Leadership Chapters 6-

Bolman and Deal's The Structural Construct

(called a "frame") deals with how organizations "structure" work processes, establish formal relationships, and how groups facilitate coupling. The structural frame assumptions are: • Organizations exist to accomplish established goals. • Organizational design/structural form can be designed to "fit" the situation. • Structural frame assumptions (cont.): • Organizations work best when governed by rationality and norms. • Specialization permits more productivity and individual expertise. • Coordination and control are essential to effectiveness. • Problems originate from inappropriate structures and inadequate systems that can be resolved through restructuring and developing new systems (modern reengineering).

Micro-Environmental Forces

-Planning and public policy (regulation, licensure, and accreditation) forces -Competitive forces -Healthcare financing (third-party payers, public and private, and financial risk) -Technology (equipment, material, and supply entities) forces - Health research and education -Health stays and health promotion (wellness and disease) -[Integration with other disciplines] Public health (sanitation, environmental protection, etc.) forces

How do leaders shape culture? Schein suggests the following five primary mechanisms:

1. Attention: Leaders communicate their priorities, values, and concerns by their choice of things to ask about, measure, comment on, praise, and criticize. 2. Reaction to crisis: This reaction increases learning about values and assumptions. 3. Role modeling: Leaders set examples for others. 4. Allocation of resources. 5. Criteria for selection and dismissal: Leaders influence culture by recruiting people who have particular values, skills, traits, and by promoting, or firing, them. • It is imperative that health organization leaders understand the factors that influence culture. Culture is more stable and harder to change than "climate," since climate usually is not stable over time.

• Specific areas of scanning, monitoring, and assessing for the health leader are:

1. Competitive advantage and the unique or distinctive competencies the organization possesses (centers of excellence for example) 2. Strengths and weaknesses of the organization 3. Functional strategies for implementation of strategies that are supported by goals, objectives, and action steps 4. Operational effectiveness, efficiency, and efficacy 5. Organizational culture (Is the culture aligned with the organization's direction?)

In any decision making, you have two options:

1. Do nothing 2. Do something

Kotter's 8 steps SEE in textbook

1. Establish a sense of urgency 2. Create the guiding coalition 3. Develop a vision and strategy 4. Communicate the change vision 5. Empower the broad-based action 6. Generate short-term wins 7. Consolidate gains and produce more change 8. Anchor new approaches in the culture

Six-step mode of decision making applies willful choice model as follows:

1. Identify the problem. 2. Collect data. 3. List all possible solutions. 4. Test possible solutions. 5. Select the best course of action. 6. Implement the solution based on the decision made.

Lynn said success depended on four factors:

1. Personality 2. Skills and experience 3. A design for change 4. Favorability of the situation

Robert Kelly's five general types of followers:

1. Sheep - Team members who are passive and require the leader to motivate them externally 2. Yes-people - Team members who are committed to the goal of the team and do not question the actions of the leader 3. Pragmatics - Tend to support the majority decision and tend to remain in the background of the group 4. Alienated - Can usually be found questioning the actions of the leader and attempting to stall or bring down the efforts of the group. 5. Star -Independent, positive, and active

Choice is guided by four basic principles:

1. Unambiguous (you know what questions to ask) knowledge of alternatives 2. Probability and knowledge of consequences 3. A rational and consistent priority system for alternative ordering 4. Heuristics or decision rules to choose an alternative

Willful Choice Decision-Making Models The practical six-step model assumes

1. time and information are abundant 2. energy is available 3. goal congruence of participants (everyone is focused on the same set of goals) has been achieved.

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When the size of a group increases beyond __ members, the potential contribution of adding anyone else should be carefully weighed against the added difficulty of running an effective meeting and for the project as a whole.

8

Leaders of the health organization should consider the changes in the macro- and micro- environment against the cost, quailty, and access constricts for the community members they serve.

Changes to the health organization concerning: -Operations -Workforce -Supply chain -Revenue management/reimbursement -Community health status

Triangulation Methods

Combine quantitative and qualitative methods where, classically, qualitative methods are "theory building" and quantitative methods are "theory testing, validating, or confirming."

