Leadership And Service Improvement Management Essay

Leadership And Service receipts Management EssayThe study of leadinghip and lead has led to many competing theories which attempt to distill the center field of capacious lead into its component affairs, to allow others to acquire some of these attri andes, and generate more effective leaders.The very earliest theories on leading tended to assume that leaders were born, and that leadership was non a skill, or deal of skills that could be acquired. The overall impression was that Great Men had inherited leadership qualities from their ancestors, which would make them effective leaders when placed in positions of authority (Kirkpatrick and Locke 1991). This is not a very helpful counselling to look at leadership, and does nothing to assist students of leadership in their efforts to become better leaders themselves. It is not, though a great leap from identifying natural leaders to identifying which parts of their character or personality mark them out from others. This un derpins the indication theories of leadership.Trait theory was canvas extensively in the mid part of the 20th Century, and had a wide range of results. Kirkpatrick and Locke (1991) explain that trait theory do no assumptions as to the origins of the traits studied, but simply highlighted the differences between leaders and non-leaders. In 1974, Stodgill published the results of his studies of leadership theory, and identified 22 traits and skills which argon present to varying degrees in the individuals studied. This did not show how individuals could become better leaders, but, the identification of leadership as a skill has been vital in the subsequent development of leadership training. He himself ultimately concluded that A person does not become a leader by virtue of the possession of some combination of traits. (Stodgill 1948 cited in Levine 2008)McGregor (2005) looked at leadership behaviours as relating to underlying traits or world views. They examined the ways in which managers and leaders border oned a labor movement, and tried to understand the motivating factors. McGregror (1960) felt in that respect were 2 major theories of human motivation which lay behind the actions of the leaders he studied. His theories were labelled X and Y. Theory X assumes that the average human being inherently dislikes carry, and in that locationfore essential be coerced to perform at the required take aim. The motivating factors here are extrinsic. Theory Y assumes that work is a natural part of life, as much as is play or rest, and intrinsic motivation is key. This intrinsic motivation can be viewed as an expression of the Hierarchy of call for (Maslow 1943) The work of McGregor informed the production of methods to map leadership behaviours. Blake and Mouton (1964) plotted concern for production against concern for people. This produces a helpful framework for mapping behaviours, but it is rather passive in form, and seems mainly useful for reflection o r critique, to inform future endeavours. It does not necessarily inform leaders of what behaviour is beaver suited to the group they are working with at a particular magazine.Action centred leadership was proposed as a leadership bewilder by Adair (1973). His clip in the Army and work as a trainer at the Royal Military Academy at Sandhurst led him to develop a stupefy that considers three domains line of work, Team and Individual. He argues that each domain requires the attention of a leader, but the relative importance of each will vary. The relationship of these domains is represented by a venn diagramTask take onsTeammaintenanceneedsIndividualneedsThis stick then details the areas a leader should manoeuvre in each domainTask Practical managerial concerns, for example creating a plan, monitoring performanceTeam Facilitating group working by agreeing standards of behaviour, settle group conflicts and so onIndividual Ensuring individuals are performing as well as come-at- able by supporting through challenges, allocating work according to strengths etc.There is considerable overlap and interaction between each of these domains, and it is argued that attention to each domain is required for a balanced team.The key feature of this model which made such an impact was providing a practical framework which allowed leaders to combine some of the softer skills of leadership with more managerial traits of time management and task focus.Situational / Contingency Theories of LeadershipThe studies of leadership discussed above have all looked at leaders and leadership behaviour and depict them, allowing leaders to analyse their behaviour. The theories above, over time have been developed to include a degree of dynamism, but were initially descriptive exercises. It was the recognition that there was not necessarily on right way of leading that prompted thinking about the possibility of adaptive styles of leadership (Schermerhorn 1997). The study of leadership i n different situations and settings, and the observation that the well-nigh effective style of leadership changed with respect to situational variables led to situational leadership models.The earliest described was the Contingency Model (Fiedler 1964). This model relies on a self-rated scale to determine a preferred leadership style. Fiedler then studied working conditions, and described them through three variablesLeader-member relations how willing team members trust and will follow a leaderTask structure how well defined a task is, or if it follows a standard procedurePosition Power the extent of the rewards and punishments a leader has available. done his studies, Fiedler constructed a visual guide to represent his findings about which type of leader was some effective abandoned the situational variables.The model states that leaders with high LPC scores should work with teams where the situation is moderately