Leadership, management & how to lead changes in health professions education

1. Leadership, Management,
and How to Lead Changes
Hirotaka Onishi MD, MHPE
Int’l Research Center for Medical Education,
Graduate School of Medicine,
University of Tokyo

2. Overview
1. Leader and manager
2. Four frameworks by Bolman & Deal
3. Situational Leadership Theory by
Hersey & Blanchard
4. Team-oriented Approaches

3. 1. Leader and Manager

4. What is a Leader?




 A leader should “lead” a group of people
for some direction.

5. Who is the Leader?





6. A Leader Can Be….
 President of a school/university
 Department head
 Chairman of a committee
 Leader of a PBL group
 A physician seeing a critically ill patient
 Master of one’s home
 Most people have some kind of leader
role experiences

7. Leadership
 The action of leading a group of people
or an organization (Oxford Living Dictionary)
 One important question in education is,
“can we teach leadership to anyone?”

8. Who Is a Good Manager? Is a
Manager Different from a Leader?





9. Leader vs Manager
Leaders:
 Align people
 Motivate & inspire
 Decide direction
 Initiate change
 Move forward
Managers:
 Plan & budget
 Organize & staff
 Solve Problems
 Produce order &
predictability
 Complete tasks

10. Lead
when change
is needed
Manage
when stability
is needed

11. Vision vs Mission
 The Vision describes a future identity and the
Mission describes how it will be achieved
 Mission statement may define the purpose or
broader goal for being in existence or in the
business. It serves as an ongoing guide without
time frame.
 The Mission can remain the same for decades if
crafted well.
 Vision is more specific in terms of objective and
future state. Vision is related to some form of
achievement if successful.

13. Strategies to
Manage Change (Kotter)
1. Establishing a sense of urgency
2. Forming a guiding coalition
3. Creating a vision
4. Communicating the vision
5. Empowering others to act on the vision
6. Generating short-term wins
7. Consolidating gains & producing more
change
8. Anchoring the change in the culture

14. Key Steps
 Sense of urgency
 People do not want to change because
they like to maintain stable situation
 Good management  stability !!
 Outside pressure vs inside stability
 Vision sharing
 Vision  where to go
 Small win
 Experience of winning will motivate people

15. 2. Four Frameworks
by Bolman & Deal

16. 4 Frameworks for Leadership:
The Bolman/Deal Model
1. The Structural Framework
2. The Human Resource Framework
3. The Political Framework
4. The Symbolic Framework
 Some frameworks work better than
others in some situations
Bolman & Deal, 2008, Reframing Organizations 4th Ed

17. Which Framework Do You
Use for Each Situation?
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework

18. Structural
Framework
 Clarify organizational goals (missions)
 Manage the external environment
 Develop a clear structure appropriate
to task, and environment
 Clarify lines of authority
 Focus on task, facts, logic, not
personality and emotions
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework

19. http://www.businessinsider.com/apples-new-organizational-structure-could-help-it-move-faster-2013-5
Richard Lewis, When Cultures Collide, 1994

20. Structure
 Formal structure
 Organizational chart
 Informal structure
 Direct contact with friends, relatives, secret
group, etc
 Informal structure sometimes plays
very important role

21. Human Resource
Framework
 Manager views people as the heart of any
organization and attempts to be responsive to
needs and goals to gain commitment and
loyalty.
 The emphasis is on support and
empowerment. The HR manager listens well
and communicates personal warmth and
openness.
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework

22. Labor Management
Perspectives
 Salary and Bonus
 Relationship with pay raise and evaluation
 Vacation leave, benefits package
 Party, Excursion, Drinking…
 Environmental control
 Personal space, lighting/air flow
 Rules and regulations

23. Human Resource
Management Perspectives
 Job satisfaction and motivation control
 Labor division and cooperation
 Freedom, Task ordering
 Career management, work-life balance
 Personal ability vs Organizational power
 Evaluation/Reward system

24. Political
Framework
 The political leader understands the
political reality of organizations and
can deal with it. He or she understands
how important interest groups are,
each with a separate agenda.
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework

25. What is Politics?
 Power game for limited resources
 Possible resources
 Human resource
 Time
 Money, budget
 Facilities and equipments
 Information

26. Three People: Win-Win-Win
Ex) A young researcher would like to have budget for a
research work. He has enough time to work for a
senior member with skills to analyse data. A senior
researcher would like to be helped for a data
analysis. A department head knows the needs of
both persons and take them to a dinner to have a
discussion between two researchers to help each
other. Two researchers thanked the head to support
any kind of work.

