Motivational Management Developing Leadership Skills

Diane M. Eade

Whether you work in a hospital, private practice, health maintenance organization, government facility, or university, you probably supervise other people. Your behavior as a manager has a direct impact on staff performance, productivity, satisfaction, and turnover. In this article, an expert management consultant examines qualities of managers who motivate, providing proven techniques to inspire those who work for you.

Perhaps the single most important technique for motivating the people you supervise is to treat them the same way you wish to be treated: as responsible professionals. It sounds simple; just strike the right balance of respect, dignity, fairness, incentive, and guidance, and you will create a motivated, productive, satisfying, and secure work environment.

Unfortunately, as soon as the complexities of our evolving health care delivery system mix with human relationships, even the best-intentioned supervisors can find the management side of their jobs deteriorating into chaos. Today's health care providers face expanding workloads, fewer resources, greater patient expectations, increasing threats (e.g., malpractice lawsuits), and closer scrutiny, especially from third-party providers. The art of healing is being transformed into a business. And like it or not nurse practitioners and physician assistants often find themselves in middle-management roles, with tremendous responsibility and little real authority. Job performance is reflected more in the bottom line than in the quality of patient care. Why, in this environment, do some managers thrive while others burn out? The answers lie in each manager's ability to inspire trust, loyalty, commitment, and collegiality among team members. The same techniques that work elsewhere in business can bring success in nursing and medicine - whether you're working in clinical practice, administration, or academia. More often than not, though, the task can be accomplished only by replacing learned behaviors with newer, more effective models.

UNLEARNING AUTOCRATIC STYLES
Good management technique used to be simple. The boss told employees what to do, and they complied. No one worried if somebody's feelings were hurt along the way. Employees who failed to toe the line were either whipped into shape or fired. These authoritarian managers believed that authority should (in a moral sense) be obeyed. Therefore, they expected unquestioning obedience from their subordinates and they, in turn, submissively obeyed their own superiors. What could be simpler? Fear ran the work setting. The system was efficient.

Health care delivery, in particular, followed this autocratic model. The physician's order ruled, without question or negotiation. Physicians, in turn, had their own hierarchy. Authority was understood, respected, and obeyed.

The example set by past generations has led to huge numbers of autocratic managers today. Some lead this way because they honestly, and consciously, believe it is the best management style. For most, however, it is how they were treated throughout their careers (particularly at a first job). The cycle works very much like child abuse, where the abused child grows up to be an abusive adult. If you were managed by an autocrat, it is very likely that your most natural, comfortable method of management reflects that of a previous supervisor, especially your first.

Physician assistants and NPs find themselves particularly vulnerable to this cycle of abuse. Both professions faced great hostility from the moment of their inception. Today's NP or PA leaders spent years struggling to prove their professions' full worth, overcoming the mentality that nonphysician providers were hired to answer telephones and empty bedpans. Frighteningly, today's senior PAs and NPs are the product of that mentality.

WHY CHANGE?
While fear as a management style can accomplish impressive short-term results, the long term consequences can be devastating. With demand high and supply short for NPs and PAs, no manager can afford to alienate other clinicians. Similarly, efficient support staff are also becoming harder to recruit and train, as the technology of the workplace speeds along at a blinding pace. Disgruntled employees may vent their frustrations by being rude to patients, performing poorly, quitting, or complaining to upper management; some supervisors may even face lawsuits for treating subordinates unfairly.

An autocratic management style feeds high staff turnover and low employee morale. Low morale, in turn, causes a decline in productivity and in the quality of service provided to your patients. And while many autocratic managers still populate the American health care system, reform demanding higher efficiency and productivity will eventually squeeze such managers out of the marketplace. In short, motivational management produces better results; those who focus on positive reinforcement rather than fear and intimidation will be the successful managers in the next millennium.

UNDERSTANDING CHANGE
Because autocratic management is a learned behavior focusing on dramatic, short-term results, true change can come only from within. Such change requires an understanding of the need for a new management approach. Motivating yourself to change is the first step in learning to motivate others.

Decisions that incorporate the ideas of a group of people are vastly superior to the single viewpoint of one person imposed on the rest of the group.

Rapid, relentless advances in technology and vast amounts of new information pounding at us every day make it impossible for a single leader to know more than the sum of his or her subordinates. Each team member's knowledge and perspective are essential to good decision making. Decisions that incorporate the ideas of a group of people are vastly superior to the single viewpoint of one person imposed on the rest of the group.

In past generations, employees stayed with a company for the duration of an entire career. Today, people change jobs several times during their working years, and many change careers altogether. This adaptation to change gives employees more options. When a well-trained employee quits, the business incurs not only out-of-pocket hiring and training costs, but the "opportunity cost" of having a less effective, brand-new employee who will require 3 to 6 months before becoming a productive, efficient member of the team.

Fundamental changes in American society also herald the end of the autocratic manager. The extended family unit - two-parent households supported by closely linked (geographically) grandparents, aunts, uncles, siblings, and cousins - is the exception, not the rule. Divorce and geographic mobility undermine the role of the nuclear family. Most managers accept how child care, family leave, and single-parent households are changing the workplace. But what about the void that now exists where once was a powerful family unit of "belonging"?

