Gerotalk : Leadership

The Importance of Selecting Good People

Brian Garavaglia — Tue, 18 Aug 2009 14:00:00 GMT

Click here to read Brian's column "Gerotalk" on the ADVANCE for Long-Term Care Management Web site.

One of the important needs of an administrator is to select people that are well-rounded, and knowledgeable in their skills. One of the important duties of a long-term care administrator is to select the appropriate people to fill the necessary positions within the long-term care facility. The administrator often has to select and fill important managerial positions, and the ramifications for selecting the correct people can have important implications for the proper functioning of the facility. Therefore, the administrator has to be fully aware of the impact of their decision.

Although most administrators are aware of the importance in selecting the correct person to fill important managerial positions, they frequently will make less than the optimal choice in their selection process. A common mistake that I often hear, and one that often makes very little sense is, "the person is overqualified for the position." As they filter through a number of resumes, they will often disqualify those individuals that have considerable qualifications. Now, in the opposite direction, it makes perfect sense to eliminate those that do not have the necessary qualifications to take on an important managerial position. However, at the other extreme, using the argument that you eliminated a person because "they are overqualified" is not a logical argument whatsoever. Hiring a person is a binary distinction: They are either qualified or they are not qualified. You can disqualify a candidate for not having the necessary qualifications, but to disqualify a candidate for being supposedly "overqualified" is an error in logic and can limit your candidate selection pool to suboptimal candidates.

Think of the lack of logical consistency that exists behind this type of statement. Although most individuals what to hire the "best" candidate they often will automatically disqualify certain individuals based on this error in thinking. How can one select the best candidate for a long-term care facility, or for that matter any job, if you disqualify certain individuals due to the "overqualified fallacy"? In reality, how can one be overqualified? What does this statement really mean?

On many occasions individuals will use this illogical terminology to protect themselves. Many individuals, due to hubris, will attempt to protect themselves against hiring a person who is perceived to be too smart or too experienced. To hire a person that often has greater qualifications then themselves can be intimidating to many, but this type of hubris can also limit the administrator from hiring the best qualified person to fill an important position.

Another reason that is used to disqualify the supposedly "overqualified" person is that they will request too much money. Most individuals that apply for positions often are quite aware of the salary range for these positions. However, many who are hiring for these important positions assume the person that is seeking these positions are totally naïve about the position's salary range. Therefore, the person who may want to come and work for the long-term care facility, with considerable qualifications and who would excel in this position, is presumptuously eliminated by those doing the hiring.

Without providing an interview, many excellent candidates are frequently lost due to their resumes being thrown in the garbage without any follow up due to the all too assuming administrator thinking that they will not be able to afford the person. In our current economy, many workers who are very qualified are looking for work. Many also are able to bring a considerable level of skills and knowledge to the long-term care community. However, because those who are in charge of hiring continue to make assumptions without even speaking to the candidate, many facilities loss qualified personnel that can ultimately enhance the quality of the long-term care environment.

One last comment: As a corollary to the aforementioned assumption made about higher qualifications equaling too high of a salary, even when a person is interviewed and is determined to be an excellent candidate for the position, many will fail to hire the candidate since their requested salary is slightly hirer than the budgeted salary for that position. In many cases the administrator or other hiring personnel make another important error in thinking: they view the cost of the candidate on a purely monetary level. They look totally at the wage expense and fail to look at how the candidate themselves could potentially save costs for the facility in the long run. This myopic tendency to focus only on wages is all too frequently the only calculated interest that many administrators take into consideration. However, if the person has cost-saving qualities, going beyond the budgeted salary cap can make very good sense, especially when their skills will offset this higher salary and ultimately save the facility numerous costs that would not be saved by hiring a less qualified person.

The administrator and other hiring personnel within a long-term care facility often fall prey to common errors in thinking, which ultimately hamper their ability to select the best people to fill important positions. This can be a major problem and many facilities actually settle for hiring less qualified people due to presumptuous mental biases that administrators and other members of the hiring team hold. As mentioned, many people will often invoke the "overqualified fallacy," which has no logical basis.