flourishing. The more task focused leaders will be more effecti ve in situations which are either very favourable or unfavourable to the the leader. This model has been studied extensively and has received both criticism (Ashour 1973) support (Strube and Garcia 1981). A major source of controversy in this model is the LPC. One important point to note is that Fiedler felt leaders would find their behaviour difficult to alter, and physical compositions should therefore recess the correct leader for a presumptuousness team. This is in contrast to other models which suggest leaders should be adaptable.The Hersey-Blanchard (1969) model of situational leadership looks at a different variable in the team mise en scene the maturity of followers. The underlying assumption is that a leader should adopt a style of leadership which reflects the needs of the team. This is in direct contrast to Fiedlers (1964) assertion that organisations should pick leaders given the favourability of the situation. In this model, a two by two grid which is very similar t o the Blake Mouton (1964) Managerial Grid, is used to describe four leadership stylesS1 Telling (low relationship, high task)S2 Selling (high relationship, high task)S3 Participating (high relationship, low task)S4 Delegating (low relationship, low task)There is an accompanying scale which rates the team a leader is concerned withM1 Low competency, and low commitmentM2 Low competence, and high commitmentM3 High competence with low/variable commitmentM4 High competence and high commitmentThe M score for maturity of the team members was developed over time, and was later divided to reflect job and psychological maturity (Hersey and Blanchard 1982). tune maturity is the ability or capacity to perform the task in hand. Psychological maturity indicates motivation.The model has received criticism from a theoretical standpoint, and from observational research. Graeff (1983) claims that the maturity scale is invalid, as it classifies workers who have skill and are unmotivated (M3) as mor e mature than those who lack skill but are use to a task(M2). He also argues that the additive nature of job and psychological maturity in the model is invalid. He supports this view by suggesting that in tasks where skill requirements are low, motivation has a much greater importance. One study into the model concluded that, because high follower maturity did not obviate the need for supervision, their results lent very little support to the model (Cairns et al 1998). This study though had methodological flaws, a skewed population, and did describe some support for tone of the SLT model.The practical application of this model relies on the ability of the leader to determine the maturity of their followers, and reflect this in their leadership style. Perhaps the most important fount of the model is the recognition that leadership styles are not fixed, and leaders can change their approach to suit a given team or individual.In novel health manage settings, there has been a chang e in the nature of teams. There is no longer a stable, downhearted, hierarchical team. Instead, teams form and disperse on an almost shift-by-shift basis. To lead effectively in this environment, it is necessary to be adaptable, and be able to support team members to realise their potential. The models described above illustrate that there is no one best way to lead a team. Instead, by appreciating the different situations, individuals and tasks involved, leaders stand a better chance of forming teams which can trade with the varying demands of the modern NHS. Perhaps Goleman (2000, p.4) has argued this most eloquently through his work which revealed that the most effective leaders do not rely on except one leadership style they use them seamlessly and in different measure depending on the business situation.Service Improvement MethodsThe literature describes a large emergence of service improvement methods which have been applied in some form to healthcare settings. Most ser vice improvement methodologies that have been implemented in healthcare have been adopted from industry, where the driving force is to maximise profits for shareholders. The adoption of industrial techniques for service and quality improvement has often met with a degree of apology from the medical profession (Moss and Garside 1995) and from the health sector as a full-length. This has been attributed to the professional nature of healthcare, which involves large numbers of autonomous, independent practitioners who often place independence of clinical decision making at the heart of their operating values. (Degeling et al 2003)Recently though, there has been a recognition within the medical profession of the need to storm up standards in healthcare, and to focus on overall quality of care, rather than just direct clinical activity. Included in most definitions of quality is capacity of healthcare delivery. This focus on efficiency is built on the growing recognition that publicl y funded healthcare systems need to be accountable for the expenditure they make. (Donabedian 1988)It is in the context of increased demands for efficiency, increasing burden of chronic disease, and ever increasing expectations from the users of the health services that service improvement in additionls have started to be implemented on a wider scale than ever before.Systematic approaches to service improvement have been in existence for a long time. Taylor published his Principles of Scientific Management in 1911 after many years of employing what are now known as time and motion studies to various industrial touch ones. His approach was much criticised for giving too much power to managers, and its use was even banned by the American Senate in defence establishments for relying too heavily on command and control leadership (Mullins 2005a). However, his methods produced great improvements in efficiency, and he made an argument about systems which is still valid today The remedy f or this inefficiency lies in systematic management rather than in searching for some unusual or extraordinary man.