiring Monitoring

. Model a trusting attitude, respect, and integrity in all interactions inside and outside the team . Conduct performance evaluations and give feedback . Track measurable progress of the team and share findings . Give recognition whether individual or collective contribution to organizational goals

Evaluating

 Inability to delegate tasks to other members of the

team

Competition with or micromanaging team members who work in the area of ones expertise Tendency to consider time spent coaching or supporting team members as wasteful/unproductive Questions or requests for help from team members considered interruptions

 Recurrent urge to fix supervisees mistakes, rather

than teaching them how such can be prevented

Tendency to have distance from team members

mistakes and/successes

Tendency to treat stakeholders (e.g. patients, community, and government officials) as outsiders

Practice

What to Do

Scanning Focusing Planning

. Look for signs of success or failure in Level 1 Managers ability to exercise management functions . Help them set priorities . Educate yourself about the larger strategic context within which the program operates . Identify teams not performing well and look into the causes . Guide teams in their performance

Aligning Mobilizing Organizing Implementing

. Teams work should contribute to the larger program strategies . Mobilize resources/aligned with needs . Align goals and create team spirit across boundaries . Provide challenging assignments to help level 1 managers develop their managerial skills

Inspiring Monitoring Evaluating

. Coach team leaders on effective managerial behavior . Provide appropriate feedback and support . Serve as an example to team leaders . Check regularly on progress . Share results of evaluations and celebrate successes . Recognize . Reward

. Interfering with job of immediate staff whos managing performance of people in those units . Bypassing or usurping the unit leaders authority

. Missing cues that show a unit leader is sliding back to being solely a service provider
. Failure to delegate tasks . Inability of reporting units to deliver results or to implement plans

. Sabotage or competition amongst supervisees . Overemphasis on doing the real work at the expense of org culture, work climate and strat issues . Tendency to rewrite memos, letters, and reports already delegated to others . Selecting service providers as future health managers who are most like oneself who are connected (e.g. family, political connections, ethnic/tribal links) .

Practice Scanning Focusing Planning

What to Do .Take a broad view of all the developments that positively or negatively affect services . Immerse to new areas of responsibility that are unfamiliar or not in your field of expertise

. Know the needs and concerns

of key stakeholders who influence, receive or affect services

.Identify overall strategic priorities for the program .Use data to identify challenges and identify resources and actions to address them

ALIGNING . Work on interorg or national MOBILIZING task forces to expand your ORGANIZING perspectives and your network of IMPLEMENTING relationships . Meet periodically with peers to see the totality of organization efforts ; exchange information and receive feedback
. Look for new funding sources . Shift resources as priorities change or new opportunities arise . Intervene when program implementation appears to be blocked

INSPIRING MENTORING EVALUATING

. Support lower level managers . Recommend promotions or pro vide other rewards for good leadership and sound management . Show leadership maturity in interactions . Show humility . Track program progress and reflect on these and setbacks with others . Share successes and failures and learn from the experience

. An obsession to show that ones program is responsible for improved health indicators . The tendency to point fingers to others for mistakes absolving oneself and team from blames . Favoritism . Signs of short term thinking and an operational rather than a strategic mindset . Tendency to ignore or ridicule organizational policies , compliance requirements, programs, needs

Tendency to isolate oneself from contact with the people who do the footwork(field) Significant turnover of staff and low morale Poor communication with stakeholders Lack of trust in others leading to doing work by himself/herself and maintaining strict control A tendency to overdelegate, combined with poor control systems

. . .

Satisfaction with or use of superficial or selfserving assessments and analyses to guide the team

. Unwillingness to recognize ones weaknesses and accept coaching or support . Inability to see ones role in causing serious organization problems

PRACTICE

WHAT TO DO

SCANNING FOCUSING PLANNING

. Spend time with your senior team members and learn from them . Maintain a broad network of contacts . Scan the professional literature, skim reports, or have others produce digests and find ways to attend meetings and international conferences . Talk with participants in training events

. Visit health centers, meet the people your organization serves and listen to their concerns . Identify with your top team 3-5 issues of strategic importance that your organization needs to address . Address critical challenges . Pay attention to imbalance in your organization and establish task forces to study the issues

ALIGNING MOBILIZING ORGANIZING IMPLEMENTING

. Make sure your org is represented in multidisciplinary and multi-sectoral task forces . Look for new donors and supporters . Pretest important decisions and and major change initiatives via trusted advisors . Maintain your relationships and participation in multiple networks

INSPIRING MONITORING EVALUATING

. Create a work environment that inspires people to put forth their best efforts . Act with integrity, be humble

. Check how you are doing from time to time from people who will be able to give honest feedback
. Share results and celebrate accomplishments . Articulate what you are learning and apply it to new situations

 Uninspired communication with employees or the

organizational stakeholders outside the organization

Inability to see different perspectives from a

particular typical bonus

Inability to put together a strong team Difficulty with or resistance to grasping the

the implications of sustainability

. Time management problems

. Ignoring ones role as custodian of the culture of the organization by engaging in unethical actions . Little awareness of unspoken norms and impact of ones behavior on others . Self-imposed isolation from receiving useful feedback from staff (or maintaining a culture in which this is not encouraged . Low priority of soft issues not directly linked to results