Furthermore, since many also suffer from "wage myopia," viewing the highly qualified candidate totally in light of a wage expense that they cannot afford, many will often fail to interview the person or disqualify them on the basis of being an over-budgeted wage expense. Yet, as was mentioned, one has to also look at the other side of the equation. Although the facility may pay a wage expense that slightly exceeds the budget for that position, the slightly higher expense paid out in wages may be recouped in savings in other areas that a highly qualified person can bring to the facility. Therefore, before an administrator makes cursory judgments toward disqualifying potential candidates based on the errors in thinking that were mentioned, it would behoove them to closely examine these potential biases that they may hold and the costs that these biases may have for the facility.

Organizational Lines of Authority & Administrative Success

Brian Garavaglia — Wed, 28 Jan 2009 13:15:00 GMT

One of the most important features for organizational success is making sure that the lines of authority are well delineated. Organizational charts within nursing facilities should be quite explicit and larger companies should also make sure that this is clearly understood by those working under the larger organizational umbrella. Unfortunately, all too often, we see that there fails to be a clear delineation in the levels of authority and who answers to whom. For any organization, including long-term care organizations, their success depends on a clear understanding of the authority structure within these organizations.

Understanding the importance of line and staff authority functions is critical for the success of long-term care facilities. Line personnel are those that are directly involved in the daily operations of the nursing care facility. Starting with the administrator, the director of nursing, to the management nurses, down to the certified nurse assistants, these individuals all hold important line functions for the daily operations of the nursing care facility. Furthermore, this creates a hierarchy of authority that needs to be explicitly understood for proper daily operational functioning within the nursing care facility. Staff authority provides advice and assistance for the facility or organization. Staff members do not have authority over line personnel. However, this is where many organizational problems often start.

A major problem that I have witnessed in many nursing homes is when many staff workers attempt to get involved in the decisions related to the line staff. Decision-making and levels of control have to be clear and unambiguous. Each person plays a particular role and each individual has to understand who they answer to in the organizational landscape. As companies grow larger, there becomes a tendency for many of these lines to become blurred. This is especially problematic since many companies have many consultants within their company holding many staff functions on an advisory level. As the company grows, and the number of staff personnel increases, delineating clearly a line of authority that needs to be followed, with a clear demarcation between those that hold line versus staff functions is imperative.

One of the critical problems that results from this nebulous distinction between individuals that hold line and staff functions is that role ambiguity results. Roles have to be clear to not only aid those that hold these two different types of functions, but also to enhance their roles in the respective areas that they are involved in to conduct their jobs effectively and efficiently. For instance, a nurse or human resources consultant, if they hold a consultant role, would typically be placed under a staff function. However, if these individuals do hold some level of line function, it needs to be clearly established in the organization chart.

So one can see the need to clearly distinguish between those that hold line and staff functions in nursing care facilities. Although this may seem to be quite trivial, in reality making this distinction is very important for a proper functioning organizational environment. One of the biggest issues that often happens in nursing care settings is worker confusion on what roles certain individuals play and who they should answer to as it relates to their position. As most individuals, especially those who have been in management within a long-term care facility can attest to, having workers being confused on the roles of others is very common. Furthermore, the administrator has to further establish the clarity that needs to exist and reinforce proper line and staff distinctions when ambiguity is found to exist and be a problem.

The organizational environment works best when authority functions are well known. This helps to foster a clear understanding of the responsibility and expectations for individuals that hold particular positions. Not only is this important to the non-management personnel, but management personnel also have to understand clearly the responsibilities and expectations that are held for each individual in the organizational environment. Is this a simple problem to rectify? It appears that it would be, but in reality it continues to exist as a major problem in most organizations.

Moreover, as long-term care organizations grow and get larger, the organizational complexity often leads to this problem being endemic in most long-term care environments. Therefore, in reality, the organizational complexity that develops from the growth of the organization itself not only makes this problem common, but more difficult to eradicate then it may appear. With that said, the managerial environment within a nursing care facility needs to continue to make sure that clear delineations between levels of authority as well as between line and staff functions exist. The managerial optimization of organizational resources strongly depends on this clarity.

Problem Personalities can Lead to Workplace Turmoil

Brian Garavaglia — Tue, 29 Apr 2008 16:58:00 GMT

We are all quite different, and all of us come to the workplace setting with different personalities. Long-term care is no different. It brings individuals of different skills, education levels, temperaments, and in particular personality types to the organizational setting. Some individuals come in with a more introverted, placid personality, while others come to the milieu with a more extroverted, gregarious personality.

