Leadership
Carol Alexander, RN, MS
Director of Emergency & Education
Depts.
Porter Adventist Hospital
Denver, Colorado
One of the most universal
cravings of our time is a
hunger for compelling and
creative leadership.
James Burns
Courage
Strength to venture into
uncharted territory, persevere
in the wilderness, and
withstand danger, fear or
difficulty associated with
becoming architects of the
future.
Leadership is...
courage to adjust mistakes,
vision to welcome chance,
and confidence to
stay out of step
when everyone else
is marching
to the wrong tune!
According to ancient Indian
folklore, we need the vision of
the eagle and the view of the
mouse
What We Want from Work

Is my work significant in terms of achieving
critical outcomes and a meaningful cause?
 Does my work enable me to use my creative
talents?
 Will my work make a difference to the world?
Is this how I want to be in the universe?
 Does my work meet my spiritual needs?
Inspirational Leadership
 Define
your cause
 Enable followers to
find their calling
 Align the calling
with the cause
 Serve the followers
Vision without action is a
daydream
Action without vision is a
nightmare
Inspirational Leadership

Guide the
contribution of
brilliance
 Create the
environment that
encourages
followers to
inspire their
leader
If you can dream it,
you can do it.
HIGHER GROUND LEADER
C – COURAGE
A – AUTHENTICITY
S – SERVICE
T – TRUTHFULNESS
L – LOVE
E - EFFECTIVENESS
The Greatest of These is Love
If I have not understanding that
touches the heartbeat of my patients, I
only chatter.
If I have not mastered the gift of
compassion, my endeavors are hollow.
If I do not notice wounded hearts and
broken dreams, my mission is not
fulfilled.
Leadership
 Source
of vision and inspiration
 Creator of options-capitalize on
possibilities
 Capacity to influence others
 Ability to achieve priority results
 Producer of actions that make a
difference
LEADERSHIP PARADOXES
 PROACTIVE
PREFERRED FUTURE
VERSUS CRISIS MANAGEMENT
 COMMITMENT VERSUS
OBEDIENCE
 PROFIT WITHOUT GREED
 QUALITY OUTCOMES NOT
ILLUSIONS
 COACHING NOT ABANDONMENT
LEADERSHIP PARADOXES
 LEARNING
ORGANIZATION
VERSUS COMPETENCY SKILL
CHECKLISTS
 TRUTH NOT UNDISCUSSABLES
 INTEGRATION NOT TURF BATTLES
 REENGINEERING BEFORE
DOWNSIZING
 HUMANISM NOT SUFFERING
The Virtuous Cycle of
Attributes and Results
So that
ATTRIBUTES
HOW IT
HAPPENS
RESULTS
X
WHAT
HAPPENS
because of
From, D. Ulrich, J. Zenger, and N. Smallwood, “Results Based Leadership,” (Boston, MA: Harvard Business School Press, 1999)
Evaluation:
Final results
match
intended
outcome?
Environmental
Identify Desired
Assessment
Outcomes
-Demographic Trends
-Industry Trends
-Through
Vision
-Through Analysis
-Competitor Activity
GAP
ANALYSIS
-Strategic Initiatives
RESULTS
ORIENTED
LEADERSHIP
What
supports
Achieving
Outcomes?
What
obstructs
Achieving
Outcomes?
How to
Maximize
How to
Minimize
Desired Outcomes clear?
Implementation
-Feedback loops &
strategic planning
corrections in place
Focus is on results – not assorted symptoms?
Diverse views/stakeholders included?
Clear plan to engage others?
Measurement and feedback plan in place?
Time frames reasonable?
PLAN
ng
&
De
ve
lo p
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tab
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Ch a
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Attit
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Personal
Prioritizati
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Ac
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Capital
Plannin
Facil
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& Eq
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Was
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Handling
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In
15 Competencies of High-Performance Nurse Managers
2002 The Advisory Board Company
Talented, motivated empowered
ASSOCIATES
Resulting in the
delivery of our Inspire vision
revenue and
& optimism
margin
FINANCIAL
commitment
LEADER
Exemplify our
values
Constantly,
creatively
Nurture &
finding better
develop talent OPERATIONAL
ways to improve
performance
Inspire trust
CASTLE
And become
Partners for Life
to allure service
So we meet
and exceed
CUSTOMER
expectations
ACCOUNTABILITY
The act of accepting
ownership of the results
or lack thereof.
Ham & Eggs $1.98
Levels of Accountability
Below the Line
 Ignore/Deny
 It’s
Not My Job
 Finger-Pointing
 Confusion/Tell Me What To Do
 Cover Your Tail
 Wait and See
Levels of Accountability
Above the Line
 Muster the
Courage to See It
 Fine the Heart to Own It
 Obtain the Wisdom to Solve It
 Exercise the Means to Do It
Enhancing Personal
Accountability
 What
clinical outcomes do I actively
strive to achieve on a daily basis?
 Do I do the right things for
patients/families?
 Do I advocate for high standards
despite unpredictable consequences?
Enhancing Personal
Accountability
 How
can I intentionally discover
innovative solutions to identified
problems?
 How can I collaborate with others to
overcome system barriers?
 If I really “owned it,” what would I
do differently?
Enhancing Personal
Accountability
 Am
I comfortable engaging in risktaking behaviors that produce results?
 What do I pretend to not know about my
personal accountability in a given
situation?
 Do I use excuses that sabotage my
ownership of the consequences of my
actions or non-actions?
Enhancing Personal
Accountability
 Can
I learn from errors and/or mistakes?
 Can I avoid blaming myself and/or others
if the outcomes are acceptable but not
ideal?
 Can I overcome feelings of hopelessness,
powerlessness, and despair so I am
proactively responsive to needs of others?
Enhancing Personal
Accountability
 How
do I let others know that I support
joint accountability?
 Do I have a role in holding colleagues
accountable or is that just the
manager’s responsibility?
 Can I confront colleagues when they fail
to hold themselves accountable?
Enhancing Personal
Accountability
 When
should I give direct feedback
to others in order to create a
culture that values stellar clinical
outcomes?
 Do I support disciplinary
corrective action when I or others
fail to be accountable?
Enhancing Personal
Accountability
 How
can I focus on what I can
control in a given situation?
 Do I embrace coaching and “grace,”
thus avoiding judgment while
refining my own accountability?
JOINT
ACCOUNTABILITY
People share ownership
for organizational results
that come from collective,
not individual activity.
JOINT
ACCOUNTABILITY
Everyone works together so
the “ball” is not dropped.
Should it be dropped,
everyone dives for the
“ball” to pick it up.
JOINT
ACCOUNTABILITY
Because staff assume joint
accountability for all aspects of
a project, boundaries disappear
and the group is collectively
responsible for outcomes.
Holding Others Accountable

