Leadership And Service Improvement Management Essay

Leadership And Service Improvement oversight EssayThe study of leading and leading has led to m either competing theories which attempt to distill the essence of with child(p) attractership into its comp singlent fractures, to allow others to acquire some of these attri just nowes, and become a lot telling leading.The real early theories on leaders tended to assume that leaders were born, and that leadership was not a adroitness, or crop of skills that could be acquired. The boilers suit impression was that Great Men had inherited leadership qualities from their ancestors, which would make them useful leaders when placed in positions of authority (Kirkpatrick and Locke 1991). This is not a really helpful way 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 striking leap from identifying natural leaders to identifying which separate of their character or personality ma rk them out from others. This underpins the Trait theories of leadership.Trait hypothesis was analyse extensively in the mid part of the 20th Century, and had a wide feed of results. Kirkpatrick and Locke (1991) explain that trait guess do no self-reliances as to the origins of the traits studied, exclusively obviously lavishlylighted the differences between leaders and non-leaders. In 1974, Stodgill published the results of his studies of leadership theory, and identify 22 traits and skills which are present to varying degrees in the individuals studied. This did not picture how individuals could become better leaders, nevertheless, the identification of leadership as a skill has been vital in the subsequent development of leadership training. He himself finally think 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 underly ing traits or world views. They examined the ways in which managers and leaders bettermented a toil, and tried to under bear the motivating factors. McGregror (1960) matte in that location were two study theories of man motif 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 dis exchangeables solve, and therefore must be coerced to act at the required level. The motivating factors here are extrinsic. Theory Y assumes that bunk is a natural part of life, as much as is command or rest, and intrinsic motivation is key. This intrinsic motivation sess be viewed as an expression of the Hierarchy of Needs (Maslow 1943) The work of McGregor in hurled the achievement of manners to map leadership behaviours. Blake and Mouton (1964) plotted carry on for business against allude for people. This produces a helpful framework for mapping behaviours, but it is rather dormant in for m, and seems mainly useful for reflection or critique, to inform future tense endeavours. It does not necessarily inform leaders of what behaviour is outmatch suited to the group they are functional with at a particular while. feat centred leadership was proposed as a leadership framework by Adair (1973). His time in the Army and work as a trainer at the Royal Military Academy at Sandhurst led him to develop a model that considers three field of studys lying-in, aggroup up up and individualist. He argues that each domain requires the anxiety of a leader, but the relative importance of each exit vary. The relationship of these domains is represented by a venn diagramTask demand squadmaintenanceneedsIndividualneedsThis model then expatiate the reachs a leader should address in each domainTask Practical managerial concerns, for example creating a plan, monitoring performanceTeam Facilitating group working(a) by agreeing standards of behaviour, resolving group conflict s etc.Individual Ensuring individuals are performing as head as possible by supporting by dint of challenges, allocating work according to strengths etc.There is tidy 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 do such an impact was providing a practical framework which allowed leaders to flow some of the softer skills of leadership with more managerial traits of time trouble and task focalise on.Situational / Contingency Theories of LeadershipThe studies of leadership discussed above give birth all looked at leaders and leadership behaviour and described them, allowing leaders to analyse their behaviour. The theories above, over time micturate 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 just about the possibility of adaptive styles of leadership (Schermerhorn 1997). The study of leadership in unalike situations and settings, and the observation that the about effective style of leadership ex win overd 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 outstrip to go down a preferred leadership style. Fiedler then studied working conditions, and described them through three variablesLeader-member relations how imparting team members blaspheme and will follow a leaderTask structure how well defined a task is, or if it follows a standard mathematical serve wellPosition Power the extent of the rewards and punishments a leader has available. with his studies, Fiedler constructed a visual guide to represent his findings about which type of leader was around effective presumption the situational variables.The model states that leaders with high LPC score s should work with teams where the situation is moderately favourable. The more task poreed leaders will be more effective in situations which are either precise favourable or unfavourable to the the leader. This model has been studied extensively and has legitimate both critique (Ashour 1973) support (Strube and Garcia 1981). A major source of quarrel in this model is the LPC. single of import point to note is that Fiedler felt leaders would find their behaviour difficult to alter, and agreements should therefore pick the limit leader for a disposed(p) team. This is in contrast to other models which signal leaders should be adaptable.The Hersey-Blanchard (1969) model of situational leadership looks at a different variable in the team background 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 favour top executive of the situation. In this model, a two by two grid which is very similar to the Blake Mouton (1964) Managerial Grid, is apply to describe four leadership stylesS1 Telling (low relationship, high task)S2 Selling (high relationship, high task)S3 Participating (high relationship, low task)S4 mission (low relationship, low task)There is an accomp eaching scale which rates the team a leader is concerned withM1 Low competence, and low commitmentM2 Low competence, and high commitmentM3 senior high school 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). Job 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 empirical research. Graeff (1983) claims that the maturity scale is invalid, as it classifies workers who earn skill and are unmotivated (M3) as more mature than those who omit skill but are dedicated to a task(M2). He overly 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 alter 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 boldness 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 