This post is a response to this link: https://create.twu.ca/stellapetersldrs501/2018/10/25/response-to-pierres-post-4-1/

Hello Stella,

Thank you for your response to my post. I am glad you have found my saga to be of value.

I was unfamiliar with the term “metacognition” and I had to look it up. Chick (2013) says metacognition is “thinking about thinking” or thinking about one’s own understanding. Thank you for introducing me to a new term!

I love thought experiments. Einstein used thought experiments, or gedankenexperiment, to help form his theory of relativity (Perkowitz, 2010). Thought experiments such as the Liberating Structure based on TRIZ (Lipmanowicz & McCandless, 2014) allow me to dream up the worst scenarios without violating ethical or legal boundaries. Plus, sometimes it’s fun to try and tear down everything you’ve built!

You asked about my current workplace. My staff members come from diverse ethnicities and different life experiences. There are employees with 3 months of experience, and some with over 40 years. My leadership team is also diverse – 60/40 gender split (female dominant), many members from visible minorities, and varying levels of experience. This leadership team also ensures our staff complement does not swing too far in any one direction.

I read your post and saw your struggle with delegation. I know we don’t mean to convey the message of a lack of trust, but sometimes it just seems easier to do the task ourselves or to not bother others. Unfortunately, as I learned the hard way, I just get burnt out.

I apologize for the lack of page numbers. I use the electronic version for all my textbooks and shamefully neglected to cite locations, figuring most people could use technology to find the appropriate passage. Lepsinger (2010) discusses the “dump and run” delegation style on Table 5.1 of his book.

Finally, I have a pretty good idea of who you are – you put your real name on your blog in one of your earliest posts 😀

Thank you again for your reply!

References:

Chick, N. (2013, June 26). Metacognition. Retrieved October 25, 2018, from https://cft.vanderbilt.edu/guides-sub-pages/metacognition/

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco: Jossey-Bass.

Lipmanowicz, H. & McCandless, K. (2014, March 26). Making space with TRIZ. Retrieved October 23, 2018, from http://www.liberatingstructures.com/6-making-space-with-triz/

Perkowitz, S. (2010). Gedankenexperiement. Retrieved October 25, 2018 from https://www.britannica.com/science/Gedankenexperiment

This post is postmortem documentation to my past employment at a contracted service provider to a care organization, previously discussed here:
https://create.twu.ca/pierreflorendo/2018/10/16/strategic-leadership-teams-hc1/ and here: https://create.twu.ca/pierreflorendo/2018/10/17/response-to-samsons-response-to-strategic-leadership-teams-hc1-post-leader/. For the sake of clarity, I will focus on the contracted service provider, as I had the most knowledge and power within that organization.

My previous posts outlined the relationship between the contracted service provider and the care organization. I will now discuss the details of the provider organization, including its structure, processes, and culture.

Background Information

The contracted service provider was composed of three owners: two sisters and the husband of one of the sisters. The company considered itself a small business with 200 employees spread over the previously mentioned four sites. At the time, the company only had the one customer – the Executive Director in charge of the four facilities. Therefore, our identity melded with the care organization. This identity had positive aspects, as the Executive Director had a reputation of being tough to the point of unreasonableness, so other care organizations knew we had high-quality service and tenaciousness. However, this same identity made contracting with other care organizations difficult, as some were uncomfortable with the closeness of the bond. Some organizations declined our proposals, not wanting to deal with the Executive Director in sector meetings.

Another quality of the service provider’s identity was our pricing. Many contracted service providers compete on price, with some providers providing a very low quote, and then filing incremental requests to increase service when problems would occur. Our company instead offered a higher ratio of staffing but at a premium price. Our identity of a high price for quality service provided us with an excellent reputation in the community but a low uptake for service due to budget constraints with other care organizations. We were desperate to keep our one customer, so our bonds tightened.

This closeness between the organizations results in the care organization strongly influencing the operations of the service provider. Service providers, as a rule, follow the policies and procedures of the care organization where applicable, as if the frontline employees were directly employed.

Further, the service provider should have had policies and procedures to follow. Sadly, its policies and procedures were barebones. The service provider heavily relied on the care organization for policies and procedures.

This reliance on the care organization extended to human resources, although the owners had independent challenges with HR. Previously, I said 90% of the frontline staff were of the same ethnicity (Florendo, 2018). This bias in hiring did not appear to be due to overt racism, as the owners did hire people of other ethnicities. Instead, this bias seemed to be in-group/out-group bias. Johnson & Levin (2009) say this bias “is more likely when there is strong categorization into groups, large actual or perceived inter-group threats and low information flow between groups.” My previous post discussed the mistrust, hidden agendas, and poor communication between the care organization and service provider. The care organization also had an indirect say on who could work in the facility – they could not directly terminate our staff, but they could refuse to have certain staff members work in their buildings, effectively firing them unless we could have them work in our head office.