Furthermore, the adjustment level of certain individuals also demonstrates great levels of variability. Some individuals come to the workplace with a very stable personality while others have highly volatile, unstable personalities. It is addressing this latter element that will briefly be focused on in this paper. Whether we have come to be aware of it or not, many of the issues that are found in long-term care deal with addressing different personalities with varying levels of stability. So it becomes important to understand how certain personality characteristics can lead to problems that are found in the long-term care environment.

One personality type that often is found in organizational settings that leads to many problems are individuals that have a passive-aggressive personality type. In reality, this is not a current diagnostic classification in the Diagnostic and Statistical Manual of Mental Disorders. However, behavioral scientists are well aware of this personality and administrators and other long-term care professionals, some of whom may also harbor this personality, have witnessed the impact of this type of personality.

In fact, this is actually a type of aggression that is one of the most dangerous forms of aggression. This person is often the individual that is often agreeing with you while circumventing the organizational climate any time they get the opportunity. They will demonstrate a façade of feigned compliance when in reality they are contravening the organizational climate in their own manipulative ways. They are destructive to the team structure that is needed in a health care setting by superficially stating they are team players while they are at the same time attempting to split staff and drive a wedge in the team environment. The underlying aggressive nature of their personality is so insidiously subtle that is destroys the morale of others, fostering a consecution of destructive emotions in others in their immediate environment.

With the passive-aggressive personality instead of expressively asserting their aggression, they do their destruction by failing to do many things instead of actively or directly engaging in aggressive behavior. In long-term care environments these individuals assert their aggressive nature through being tardy or showing up late for work and their assignments, procrastinating on particular projects and tasks that need to be completed, or engaging in intentional forms of inefficacy. Since their passive-aggressive tendencies inflict pain to others that have to cover for them in their work, do the work that they continue to put off, or enhance their performance to make up for the reduced efficiency of the passive-aggressive person, it quickly leads to an epidemic dissatisfaction found among other workers.

The narcissistic personality is another personality that can wreak havoc among a long-term care team. Generally speaking, successful work teams in long-term care settings have to subordinate their own needs and interests to the interest of the larger team environment. This is very difficult, if not impossible, for the person who has highly narcissistic personality traits. The major reasons relate to the fact that the very traits that make up this personality type run counter to successful team building. These individuals often hold a grandiose view of their own self-importance. They are very individually centered, consumed and preoccupied with attaining their own success. They often hold strong feelings of entitlement, and furthermore they have an insatiable need to be admired. Moreover, their tendencies to exploit others to advance their own self-interests, express themselves in an arrogant manner, as well as being deficient in their ability to empathize with others, make them the ideal "anti-team" member.

As many of those who have worked in long-term care have witnessed, these individuals are also quite destructive toward enhancing a stable organizational environment. In any health care environments, where the emphasis has to be on the patients or residents, these individuals are so involved in their own self-aggrandizement that they lose sight of those who they are serving, as well as those that they have to work collaboratively with to achieve the results of the organization. Many of us have met physicians, nurses, administrators, therapists, as well as nurse assistants that have held this false sense of self-importance. Furthermore, many of us have witnessed the difficulty in working with individuals that exude such an exaggerated sense of self-worth.

Finally, many of those in long-term care have been on the receiving end of the narcissist's wrath when they have criticized these individuals. Because of the importance they place on their grandiose view of self-importance, they are very sensitive toward criticism that is directed toward them.

The last personality that will be discussed here is the paranoid personality. As is evident by its name this person has a widespread suspicion of others and their behaviors. They have great difficulty feeling secure and building a sense of trust with others due to their suspicions. They feel that others may be belittling them or engaging in unwanted attacks against their character. Often normal behavioral interactions that others place very little emphasis on will spur ruminations among the paranoid personality that individuals are targeting them in some manner. Their pervasive suspicion leads to feelings of resentment, ill-will, and a general unease with others, who are often viewed as a threat to them in some manner.

Here again, one can see that these individuals can be quite destructive to a long-term care environment predicated on cooperative team efforts and trust. These individuals are often unable to invest the significant level of trust needed in cooperative team efforts and this in turn leads toward the paranoid personality frequently isolating themselves from the larger social environment. In an environment predicated on social interaction with workers, residents, and family members, these individuals stick out like a sore thumb. Their destructive nature rests on the inability to trust others and react against those that they perceive are attempting to attack their character.

