Finding the Right Leadership
Style for Your Quality
Improvement Agenda
ISQua Global Webinar
May 6, 2014
Dr. Ben Chan, MD MPH MPA
Assistant Professor,
Division of Global Health & IHPME
University of Toronto
www.ihpme.utoronto.ca
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Objectives
 Understand difference between leadership
& management
 Learn about different leadership styles
 Consider pros & cons of different styles &
their relationship to quality theory
 Reflect on the fit between your leadership
style, your work context & what you want
to achieve in quality improvement
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Leadership
vs
Management
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Leadership vs Management
Leadership
Innovates
An original
Inspires trust
Long-range view
Asks what and why
Tells us where we’re going
Designs
Murray, 2010
Management
Administers
A copy
Relies on control
Short-term view
Asks how and when
Gets us there safely, on time,
on budget
Executes
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What Motivates People?
MacGregor’s Theory X & Y
Theory X
Theory Y
Workers don’t like to work
Workers like to work, are self-motivated
Workers need constant
supervision, direction
Workers need creative space
Workers motivated only by
fear of punishment, explicit
rewards
Workers motivated by greater
responsibility, pride in job well done &
satisfaction with mastery of skill
May be most applicable in
Most applicable in high-skilled
workers with low-skill, routine professions with complex tasks
tasks
requiring judgement, problem-solving
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Emotional Intelligence viewpoint
 Leaders can sway emotions of group
 Resonant Leadership
 Drive emotions positively
 Develop connection with followers, exhibit
empathy
 Performance soars when staff emotions
pushed towards enthusiasm
Goleman, 2002
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What Quality Results Do We Want?
 Better outcomes
 Better execution of clinical best practices
 Better measurement
 More accountability
 Better costs
 More efficient use of resources
 Reduced waste
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What Quality Results Do We Want?
 Better patient experience
 Courteous interaction
 Engagement in decision-making
 If this is the type of patient interaction do we
want, then how does our leadership style
reflect & model the behaviours we want our
staff to adopt?
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What Quality Results Do We Want?
 Creating a safe hospital – push to
eliminate avoidable adverse events
 Develop a culture of safety
 Staff rewarded, not punished for errors
 Motivation based on improvement, not fear
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Leadership Styles: Classifications
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Lewin’s Leadership Styles
 Authoritarian / autocratic
 Democratic / participatory
 Laissez-Faire / delegative
Lewin, K., Lippit, R. and White, R.K. (1939). Patterns of aggressive behavior in experimentally created social climates.
Journal of Social Psychology, 10, 271-301
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Blake-Moulton Leadership Grid
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Goleman / Emotional Intelligence
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Commanding
Affiliative
Coaching
Pace-setting
Democratic
Visionary
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Wikipedia

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
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Authoritarian
Paternalistic *
Democratic
Laissez-Faire
Transactional *
Transformational *
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Authoritarian

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
aka Commanding (Goleman)
Leader makes key decisions
Outside input into decision limited
Workers told what to do & how to do it
More closely aligned with Theory X
Fear a key motivation
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Authoritarian
Pros
Fast, efficient
Cons
Short-term gains outweighed
by long-term dysfunction
Great if you have an
Loses wisdom, observations
extremely smart, wise leader of other key individuals
May be useful in a crisis
Applicable in organizations
Employees disengaged,
with low-skilled workers
demoralized
doing routine tasks?
Talent flight
(some would disagree with this)
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Pacesetting
 Similar to Produce or Perish (BlakeMoulton)
 Leader holds high standards – for self &
organization
 Always demanding faster, better
performance
 If poor performance, pushes staff harder
or fixes problem him/herself
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Pacesetting
Pros
Works with very hightalented, self-driven teams
Focused on results
May be useful in start-up,
entrepreneurial phase
Leader fixing problems for
staff may get short-term
results
Cons
Difficult to sustain pace;
anxiety, burnout
Obsession with results at
expense of staff wellbeing
Pressure for immediate
results may restrict creativity,
innovation
Micromanagement erodes
trust, stunts development
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Visionary






