Leadership and Communication in Health Organizations

Leadership for Health Professionals: Theory, Skills, and Applications

Organizational Environment and Leadership

• Health service organizations interact with, influence, and depend on their external environment.
• These organizations must also manage their internal environments to provide health services.
• Traditional leadership development was based on pre-employment education; however, current restructuring and technological changes cause rapid job obsolescence, necessitating leaders to rely on external relationships.
• Managing alliances and networks requires leadership development efforts to concentrate on networking across the organization with stakeholders.
• Networks are adaptive systems where members rely on each other for survival and growth.
• Strong relationships within networks ensure support if one area is threatened.
• Building relationships and networks is crucial in the health environment.
• Health organizations establish supply chains that serve as networks and alliances.
• Strategic business relationships with customers, suppliers, and partners are critical.
• Forming collaborative relationships leads to greater success and profitability.
• Steps in forming these relationships include planning, preparing, interaction, analysis, and refinement.
• These relationships are complex and require consideration of each party's needs.

Formal and Informal Networks

• Leaders need the support of formal and informal networks to perform their duties.
• Formal networks include peers, superiors, and professional association links.
• Informal networks are based on friendship and longevity.
• Internal networks help leadership achieve goals and shape organizational culture.
• External networks are important for career progression and organizational integration into the community.
• Interpersonal relationships form the basis of building both internal and external networks.
• Formal networks often mirror the organizational structure.
• These relationships are supervisory and involve annual performance appraisals.
• Great leaders should be emulated, while not-so-great leaders offer lessons on what not to do.
• Leaders may use coercion and position to manipulate subordinates, focusing only on outcomes.
• It can be challenging to work for such leaders, but subordinates in job-lock situations may have limited options.
• It is important to be a great leader to those who follow you, regardless of your position.
• Informal networks are based on mutual understanding and shared values.
• Local community hospitals and health organizations benefit from the participation of affiliated hospitals.
• Larger networks enhance credibility when lobbying local government for policy changes.
• CEOs benefit from allying with peers and stakeholders to achieve economies of scale, resulting in better outcomes.
• Union representatives may have formal relationships within a facility.
• A positive relationship between union leaders and CEOs is essential for smooth contract negotiations and employee relations.
• Poor relationships may lead to lawsuits and litigation.
• Leaders in nonprofit health organizations often engage in fundraising and lobbying.
• A CEO's ability to influence and leverage relationships can lead to advantageous fund distribution and charitable contributions.
• Organizational survival may depend on the CEO's informal professional network.

Interpersonal Relationships

• Building relationships in a leadership role requires maintaining authority.
• Honesty, inclusion, and sincerity are the building blocks of trust.
• Culturally competent communication is essential.
• Leaders should gauge the nature of relationships based on disclosure levels.
• Excessive disclosure can reduce power and authority.
• Being "disclosure conservative" is advisable when building new relationships.
• Interpersonal relationships are beneficial and enhance leadership capability.
• Yukl's taxonomy of managerial behaviors includes "building relationships" as a major domain.
• Activities such as managing conflict, team building, networking, supporting, developing, and mentoring strengthen relationships.
• Health leaders should enhance relationships with organizational stakeholders.
• "Management by walking around" is a powerful approach to building relationships.

