Effective Leadeship

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\\,JK SCIENCE HOSPIT L NOTESffective Leadeship for etter Management ofHospital

~ o m s Gupta*, Jasbir Singh**

IntroductionThe hospital is a complex organisation humming with

activities aimed to achieve the patient care satisfaction.This organisation is though, entirely different from otherorganisations like cotton industry, industry associated\\ ith production of toys or cars, yet all the principles ofmanagement are applicable in the hospital environment.Since hospitals are labour intensive organisations andinvolve a large numberof professionals who are workingin a life and death activity , leadership is one of theareas which attaches lot of significance in the hospitalmanagement.Definition

Leadership has been defined in various ways byd ffcrent authors but the most appropriate one in thehospital scenario is the process of influencing theactivities of an individual or a group so that they strivewill ingly towards the achievement of organisation goals.Types of leadershipThere are three types of leadership (Fig. 1 . utocratic eadershipThe characteristics ofAutocratic leadership are :-

(a) The leader mainly seeks the obedience from hisgroup. They have just to carry out the work asdesired by the leader.

(b) The entire authority is centralised with the leaderand he only determines everything.(c) The l eader s truc tures complete work for his

employees.(d) Communication IS usually unidirectional from

above downwards.(e) Workers compliance is obtained through threats

and punishments. Those who obey orders arerewarded and those who do not are punished. It isa carrot and stick type of leadership.

(f) Employees have very little responsibility.(g) Employees feel a certain amount of security.(h) Decision making is quick and less competent

subordinates can be easily employed.(i) Highly qualified professionals do not like this type

of leadership as there is lack of scope for growth,development, init ia tive and sense ofresponsibility.

*OCfluty J\ledical Superintendent, **Medical Superintendent, Government Medical College Hospital, Jammu J K) India.Correspondence to : Dr. Romesh Gupta, Deputy Medical Superintendent, Govt. Medical College Hospital, Jammu (J K) India.

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Fig. 1 : Types of leadership. L - Leader, E - Employee.

Epidemiology of Leadership ill different situations

8 GL f \ A t ~

Democratic Leadership Free Rein Leadership

8oAutocraticLeadership

This is more suitable for research laboratories and similarorganisations.

a Here the leader and workers share the decisionmaking.

b The leader draws the ideas and suggestionsfrom the workers by discussions andconsultations.

The characteristics ofDemocratic Leadership are :

j Fear, conflict; dissatisfaction and frustration candevelop easily.

Participative or emocratic Leadership

c The workers are encouraged to take part Insetting organ isation goals and the job ofleaderis mainly that of moderation.

In order to dete rmine the best leadership stylefollowing three factors must be considered.

The situation in which the leading takes place.d It is not a carrot arfd stick type of leadership.

There are no punishments but correct iveactions and rewards are based on objectiveachievements.

e Commun ication is in all directions.

2. The people being led.3. . The personal characteristics of the leader

himself. Because differences occur in all three of thesefactors, there can be significant variation in leadershipstyles, all ofwhich are effective as shown in Fig. 2 .

OptimumLeaderhip

Style Situation Hospital Population

Leaderf The workers have a sense of belonging andsatisfaction.

g Knowledgeable and skilled workers feel morehappy and satisfied.

h Decision making takes more time.i Unskilled and lower level workers who have

strong need of security do not like this style.Fig. No.2

Hospital populationLaissez Faire or Free Rein Leadership

In this type of leadership, each worker has his ownand the leader is more or less like an

rmation booth. He exercises a minimum control andsumes the role of just another member of the group.

[n the hospital there are various types of people, whocome across, like hospital employees, patients and thevisitors. But in this paper the scope is more or so limitedto the hospital employees. As already discussed hospitalis a complex organisation humming with various types

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~ SCIENCEof activities performed by various groups of employeesran ging fro m unskilled to h ig hl y ski ll ed and h ig hl yqualified employees. Mainly the hospital employees canbe divided into three groups.

a) Med ical Pro fess io nals ).

th eir b as ic and s ecurity n eeds. Merel} l ; ;::;neya nd m at er ia l b en ef it s can s at isf y t his group.Sin ce their n eeds are v ery limited and req uirejo b security, the autocratic style of leadershipis better wa y of controlling them.