Finally, the care organization had a profound effect on the culture of the service provider. As expected, the service provider placed a heavy emphasis on loyalty to the service provider, not to the care organization. My previous post talked about the culture of “family.” This type of culture extended to disparaging the care organization’s leadership and maintaining silence and solidarity in the face of their questions. The culture also reflected the dominant ethnicity concerning saving face and avoiding blame. As I mentioned before, the culture was not all bad; the sense of family meant a closeness within the service provider organization (as well as boisterous annual celebrations!)

IMPLEmenting change

I have provided more background on the structure, processes, and culture of the service provider organization. There are some parts of the organization that could be improved. I will use the Liberating Structure method developed by Lipmanowicz & McCandless (n.d.) based on TRIZ to determine which organizational actions would make things worse.

Thought Experiment: Make Things Worse

First, I would continue to cater to the whim of the Executive Director at all costs. Because I believe our organization should be customer-centric, I would continue “searching for more customer needs to satisfy” (Galbraith, 2014).  Ungerer, Ungerer & Herholdt (2016) refer to this as a dependency thinking stance, identifying the organization and its employees as just a pair of hands. Staff would become even more passive-aggressive and would complain further. Striving to meet the Executive Director’s every demand could also result in setting unrealistic goals and all but guaranteeing failure.

Second, I would continue to misuse power. Johnson (2018) says leaders cast shadows, or harmful responses to the challenges of leadership. One shadow comes from the misuse of power. Examples of inappropriate power use include inequity due to favoritism, disregard for employee’s lives outside of work, and creating a master-servant relationship. Casting this shadow of power would contribute to worsening employee morale.

Finally, I would continue to fail to hold any employees accountable. Lepsinger (2010) says “lack of accountability creates and reinforces a culture of blame – which, in turn, generates other problems.” Holding no one accountable would result in unclear performance standards and would, therefore, lead to chaos. I could also choose to hold certain people accountable while ignoring the poor performance of others. This behavior would undoubtedly contribute to torpedoing the company’s efforts!

THOUGHT EXPERIMENT: MAKE THINGS BETTER

The Liberating Structure thought exercise shows me the practices contributing to the negative output produced by the company. Stopping these actions would halt the decline. Further, I feel doing the reverse of the above-listed actions would result in positive results.

Instead of catering to the Executive Director, I would advise the company to define its values. Johnson (2018) lists characters strengths such as “courage, temperance, wisdom, justice, optimism, integrity, humility, and compassion.” After defining these values, the company would be able to discern when requests run contrary to the organization’s values, and would seek solutions that would be more palatable, or would choose to decline the request respectfully.

Instead of misusing power, the company would let go of the old economy of coercion and would instead embrace the new economy of collaboration and co-creation (Ungerer et al., 2016). Leaders would seek to give away power to “empower others to do great things” (Ungerer et al., 2016). Empowering employees has an indirect influence on employee engagement (Cai, Cai, Sun, & Ma, 2018), and engaged employees are satisfied and committed workers (Moura, Orgambidez-Ramos, & Gonçalves, 2014).

Lastly, I would hold all employees accountable, including myself. Ulrich & Smallwood (2013) say accountability for leaders includes consistency with personal values and brand. If I define my values, I will be able to hold myself accountable to those values. Similarly, I can hold others accountable by clarifying objectives and identifying progress measures. Further, being clear on consequences helps the employee understand their responsibilities and guides them to make the right decisions.

Three “Threes”

This final section of the post briefly describes steps I am taking within my practice, broken down into positive, negative, and corrective categories for renewal, execution and organizational design principles.

The three positives:

1. I support and welcome innovation from all employees within the organization. Ungerer et al. (2016) describe innovation as new connections leading to new insights. Atha (2018) says “systems cannot be fully perceived with one set of eyes,” so I encourage input from all staff members. Frontline staff bring valuable insight invisible to me and can implement small changes which may lead to significant paradigm shifts.
2. I consistently coach to follow the company’s mission, vision, and values (MVV). Hughes, Beatty, and Dinwoodie (2014) say MVV helps employees understand the company’s purpose, goals, and beliefs. I frame every action toward the company’s direction, and help staff members align their efforts in that direction. Empowering the staff increases the likelihood of commitment.
3. I create a supportive environment. Lepsinger (2010) says “a supportive environment encourages people and makes them more comfortable with trying new behaviors and taking on challenging assignments.” This supportive environment increases the chances of innovation, connecting to my first action above.