(Taylor 1911)Total Quality ManagementThis approach to systematic improvement was developed by Deming during his work with Japanese manufacturers in the aftermath of World War II. He was initially concerned with education statistical control methods to Japanese manufacturers to improve efficiency. However, he adjusted his teaching to focus on the transit, rather than individual performance, and emphasised the need for good management and a collective push for optimisation. He published his recommendations for industry, government and education, which set out his 14 points for management in the seminal work Out of the Crisis (Deming 1986). TQM is more than a technique or set of tools for improvement, and can be described asa way of life for an organisation as a whole, committed to total guest satisfaction through a continuous process of improvement and involvement of pe ople. (Mullins 2005b)TQM has been utilised in healthcare since the early 1990s, and aspects of it are increasingly being employed today. It is often the tools associated with the approach which are used, rather than the sell systems change originally described, and this lack of clarity regarding the true nature of what is called TQM has contributed to a lack of clear evidence of benefit. (vretveit and Gustafson 2002) Where the whole package of TQM has been implemented, results have been mixed, but there are numerous examples of where certain elements have shown benefit. The most commonly employed techniques derived from TQM are statistical control methods, and the PDSA cycle.Plan Do Study Act (PDSA) aboard his work on TQM, Deming is credited as being one of the key proponents of the PDSA (or PDCA) cycle. This cycle of erudition, implemented as a quality improvement tool had been taught by Shehwart (1939) whilst Deming was working with him. Deming took this knowledge to Japan and i t formed part of his work on TQM (Hossain 2008).The cycle reflects Kolbs learning cycle (1973), and is a tool for testing changes, and reacting to the results. It can be seen as either a standalone tool for change, as part of a larger system of change, or as a key part of a philosophy for wide-scale change across an organisation.(Cleghorn and Headrick 1996)The PDSA cycle consists of four partsPlan The objective of the test must be defined, and a method of data assembling must be incorporated.Do The planned change to a process is carried out, with concurrent data collectionStudy The data is analysed, compared with predicted outcomes, and a summary of learning is produced.Act The conclusions from the data are utilised, and used to inform the next plan.The underlying rationale for the PDSA cycle lies in systems theory. Systems theory implies that piffling scale changes within a system can create large results. The PDSA cycle is useful for testing small changes, and reflecting on the effects before either applying them across a whole system, or making further changes (Berwick 1998). When cogitate together, PDSA cycles can be used to drive up quality.This approach of multiple linked cycles and this approach of multiple linked PDSA cycles is used in the Model for Improvement, the rapid cycle model of change, and the collaborative approach (Langley et al 2009, 1992 Institute for Healthcare Improvement 2003).In contrast with small PDSA schemes within a team or organisation, the collaborative approach uses multiple PDSA cycles within separate organisations, whilst aiming for improvement in a shared area of careThe PDSA model, when used within the model for improvement, or as a chain of cycles within a atomic number 53 team is a clear, simply understood, but almighty tool for implementing change, and improving quality. Its strength lies in its ability to be applied to small scale changes, but achieve significant results. From an organisational point of view, the re latively small amount of resource which is required to test each hypothesis makes this model very attractive. Processes can be studied with little disruption of everyday activity, and if the results are not favourable, learning can continue without significant loss to the organisation. In clinical processes, the PDSA cycle is an excellent tool for testing hypotheses, especially where evidence whitethorn be lacking and inaction seems inappropriate, but action without reflection sees un-wise (Berwick 1998)The smaller, more local focus of PDSA cycles, and small resource requirements make this model particularly companionable to staff of all levels, and as the engagement of frontline staff, and in particular doctors has been shown to be a key factor in the success of change in the healthcare setting, this is a major strength. (Greenhalgh et al 2004 and vretveit 2005)The incorporation of the PDSA cycle into wider schemes of change management brings additional complexity, and also invite s additional problems. There have been varied results in the death penalty of the collaborative approach within healthcare as a service improvement tool. Some studies report great success (Monteleoni and Clark 2004 Schonlau et al 2005) while others (Newton et al 2007) found that there were difficulties using the same model. The major difficulties identified were lack of adequate resources, the conceptual difficulties associated with the model, and poor leadership. A juvenile review concluded that there is currently no evidence about the long term results or cost effectiveness of collaboratives compared with other models. (vretveit 2002).Toyota Production System (TPS) / LeanOne approach to service improvement which is being applied with growing enthusiasm within the NHS is Lean. Lean thinking and theory emerged from studies of the manufacturing