The role of the traditional family is being replaced by the workplace. More and more employees look for jobs where people matter. Such employees want to work with managers, not for them. This presents a huge challenge for businesses and creates a responsibility for which most managers are unprepared.

BREAKING ESTABLISHED PATTERNS
Autocratic management requires less skill and effort than participatory management, so the decision to change requires true commitment. In the autocratic model, you simply exercise your authority, make a decision, and take responsibility for the results. Participatory management means learning and playing by a whole new set of rules. Such change is never easy.

The first step toward a new style of leadership is deciding that you need and want to change. Involving your staff in decision making requires diverse and refined interpersonal skills. You need to learn the capabilities and aspirations of each subordinate in order to use participative techniques without wasting vast amounts of time. Time constraints, personality traits, and lack of consistent motivation often combine to work against managers' efforts to develop these skills. Behavior change takes time, focus, and practice.


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PATHWAY TO SUCCESS
Good management, like good health, is the result of daily conditioning. What qualities lead to successful motivational management? The following sections - plan; teach; delegate, not dump; encourage independent thinking; build a team; listen; set an example; accept responsibility; and share the spotlight - set forth proven strategies for becoming an effective leader in today's business world.

Plan
Planning may be the most important and most overlooked aspect of effective management. Take, for example, a practice in which clinicians are expected to see 30 patients each day, or a hospital where each practitioner routinely manages 20 critically ill patients. To that, add walk-ins and emergencies. Triage is random, with little thought given to support and backup. The clinician loses all control of time, constantly running from one crisis to another.

Consider, too, the clinician who routinely directs clerical staff to begin work on numerous projects, without establishing priorities or understanding the amount of work involved. Many of the projects are never completed; others are rushed and sloppy. A pattern of "false starts" develops, leaving employees feeling disempowered and frustrated.

Good planning involves a sense of strategic direction. What does the team need to do, in a global sense, to get to an established goal? What constraints can be identified, and can each member of the team contribute?

It must be noted that solid strategies are necessary, but not sufficient in and of themselves, for good planning. Detailed action plans based on those strategies are critically important. The key to effective management is how you involve your subordinates in the development of these action plans. Solicit input from all, and listen with an open mind. The people who actually do the work can provide you with invaluable insight into how to get the job done. Negotiate a consensus, and then make certain everyone agrees on who will do what, by when. Once an action plan is adopted, make sure the team has the resources (e.g., funds, equipment, and human power) to execute those plans.

Become a Teacher
A role model for the effective participatory supervisor is the teacher who views any shortcoming as an opportunity for you to grow, someone who always focuses on your potential when he or she works with you. Such managers consistently support their employees, helping them discover the paths to success.

To help yourself reach your potential as a participatory manager, try some of these techniques:

First, list the benefits of becoming a good teacher for your subordinates, and share that list with the people you supervise. There's nothing like a public commitment to keep your own motivation high!

Next, approach teaching as a reflection of your personal values. Know that your personal power is greatly enhanced when you live up to your own principles and values.

Remember that to be an effective teacher you do not need to know everything your subordinates know. Rather, you must invest your energy in creating opportunities for your subordinates to become experts in their skill areas. Then, give them the chance to demonstrate their expertise.

View teaching as your primary responsibility. It is not an also-ran for effective managers. And as your subordinates grow, reward them; nurture their careers and professional growth in every way possible.

Delegate, Never Dump
The easiest way to become good at delegation is to surround yourself with subordinates whose abilities you respect; then you would be foolish not to use them to the best of their capabilities. When people sense that you expect great things from them, they tend to be challenged by that expectation and work hard to live up to it. Load your people with responsibility, provide them with the resources to do the job, and never be punitive when they make mistakes.

Delegation crosses the line and becomes dumping when we delegate only the work we don't want to do ourselves; keep all the "glorious" fun projects for ourselves; fail to provide adequate resources for our subordinates to complete their work; delegate all the responsibility and none of the authority for the job; or abandon our subordinates, failing to provide them with timing requirements, project guidelines, or our personal counsel when they need it.

Encourage Independent Thinking
Consistently encourage your subordinates to come to you with problems and solutions. If they come to you only with the problem, it's your job to elicit their opinion for correcting the situation. Listen to their suggestions; draw them out. Help them to think the solution through. Ask them a series of questions that encourage them and lead them to a workable solution.

Such independent thinking demands your recognition that your solution to a problem is not the only solution; it may not even be the best solution. Give your subordinates the latitude to try new options, within reasonable limits, and your workers will start to develop their real potential.

Build a Team
Similar to the teacher analogy, effective participatory managers strive to build cohesive teams, seeing themselves as the team's captain. The team captain inspires excellence and earns loyalty, serving as a role model to be admired, not feared.

