Leadership Midterm Exam

Ethics

"Occupational therapy involves ethical leadership on a daily basis" -(Dunbar-Smalley & Winston 2022). OT Code of Ethics: Beneficence Non-maleficence Autonomy and Confidentiality Social Justice Procedural Justice Veracity Fidelity

laissez-faire leadership

"leave it be"/hands off leaves his or her colleagues to get on with their work; -authority and power lies in hands of employees -works for teams in which the individuals are very experienced and skilled self-starters

Dissatisfaction can lead to...

- Decreased patient satisfaction - An overuse of resources - Increase costs of care - Decreased levels of empathy - Decreased patient safety

Stress-filled environment led to

- Lack of teamwork - Disrespect between colleagues - Lack of workforce engagement

OT Practitioner responsibility

- advocate for clients and profession - be policy driven - context needs to be considered

Occupational rights

1. right to experiences occupation as meaningful and enriching 2. right to develop through participation in occupations for health and social inclusion 3. Right to exert individual or population autonomy through choice in occupations 4. right to benefit from fair privileges for diverse participation in occupations

4 principles to informed consent

4 Principles to informed consent - You must have the capacity to make the decision - The provider must disclose information on the treatment, test or procedure including the benefits and risks - You must comprehend the relevant information - You must voluntarily grant consent (without coercion or force)

Formal Leadership

Assigned leadership which involves a formal title or position

LMX (leader-member exchange theory)

Better Leadership = high quality exchanges and relationships with followers Relationships should entail trust, liking, and mutual respect Cultivate fair and supportive environment Establish partnerships with all follower Self reflection of leader based on the assumption that leaders develop unique one-to-one relationships with each of the people reporting to them Leader forms different relationships with each follower ○ High Quality ○ Low Quality

Generational Characteristics

Care to clients is multigenerational meaning some certain norms and values come with different generations of people. Generational characteristics can be seen in both the person and the workplace and can effect the way we as therapists work with clients.

Attributional Leadership

Cognitive processes individuals utilize to understand cause and effect in problem-solving situations. These include skills and strategies such as consensus, consistency of team member behaviors, explanations and descriptions. Observation of subordinates to determine the"why" something is happening and constructs causal explanations to guide leadership behavior Assessment can be of thought process, motivations, rationale for the behaviors Has both positive, negative sides

4 main types of leadership behaviors within Path-Goal theory that impact employee motivation

Directive- telling team members what to do Supportive-friendly, respectful, treating equally to management Participative- further to invite followers to be part of key work environment decisions Achievement-oriented- promotes optimal performance through high level challenges, and high expectations Leaders must assess/understand employees/followers individually to determine the appropriate style to motivate employee/follower to meet their goals by removing barriers

Characteristics of a servant leader

Empowering Commitment to growth of people Empathy Awareness Building community Behaving ethically Putting members first

Health Care Reform Results

Framework adopted by health care practitioners but additional stress for entire health care continuum and hierarchy from front line, administrative, and support staff associated with: - Burnout - Loss of empathy - Depression - Alienation, ...and even... - Addiction - Suicide

THEORY U

Future-focused, how to lead in changing times. Allows leaders to create a vision that is able to be adapted the the ever changing contexts of life and work. To facilitate and support change in society that is needed comes with open mind, open heart, open will Open Mind- identifies one's assumptions might be taken for granted and there can be perspective gained from from further or new knowledge. Open Heart- reflective, allows for change to occur, take responsibility for feelings and thoughts related to change, need for change, or inhibiting a change Open Will-what is needed to make necessary change for the greater good. Presence and Sensing- seeing self as the self they will become path to goal attainment with future possibilities.