Collaborate to
determine desired
outcomes
 Clarify expected
results
 Coach for successful
performance
 Monitor performance
for compliance

Provide feedback
regarding acceptable
and unacceptable
behavior
 Institute corrective
action if necessary
 Reward actionoriented behavior
that produces results
Priorities for Action by
Exceptional Leaders
 Forecast
the future
 Distinguish trends from fads
 Articulate vision for preferred
future—shape course of healthcare
Priorities for Action by
Exceptional Leaders
 Find
new directions amid waves of
turmoil—heal wounds if necessary
 Define overarching goals that unify
constituencies and focus energies
 Revitalize shared beliefs and values—
align individual and group goals
Priorities for Action by
Exceptional Leaders
 Create
loyalty to the larger venture
 Conduct an environmental
assessment—critique current system
 Identify desired outcomes—
challenge sacred assumptions
Priorities for Action by
Exceptional Leaders
 Design
organizational
transformational models
 Prioritize work processes requiring
reengineering
 Foster renewal to enhance the vitality
of the system—avoid stagnation
Priorities for Action by
Exceptional Leaders
 Build
a learning organization—
generate the optimum learning
structure
 Promote wisdom—set strategic
targets for learning
 Exhibit transformational leadership
competencies
Priorities for Action by
Exceptional Leaders
 Engender hope
in turbulent times
 Implement a bias for action that
produces desired outcomes
 Be accountable for both actions and
outcomes
Leadership is action,
not position.
One who fears failure
limits his worth.
Failure is the opportunity
to begin again more
intelligently.
When you’re falling
on your face,
you’re actually
moving forward.