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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

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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

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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.

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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

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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