The three negatives:

1. I do not set challenging goals for my staff. I am still learning to trust my staff and to find out what their capabilities are. I am also afraid of losing influence or of burning out top performers. Lepsinger (2010) says I can express confidence when I gave people a chance to work on big things, so I can work on giving meatier tasks to more of my staff.
2. I tend to “dump and run” (Lepsinger, 2010). When I delegate, I fail to provide essential details, mostly because I assume everyone thinks the same way I do. I also wait until the last minute to delegate, because I get overwhelmed and haven’t mastered the art of appropriate delegation.
3. I do not always communicate well. With the previous negative, I have trouble communicating at times because I believe employees “should” know the answer. Lepsinger (2010) says one mistake in communication is failing to do a comprehension check, making sure other people know how I understand things.

The three corrective actions:

1. I continue to engage in self-reflection and think on how I can change. Ungerer et al. (2016) say the leader’s previous behavior heavily contributes to the reason for required Kraemer (2015) notes the importance of self-reflection in increasing self-awareness and in turn becoming the best self as a leader.
2. I continue to seek understanding regarding my employees’ thoughts, feelings, and values. Listening and empathy are servant leader characteristics (Northouse, 2016). Ungerer et (2016) note an employee’s needs “to be valued as a human being, to be respected by others, to be taken seriously and to understand the rationale behind specific decisions.” Fulfilling these needs can even persuade them to go against their self-interest. I used to consider employees as machine cogs, not considering their circumstances.
3. I continue to develop employees. People development is a TSL leadership competency aiming to foster employee growth to meet company needs better and to increase employee satisfaction (Mitchell, Strong, Willaume, & Wu, 2017). Ungerer et al. (2016) note the importance of mindsets and behaviors concerning Previously I felt employees should be good enough to do their jobs and did not consider their growth.

References:

Atha, D. (2018). Unit 3 learning activities. Retrieved October 23, 2018, from https://create.twu.ca/ldrs501/unit-3-learning-activities/

Cai, D., Cai, Y., Sun, Y., & Ma, J. (2018). Linking empowering leadership and employee work engagement: The effects of person-job fit, person-group fit, and proactive personality. Frontiers in Psychology, 9. Retrieved October 23, 2018, from https://doi.org/10.3389/fpsyg.2018.01304

Florendo, P. (2018). Response to Samson’s response to strategic leadership teams – HC1 post leader. Retrieved October 23, 2018, from https://create.twu.ca/pierreflorendo/2018/10/17/response-to-samsons-response-to-strategic-leadership-teams-hc1-post-leader/

Galbraith, J. R. (2014). Designing organizations: Strategy, structure, and process at the business unit and enterprise levels.

Hughes, R., Beatty, K. & Dinwoodie, D. (2014). Becoming a strategic leader : your role in your organization’s enduring success. San Francisco: Jossey-Bass.

Johnson, C. E. (2015). Meeting the ethical challenges of leadership: Casting light or shadow.

Johnson, DDP, & Levin, SA (2009) The tragedy of cognition: psychological biases and environmental inaction. Current Science 97 (11): 1593-1603.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco: Jossey-Bass.

Lipmanowicz, H. & McCandless, K. (n.d.). Making space with TRIZ. Retrieved October 23, 2018, from http://www.liberatingstructures.com/6-making-space-with-triz/

Mitchell, K., Strong, H., Williaume, D. & Wu, T. (2017). Leadership competency framework. Unpublished manuscript. Master of Arts in Leadership. Trinity Western University: Langley, Canada.

Moura, D., Orgambídez-Ramos, A., & Gonçalves, G. (2014). Role stress and work engagement as antecedents of job satisfaction: Results from Portugal. Europe’s journal of psychology, 10(2), 291–300. Retrieved October 23, 2018, from https://doi.org/10.5964/ejop.v10i2.714

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

Ungerer, M., Ungerer, G., & Herholdt, J. (2016). Navigating strategic possibilities: Strategy formulation and execution practices to flourish. Randburg: KR Publishing.

Marcelo’s post can be found here: https://create.twu.ca/marcelowarkentin/2018/10/16/mssl-et1-el-equipo-directivo/

Marcelo, thank you for your post. Are you sure this post isn’t about the Philippines? You wrote about Paraguayans being fatalistic, believing in a predetermined destiny (Warkentin, 2018). Filipinos also have a reputation of fatalism – our expression is “Bahala na”, or whatever happens is Bathala’s will (Menguito & Teng-Calleja, 2010). This expression has both negative and positive implications – negatively, relying on the omnipotent may result in “irresponsible and passive resignation” (Avelino & Matienzo, 2015). On the other hand, the positive side of “bahala na” is “acknowledging our role in the overall design of nature in which there is one Supreme Being watching over us” (Mengutio & Teng-Calleja, 2010). If anything, I can see the common Spanish roots, as quoted by the famous song, whatever will be, will be!