Aka “Transformational” leadership
Leader articulates where group is heading
Sets forth an inspiring vision of the future
Builds excitement
Resonates with values, aspirations of staff
Leader helps staff see how their work will
contribute to a better world
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Visionary
Pros
Gives clear direction to
organization
Cons
Conflicts if other strong
individuals in organization with
competing vision
Motivates, excites
employees
If implementation weak, failure to
achieve vision demotivates staff,
leads to cynicism
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Paternalistic
 Leader takes care of employees, gets
strong loyalty in return
 Employees feel like part of the family
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Affiliative
 Similar to “Paternalistic”, consistent with
“Country Club”
 Promotes harmony among followers
 Nurture personal relationships, emotional
needs of employees
 Helps resolve any conflict
 Build teams to ensure followers connected
to each other
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Affiliative / Paternalistic
Pros
Helpful in healing
organizations with serious
divisions, conflicts or broken
trust
May be popular in certain
regions of the world
Produces happier workers
Cons
Focus on praise,
relationships at expense of
results; may send message
that mediocrity is tolerated
Staff may not receive
enough specific advice on
how to improve
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Coaching
 Leader aims to bring out best in key staff
 Invest in personal development of staff
 Help staff set long-term goals
 Identify strengths/weaknesses, help staff
identify their calling
 Delegate challenging assignments that will let
them grow
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Coaching
Pros
Cons
Works well if leader has staff If staff not self-motivated,
who are self-motivated
may not benefit from
coaching experience
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Democratic Style
 Seeks input from key people on important
decisions
 Listens carefully to concerns
 Collective decision strengthened by buyin, commitment across organization
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Democratic
Pros
Works well in organizations
with broad mix of highly
skilled individuals
Cons
May be difficult to implement
in settings, cultures where
staff afraid to give input
Develops decisions with
strong shared ownership
May take too long to arrive at
decisions; slow progress can
affect staff morale
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Laissez-Faire
 Leader trusts very talented staff to do their
work, freely delegates tasks
 May set some general expectations for
product but wide latitude on how to
achieve it
 Key leadership task is to find the right
talent in whom this level of trust can be
given
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Laissez-Faire
Pros
Can be useful in
environments where highly
creative or motivated people
need space to innovate or
problem-solve
Cons
If staff not highly motivated
or talented, then
organization suffers from
lack of direction or guidance
with implementation
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Transactional Leadership
 aka task-oriented leadership
 Focus on completion of specific welldefined tasks
 Motivation through reward and punishment
 If tasks highly routine, consider
management by exception
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Transactional / Task-Oriented
Pros
Works best for basic
‘assembly-line’ type tasks
Cons
Not as suited to situations
requiring creative problemsolving
Does not focus on quality of
relationships, team
functioning
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Can You Have More Than One
Style?
 Leaders may combine different styles
 May have a predominant style & learn to
use other styles in special circumstances
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Cross-Reference of Styles
Lewin
Goleman
Authoritarian
Commanding
Pacesetting
Democratic
Blake-Moulton
Authoritarian
Publish or Perish
Democratic
Affiliative
Wikipedia
Democratic
Country Club
Paternalistic
Coaching
Laissez-Faire
Laissez-Faire
Visionary
Transformational
Transactional
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Leadership Styles:
When to Use?

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
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
Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
Consider when leading
highly trained, motivated
individuals, professionals
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Leadership Styles:
When to Use?





Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
Often reserved for crises, startups, other urgent situations
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Leadership Styles:
When to Use?





Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
Helpful in situations with broken
relationships, mistrust
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Leadership Styles:
When to Use?





Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
Useful in most leadership
situations; often combined with
other styles
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Leadership Styles:
When to Use?





Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
More management than
leadership; consider use in
stable, routine processes
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Reflective Questions
 How would you describe your current
leadership style?
 How would you describe the leadership
style of the person you report to?
 Is there a consistent leadership style
within the culture of your organization?
 Does the leadership style fit the context
you find yourself in?
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Poll: What Best Describes Your
Management Style?
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
Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Scenario 1: Crisis
 You have been asked by the Ministry of
Health to take over a hospital in crisis, as
interim CEO. Its last CEO and three of its
five most senior executives have just been
fired over a fraud scandal. It is suspected
that others in the organization were
involved in the fraud. The hospital is in the
midst of a financial crisis with a deficit
equal to 5% of its budget this year.
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Scenario 1: What Leadership
Style Would You Choose?
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



Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Scenario 2:
 You are starting your first middle management
position which includes housekeeping. C
difficile rates are exceptionally high. Patient
surveys show common complaints about
frequency and quality of cleaning, especially
washrooms. There are policies for this but
nurses complain that the housekeeping staff are
not following them. The outgoing manager says
that housekeeping staff morale is poor, hours
are long, pay is low and turnover is high.
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Scenario 2: What Leadership
Style Would You Choose?
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



Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Scenario 3:
 You are the new Director of a primary care
teaching centre in a low-income country. The
centre very well respected for its work with the
poor and its research. You have inherited a
team with several highly trained physicians and
researchers with good success at getting
foreign-funded grants. Although there are some
divisions, people generally get along. The
biggest worry of the outgoing Director was that
key talent was being lured to wealthier countries.
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Scenario 3: What Leadership
Style Would You Choose?





Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Scenario 4:
 Westbury and Eastview hospitals have recently
merged, and you are now the Chief of Staff of
the new organization. There are deep divisions
and mistrust between doctors in the two groups.
Westside serves the inner city poor and prides
itself on practical solutions & its interdisciplinary
approach, while Eastview serves a more affluent
neighbourhood, has more subspecialists and
greater academic activities. Doctors at both
sides were not consulted about the merger.
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Scenario 4: What Leadership
Style Would You Choose?
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



Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Scenario 5
 You are the new CEO of Safeview hospital. It
has had two high-profile incidents of patient
deaths, from wrong-site surgery & medication
error. The previous administration relied on
incident reports and issued reprimands to staff
for not following policies. Staff are very afraid to
flag safety issues where they were involved.
You want to build a “just culture” around safety
incidents and encourage everyone to report and
create QI teams to fix safety issues.
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Scenario 5: What Leadership
Style Would You Choose?
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



Visionary
Affiliative/Paternalistic
Coaching
Democratic
Laissez-Faire
 Authoritative
 Pace-setting
 Transactional
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Summary
 Many different leadership styles exist
 Address people’s underlying motivation to
follow you
 Theory X & Y, resonant leadership
 Develop a repertoire of different styles
 Select best style for where your
organization is at in its quality journey
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Recommended Readings
 Daniel Goleman et al. Primal Leadership: Learning to Lead with
Emotional Intelligence. Harvard Business School Press, 2002.
 Gary Heil et al. Douglas McGregor, Revisited: Managing the Human
Side of the Enterprise. Wiley & Sons, 2000.
 Alan Murray. Wall Street Journal Essential Guide to Management.
Harper & Collins, 2010.
 Bass, B. M., & Bass, R. The Bass Handbook of Leadership: Theory,
Research, and Managerial Applications. New York: Free Press,
2008.
www.ihpme.utoronto.ca
Dr. Ben Chan, MD MPH MPA
Email: drben.chan@utoronto.ca
Twitter: dr_benchan