The most effective teams comprise members with diverse skills and personalities. These are also the most difficult teams to manage. It can be frustrating work, but the rewards are tremendous when you watch the team become greater than the sum of its parts.

In planning, you determined the goals of the team. To manage the team successfully, make sure everyone clearly understands his or her role in reaching those goals. Communicate the rules or norms for operating together. For instance, a rule that many successful teams adopt is, "When you have a problem with any team member, it is your responsibility to discuss the problem directly with that team member. If you approach another team member instead, you will immediately be referred to the team member who has caused you difficulty."

As the team leader, it also becomes your responsibility to help integrate the individual personalities of team members. Encourage cooperation and coordination among members. This may occasionally mean sharing the perspective of one member with another to facilitate mutual understanding and respect.

Listen
Many managers talk about being good listeners, yet this skill often remains an area in need of substantial improvement. The benefits of good listening are numerous. Relationships improve, productivity and work performance are enhanced, team spirit is fostered, morale increases, and your staff gains better perspective and understanding of your mission as health care providers. Good listening skills engender trust. And trust is what separates effective participatory leaders from autocratic managers.

If you're listening effectively, the odds are that your subordinate is talking 80% of the time, and you're talking only 20% of the time. When you speak, you ask short, simple questions that draw the person out. What's more, you ask questions in a concerned, nonthreatening style and tone. Good listeners let their subordinates vent when necessary and acknowledge their feelings.

It is critical that the listener stay open and nondefensive, conveying genuine concern, no matter what the staff member says. Maintain the attitude that this person is your teammate and wants to improve things. Learn all you possibly can from your teammates so you are able to address their concerns effectively. Demonstrating your concern by helping team members resolve problems to their satisfaction not only strengthens the unit, it also provides flexibility for you when problems that are beyond your control arise. Past successes build trust, so your teammates are much more likely to listen to you and be reasonable when a problem exceeds your authority.

Set an Example
People rarely learn from what we tell them to do. More often they learn from example. If you have any doubts, go back to the discussion of autocratic managers and child abusers. Not only does the example you set dictate your success as a manager, but it teaches tomorrow's clinicians how to lead. So set a good example.

Start by living up to the rules you've already negotiated with team members. Treat each staff person with respect. Be kind and courteous. Keep your cool in crisis situations. Your calm will be just as contagious as your panic and temper flare-ups. Keep your word - to the letter. Nothing undermines trust in a professional setting more precipitously than a manager who breaks his or her commitments.

Accept Responsibility
Perhaps the most frightening aspect of management is that you've become responsible for someone else's performance. People do things their own way, and sometimes they make mistakes. While your subordinates are responsible to you for their mistakes, you are responsible to your manager for those mistakes. Don't pass the blame down to your subordinates. It's your department; the buck stops with you. Your team respects your integrity and trusts you to lead. You become a champion, not an oppressor.

Share the Spotlight
The flip side of accepting responsibility for everything that goes wrong is giving subordinates just credit for everything that goes right. Never take credit for a subordinate's work, and mention names at every possible opportunity.

Don't be afraid that this approach endangers your own career. You were made a supervisor because others in authority recognized your capabilities. The test of your value as a supervisor is your ability to create a productive, efficient team. Show management that working for you is the best thing that ever happened to your staff by drawing attention to each subordinate's excellent performance. If your team is performing at a high level, you won't need to blow your own horn - your value will be obvious.


Assume responsibility for your own actions. If you are not successful, don't blame anyone else. Take it on the chin and learn from it.
Assume responsibility for your emotional reactions. It's not what happens to you that matters; it's what it means to you that determines your reaction. Stand back and get perspective. Ask yourself, "What can we learn from this?" and it's easier to control yourself.
Identify the potential in each of your subordinates. Remember that people tend to live up to our expectations of them. Let your people know how terrific you think they are.
Make an inventory of the resources at your disposal and use those resources to help your staff perform better. We live in a world of limited resources. Given that restraint, how can you optimize the results your department delivers?
Be optimistic. Optimism is contagious; so is pessimism. If your team is going to develop a positive, can-do attitude, you will need to set the tone.
Develop a team vision for your department. Define what the team will become - make it inspiring! This is particularly powerful when you develop your vision as a team.
Set specific and measurable goals to make that vision come true. Include time frames and resource requirements.
Treat others with empathy and respect - no matter what. Gain the independence, power, and self-respect that come from doing the right thing, without regard to what others do.
Think less about your own needs and more about the needs of your team. You will reap what you sow.
Set an example - be a high performer. Work hard and smart. People will follow your example. Be honest with yourself and your team. Realize that eventually, people who work with you will know you for who you are. Be open to their criticism and learn from it.
Set a schedule for your own training and development - stick to it. Keep yourself growing and motivated. You're worth it.
Model your management style after someone who inspires you. It's hard work to cut a path through the woods. It's much simpler to walk in someone else's tracks.
Good input = good output. Find and consistently use good sources of management guidance for reading, viewing, and listening.

Eade D: Motivational management: Developing leadership skills. Clinician Reviews 1996; 6(10):115-125.

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