27. Symbolic
Framework
 This leader views vision and inspiration as critical;
people need something to believe in.
 People will give loyalty to an organization that has a
unique identity and makes them feel that what they
do is really important.
 Symbolism is important as is ceremony and ritual to
communicate a sense of organizational mission.
 These leaders tend to be very visible and energetic
and manage by walking around
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework

28. Which Framework Do You
Use for Each Situation?
Political
Framework
Human
Resource
Framework
Structural
Framework
Symbolic
Framework
 Heart of the
organization is
people
 Empowerment
 Servant
 Inspiration
 Prophet
 Visions
 Recognizes
major
constituencies
(stakeholders)
 Coalition
 Problem based
 Processes
 Analysis
 Design

29. How Does Official Position
Influence Leadership
 The Structural Framework
 Line of information, decision making, etc
 The Human Resource Framework
 Salary, social welfare, etc
 The Political Framework
 Share resources, support, etc
 The Symbolic Framework
 Positioning itself has symbolic meanings

30. Case 1-1
 You are appointed as the chief expert for a
project to establish a new teaching hospital in
a remote area to strengthen community-
based medical education. The project is
financially supported by a bilateral agency.
 You can appoint three local experts in the
setting you choose.
 What kind of tasks would you like to assign to
those three experts? Please draw a big
picture of the project.

31. 3. Situational Leadership Theory
by Hersey & Blanchard

32. S3 (Participating)
Leader and follower
decide together
S2 (Selling)
Leader decides,
with explanation
S4 (Delegating)
Follower decides
S1 (Telling)
Leader decides
Task Behavior
Relationship
Behavior Leader Style
(S = Style)

33. What is YOUR “Natural”
Leadership Style?
 TELL: You decide and tell
 SELL: You decide and explain
 PARTICIPATE: You decide together
with follower
 DELEGATE: You let the follower
decide and support the decision

34. H
I
G
H
Able &
Willing
Able but
Unwilling
Unable but
Willing
Unable &
Unwilling
L
O
W
R4 R3 R2 R1
Follower Readiness
（R = Readiness）

35. S3 S2
S4 S1
R4 R3 R2 R1
S: Style, Leadership
R: Readiness, Followership

36. High Moderate Low
R4 R3 R2 R1
Able &
Willing
or confident
Able but
Unwilling or
insecure
Unable but
Willing or
confident
Unable &
Unwilling or
insecure
Explain
decisions
and provide
opportunity
for
classification
Share ideas
and facilitate
in decision
making
Turn over
responsibility
for decisions
and
implementation
Provide
specific
instructions
and closely
supervise
performanceS4
S3 S2
S1
(SupportiveBehavior)
RELATIONSHIP
BEHAVIOR
LEADER BEHAVIOR
TASK BEHAVIOR (Guidance)
FOLLOWER READINESS
(Low)
(High)
(High)
FOLLOWER DIRECTED LEADER DIRECTED

37. Leadership Styles –
Situations for Reflection
 What are the consequences of a
mismatch between leadership style
and followers’ readiness?
 How is this relevant to being an
educational leader?

38. Case 1-2
 Following Case 1-1, please consider
how to allocate resources to the local
experts.
 State a tag line for the teaching hospital
for the new webpage of the project.

39. 4. Team-oriented Approaches

40. Key Characteristics
of Teams
 Shared goal(s)
 Interdependent members
 Explicitly defined membership
 Members have authority to manage
their own work
 Context specific operation
Hackman 1990

41. What is an Optimal Team
Size and Why?
 > 2, < 25 members
 Smaller teams have fewer
complementary skills to draw from
 Larger teams are more likely to have
problems with team common purpose
and commitment

42. Components of Effective
Team Building
1. Clarity of
expectations and
objectives
2. Perspective
3. Dedication
4. Capability
5. Contract
6. Resources
7. Power
8. Cooperation
9. Communication
10. Creative
improvement
11. Responsibility and
accountability
12. Harmonization
13. Cultural change
Fapohunda. Towards Effective Team Building in
the Workplace. Int J Educ Res 1(4):1-12, 2013

43. Case 1-3
 List stakeholders
 Features of the hospital
 # of beds
 specialty care, other costly services like imaging…
 Specify differences from similar hospitals
 How to find human resources
 Time frame to proceed the project
 How to evaluate the success