© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011

Leadership, Teamwork, and Engagement

Michael A. Rosen, PhDArmstrong Institute for Patient Safety and QualityJohns Hopkins University School of Medicine

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Agenda

• Why talk about leadership, teamwork, and engagement?

• What do effective leaders do?1. Use power wisely.2. Lead with vision and values.3. Build trust.

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Why talk about leadership, teamwork, and engagement?

• It matters for managing patient care.

• It matters for safety and quality improvement teams.

• It matters at the organizational level.

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Trust in Leadership and Patient Safety

Vogus, T.J., & Sutcliffe, K.M. Medical Care, Vol. 45, No. 10 (Oct., 2007), pp. 997-1002

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Perceptions of leadership and mortality

Huang et al., 2010

…the odds ratio for mortality was

1.24 for the hospital.

For every 10% decrease in

perceptions of management

items…

Leadership matters at the organizational level

• Hospital scores on the PSOA Leadership Domain are meaningfully related to Core Measure Performance

7% - 9%

PSOA scoresOther factors

Weaver, Rosen, Goeschel, et al., in progress

What is leadership?

• “…the only thing of real importance that leaders do is to create and manage culture… the unique talent of leaders is their ability to understand and work with culture… it is an ultimate act of leadership to destroy culture when it is viewed as dysfunctional.”– Schein, E. H. (2006, p. 11). Organizational

culture and leadership. Jossey-bass.

Five conditions leaders can put in place to facilitate teamwork

1. Ensure the team is a ‘real’ team2. Compelling direction3. Enabling structure4. Supportive organizational context5. Expert coaching

Hackman, 2002

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What do effective leaders do?

1. Use power wisely.

2. Lead with vision and values.

3. Build trust.

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1. Effective leaders use power wisely.

• What is power?

• How do leaders exercise power?

• Which strategies are effective under what conditions?

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We talk about empowerment, but what is power?

PowerLegitimate

Reward

Coercive Expert

Referent

Control over

information

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How do leaders exercise power?

• Rational persuasion• Apprising• Inspirational appeals• Consultation• Exchange tactics• Collaboration

• Personal appeals• Ingratiation tactics• Legitimating tactics• Pressure tactics• Coalition tactics

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What strategies work best?

Attempting to influence someone to support and idea or to do something?• Consultation and inspirational appeals work well.

People don’t understand what you want to do?• Rational persuasion works well (in a strong form; weak forms don’t work).

People believe in the idea, but don’t think it’s feasible?• Collaboration works well.

Avoid pressure and legitimating tactics• They rarely work.

Have an idea with strong and salient personal benefit for people?• Apprising tactics work well.

Influencing a subordinate?• Exchange and ingratiation are moderately effective. Ineffective for dealing with superiors.

Pre-existing personal relationships with person you are influencing?• Personal appeals are moderately effective.

Yukl, 2009

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2. Lead with vision and values

• Vision is a leader’s statement of a desired, long-term future state.

– The quality of a vision statement has been shown to impact individual, group / team, and organizational outcomes (e.g., performance, attitudes, capacity to manage change).

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What does an effective vision statement look like?

BrevityClarityAbstractness and stabilityChallengeFuture orientationDesirability or ability to inspire

Kirkpatrick, 2009

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Leading with vision and values

• State the desired values.

• Model the desired values.

• Integrate the values into the organizational systems.

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3. Build trust.

• Trust is the estimated probability that someone will do something:– That will affect our own actions, workload,

emotions, or other outcomes– Without our being able to monitor and double

check they’ve done it• Do you feel comfortable putting something

you value in the hands of someone else?

BenevolentIntentionsIntegrityAbility

Mayer & Davis (1999); Colquitt et al., (2007)

Components of trust

Components of Trust

BenevolentIntentionsIntegrityAbility

My perception that another…• Is capable of performing task at hand• Is known to be successful at things

they try• Has necessary knowledge• Is well qualified• Has skills that increase our

performance

Mayer & Davis (1999); Colquitt et al., (2007)

BenevolentIntentionsIntegrityAbility

My perception that another…• Cares about my welfare • Would not knowingly do anything to

hurt me• Looks out for me• Will go out of their way to help me

Mayer & Davis (1999); Colquitt et al., (2007)

Components of Trust

BenevolentIntentionsIntegrityAbility

My perception that another…• Will stick to their word• Tries to be fair in dealing with

others• Shows consistency between their

words & actions• Uses sound principles or values

to guide their behaviorMayer & Davis (1999); Colquitt et al., (2007)

Components of Trust

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How can leaders build trust?

• Build a culture of trustworthiness.

• Increase leader ability.

• Build leader benevolence.

• Demonstrate leader integrity.

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Action items

• Self-assess (as a team)…– Who uses what type of power through which

means in your projects? • Are there better approaches?

– Do you have a vision statement for your organization? For your CUSP team?• Does it meet the criteria of effectiveness?• How is it implemented?

– Where are our opportunities to build trust?• Increase ability? Build benevolence? Demonstrate

integrity?