Although only three personality types were examined here, there are others that can be instrumental in destroying staff morale and inhibiting team development. However, this paper only focused on these three types of personality. It should also be mentioned that these are not the norm and most individuals, even those that are frequently labeled as "trouble-makers" hold more stable personality traits. Nevertheless, it is important to take note of those individuals that may hold passive-aggressive, narcissistic, and paranoid personality traits. I

ndividuals that have these types of personality traits can be quite damaging to the organizational environment. In addition, because these features are enduring by the very nature of personality, they are often not just your ordinary trouble-makers or discontented worker. They hold a persistence toward disruption that continues to interfere with the functional nature of the long-term care environment.

Therefore, although this paper did not speak about intervention, which is a much more sophisticated issue, it is important for long-term care professionals to understand the personality makeup of certain individuals, and in particular, those individuals that may hold a persistent disregard for the workplace and team environment and lead to a contagious turmoil that contaminates the morale of the long-term care environment. Although these individuals are more the exception than the norm, when they do make their appearance, they often hold a detrimental and destructive impact on the organizational behavior of the long-term care environment.

GroupThink as an Impediment Toward Team Decision Making

Brian Garavaglia — Thu, 06 Mar 2008 19:40:00 GMT

Health care administration is not an easy job. Decisions have to be made and often these decisions rely on more than just one person. In the long-term care environment many decisions are made within a team framework. The administrator, along with the director of nursing, rehabilitation director, dietary and activities directors, maintenance supervisor as well as many other important administrative team players hold important positions in the decision making process.

However, there are times when decisions become compromised within group situations. Teams can be an incredible asset to assist in making important decisions, but also the important significance of bringing people together into a team situation can also lead to problems. One of the major issues that can compromise decision making in teams within the long-term care health setting in what is referred to as Groupthink.

Groupthink, a concept that was developing by Irving Janis (1982), is the propensity for group decision making to become hindered within decision making groups, regardless of whether they are in health care settings, large fortune 500 corporations, or even in Presidential cabinets. It does not just happen to people that are of modest intellect, but also among the brightest individuals as well.

For instance, groupthink has been implicated in such large-scale events as the Bay of Pigs invasion, the entry and escalation into Vietnam, as well as even our decisions to enter into our country’s current Iraq war. In all these cases there were reservations about the final decisions that were made that were never raised, acknowledged and properly evaluated. If decisions of such magnitude, affecting our nation on such a large scale, made by individuals who are intelligent and knowledgeable in their respective areas can become compromised, one can only guess how often it happens daily in more common situations. Although no exact number can be given, it can be stated that groupthink is quite pervasive, happening in most, if not all, organizations daily.

What are the symptoms of groupthink? Two key symptoms are an assumed consensus and a feeling of group unanimity. What this means is that often many individuals will not say anything or express their opinion because they feel that everyone else is in consensus with the group. Since they feel that everyone else is on the same page and share a consensual opinion, many will fear speaking about any reservations they may have with a particular idea or plan. If team members feel that they should express themselves on a particular issue, but feel that there is a unanimous opinion and shared consensus among the other group members, that is often enough to inhibit them from getting involved in expressing important opinions.

To prevent this it is important for the administrative staff to know about these endemic group forces that can lead to an inhibition toward full-team participation. Furthermore, the administrator should often encourage other group members to express their opinions, reservations and even possible dissenting opinions. Once the administrator becomes aware that individuals within the team meetings appear to be “shutting down,” it is at this point that the administrator should ask for opinions and even dissenting opinions. This may sound problematic since most administrators do not what to hear dissenting opinions. This does not mean they should encourage contention, but healthy disquisition on what other views may exist and what weaknesses may appear in the existing plans and ideas that have been presented to the team.

There are other important characteristics of groupthink. For instance, placing pressure on team dissenters is often a problem that is faced with groupthink. Since dissenters may be viewed as problem individuals that are failing to be cooperative team members, individuals will often not want to raise a dissenting opinion. There is often a misconception about the group or team. Many individuals feel that if dissenters exist they are not good team players and anything they say should not be given any weight and disregarded. Unfortunately, this often leads to the glossing over of many important opinions and views that are raised. Moreover, if individuals feel that they will be looked at in a negative light and that their opinions will not be given any credence, this will lead to pressure for them to not raise any dissenting opinions.