Factors to Strengthen Relationships

• A relationship encompasses feelings, roles, norms, status, and trust.
• Relational communication theorists assert that every message has both a content and a relationship dimension.
• Content conveys specific information.
• Relationship messages provide hints about whether the sender/receiver likes or dislikes the other person.
• Effective communication provides both content and positive relationship information.
• Language, tone, and $nonverbal$ communication contribute to communicative meaning.
• Nonverbal communication is more prevalent than verbal communication and includes eye contact, facial expressions, body posture, and movement.
• People tend to believe nonverbal communication more than verbal communication.
• $65$ of meaning is derived from nonverbal communication.
• Emotions are primarily communicated nonverbally, with $95$ of emotions conveyed nonverbally.
• Frequent, timely, useful, and accurate communication reinforces relationships.
• Quality communication of sufficient frequency is important.
• Disclosure involves sharing information and is a factor in evaluating relationship depth.
• Deeper information sharing leads to closer bonds.
• Broader topics of information sharing strengthen relationships.
• Self-disclosure is positively correlated with trust.
• Powell's model categorizes self-disclosure levels:
  • Level 5: Cliche communication
  • Level 4: Facts and biographical information
  • Level 3: Personal attitudes and ideas
  • Level 2: Personal feelings
  • Level 1: Peak communication (rare)
• Self-disclosure characteristics:
  • A function of ongoing relationships
  • Reciprocal
  • Timed to relationship context
  • Relevant to people present
  • Usually moves in small increments
• Trust is built over time through honest interaction.
• Honesty, inclusion, and sincerity are linked to building trust.
• Honesty involves being truthful and open.
• Inclusion means involving others in important activities and experiences.
• Sincerity means acting authentically without keeping score.
• Interpersonal skills are desirable in low-level leaders, while dominant traits are seen as more desirable in higher-level leaders.
• Cultural competence is important in building relationships.
• It involves understanding cultural differences based on ethnicity, nationality, and socioeconomic factors.
• Understanding and modifying your approach based on cultural differences is beneficial.

Communication and Culture

• Health leaders need exceptional communication skills for clarifying and being clear.
• Mintzberg's study found that managers prefer oral communication to written reports.
• Oral communication is a valuable tool for achieving success.
• Communication is the process of acting on information.
• It contributes to the culture and climate of the health organization.
• Response-feedback is essential.
• Obstacles to communication, called noise, can lead to inaccurate understanding.
• Communication is the main catalyst for motivational efforts.
• Goal setting, reinforcement, feedback, and evaluation require communication.
• Three goals of communication:
  • Understanding
  • Achieving the intended effect
  • Being ethical (moral)
• Communication is a process of active transaction.
• Everything communicates something.

Media Richness Theory

• Media richness theory explains why certain technologies are effective in communication.
• Selecting the appropriate communication media channel predicts successful communication.
• Email may not always be the best choice.
• Media are placed on a “richness” continuum based on:
  • Potential for instant feedback
  • Verbal and nonverbal cues
  • Use of natural language
  • Level of focus
• Ambiguity, also called equivocality, is based on the receiver's ability to ask questions.
• Uncertainty resolution is “having the question answered.”
• $Uncertainty$ is a measure of ignorance about a variable; $equivocality$ is ignorance of whether a variable exists.
• More information reduces uncertainty.
• The more similar the work, the more ambiguity exists.
• The richer the media, the greater the chance of success in leader communication.
• Richer media cost more.
• Health leaders will be more effective if they master the basics of media richness theory.
• Points to reflect on for leadership success:
  • Select media channels to reduce ambiguity and uncertainty.
  • The more complex the issues, the more group members like face-to-face meetings.
  • Computer-mediated communication (CMC) deals more with tasks but less with group relationships.
  • CMC may increase polarization.
  • CMC works best with linear, structured tasks.
  • CMC increases individual “information processing” requirements.
  • People with technological skills gain more power in CMC group communication.
  • More cliques and coalitions form with CMC than with face-to-face communication.

Symbolic Convergence Theory

• Symbolic convergence theory explains how communication shapes a group’s identity and culture.
• Groups develop “fantasy” themes and stories.
• Groups build a unique “group identity” based on shared symbolic representations.
• These cultures evolve through the adoption of fantasy themes or group stories.
• Stories provide insight into a group’s culture, values, and identity.