b) Nursing and paramedical. c) N on- med ic al .

a) Professional employees: This group consistsof doctors, specialists and super specialists whoare highly qualified and highly skilled workers.Altho ug h mon ey and materials may motiv atesome of them but basically they are motivatedonly after t he ir p sy ch ol og ic al n eed s are m etwith. Their p sy ch ol og ic al needs ca n o nl y b emet once they are participating actively in th edecision making. As a result of which they feelsense of belonging and achieve recognition aswell.

b) Nursing an d pa.-amedical employees: Thisgroup consists o f semiskilled technical workers with social status low er than thep ro fess io nal g ro up . Ini ti al ly they need jo bstructuring by autocratic way of leadership butas th e t im e p as se s t he y a cq ui re so muchproficiency that guidance and self control takeshigher precedence in motivating them and theybecome an import lnt constituent o f th edemocratic leadership.

c) Non-Medical employees: This group consistso f ground level workers with very littleeducation and very low socio-economic status.Their m ot iv at io n c om es t hro ug h by m eet in g

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2. SituationThere are tw o types of situations in hospital industry.

a) Normal situation. b ) C ri si s si tu at io n.

a) Normal situation: During normal situationsprofessional, nursing and paramedical groupso f workers ar e controlled better with thed em oc ra ti c t yp e o f leadership. Even th ehospital disaster plan can be discussed andmodified accordingly as per the paste xp er ie nc es w it h t he g ro up w it h d em ocr at ictype of leadership. Th e non-medical group ofemployees are better governed by the autocraticstyle of l eadersh ip even d ur in g t he normalsituations.

b) Crisis situation : Th e relatively sudden andwide spread disturbance of the so cial sy steman d t he life of a community b y so me a gen t orevent can amount to large scale admissions ofpatients and lead to th e cr isis situationin t he ho spi ta l. H os pi ta l d is as te r plan isa ct iv at ed in su ch s it ua ti on s a nd t he si tu at iondemands autocratic style of leadership at thattime.

3. LeaderFo r achieving optimum leadership style the leader

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J l ?:IK SCIENCE- - - - - - - - - - - ~ - ~ i i : i - - - - - - - - - - - - -has to ta il or his working according to the needs whichcan be be tt er understood in the following chart.

In olden days leadership was considered to be the inborn t ra it a nd u se d to run in the particular families. Dueto advancement of the scientific knowledge and withavailability of better management tools, now it isconsidered that leadership basically involves motivatingthe staff and application of communication skills.Effective leadership is an essential requirement for higheruti Iization of scarce hospital resources and higher qual ity

Situation

Normal

Crisis

Summal Y

Professionalemployees.

Democraticstyle.

.PredominantAutocraticstyle.

Nursing para-medicalemployeesPredominantAutocraticcoupled withDemocraticstyle.Autocraticstyle.

Non-medicalemployees.

Autocraticstyle.

Autocraticstyle.

of medical care. It has been discussed that democraticstyle is more suitable fo r the normal s ituations amongthe professional, nursing and paramedical group, whereascrisis situations are better managed through autocraticstyle of leadership. The non-medical group is bettercontrolled by the autocratic style of leadership. Thehospital administrator should have proficiency in all thestyles of leadership and should select the one accordingto the situation.References

I Koontz HO. Do nn el C and Weihrich H Management. MeGraw-Hill Kokakusha Ltd New Delhi. 1986: 505-24.

2. Harsey Pau . Blanchard Kenneth H. Management oforganisational behaviour. Prentice-Ilall of India Pvt. Ltd New De lh i. 1 98 8 ; 1 05 -2 6.

3. Massie, Joseph Essentials of management, Prentice-Hallof India Pvt. Ltd., New D elhi. 1987 ; 98- 111.

4. Newman WH, W ar re n E K. McGill AR. The process ofmanagement, strategy, Action, Results Prentice-Hall of IndiaPvt. Ltd., New Del hi . 19 88 ; 350-69

5 McMahon Rosemary, Barton Elizabeth Piot Maurice. Onb ei ng i nc ha rg e. A guide for middle level management inPrimary Health Care. WHO Geneva 1980 ; 71- 86.

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137 Vol. 1 No.3, July-September 1999

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Effective Leadeship