What is also important to mention is that many team members often fear dissent due to group norms that develop dealing with not questioning the leaders or by leaders, such as the administrator or director of nursing shutting down any conversation or differences in opinion. It is not uncommon for leaders to nurture a view of themselves as an omniscient individual that is the prevailing expert in what they do. Soliciting opinion is often viewed as a weakness due to a perceived lack of knowledge. With this comes the intolerance toward opinions that differ from their own.

Therefore leaders, especially those that are easily threatened due to feeling insecure in their position or with their knowledge, attempt to minimize dissent. In so doing they delude themselves toward thinking they have enhanced the solidarity of the group as well as protected their status as the undeniable expert for the facility. Ultimately, attempting to enhance their power and control by shutting down or disregarding opinions from other team members enhances the likelihood for groupthink to insulate itself into the team decision-making process.

What is interesting about groupthink is that it is a ubiquitous component of groups and teams at all levels. Unfortunately many individuals think that they would never act or behave in such a manner and that they are too much of an individual to be influenced by such group forces. Only individuals that are easily led can fall prey to such a problem. However, as has already been stated, no one is necessarily immune to groupthink and the problems that it brings. It has been shown that even bright individuals, involved in extremely important decisions that involve the national welfare of our country can fall prey to groupthink.

However, possibly the greater sin in not necessarily falling prey to groupthink, but denying its existence or its ability to effect you and your decisions. In fact, groupthink often breeds feelings of invulnerability by the group members and it is often these same feelings of invulnerability that lead individuals to be quite insidiously influenced by this prominent group force that can lead to potentially destructive team decisions (DeLamater & Meyers, 2007).

Although team decisions are important within any organization, and long-term care team decisions are no different, one has to recognize that team decisions can also go awry. In long-term care groups or teams, decisions are often part of the daily culture of the organization. Although many individuals have increasingly encouraged teams and team building as an important and effective part of long-term care management, one has to also realize that the team in itself does not work automatically. Team administrative management is an important factor for good long-term care administration.

However, teams have to be used effectively to maximize the decision-making process. As is evident, being aware how the decision making process can be thwarted through groupthink will become an important administrative skill toward preventing this type of process from leading to potentially destructive team decisions. Realizing that no individual or team is absolved from groupthink’s influence will help administrators make better use of the team and the potential that teams hold for making very sound and informative decisions.

References

DeLamater, J.D., & Myers, D.J. (2007). Social psychology. Belmont, Wadsworth.

Janis, I.L.(1982) Groupthink. Boston, Houghton Mifflin.

Conditions of Certainty, Uncertainty, and Risk in Organizational Decision-Making in Long Term Health Care

Brian Garavaglia — Thu, 28 Feb 2008 17:37:00 GMT

The level of information that one has to makes decisions in health care settings often differs dramatically in any one situation. Decisions are often incumbent on the level of information that is available to the decision makers. Administrators face these issues daily when making decisions. Therefore, it is important for administrators to realize that decision-making is not a one-dimensional process. Although individuals often think of decision-making as “taking a stand” and “being decisive,” the complexity of decisions is predicated on more then these common trite explanations; the type and amount of information that lends itself to administrators and the administrative staff has to also be taken into consideration.

For instance, in understanding the complexity of decisions, one has to evaluate whether you are dealing with a “programmed” or “non-programmed” decision. Programmed decisions occur frequently. Because they occur frequently there are often well-developed types of procedures and rules that guide decisions in these areas. Take for instance dealing with disciplinary actions dealing with employee absenteeism or tardiness. The administrative staff often deals with these issues frequently and quite commonly. Since this is a recurrent issue, decisions rules in this area are not only explicitly stated, but also implicitly determined. Even dealing with routine survey issues that administrators face are frequently programmed, especially for those administrators who have been involved in long-term care for quite some time.

Conversely, non-programmed decisions are encountered in situations that happen less frequently and are more unusual. Often there fails to be well-established decision rules for dealing with these issues, and because of their less frequent occurrence, administrators often face greater levels of ambiguity in addressing these concerns. Because of the unique situations that are frequently part of non-programmed decisions, the lack of routinization that is part of programmed decision-making leads to a comfort zone that is much less secure for many administrators.