Communication Environments

• Health organizations function best in open, honest, and fear-free environments.
• Environments should support diverse teams.
• Organizational communication environments promote either defensive or supportive climates.
• Behaviors used by leaders contribute to these environments:
  • Evaluation vs. descriptive communication: "You" language vs. "I" language.
  • Descriptive language leads to more trust and cohesiveness.
  • Problem orientation: More effective in reducing defensiveness.
  • Strategic vs. spontaneous communication: Controlling vs. inclusive.
  • Superiority vs. equality: Supportive climates use participative and equity-based communication.
  • Certainty vs. provisionalism: Flexible thinking fosters a supportive climate.
• The leader and leadership team set the example for the communication environment.
• The communication environment is a major element of organizational culture.
• Leaders should foster a positive communication environment.
• A confirming communicative response causes people to value themselves more.
• A disconfirming communicative response causes people to value themselves less.
• Listening is a valuable leadership skill.
• It contributes to a supporting environment to build a culture of achievement.
• Listening encompasses:
  • Hearing: Receiving the message as sent
  • Analyzing: Discerning the speaker’s purpose
  • Empathizing: Seeing and understanding the speaker’s viewpoint
• Good leaders are also good listeners.
• A simple listening model:
  • Stop
  • Look
  • Listen
  • Ask questions
  • Paraphrase content
  • Paraphrase feelings
• Organizational theory has overlooked the influence of informal groups and communication.
• Informal communication is highly accurate.
• Characteristics of “informal leaders” to be adopted by formal leaders:
  • Recognition of subgroups
  • Recognition of differences from formal groups
  • Recognition of influence and power
  • Recognition of the esteem informal leaders command

Conflict Management

• Conflict is inevitable and necessary for an organization.
• Leaders must master conflict management styles.
• Five frameworks form the basis of modern conflict management theory and application:
  • Psychodynamic theory
  • Field theory
  • Experimental gaming theory
  • Human relations theory
  • Intergroup conflict theory
• Conflict that is channeled and managed effectively can lead to change, improvement, and organizational longevity.
• Conflict offers opportunities to find improved solutions.
• Leaders can manage conflict and train others to apply skills and tools.
• Incongruent messages lead to goal conflicts and inconsistencies.
• Constructive conflict management is a foundational construct of leadership and management.
• Conflict occurs when interdependent people or groups have different goals amid scarce resources.
• It arises when people must work together with different goals, needs, or desires in a limited environment.
• Conflict varies in intensity, from problem-solving to violence.
• Fairness, morals, social norms, and distributive justice contribute to conflict situations.
• Quality conflict management outcomes:
  • A wise agreement (if possible)
  • An efficient solution
  • A potentially innovative solution
  • Movement toward positive change
  • A better relationship between the conflicting parties
• Different situations require different styles.
• Training organizational stakeholders on conflict styles is important.
• Conflict occurs because of differing preferences, resource distribution, values, and perceptions.
• Primary tension is initial conflict.
• Secondary tension is conflict over the process for dealing with the issue.
• Both require leadership intervention.
• "Groupthink" is a negative group decision that occurs when there is no conflict.

Conflict Styles

• Six basic conflict management styles:
  1. Accommodating
  2. Avoiding
  3. Collaborating
  4. Competing
  5. Compromising
  6. Problem solving
• Each person has a dominant style and a secondary style, but all six styles can be learned and mastered.
• The best style to use depends on the situation.
• One party may select one style while the other party selects a different style.
• Only in problem solving do both parties knowingly choose that style.
• Situational contexts for each style:
  • Accommodating: When you are wrong, to allow a better position to be heard, harmony is important, etc.
  • Avoiding: When an issue is trivial, when disruption outweighs the benefits, etc.
  • Collaborating: To find an integrative solution, to learn, to gain commitment, etc.
  • Competing: When quick action is vital, on important issues, etc.
  • Compromising: When goals are important but not worth the effort of competing, to achieve temporary settlements, etc.
  • Problem Solving: Mutual vested interest in the outcome.
• Essential steps for leaders in conflict management:
  • Stay calm and rational
  • Use facts
  • Understand resource implications
  • Listen to your feelings and know what you want
  • Imagine what the other(s) feel, want, and need
  • Use a process to select a strategy
  • Rehearse your strategy
  • Be prepared to modify your approach
• When in the midst of conflict:
  • Separate the people from the problem
  • Focus on interests, not positions
  • Avoid a “bottom line.”
  • Think about the worst and best solutions
  • Generate several possibilities
  • Insist that the resolution be based on an objective standard
• Negotiation is similar to conflict resolution.
• Key points:
  • Do not bargain over positions.
  • Separate the people from the problem.
  • Focus on interests, not positions.
  • Invent options for mutual gain.
  • Use objective criteria.
  • Use your “best alternative to a negotiated agreement.”
  • Get the other party to negotiate.