Great Man/Trait Theory

Great man: based on the assumption that leaders are born, not made Belief that leadership ability is inherent Trait theory: Leaders have characteristics that differentiate them from nonleaders

Triple Aim

Introduced by Don Berwick from IHI (Institute forHealthcare Improvement)in 2008 To change health care system to a population-focused one •To optimize health care system performance

autocratic leadership

Leader exerts high levels of power, no employee input allowed high levels of absenteeism

Leadership Theories

Leadership is complex, interactive, and works to meet the needs of the group. It is needed in a variety of settings and styles. There are many different leadership styles, behaviors, and theories that help us understand leadership. Various perspectives and descriptions on how the behavior of the leader interact with and perhaps influence the actions and decisions of others

Five Practices of Exemplary Leadership

Model the way, inspire a shared vision, challenge the process, enable others to act, and encourage the heart.

Health care reform impacts

Need to engage frequently often with stakeholders • More promotion and justification for services and value services provided With every challenge or obstacle, there are both opportunities, as well as a ripple effect of change

What is needed and specific suggestions

Needed: • Shared values of mutual respect and civility • Transparency • Truth-telling • Safety of workforce Suggestions: • Implement team documentation • Use pre-visit and pre-appointment labs • Expand roles of nurses and medical assistants (preventive and chronic) • Standardize and synchronize workflows for prescription refills • Co-locate teams to same space • Ensure solid training and emphasize role of each to patient health

How does leadership apply to OT?

OT practitioners (assistants and therapists) are often found in leadership roles, and do not usually have the benefit of formal leadership training, or deep understanding of leadership theory. There is a need for OT practitioners to see their leadership capabilities, change agency, and understand their influence on others Open to possibilities, making differences, promotion of OT, evidence based practice, adaptation, innovation, social justice And to understand this within the work setting, but also the impact health and wellness has on all aspects of occupation within life.

Occupational Justice vs Social Justice

Occupational Justice and Social Justice NOT the same thing. Occupational Justice- humans are occupational beings. Enablement to participate in meaningful occupations. Individual differences Focus on how were occupational beings and what's nest for that specific person. Social Justice- Humans are social beings. Empowerment of rights of each person. Group differences. Focus on what's best for everyone else

Transactional Leadership

Premise that employees agree to obey their leader totally leadership based on an exchange process in which followers are rewarded for good performance and punished for poor performance Employees can do little to improve their job satisfaction

Quantum Leadership Theory

Recognizes that change is constant and inevitable and though we cannot predict exactly what will happen we can work to guide or direct it. Views an organization and its members as interconnected and collaborative—a helpful approach when unpredictable events and changing environments present themselves

informal leadership

Results from what one does and how one acquires support from followers" (Northouse, 2013, p. 15). or Unofficial leadership accorded to a person by other members of the organization

Situational Leadership Theory

Situational leadership is based off of 3 factors: Guidance/direction from a leader, amount of support from a leader, and readiness of the follower. There are 4 types of leadership behaviors dependent on the leaders evaluation of the task at hand, perceived support needed, and the followers readiness to complete a task. (The picture above depicts the flow of situational leadership starting in the lower right box and flowing up and to the left) Readiness and developmental level of employee often critical in decision of which style to use Leader gives follower control over the task, but remains available for support or facilitation based on the individual's needs There is not one right way to lead or manage that suits all situations

Leadership Competencies

Societal + political changes significantly impact healthcare + Organizational ambiguity + complexity= challenging and shifting context Successful leaders have: Cultural humility Interprofessional value Effective communication Ethical decision making

occupational justice

The right of every individual to be able to meet basic meeds and have equal opportunities and life chances to reach toward their potential but specific to the individual's engagement in diverse and meaningful occupation.

Theory X/Y

Theory X bosses believe employees are: ○ Lazy' ○ Untrustworthy ○ Lack motivation ○ Uninclined to work or possess skills to complete tasks Key Attributes: ○ Multiple levels of management with low rate of delegation ○ Micromanaged with little autonomy ○ Central authority base ○ Authoritative style ○ Uses rewards and punishments to motivate employees ○ Rely on extrinsic factors and coercion ○ Closely monitor employees Theory Y Theory Y bosses believe employees are ○ Industrious ○ Honest ○ Hardworking ○ Able ○ Desire to contribute ideas and creativity Key attributes: ○ Emphasizes the intrinsic interest in work, and the desire to be self directing and seeking responsibility○ Better managerial approach that leads to greater workplace satisfaction○ Requires more participation from managers■ Supervisors could better motivate their employees to meet their highest potential○ Employees keep the long-term goals of the company in mind

levels of OT advocacy

Therapy or Grassroots; clinic/ individual. Part of daily practice to insure clients get what is needed Organization/ programmatic/ community; formation of programs within the community or organization professional; educate potential referral sources, engage in program development health systems; policy/societal. Public policy debates