Further, you note in your section of systems thinking the discouragement of making decisions and not immediately seeing the results, expressing an occasional failure to see long-term (Warkentin, 2018). Northouse (2016) concurs, noting the Latin American culture cluster as scoring low on future orientation, which includes “planning, investing in the future, and delayed gratification”. It can be difficult to focus on future ideas when the present threatens to drown us in a myriad of concerns.  McChesney, Covey, & Huling (2016) talk about the whirlwind or the urgent day to day activities keeping us from achieving the wildly important goals. I emphasize with the struggle to encourage your team to “create more groups to tackle difficulties” due to the perception of more work (Warkentin, 2018). I also applaud your attempts to connect with your team through the various team-building activities you do. Your actions are your way of building community, one of the ten characteristics of a servant leader according to Spears (as cited in Northouse, 2016).

Finally, one of your points that hit home for me is the concept of “there is no blame”. Like your team, Filipinos do not want to lose face, or “the positive social image that individuals want to maintain in the presence of others” (Miron-Spektor, Paletz, & Lin, 2015). Accepting blame would be difficult, especially when there is a “deep feeling of inferiority” (Warkentin, 2018). Yet, a TSL has the characteristics of empathy and healing to understand and support their followers (Spears as cited in Northouse, 2016). I emphasize with your challenges and will pray for you and your team.

References:

Avelino, R. & Matienzo, R. (2015). Revisiting the philosophy of bahala na folk spirituality. FILOCRACIA: An Online Journal of Philosophy and Interdisciplinary Studies. 2. 86-105. Retrieved October 19, 2018, from http://www.filocracia.org/issue4/Matienzo_Aug2015.pdf

McChesney, C., Covey, S., & Huling, J. (2016). The 4 disciplines of execution: Achieving your wildly important goals.

Menguito, M. L. M. & Teng-Calleja, M. (2010). Bahala na as an expression of the Filipino’s courage, hope, optimism, self-efficacy and search for the sacred. Philippine Journal of Psychology, 2010,43 (I), 1-26. Retrieved October 19, 2018, from http://lynchlibrary.pssc.org.ph:8081/bitstream/handle/0/1543/03_Bahala%20Na%20as%20an%20Expressinon%20of%20the%20Filipinos%20Courage_Hope_Optimism_Self-Efficacy%20and%20Search%20fo.pdf?sequence=1

Miron‐Spektor, E., Paletz, S. B., & Lin, C. C. (2015). To create without losing face: The effects of face cultural logic and social‐image affirmation on creativity. Journal of Organizational Behavior, 36(7), 919-943.

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

Warkentin, M. (2018). MSSL ET1 – “El equipo directivo”. Retrieved October 19, 2018, from https://create.twu.ca/marcelowarkentin/2018/10/16/mssl-et1-el-equipo-directivo/

This post is in response to Samson’s post here:

https://create.twu.ca/chiefanalyzerofthings/2018/10/16/response-to-strategic-leadership-teams-hc1-post-leader/

Thank you, Samson, for your response to my post. I apologize if my post sounded utterly negative. It was not; I did find much of my experience beneficial.

I will provide more background on the care organization. This leadership group oversaw four facilities with shared leadership. The organization only had ten staff at most, comprised of directors and managers for various departments. Contractors provided the frontline staff for the care and environmental departments. The contractor organizations had their own owners and managers.

The organization was set up with a geographical hierarchical structure as described by Galbraith (2014, p. 34). There was a board of directors for each facility, but one executive director for all four sites. There was one director of care for one site and one director of care for the three other sites (this was the daughter of the executive director). Each site also had its own care manager and environmental manager. I was the care manager for the one location.

My site had the experienced director of care. Her style of leadership resembled an opportunistic style as per Blake and Mouton’s Leadership Grid (Northouse, 2016, p. 77). She wanted her site to be the best, so she aimed to have the best employees. She accomplished this by providing lots of education. Frontline employees appreciated the training, with many of them saying they learned a lot from working at that site.  She also wanted her facility to look good within the health authority, so she regularly volunteered the home for multiple projects, thus forcing the staff and me to learn. She also protected some of the staff from the wrath of the Executive Director while at the same time expressing her ire when she deemed it necessary.

The frontline employees also found support from the contractor organization, especially the owners and the care manager. We tried to support them when they felt harassed or bullied by upper management, but also had to show them their missteps. The owners used a paternalistic leadership style (Northouse, 2016) where they regarded most of their employees as family. Part of their rationale for using this style was the common ethnic bonds; 90% of the frontline employees shared ethnic backgrounds.

Given that background, here are some of the critical lessons I learned from the experience.

Leaders must account for intragroup dynamics.