Conflict Style Selection

• Conflict style selection depends on interpersonal relationships, resources, and the importance of issues.
• Decision tree model questions:
  1. Are the issue(s) important to you?
  2. Are the issue(s) important to the other party?
  3. Is the relationship with the other party important to you?
  4. How much time is available?
  5. How much do you trust the other party?
• Figure 5.6 provides an overview of the decision tree process.
• An example illustrates the use of the decision tree.
• Conflict management requires both technical and relationship components.
• Conflict is a state of nature.
• The application of conflict styles requires good judgment.
• Figure 5.7 depicts an integration of conflict management concepts.

Overview of Culture

• Culture is a learned system of knowledge, behavior, attitudes, beliefs, values, and norms.
• Cultural differences have been classified into:
  • Language
  • Context (high vs. low)
  • Contact (high vs. low)
  • Time (monochronic vs. polychronic)
• Language is the structure and enunciation of symbols.
• High-context cultures emphasize nonverbal communication.
• Low-context cultures emphasize verbal expression.
• High-context cultures find low-context cultures less credible.
• People from high-context cultures expect communication to be indirect.
• Contact preferences differ among cultures.
• Some cultures are more comfortable with touch (high contact), while others prefer more personal space (low contact).
• Monochronic cultures are precise with time.
• Polychronic cultures are not as precise.
• Understanding time perception differences can reduce potential anger.

Bridging Cultural Differences in Communication

• Individuals hold cultural assumptions.
• Strategies to bridge cultural differences:
  • Develop mindfulness
  • Be flexible
  • Tolerate uncertainty and ambiguity
  • Resist stereotyping
  • Ask questions
  • Be other oriented

Coordinated Management of Meaning

• Individuals and groups embody their own cultural identity.
• Coordinated management of meaning (CMM) is an interactional theory.
• It focuses on how individuals organize and coordinate their meanings and actions.
• Interpretation is shaped by the context or nature of the relationship.
• Cultural patterns provide a person’s unique view of the world.
• Life scripts expand on cultural patterns.
• Contracts define expectations.
• Episodes define the kind of activity that occurs between individuals.
• Speech acts identify the intent of the speaker.
• Content is the decoding of the substance of the message.
• Raw sensory data concerns audio and visual signals.
• Constitutive rules determine meaning.
• Regulative rules specify what is appropriate.
• The CMM theory may be connected to Rokeach’s values-beliefs-attitudes model.
• It brings into focus practical elements of Shutz’s theory of affiliation, communication environments and culture, media richness theory, and interpersonal relationships.
• Figures 5-9 and 5-10 graphically illustrate the CMM model and the hierarchy of how meaning impacts people.

Summary

• A leader has personal responsibility to maintain relevancy.
• Leadership competencies and job fit are key.
• Health leaders work in a complex environment with an interdisciplinary workforce.
• Success is based on capabilities related to motivation, influence, and interpersonal relationships.
• Networks and alliances are key ways to expand influence.
• Health leaders must consider factors that play roles in interpersonal relationship building and conflict management.
• The ideas and principles presented in this chapter will serve beginning careerists well.
• Seeking out a mentor who has earned the respect of others will be beneficial.