In management arenas, what are commonplace?

decision-making load speed required in decision making uncertainty ambiguity (not knowing what questions to ask or what to do)

Ethics

defined as a theory of moral values. There is a perception that all organizations are expected to work to the highest standards of integrity and ethics. • Ethical standards and values are not created by law or regulations but are created by the board and trustees of an organization and carried out by the leadership. • Ethics is a framework for decision making and action whereas morality is the level to which the ethical framework is applied.

Much of the leadership research has been

descriptive and qualitative. There appears to be less quantitative data. As a result, qualitative research has centered on a "theory building" methodology that uses such methods as biographies, observation activities, informal interviews, and the like. • A review of the literature suggests that there are a plethora of descriptive tools on the market to measure or evaluate a leader's style or success. • Many of these tests use self-report scales. As a result, they introduce and maintain method bias. However, it is possible to control for bias by taking the test multiple times over a course of a period of time. In this manner a true response score might be found.

An assessment of the organization's leadership team, and ultimately the development of a team, should focus on building a team that is

diverse in terms of leadership, management, art, and science attributes, while securing itself in the values, beliefs, and mission of the organization. • An organization's leadership should focus on communication improvement, strategic planning, decision-making alignment, employee enhancement, and learning organization improvement, in a regular, cyclical sequence.

• For the DCL model, assessing an organization's leadership team is essential. Aligning the team to bring

diversity of style, skills, experience, and abilities is essential for organizations to maintain a robust and resilient, and even opportunistic, personality. • In this model and assessment, cultural and individual diversity are valued to better respond to dynamic organizational and external environments. • The DCL model emphasizes organizational culture creation. • "A major function of culture is to help us understand the environment and determine how to respond to it, thereby reducing anxiety, uncertainty, and confusion." • Yukl, G. (1994). Leadership in Organizations (3rd ed.). Englewood Cliffs, NJ: Prentice Hall, p. 355.

Planning occurs

formally, informally, strategically (how the organization can best serve its purpose in the external environment), and operationally (how can the internal capabilities and resources of an organization be used effectively, efficiently, and efficaciously to achieve the strategies and goals of the organization as documented in the strategic plan).

In addition to learning how to manage and lead teams the developing leader also must

gain experience with larger budgets, multidisciplinary task organization, and strategic planning. • Become involved in local community. • Seek out additional opportunities in the work place. • Volunteer in the community. • Join professional associations. • Volunteer to lead or assist in work in professional associations. SLIDE 20, L7 HAS A DIAGRAM

The key skills for healthcare leaders to develop are to

gather, unite, and make an effective group of people, who individually are great, into a synergistic team capable of superior problem solving, persistent energy, and tremendous innovative capacity.

Decision making occurs in all organizations. Health organizations are faced with many decisions each day. • The decision-making process begins with

identifying a question, problem, an area needing improvement, or an operational issue. • Problems, issues, questions, and operational challenges come to leaders and managers from many different people, both within and outside the health organization.

The crawl-walk-run (CWR) metaphor to leader development and training is baed on how

infants learn to progress from the crawling stage to the running stage in their motor ability. This theory is equally applied to their cognitive progress. The CWR premise is both a philosophical and a practical approach to development in any venue. • We do not learn to become experts in anything without gaining knowledge, skills, and abilities in a progressive manner.

Operational Planning

is about finding the best methods, systems, and processes to accomplish the mission/purpose, strategies, goals, and objectives of the organization in the most effective, efficient, and efficacious way possible. • The focus in operational planning concerns more internal resources, systems, processes, methods, and considerations.

Planning is a

journey. The journey must have a destination; this journey must be planned. It is a planned journey forward in time. In that light, planning includes both a process (achieving goals and objectives) and an outcome (the plan). • The ultimate outcome of planning is a vision that is achieved. • The desired future state is the vision of the organization. The vision is what the combined staff of the organization strives to achieve.