For the contractor, the sense of family was evident in the way they treated employees during incidents; they would scold some of their employees like children. This behavior aligns with the dimension of culture called in-group collectivism – people from Southern Asia score high in this dimension (Northouse, 2016, p. 435). Further, the pressure exerted by the care organization’s leadership group caused a sense of “us versus them”; in other words, solidifying the idea of the contractor being its own in-group. Employees worked together for the sake of the contractor organization, not the care organization. Finally, many of the staff engaged in behavior intended to enforce status and save face. This is not surprising considering many of the staff came from Southern Asia and possess values from that culture (Northouse, 2016, p. 446)

For the care organization, family dynamics quite literally existed with the care organization’s leadership group as there was an employee-boss dynamic superimposed on a mother-daughter relationship. This confluence of relationships led to rifts within the leadership group, especially between the two Directors of Care.

Leaders must also account for intergroup dynamics and power imbalance between the groups.

Positive results do not always mean a healthy team. Bartunek (2010) says relationships between care providers and administrators may be positive and respectful, sharing similar goals and working together on joint aims. However, cooperation is not always positive; Dovidio, Saguy, & Shnabel (2009) note “cooperation is often achieved at the expense of silencing disadvantaged groups, whereas conflict can be a process that recognizes dissent, allows the expression of minority views.” One possible reason for high performance during that period was the drive for cooperation and alignment with the care organization’s goals. As part of the contractor leadership team, we felt we were in the disadvantaged group, as the care organization held the power in the intergroup relationship. The care organization was our client and we felt we had to meet their expectations even if they seemed irrational.

Results are important but do not tell the whole story.

I had many frontline employees come to my office and express their sadness and anger from workplace circumstances. I even had some staff cry in my office from the treatment received by leadership. Despite this, very few employees lashed out – many of them chose to continue to do the work as best as they could. Again, culture may have played a part – many of the staff come from a culture which is steeped in fatalism, and so they feel they must persevere no matter what circumstances they face.

I feel I have learned much from this time in my life. As I reflect on leadership experiences, I believe these three lessons are the most important ones, and I seek to improve on the positive aspects of that experience while avoiding the pitfalls.

References:

Bartunek, J. M. (2011). Intergroup relationships and quality improvement in healthcare. BMJ quality & safety, 20(Suppl 1), i62-i66.

Dovidio, J. F., Saguy, T., & Shnabel, N. (2009). Cooperation and conflict within groups: Bridging intragroup and intergroup processes. Journal of Social Issues, 65(2), 429–449. https://doi.org/10.1111/j.1540-4560.2009.01607.x

Galbraith, J. R. (2014). Designing organizations: Strategy, structure, and process at the business unit and enterprise levels.

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

Years ago, I was part of a high-producing health care team. We had consistently achieved the highest levels of accreditation. We had a low risk ranking from our local health authority. Families gave us excellent feedback year over year. Turnover was very low, and we had an exceptional annual sick time of 0.1%. However, despite these accomplishments, I would rank this team to be a poor performer in strategic leadership. I give my former team this ranking based on the Strategic Team Review and Action Tool (STRAT) as described by Hughes, Beatty, & Dinwoodie (2014, pp. 290). Hughes et al. (2014, pp. 299-302) present STRAT data based on 12,364 respondents and rank the questions answered by score. For the sake of brevity, I discuss three of the top 20 items.

The highest ranked question in the STRAT is “This strategic leadership teams [sic] exhibits a high level of integrity” (Hughes et al., 2014). The team was part of a non-profit organization, and one of the unwritten expectations was to spend all annually allocated monies to prevent future claw backs. Sometimes this extra spending meant more supplies and equipment for residents, but sometimes the money was spent on additional education among selected staff members with no perceived benefit to the organization. Other times the money would be spent on expenses obfuscated from the team. The mindset of spending, even if superfluous, showed a lack of stewardship and by extension a lack of integrity.

The fourth highest ranked question in the STRAT is “Different opinions are welcome” (Hughes et al., 2014). Although the organizational chart had one Executive Director and two Directors of Care, one of the Directors of Care was the child of the Executive Director. The other Director of Care possessed decades of experience. These two did not get along and formed their armies within the team. Only the iron will of the Executive Director kept these two in check. Further, the Executive Director often pursued her interests or deferred to her child for the direction of the Care department. Therefore, the Executive Director’s goals restricted the diverse leadership perspectives of the team.

The eleventh highest ranked question in the STRAT is “There is a positive sense of energy and excitement around here” (Hughes et al., 2014). As I reflect on my experience, I recall episodes of positive energy, especially after completing an accreditation period. Otherwise, morale was low. The primary cause of low morale was the organization’s approach to accountability. The organization liked to hold people “accountable” for incidents, failing to address defensiveness. Leadership would respond to defensiveness through anger and doubling down on their stance. Lepsinger (2010) says empathy works better to combat defensiveness, but leaders lacked understanding and focused on blame.

These questions, among others, show the team’s ineffectiveness in strategic leadership. Blake and Mouton would instead describe the leadership style as Authority-Compliance (Northouse, 2016). Most of the staff were not consulted for direction but were tools to achieve results. The weakness of that leadership style became apparent when a new Executive Director joined – the team could not function in the old ways and suffered severe setbacks.