processes at Toyota. The term was first used in the late 1980s and the approach grew in stature after the publication of The Machine that C hanged the World (Womack et al 1990). Lean was not originally a single tool or approach, but instead was a philosophy to which all members of an organisation aligned themselves. This whole systems approach is probably now better value at the Toyota Production System (Liker 2003). The success of Lean/TPS has led to a proliferation of schemes which fall under the umbrella of Lean thinking but do not necessarily hold to the original principles.The TPS was developed in the 1950s in Japan, and was first published in English in 1977 by Sugimori et al. The system has been studied extensively, but many organisations, despite implementing the principles behind the TPS, have not achieved the efficiencies and quality that Toyota exhibit. (Spear and Bowen 1999). There have been many attempts to reduce the TPS to a method which can be applied in many settings, but as Sutherland and Bennett (2007) state, such a complex process cannot be adequately documented. They suggest that instead, to unders tand the system, one must learn from mentors, much like a child learns and forms habits from their parents. Liker (2003) sets out 14 principles of the TPS, but for the purposes of this assignment, three will be examined1. The thorough elimination of waste (muda)2. Jidoka or the primacy of quality3. Kaizen continuous incremental improvementOhno (1988) identifies 7 wastes (muda) which should be eliminated from any system.These areOverproduction production of more than is required for immediate use stand up / Waiting any delay between the end of one process, and the start of another.Unnecessary transportation of materialsOverprocessing using more energy than required for a given process, or exceeding the agreed specificationExcess inventory any raw materials or work in progress in excess of customer requirements.Motion any unnecessary movement of workers, eg. reaching / stretching.Defects any process or work that results in unacceptable goodsThese wastes have immediate equivale nts in most healthcare settings, and underpin a lot of the efforts in healthcare which are labelled as Lean. From these definitions many techniques for identifying waste have been developed. The NHS Institute for Innovation and Improvement (NHSIII) has developed a serial publication of products known as the Productive Series which use the elimination of waste to improve healthcare. The tools used in the productive series are often taken directly from industry (NHSIII 2007), and include some elements which date back as far as the Scientific Methods described by Taylor (1911).Jidoka is defined by Toyota (2010) as automation with a human touch. When applied to a manufacturing context, this emerges as the principle that a process should continue unless a crack is noted. Once that defect has been detected, work should stop until the problem is solved. This principle ensures in manufacturing that if a machine or worker detects a problem, or a process issue, the line is stopped, a solutio n introduced and, vitally, incorporated into the standard workflow. In this way, the defect should not arise again. The early detection of defects on a production line, and the authorization of workers to raise the alarm if defects occur also reduces waste. It is unfortunate that, although many principles of the TPS/Lean system are implemented in healthcare, it is often this concern for detecting problems and creating solutions which are incorporated into standard work which fails to be introduced. One reason cited for this area failing to be implemented is that clinical care cannot stop, in in this respect, clinicians tint methods for producing widgets cannot be applied to the art of healing (Wilson et al 2001). There are examples of where this concept has been introduced, into the healthcare environment, with clear evidence of improvements (Ball and Rgnier 2007), but a recent paper argues that more could be done (Grout and Toussaint 2010)Kaizen is the culture of continuous, incr emental improvements to a system (Imai 1986). This cultural philosophy of scientific experimentation, conducted at the lowest possible level in the organisation, is held up by Spear and Bowen (1999) as one of the key elements of the success of the TPS, and as a key stumbling block for others who seem unable to imitate Toyotas success. This philosophy, combined with other unwritten rules combine to create a community of scientists, who engage in experimentation to solve problems. These problems are often on a small scale, and the process closely follows the PDSA cycle. When this principle of widespread, incremental change is adopted across an organisation, with recognition of the value of tacit knowledge, it is possible for a learning organisation to emerge (Howells 1996).In conclusion, there are many approaches to leadership and service improvement which are being used in the healthcare setting today. commit of an adaptive model, which allows a leader to change management style de pending on the team they are leading, and the task in hand, is most appropriate for leaders of modern medical teams, in a large part due to the very flexible nature of the teams involved. The application of industrial quality improvement techniques to healthcare has great potential, and successful trials have been conducted. However, a common feature discussed in analyses of obstacles to implementation is the engagement of medical professionals. Through the use of effective leadership, and engagement of these key stakeholders, it is possible to lay the foundations for a learning organisation. A learning culture which is open to the possibilities of change through quality improvement strategies will ultimately be the most fertile environment in which to implement change for a better quality of care.