The dynamic culture leadership model entails a leadership process that emphasizes

leadership team assessment, communication improvement, strategic planning, decision- making alignment, employee enhancement, and learning organization improvement. • Leaders who follow the sequence shown in the next slide on a regular cycle have the best potential to deal with change in their environment, while building a culture that is effective even during times of change. • Members of the leadership team must be ever thoughtful in their consistency to organizational mission, vision, strategies, goals, and values but also within the model's constructs and process constructs.

Planning is a process that uses

macro- and micro-environmental factors and internal information to engage stakeholders to create a framework, template, and outline for section, branch, or organizational success; or a combination of both.

The vision provides the

motivational guidance for the organization, and typically is defined and promoted by senior leadership. • Vision is how the organization intends to achieve its goals while "mission" defines why the organization pursues the goals it does. • Both vision and mission are "directional strategies." • The mission statement is the organization's reason for being, its purpose.

Bolman and Deal The Symbolic Structure

or frame deals with meaning. This dimension gets at the heart of what organizational members feel about issues and events. The meaning of the event is more important than the event. It is based on the following unconventional assumptions: • What is important is not the event but what it means. • Events and meaning are loosely coupled. • Most significant events and processes in organizations are ambiguous and uncertain.

Bolman and Deal The Political Construct

or frame deals with resource allocation within an organization. The interesting aspect of this construct is that people create interesting webs of relationships to gain and reallocate resources. Political frame assumptions are based on power, conflict, and coalitions.

Bolman and Deal's The Human Resource Construct

or frame embraces the Theory Y model of McGregor. This dimension is critical to focus and synergize human energy in an organization. Human resource frame assumptions are: • "Organizations exist to serve human needs (rather than the reverse). • Organizations and people need each other. • Human resource frame assumptions (cont.): • When the fit between the individual and the organization is poor, one or both will suffer: Individuals will be exploited, or will seek to exploit the organization, or both. • A good fit between individual and organization benefits both: Human beings find meaningful and satisfying work, and organizations get the human talent and energy that they need."

Two of the more important health organization training efforts for leaders and their subordinates.

Cultural and moral competencies

Bounded rationality in decision making

Decision making must occur within the bounded rationality of the environmental context in which the problem must be solved.

Willful choice decision-making models

Decision-making models and current understanding imply that decisions are made rational, intentional, and willful choice.

Power

Defined as the ability to secure and maintain the most stable and most respected networks of resource chains. • In the resource-dependent environment, the organization requires resources to gain and maintain power and therefore must (sometimes reluctantly) interact with the environment.

Planning

Essential leadership skill that requires knowledge about planning and the ability to structure and develop a system of planning. Health leaders who can understand, apply, and evaluate planning will have advantages over those who haphazardly plan or fail to plan.

Greatness starts with superb people. Great groups and great leaders create each other. Collaboration is critical.

Every group has a strong leader? Might help synergy occur faster. Strong leader has potential to cause conflict or stifle creativity. No singular magical formula. The leaders of great groups love talent and know where to find it. Great groups are full of talented people who can work together. Great groups think they are on a tremendously important mission. Great groups see themselves as winning underdogs. Great groups are optimistic, not realistic. In great groups the right person has the right job. The leader of great groups give them what they need and free from the rest. Great groups share information effectively; ensure that a communication network exits and everyone has full access. Great groups ship (they produce). Great work is its own reward. (Herzberg's two-factor theory: members are intrinsically motivated by a transformational leader.)

The early leader should join and support professional organizations.

Exposes the early careerists to increased pools of health professionals. The early careerist should be a READER. In the dynamic world of health it can become immediately evident if one's relevancy is dated.

Understanding the External Environment

Focuses on scanning, monitoring, forecasting, and assessing the macro and micro forces of the external environment. • Scanning involves identifying the subtle to dramatic signals of macro and micro forces change. • Monitoring focuses on deriving meaning from a pattern of observations from scanning macro and micro forces. • Forecasting is the active development of projections and likely scenarios based on patterns indicated from monitoring. • Assessing is prioritizing and quantifying the impact of changes in the macro and micro forces' external environment, considering scenario forecasts in that valuation.