In my new role as Director of Care, I believe I have learned from this previous experience and now desire to avoid the missteps of others. I do not want staff composed of sycophants or the silent majority filled with resentment. I want a team that enjoys their work now and looks forward to making a positive impact.

Building this team will be a challenge. My current staff members have expressed an unwillingness to engage due to their experience with past management. They felt ignored, suppressed, and disenfranchised. Management and union leaders also built up an adversarial relationship over the years, reducing trust between leaders and workers. Further, a national team sets the overall direction of the “child” organizations, hampering local leadership’s ability to set the path.

Despite these factors, I believe my team can be effective. I have started asking team members, “what are we good at?” Salyers, Firmin, Gearhart, Avery, & Frankel (2015) call this appreciative inquiry, or discovering what works well and looking for ways to makes those things better. If both employees and leaders feel they excel in certain areas, they can set higher expectations for themselves. Stavros, Torres, & Cooperrider (2018) say a manager’s belief in an employee’s success increases the chances of an employee succeeding. Lepsinger (2010) calls this the Pygmalion effect. As the team grows its accomplishments, the team will move on to lofty goals and will continue to believe in themselves.

I believe this success can extend to my present working team and my team for this course, even though the composition of the teams differs greatly. Working teams in healthcare are generally interdisciplinary teams, defined as “different types of staff working together to share expertise, knowledge, and skills to impact on patient care” (Nancarrow et al., 2013). Galbraith (2014) would classify this group design as complex, as different disciplines including nursing, recreation, and dietary teams would work together for patient care. In contrast, my course team is simpler. Even if the team members have varying backgrounds, we are all students in MALEAD working towards group assignments and group learning. Despite the variation in teams, both teams require direction, alignment, and commitment (DAC) (Hughes et al., 2014) to accomplish their goals. In the case of the course team, we can develop DAC through increased communication and collaboration throughout the course. Currently, we are still working on strengthening our course team. Increased communication and cooperation would also assist in my current work environment.

Finally, challenges will test any team, be it the course team or a working team. Many of these challenges will happen because we seek change; indeed, there is no strategy to “keep everything the same” (Hughes et al., 2014, p.21). Ungerer, Ungerer, & Herholdt (2016) say people resist change actively and passively. Change in the working team could include new practice guidelines or better goals, while change in the course team could consist of working together on a project with new members, each with their backgrounds and perspectives. Ungerer et al. (2016) say empowerment moves the needle from resisting change to initiating change. Empowering others will solve many of the struggles and challenges any team faces.

References:

Galbraith, J. R. (2014). Designing organizations: Strategy, structure, and process at the business unit and enterprise levels.

Hughes, R., Beatty, K. & Dinwoodie, D. (2014). Becoming a strategic leader : your role in your organization’s enduring success. San Francisco: Jossey-Bass.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco: Jossey-Bass.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11, 19. Retrieved October 15^th, 2018 from http://doi.org/10.1186/1478-4491-11-19

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

Salyers, M. P., Firmin, R., Gearhart, T., Avery, E., & Frankel, R. M. (2015). What we are like when we are at our best: Appreciative stories of staff in a community mental health center. American Journal of Psychiatric Rehabilitation, 18(3), 280–301. http://doi.org/10.1080/15487768.2015.1059383

Stavros, J. M., Torres, C., & Cooperrider, D. L. (2018). Conversations worth having: Using appreciative inquiry to fuel productive and meaningful engagement. Oakland: Berrett-Koehler Publishers, Incorporated.

Ungerer, M., Ungerer, G., & Herholdt, J. (2016). Navigating strategic possibilities: Strategy formulation and execution practices to flourish. Randburg: KR Publishing.

Hello Wafa,

Thank you for your response to Samson’s post. I recall one of my former workplaces hiring a Lean consultant to address “muda”, or waste (Lean Enterprise Institute, n.d.). Many of the ideas presented in Lean seem beneficial, such as reducing the amount of time used and distance walked to gather medical supplies.

However, it was difficult to fully implement Lean, primarily due to another important aspect of health care, namely infection control. Many infection control items, such as gowns, masks, and gloves, must be thrown away after each use and could be considered waste. Further, other medical devices are complex and difficult to clean. These items are also considered “single use” and seem to be a waste.

The evidence for lean in healthcare is mixed. Some of the literature available states the gaps in evidence for improvement (DelliFraine, Langabeer, & Nembhard, 2010), while other papers note the lack of evidence supporting the notion of improvement from Lean (Moraros, Lemstra, & Nwankwo, 2016). Other authors note the complexity of health care improvement, comparing it to a “black box” (Ramaswamy et al., 2018). On the other hand, Lean (and its derivative Lean Six Sigma) may be beneficial to improving infection control, specifically healthcare-associated infections (Improta, Cesarelli, Montuori, Santillo, & Triassi, 2018). Lean also showed promise in surgical procedures (Mason, Nicolay, & Darzi, 2015).

