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Management Style in Long-Term Care: Does One Correct Approach Exist?

Published February 5, 2008 12:39 PM by Brian Garavaglia

A very common question that is often posed to me is, ”What type of leadership or management style do you have?” The question is often posed as if there is one correct style that exists. Moreover, there has been a substantial amount of studies done on leadership and management styles to lend a scientific understanding to this question, yet they really do not provide any definitive answer to which, if any, style is best. 


A scenario that continues to stick in my mind happened a few years ago. I was listening to an administrator presenting on this particular topic during a conference. I sat and listened hoping to get some insightful tips from an experienced gentleman in this area, but as I listened I heard him state, something to the fact that nursing home administration and leadership is not a democracy, but a dictatorship. 


That word dictatorship immediately gained my attention and I remember looking up very quickly from the agenda I had been reading. He continued to elaborate and as I sat there listening, I could not help but place a broad smile on my face. I felt that I was attending a presentation that was being given by a totalitarian dictator rather than a long-term care administrator. Upon leaving that session I found myself asking, “why would they let this person present and what educational value did his presentation serve?”  I must honestly admit I have no firsthand knowledge of how successful this administrator was in his profession, but I do feel sorry for young, impressionable administrators using him as a mentor.  Providing a “one management style fits all” was to me, patently absurd. 


In my 27 years of health care I have witnessed others who felt it was necessary to establish themselves on a Machiavellian level. Some have been successful, but most have not, and one of the reasons that this type of leadership style will fail if used exclusively is that it shuts down important and necessary lines of communication and input. Unless you are omniscient, which I have never found any human being to be, you need input and open lines of communication. Dictatorial mannerisms will shut communication down very quickly, prevent others from approaching you and help to isolate yourself from the staff that you depend upon. 


I have also seen the other extreme exist, where an administrator fails to be able to take a stand or provide any direction, remaining in what appears to be a perpetual state of equivocation and ambiguity.  As a leader and administrator, you will not always be correct in the decisions that you make, nor is it realistic to believe that you will be. However, constantly failing to take a stance, or having a difficult time taking a stance, is ultimately destructive. Here again, I recently became aware of such a problem, and listening to the consecution of events made my jaw drop. In this case the health care administrator had difficulty resolving an issue with a recalcitrant business office personnel. She wanted to meet with this particular employee to discuss the issues and the administrator and the business office staff member in question became involved in an e-mail exchange where the administrator kept asking for a time to meet with her and the business personnel kept saying she would not meet with her. 


Beyond this being insubordination one has to ask, “Why did the administrator tolerate this type of behavior?” If the administrator had any doubts about her being causative in the office problems, the insubordinate demeanor that was demonstrated in this exchange with the administrator should have helped to validate the problematic nature of this employee. 


At the time of this writing, nothing has been done about this employee and the problem has now spread further in the work environment, creating an unnecessary inflammation that could have been prevented.  However, since the administrator could not take a firm stance, she became an administrator only by salary and title.


I have found that there is no one single successful style that will work in every situation, at every facility, with every group of personnel, and on every occasion. However, I do feel that exclusive extremes on either end of the leadership and management continuum also doom the leader in this area to failure.  A nursing home administrator has to be involved, engaged and aware of the people they work with, the residents and the issues they face, the family problems that exist, as well as the myriad of other factors found in their facility. Therefore I feel the following is a list, which is not exclusive by any means, of important features that individuals need for leadership and management of long-term care environments. However, more important is for the administrator to establish their own way of administering that they find as successful and comfortable.  Avoid attempting to mimic others and establish your own administrative identity. The following is a personal list of qualities that I feel are important for long-term care administrators.  


  1. Lead with integrity and always err on the side of what is right—I am not sure if anything is more important. Your integrity as a person is emblematic of who you are. It sets the agenda of what others will expect of you and what you expect of them. As a professional your life inside and outside of the facility follows you and the integrity that you hold will set the standard of your administration, not to say your life. 
  2. Remain close to your environment, talking with staff, family members, residents, etc.  This helps to build trust and camaraderie. It also helps to proactively address issues before they even start.  
  3. Manage by walking around. Much work has to happen in your office. However, make some time in the day to move around your facility, staying close to what is going on in the immediate milieu. 
  4. Develop your own style of management and leadership. Do not attempt to mimic others just because it works for them. They often have different personality characteristics and different situations that do not lend themselves to be carbon copied. 
  5. Communicate and listen (not just hear) effectively. Remember, listening is an active process that involves you, as well as others, in the communication process.   
  6. Take a stance and do not equivocate. If you are wrong, swallow your pride and learn from it.  However, sitting on the fence and waiting for a great, definitive revelation to come about or hoping that the problem will work itself out will often lead to disaster. Remember, we all err, but erring by omission, not doing anything, often creates larger problems. Think your decisions out to the best of your ability and act on them as well as learn from them, whether you make the correct decision or the wrong decision.               
  7. Take action decisively on issues that present themselves to you. Furthermore, do not just be a reactive manager, but work toward being a proactive manager. 
  8. Establish yourself as being receptive toward others and their ideas. You do not always have to agree with them, but you should be respectful and listen, as well as provide feedback on whether you think their ideas are viable or not. 
  9. Be realistic in your management approach and your project undertaking. Do not attempt to delude yourself toward thinking that you can accomplish everything. A person who thinks of himself or herself as an omniscient and omnipotent leader only deludes themselves. Do not be fearful of introducing small changes that are incremental and may be more realistic, leading to positive results.  Know your resources and abilities, and watch out for the “change the world” mindset. 
  10. Empower your workers and create a smart working environment. Your workers need to know that you trust them and respect their abilities to oversee their areas. This does not mean that you should alienate yourself or dissolve your responsibility. It does mean you should empower and create a trust among your employees, and be an informed leader through close interaction with your employees.     




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About this Blog

    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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