"Thinking always ahead, thinking always of trying to do more, brings a state of mind in which nothing seems impossible."

Henry Ford

Bolt and Hagemann Strategies to prevent derailment of the early leader

Increased communication and feedback Developing an action plan Providing more opportunities for coaching Providing new opportunities for challenges How did you get your job, educational background, what do you enjoy, what is your advice. Handwritten thank you note.

In the walk stage

Individuals learn more difficult and more complex information about leadership. Learn how to lead successful and effective meetings. Leaders begin to understand the complexities and challenges of managing teams. A team is defined as an interdisciplinary group of individuals that are brought together to accomplish specific missions. • It is during the walk stage training that students will most likely learn about the stages of group development. A group of individuals does not become a cohesive productive group without training or without time.

In 1965, Bruce Tuckman described a process of team development that is necessary for developing leaders in the walk stage to know. These stages are:

Informing stage Forming Storming Norming Performing Adjourning The informing stage is added to the Tuckman Model. ***Know for exam

Institutional Factors

Institutional organizations and environments highlight the importance of social, political, and psychological aspects of organizational dynamics. • The institutional view, in essence, is an assessment of the organization's situation as compared against a health leader's predetermined standard or benchmark or expectations as compared with competitors. • Institutional organizations focus on the reproduction of organizational activities and routines in response to external pressures, expectations of professionals in the industry, and collective norms of the institutional environment. • Most often health organizations are a hybrid of institutional and technical environments.

"There are risks and costs to a program of action. But they are far less than the long- range risks and costs of comfortable inaction."

John F. Kennedy, May 12, 1961

Transferable skills

KSA's can be transferrable. Emirical thinking is more information driven. Evaluative thinking is more subjective, in the grey area.

The Leader's Role in Planning

People look for leaders who have a vision and someone who can direct them in the path of the mission. Planning is the fundamental function of leadership from which all other outcomes are achieved. The first step in PLANNING is establishing the organizational situational assessment; then the vision, mission, strategies, goals, objectives, and action steps are developed.

PAC

Post acute care.

Training

Responsibility of leadership and is usually housed in the Human Resources department (HRD). Training works to improve the organization's effectiveness, efficiency, and efficacy by providing employees with the learning needed to improve their current or future job performance.

Situational Assessment and Environmental Scanning **

Situational assessment and continuous environmental scanning are crucial for organizations to survive in the dynamic health industry. A health organization must understand the impact of the operating environment. The leader's responsibility is to remain current and recognize situational and environmental changes that can impact the organization.

SMART objectives are

Specific, measurable, attainable, rewarding, and timed. Objectives in pursuit of achieving goals are very specific.

Qualitative Methods

Use tools such as focus groups, interviews (formal and informal), normative group techniques, and similar tools.

Quantitative Methods

Use tools such as measurable attribute value, probability-based decision trees, analytical mathematical models, linear programming, and similar tools.

The PAARP Model Stephens, Ledlow, and Schott

When followed throughout the lifecycle of a team, can result in improved morale of team members, improved outcomes, and greater value to the organization. • Throughout the team lifecycle, identifying purpose and continual communication are keys. • The model postulates that the actions of inter-professional teams occur in five distinct phases that repeat as necessary, depending on the type of team.

The DCL model provides both

a descriptive and high-level prescriptive process model of leadership. • The model emphasizes a sense of balance that needs to be maintained in order to achieve a sustainable and continuing level of optimized leadership based on the changing macro and micro factors in the external environment. • "Optimized leadership," like the concept "high quality," is not necessarily a norm to be achieved at all times. Rather, it is a worthy goal, an ideal state.

To develop a reality-based devision-making system, a leader and manager must understand that decision making is not a sterile and orderly process in most cases. • Importantly, organizational decision making should be

aligned (decisions should be in accordance with) the organization's mission and vision statements and strategic planning−based goals and objectives.