I see Lean being part of the TSL’s toolbox. Lean helps the TSL understand current processes and possible waste in the system, thus increasing awareness. Awareness is one of the characteristics of a servant leader according to Spears (Northouse, 2013). Conceptualization is another characteristic of a TSL – Lean forces the TSL to take a big-picture view of system processes to creatively identify areas of improvement.

Thank you for sharing your overview of Lean. I look forward to adding Lean to my toolset!

References:

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the Evidence of Six Sigma and Lean in the Health Care Industry. Quality Management in Health Care, 19(3), 211–225. Retrieved October 11, 2018, from https://ezproxy.student.twu.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=52764353&site=eds-live

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of Evaluation in Clinical Practice, 24(2), 338–346. http://doi.org/10.1111/jep.12844

Lean Enterprise Institute. (n.d.) “Waste”. Retrieved October 11, 2018, from https://www.lean.org/lexicon/waste

Mason, S. E., Nicolay, C. R., & Darzi, A. (2015). Review: The use of Lean and Six Sigma methodologies in surgery: A systematic review. The Surgeon, 13, 91–100. Retrieved October 11, 2018, from https://doi.org/10.1016/j.surge.2014.08.002

Moraros, J., Lemstra, M., & Nwankwo, C. (2016). Lean interventions in healthcare: do they actually work? A systematic literature review. International Journal for Quality in Health Care, 28(2), 150–165. Retrieved October 11, 2018, from http://doi.org/10.1093/intqhc/mzv123

Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Thousand Oaks: SAGE.

Ramaswamy, R., Reed, J., Livesley, N., Boguslavsky, V., Garcia-Elorrio, E., Sax, S., … Parry, G. (2018). Unpacking the black box of improvement. International Journal for Quality in Health Care, 30(Suppl 1), 15–19. Retrieved October 11, 2018, from http://doi.org/10.1093/intqhc/mzy009

Original post at https://create.twu.ca/sally81/2018/10/09/no-other-way/

Thank you, Sally, for your post. As a leader in health care, I have a nominal role in educating clients and their families, but nothing to the extent of those in education.

I have a question regarding TSL in education, specifically with parts of the curriculum that some find in disharmony with their personal values. For example, the Science 7 part of the curriculum as evolution by natural selection as a “big idea” (British Columbia Ministry of Education, n.d.). Further, one hot topic for the coming election is sexual orientation and gender identity.  The Ministry of Education announced in 2016 the requirement to reference SOGI in codes of conduct (The ARC Foundation, 2016).

I understand the characteristics of TSL include listening and empathy, as well as building community (Spears, as cited in Northouse, 2013). TSL education leaders would need to listen to different stakeholders with their concerns over these parts of the curriculum. As well, TSL education leaders need to empathize with educators and their diverse perspectives, especially regarding the required curriculum from the Ministry of Education. Finally, a TSL education leader seeks to build community among other educators as well as students and their families.

However, the current political climate appears to hinder the process of building community. Henderson (2018) notes the current controversy with SOGI, saying “the issue has been a polarizing one rife with misinformation about what the program is actually about.” I feel as though ideologies have become more crystallized, although I cannot provide any concentrate proof – I am certain people have been arguing loudly since the beginning of time!

I agree with your emphasis on critical thinking, especially in the current political environment. Seabreeze (2018) asked if TSL is more prevalent now than it was in the past. I would like to posit the opposite question – do you see a rise in authoritarianism and followers with a “sheep” mentality? With the rise of the Internet, I see the words in Daniel coming true with knowledge increasing (Daniel 12:4), but I don’t necessarily see an increase in wisdom. Sadly, even in the religious realm, I see too many people not reading their Bibles to critically analyze their study. Instead, they rely on their religious leaders to tell them what to think.

I look forward to your response!

References:

The ARC Foundation (2018). SOGI 1: policies and procedures. Retrieved October 11, 2018, from https://bc.sogieducation.org/sogi1/

British Columbia Ministry of Education (n.d.). Science 7. Retrieved October 11, 2018, from https://curriculum.gov.bc.ca/curriculum/science/7

Henderson, P. (2018). “Anti-SOGI candidate to run for Chilliwack school board”. Retrieved October 11, 2018, from https://www.theprogress.com/municipal-election/anti-sogi-candidate-to-run-for-chilliwack-school-board/

Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Thousand Oaks: SAGE.

Seabreeze (2018). Reply to “No other way”. Retrieved October 11, 2018, from https://create.twu.ca/sally81/2018/10/09/no-other-way/

Original post here: https://create.twu.ca/chiefanalyzerofthings/2018/10/09/servant-and-strategic-leadership-tools-hc2/

Thank you, Health Angels, for your post on TSL and health care. Your post is thought-provoking and interesting. As a fellow leader in health care, you encourage me to think about my contributions to the culture of health care, whether those contributions are beneficial or detrimental.