virtually important aspect of the model is the recognition that leadership styles a re not fixed, and leaders can change their approach to suit a given team or individual.In unexampled health trade settings, there has been a change in the nature of teams. There is no longer a stable, splendid, stratified 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 produce 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 cope 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 only one leadership style they use them seamlessly and in different measure depending on the business situation.Service Improvement MethodsThe literature describes a massive chip of service mendment methods which obligate been applied in some form to health care settings. Most service improvement methodologies that have been implement in health care have been pick out from industry, where the driving force is to maximise wampum for shareholders. The adoption of industrial techniques for service and lineament improvement has a good deal met with a degree of resistance from the medical profession (Moss and Garside 1995) and from the health sector as a self-coloured. 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 watch of their operating values. (Degeling et al 2003)Recently though, there has been a recognition in spite of appearance the medical profession of the need to drive up standards in healthcare, and to digest on overall quality of care, rather than just direct clinical activity. Included in most definitions of quality is efficiency of healthcare delivery. This focus on efficiency is built on the growing recognition that in public 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 legal documents 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 more years of employing what are now cognise as time and motion studies to various industrial processes. His approach was much criticised for giving too much power to managers, and its use was even out(p) by the American Senate in defence establishments for relying too heavily on comm and and jibe 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 for this inefficiency lies in dogmatic focal point rather than in searching for some strange or extraordinary man.(Taylor 1911)Total Quality ManagementThis approach to systematic improvement was developed by Deming during his work with Japanese manufacturers in the outcome of populace War II. He was initially concerned with teaching statistical control methods to Japanese manufacturers to improve efficiency. However, he adjusted his teaching to focus on the process, rather than individual performance, and emphasised the need for good caution 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 tabu of the Crisis (Deming 1986). TQM is more than a technique or set of tools for im provement, and can be described asa way of life for an organisation as a whole, committed to total customer satisfaction through a sustained process of improvement and involvement of people. (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 employ, rather than the wholesale systems change originally described, and this lack of pellucidity regarding the true nature of what is called TQM has contributed to a lack of clear usher 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 authoritative elements have shown benefit. The most commonly employed techniques derived from TQM are statistical control methods, and the PDSA stave.Plan Do Study Act (PDSA)Alongside his work on TQM, Deming is credited as being one of the key proponents of the PDSA (or PDCA) cycle. This cycle of breeding, 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 it formed part of his work on TQM (Hossain 2008).The cycle reflects Kolbs learning cycle (1973), and is a tool for proveing 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 school of thought 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 entropy collection 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 rat ionale for the PDSA cycle lies in systems theory. Systems theory implies that small scale changes within a system can throw large results. The PDSA cycle is useful for testing small changes, and reflecting on the do before either applying them across a whole system, or making further changes (Berwick 1998). When linked together, PDSA cycles can be used to drive up quality.This approach of two-fold 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 single team is a clear, simply understood, but powerful tool for implementing change, and improving quality. Its strength lies in its ability to be applied to small scale changes, but achieve strong results. From an organisational point of view, the relatively 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 pure tool for testing hypotheses, especially where evidence may be absentminded 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 accessible to provide of all levels, and as the take inment 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 invites additional problems. There have been varied results in the implementation 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 new-fangled 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 takings 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 mid-eighties and the approach grew in stature after the publication of The Machine that Changed 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 recognise 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 mid-fifties 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 attempt s 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 understand 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 areoverrun production of more than is required for fast useDelay / postponement any delay between the end of one process, and the start of another. spare 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 surplus 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 equivalents 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 series of products cognize as the Productive Series which use the elimination of waste to improve healthcare. The tools used in the productive series are often interpreted 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. formerly that defect has b een 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 solution 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 empowerment 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 feel methods for producing widgets cannot be applied to the art of better (Wilson et al 2001). There are examples of where this concept has been introduced, into the healthca re 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, incremental 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 replicate Toyotas success. This philosophy, feature 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. Use of an adaptive model, which allows a leader to change management style depending 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 plentiful environment in which to implement change for a better quality of care.