Leadership styles one size doesn't fit all

There is no one "right" way to lead or manage that suits all situations. O A good leader will find themselves switching instinctively between styles according to thepeople and work they are doing O To choose the most effective method, you need to consider many factors including: O The skill levels and experience of employees or team members O The work or task involved O The organizational environment or context O You own preferred style

Servant Leadership

This method of leadership has leaders perceive themselves as servants. Servant leaders prioritize the needs of others and hold the concerns of their followers in high regard. Work in servant leadership is done as a team and is based on legitimate power. Servant leadership is more of a philosophy than a leadership style so it can be combined with others

Transformational Leadership

Transformational leadership focuses on engaging followers through motivation, support, and opportunity. It places an emphasis on the "4 I's" which are inspirational motivation, idealized influence, intellectual stimulation, and individualized consideration.

democratic leadership

a leadership style in which managers work with employees to make decisions Acts as a "coach" who has the final say, but gathers information from employees before making the final decision Can produce high quality and high quantity work

Path-Goal Theory

a leadership theory that states that leaders can increase subordinate satisfaction and performance by clarifying and clearing the paths to goals and by increasing the number and kinds of rewards available for goal attainment

Ways to look at/ think about advocacy

active support of a cause, idea, policy to speak up for something: a part of our history Can involve publicity, personal selling, and advertising Promotion, marketing and lobbying may be a part of it For OT's means being at the table and to be involved in change

Leadership Styles

autocratic, democratic, laissez-faire

Outcomes of occupational injustice

deprivation- most prevalent Marginalization- invisible norms Alienation- prolonged experience Imbalance- excessive time in one area Apartheid- formally instituted occupational injustice

Direct and indirect advocacy

direct- face to face meetings with elected officials, lobbying activities, engaging with key decision makers, often representing others as well indirect- education the public (community, family, friends), outreach activities about a policy

Business of Healthcare ppt not on here (week 6)

not on exam!

Fourth Aim

• Added to improve the experience of providing care • Make it meaningful for providers • Well-being of team prerequisite for achieving TripleAim

How does OT address the four aims?

• Aim 1: quality of care - Being client -centered - Using EB intervention and standardized assessment; using OCCUPATION -Emphasizing appropriate utilization of care Aim 2: Improve efficiency of system - Screening for risk factors - Incorporating wellness/prevention strategies - Develop/use tx. protocols for at -risk population - Lead care transitions Aim 3: Reduce costs -Assess for safety, health, risks prior to D/C - Perform home evaluation prior to D/C - Promote self-management approaches for chronic conditions - Examine cost effectiveness - Interprofessional collaboration Aim 4: Well-being of team prerequisite for achieving the Triple Aim Improve work experience for care providers - Provide respect to colleagues - Be a productive, trusting, and collaborative team member - Thank others for their contribution

3 aims of triple aim

• Improve the health of the population • Enhance client experience of care • Reduce per capita cost of health care

How to document aims

• Need to document distinct value of OT by emphasizing: - Client centeredness - Capturing skills of OT profession - Telling the client's narrative - And by using OCCUPATION in intervention, and then in the notes

Health Care Reform

• The Affordable Care Act and other health care reform initiatives have incentivized increased integration and coordination of care delivery .• New models of delivery are being tested, such as accountable care organizations and patient-centered medical homes. • New payment methods to reduce the prevalence of fee-for-service reimbursement will also increasingly appear such as the use of bundled payments.

Distinct Value of OT and distinct value statement

• The word distinct chosen purposefully • Signifies noticeably different and strength • The power of everyday life is our primary distinct value Statement: OT can increase health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life.