I want to add some information to your post for discussion. First, you state, “health care professionals are overworked” and many professionals suffer burnout. You also discuss burdens placed on both the patients and the health care workers.

One dimension to consider is the phenomenon of workplace violence. A health care worker’s load may not only affect wait times, but also the length of time a worker can spend with a patient. Physician appointment times are usually 15-20 minutes long (Linzer et al., 2015). Limited interaction time with patients contributes to burnout, leading to cynicism and exhaustion (Anandarajah, Quill, & Privitera, 2018). This cynicism and exhaustion can negatively affect staff behavior. Shafran-Tikva , Chinitz, Stern, & Feder-Bubis (2017) note staff behavior playing a role in the creation of violence in hospitals. Finally, Hutchinson & Jackson (2013) note nurses claim hostility from other members of the interdisciplinary team to be their most significant concern with regards to workplace violence.

You say creating a culture of learning is the key. I would beg to differ. I do not believe burnt out staff members are in a position to learn if their concern is navigating workplace stress and recovering from burnout. I would like to propose the importance of a “culture of caring” before transitioning to a culture of learning.  This culture of caring seeks to improve the work life of health care workers. Health care workers need care to provide care. Bodenheimer & Sinsky (2014) say “care of the patient requires care of the provider”, and propose to transform the Triple Aim into the Quadruple Aim.

Regarding your section on Critical Thinking, I have an alternate viewpoint regarding resources in health care. You state, “there is no money”, yet the Government of British Columbia recently committed $500 million dollars on home and community care (British Columbia Ministry of Health, 2017). Further, Simpson (2012) says this about money:

Nor, as Canadians have seen over the past decade, do large amounts of additional money necessarily buy change. Most of the money reinforced the status quo, which is what one would expect in a provider-driven, bureaucratically administered system. Canada poured tens of billions of dollars into health care, following the Romanow commission recommendation, but got a poor return on that investment. Those tens of billions of dollars represented the costliest lost public-policy bet of this generation.

I say the larger problem with our health care system is not money per se. I heartily agree with your second point: health care organizations and governments are rigid. I would like to expand that point to say the public is also rigid in its view of health care – people are frightened of the word “private health care”, even though many of the health care delivery organizations are private (Simpson, 2012). Further, the public will not accept a decrease in services, nor would they accept an increase in taxes. Therefore, health care is stuck trying to deliver services in the same way with an old plan and an increasing bill. A TSL leader with visioning and strategic thinking could “creatively envision value-added future oriented organizational goals” (Mitchell, Strong, Williaume, & Wu, 2017) and may have better solutions for the looming health care collapse.

Again, thank you for your well-written post. I look forward to your reply.

References:

Anandarajah, A. P., Quill, T. E., & Privitera, M. R. (n.d.). Adopting the quadruple aim: The University of Rochester Medical Center experience moving from physician burnout to physician resilience. AMERICAN JOURNAL OF MEDICINE, 131(8), 979–986. Retrieved October 10^th, 2018, from https://ezproxy.student.twu.ca:2420/10.1016/j.amjmed.2018.04.034

British Columbia Ministry of Health (2017). An action plan to strengthen home and community care for seniors. Retrieved October 10^th, 2018, from http://www.health.gov.bc.ca/library/publications/year/2017/home-and-community-care-action-plan.pdf

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider.Annals of Family Medicine, 12(6), 573–576. Retrieved October 10^th, 2018, from https://ezproxy.student.twu.ca:2420/10.1370/afm.1713

Hutchinson, M., & Jackson, D. (2013). Hostile clinician behaviours in the nursing work environment and implications for patient care: a mixed-methods systematic review. BMC Nursing, 12, 25. Retrieved October 10^th, 2018, from http://doi.org/10.1186/1472-6955-12-25

Linzer, M., Bitton, A., Tu, S.-P., Plews-Ogan, M., Horowitz, K. R., Schwartz, M. D., & for the Association of Chiefs and Leaders in General Internal Medicine (ACLGIM) Writing Group*. (2015). The end of the 15–20 minute primary care visit. Journal of General Internal Medicine, 30(11), 1584–1586. Retrieved October 10^th, 2018, from http://doi.org/10.1007/s11606-015-3341-3

Shafran-Tikva, S., Chinitz, D., Stern, Z., & Feder-Bubis, P. (2017). Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study. Israel Journal of Health Policy Research, 6, 59. Retrieved October 10^th, 2018, from http://doi.org/10.1186/s13584-017-0183-y

Simpson, J. (2012). Chronic condition: Why Canada’s health-care system needs to be dragged into the 21st century. Toronto: Allen Lane.