Key Points of Leadership Role

Multidirectional Leads Other Managers

Power

Emerging theories and concepts

Transactional Leadership
Transformational Leadership Charismatic Leadership

Transactional vs Transformational Leadership

Transactional Leader/Manager
occurs when one takes the initiative, making contact with others for the purpose of an exchange of valued things Rely on leaders promises and benefits to subordinates for the subordinates fulfillment of agreements with the leader Considers needs for the moment (Burns, 1978) Brings a measure of order and consistency to organizations by planning and budgeting, organizing and staffing, controlling and problem solving (Kotter, 1990)

 Function of a transactional leader is to

MAINTAIN the organizations operation RATHER THAN change it

Brings order and consistency to an

organization through processes

Transformational Leadership
Occurs when one or more persons engage

with others in such a way that leaders and follower raise one another to higher levels of motivation Able to motivate followers to transcend their own interests for the good of the group, organization or society Considers long term needs for development (Burns, 1978) Establishing a direction, aligning people, and motivating and inspiring them (Kotter, 1990)

Transformational behavior pattern Charisma - an endowment of an extremely high degree of esteem value, popularity, and or celebrity status attributed by others He or she makes everyone around enthusiastic about assignments I have complete faith in him or her He or she is a model for me to follow

 Able to produce constructive and

sometimes dramatic change by calling followers to COMMITMENT to a transcendent goal

Has a long-term view and appeals to followers

Mastering Change ability to view change as an opportunity for new experiences, alternative operations and calculated risks Systems Thinking ability to understand relationships and patterns in defining and solving complex problems Shared Vision ability to craft a collective organizational vision of the future and to energize current reality toward its attainment

Continuous improvement ability to create and sustain a never satisfied attitude that supports the ongoing and continuous improvement of service quality and clinical outcomes Redefining health care ability to focus on healing and changing lifestyles and the interplay of spirit, mind and body in nurturing health Serving public/ community ability to pursue organizational goals, objectives, and actions in the context of a larger social consciousness and commitment

Personal Growth Approach

Through personal growth, individuals

engage with their inner selves and become individually motivated to high performance and better able to formulate a vision and to motivate others Risk taking, teamwork, selfacceptance, personal mastery, emotional competence, reaching for ones potential, balanced living, being open to opportunities and possibilities Fortification of self-esteem

The Conceptual Approach

I know, therefore I am Comprehension of how leaders act => motivates individual to develop a lifelong commitment to learning to LEAD Think conceptually/ strategically Conceptualize the ROLES of leaders Achieved through education and training

The Feedback Approach

. Created an understanding of individual strengths and weaknesses and motivates individuals to improve practices . Feedback should encourage maintenance of desired behavior, assist in solving a problem or enable greater productivity

The Skill Building Approach

Teaching of key leadership skills through demonstration and experiential exercises Skill programs should emphasize simpler transactional skills and more complex transformational skills

The Ideal Approach

One of the approaches is adequate; a balanced, integrated and iterative system of development is needed Combination of 4 approaches Conger (1992)- leadership development will need to undergo radical change for real and sustainable growth in leadership.. Why are we inundated?

Summary- Roles and functions of a leader

Scanning Focusing

Aligning/Mobilizing
Inspiring

scanning
Identify clients and stakeholders needs

and priorities Recognize trends, opportunities, and risks that affect organization Look for best practices Identify staff capabilities and constraints Know self, staff and organization the values, strengths and weaknesses

focusing
Articulate the organizations mission and

strategy Identify critical challenges Link goals with the overall organizational strategy Determine key priorities for action Create a common picture of desired results

Aligning/ mobilizing
Ensure congruence of values, mission, strategy, structure, systems, and daily actions
Facilitate teamwork Unite key stakeholders around an inspiring vision Link goals with rewards and recognition Enlist stakeholders to commit resources

inspiring
Match deeds to words
Demonstrate honesty in interactions Show trust and confidence in staff,

acknowledge the contribution of others Provide staff with challenges, feedback and support Model creativity, innovation and learning

Summary -Roles and functions of a manager

Planning Organizing Implementing Monitoring Evaluating

planning
Set short-term organizational goals and

performance objectives

Develop multi-year and annual plans Allocate adequate resources (money,

people, materials)

Anticipate and reduce risks

organizing
Ensure a structure that provides

accountability and delineates authority Ensures that systems for human resource management, finance, logistics, quality assurance, operations, information, and marketing effectively support the plan Strengthen work processes to implement the plan Align staff capacities with planned activities

implementing
Integrate systems and coordinate

workflow

Balance competing demands Routinely use data for decision-making Coordinate activities with other programs

and sectors

Adjust plans and resources as

circumstances change

Monitoring/ evaluating
Monitor and reflect on progress against

plans

Provide feedback Identify needed changes Improve work processes, procedures and

tools

Summary- Qualities of outstanding leaders

Personal Qualities Setting Direction

Delivering the Service

Personal qualities
Self belief
Self awareness Self management Drive for improvement Personal integrity

Setting direction
Seizing the future
Intellectual flexibility Broad scanning Political astuteness Drive for results

Delivering the service

Leading change through people
Holding to account Empowering others Effective and strategic influencing Collaborative working

High performance leadership

Systems Thinking Visioning Facilitating Learning Empowering Followers

Developing leadership skills

Mentoring Reflecting Understanding Self Understanding Followers Continued Learning

THANK YOU