The problem of dealing with abuse, fires and evacuation, or being informed that there needs to be an immediate abatement to an immediate jeopardy citation leads to the need for insightful decisions that are not part of one’s daily, routinized decision-making ability. This may lead many to ask the question, is this not the fault of the administrator since they were not prepared? The answer to this question is even the very best administrators cannot anticipate every contingency, and even though you may have layers of policies that in some way, shape or form, address many of these issues, the reality of the situation always supersedes simulation and paper policies.

Also, even though long-term care environments share a great deal of similarity in what are programmed and what are non-programmed decisions, there are also inter-facility differences. For example, facility A may deal with a high level of acuity as it relates to issues of bariatric residents. Emergent issues related to bariatric residents may be quite routinized and part of their daily programmed decision-making strategies. However, facility B may have a lower acuity and they may not deal with the needs of bariatric residents as routinely as facility A. Therefore, if facility B has a bariatric resident that becomes severely compromised, the decision rules may be more ambiguous due to not having to frequently deal with this type of issue.

So what is a programmed decision in one facility may actually be a non-programmed decision in another. Administrators have to be aware of many of these common facility-to-facility programmed decisions as well as the variances that are found between facilities that lead to non-programmed decisions to be encountered.

Health care decisions, regardless of being programmed or non-programmed, can also exist under conditions of certainty, uncertainty and risk. In some cases the decisions that are made exist under conditions of certainty, in which the outcomes and alternatives to particular outcomes are known. In this condition administrators have a clear understanding of the alternatives and how each alternative will impact the health care facility. In most conditions it is clear that if they have $30,000 to spend for capital improvement and two areas need improvement, the kitchen and physical therapy, then what is spent on the kitchen becomes and opportunity cost to physical therapy. If $20,000 is spent on the kitchen it is clear that only $10,000 exists for physical therapy enhancement.

With conditions of uncertainty there is not enough information to make a clear decision and understand how making a decision will influence alternative outcomes. Under these circumstances some individuals will guess at what they “think” is the right decision. Administrators often like to use the “based on my years of experience argument” to justify their decisions on a lack of information. In reality this skewed type of thinking just does not happen in health care, but in all phases of our lives. However, in a case when one is dealing with lives, the must prudent means is often to seek more information to act and decide in a prudent manner.

However, probably the most difficult decisions that are faced are those that incur some probability of risk. In reality, many decisions that administrators face are probabilistic in nature, where they are unable to know with certainty what outcome given actions will have after decisions are made. Under these conditions of risk there is often enough information available to the administrator to make informed decisions based on a level of probability. However, just because you decide to make a decision based on an 80% probability that the payback period will be six months or less or that there is an 80% probability that instituting a wage increase will reduce nursing turnover by 50 percent does not mean that it always will.

In addition, it is very common to make decisions based on probability but to delude ourselves into thinking that the probability will become the actual occurrence. Psychologically this helps use feel better about decisions that often incur risk. However, just because the probability of a penny being either heads or tails is 50% and that it has turned up heads on the first toss, does not mean that the probability for it to be tails on the second toss increases. The probability still remains at 50 percent.

For many, decision-making appears to be a clear and easy process. However, as been addressed in the preceding paragraphs, decisions hold a level of complexity that is often not recognized. Long-term care administrators face many different types of decisions and it is important for long-term care professionals to understand that decision-making is more than just an arbitrary and capricious enterprise. Yet, understanding about the decision-making process, the types of decisions that are often incurred by long-tem care professionals, and the challenges they face in dealing with this very important task, will help professionals deal with the unending conundrum and anxiety that is part of decision-making. Therefore, decision-making is a skill that can be improved by being cognizant of the types of decisions that one is presented with, the common problems that exist in making decisions, as well as recognizing your strengths and weaknesses in this area.

References

Moorhead, G. & Griffin, R.W. (2004). Organizational behavior: Managing people and

organizations. Boston, Houghton Mifflin.

Plous, Scott (1993). The psychology of judgment and decision making. New York,

McGraw-Hill.

Rajagopalan, N, Rasheed, A.M.A. & Datta, D. K. (1993). Strategic decision processes:

Critical review and future directions. Journal of Management, 19(2): 349-384

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

Brian Garavaglia — Tue, 05 Feb 2008 17:39:00 GMT

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.

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.
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.
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.
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.
Communicate and listen (not just hear) effectively. Remember, listening is an active process that involves you, as well as others, in the communication process.
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.
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.
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.
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.
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.