Cultural competence provides the knowledge, skills, and abilities that

allow health leaders to increase their understanding and appreciation of cultural differences among groups of people. • Cultural competency focuses on behaviors, attitudes, and policies. It is this foundation that enables exploration of different cultures, learning about cultural heritages, and the effects of diversity on health care and the health industry.

Garbage Can Model Concepts

attempts at finding logic and order in the midst of decision-making chaos. • Garbage, defined as sets of problems, solutions, energy, and participants, is dumped into a can as it is produced (streams of "garbage" in time); when the can is full, a decision is made and removed from the scenario. • Many things seem to be happening at once, technologies are changing and poorly understood; alliances, preferences, and perceptions are changing; solutions, opportunities, ideas, people, and outcomes are mixed together in ways that make interpretation uncertain and leave connections unclear.

Highly cohesive groups sometimes foster a phenomenon called 'groupthink.' Groupthink involves

certain kinds of illusions and stereotypes that interfere with effective decision making." Ensuring constructive conflict in the group or establishing and maintaining a "devil's advocate" role or contrarian role in the group can reduce the potential for groupthink.

Strategic Planning

concerned with finding the best future for your organization and determining how the organization will evolve to realize that future. • It is a stream of organizational decisions focused in a specific direction based on organizational values, strategies, and goals. • The focus is on external considerations and how the organization can best serve the external markets' expectations, demands, and needs.

Forced that contribute to the health industry's rapid and dynamic environment are varied but are

cumulative and thus, have a cumulative impact on the industry.

A strategic plan is a

roadmap, the organizational vision is the final destination, describing where the organization is going. • The healthcare leader must energize followers to buy in to the vision in order for the organization to begin its strategic journey. • Vision must be tested and retested to ensure buy-in from all stakeholders, including external and internal.

The crawl stage begins with

self awareness. After experimentation, experience, and the ability to fail without consequences. From a mentoring standpoint, in the crawl stage, early careerists must be given very explicit lessons and directions to learn very basic knowledge, such as what is a leader, what are leadership characteristics, what do leaders do. Defined more by LEARNING not so much doing. The crawling leader should be a volunteer. Volunteering to sit on committees, conduct extracurricular management analysis, assist others who are involved in interdisciplinary team projects and making it known to the organization that you are not limited by your own job description.

Contingency depends on the

situation

Lynn's leadership art and science in public leadership and management model

suggests that most situational leadership models are correct but are difficult to prove. • An interdisciplinary balance of "art" and "science" is the best method for situational model development.

Leaders in health organizations must develop a

system of decision making while understanding that decision making is not always orderly.

The Theory of Planned Behavior (TPB)

useful to the leader when thinking about the purpose of a group. • TPB links the beliefs of an individual to their behavior and improves on the predictive ability of previous psychological theories. SLIDE 8, L8

Action Steps

• Action steps (or action plans) are created to produce a step-by-step or task-level implementation sequence for each objective. • Each task in the action steps (or plan) has a responsible person(s) or owner, a time range for accomplishment, and may have a measureable variable as well. • Action step owners "report" to the objective owner who "reports" to the goal owner, who ultimately reports to the leadership team at the strategy level. "Strategy-making processes are organizational- level phenomena involving key decisions made on behalf of the entire organization."

• Leadership in the dynamic culture leadership (DCL) model is recognized at three levels as the critical ingredient in the recipe for overall success:

• At the personal level • At the team level and certainly • At the organizational level • The DCL model is intended to fit within the situational and transformational leadership paradigm with an emphasis on organizational culture development.

• In the very dynamic nature of the health industry, it is critical for the leadership team to bring multiple knowledge, skills, abilities, perspectives, and backgrounds (DCL leadership alignment assessment) to the organization to successfully and proactively navigate the external environment and focus the internal people and resources on mission, vision, strategies, goals, and objectives. • The leadership team must consciously determine the organizational culture of the organization and guide and direct culture through communication improvement, organization-wide strategic and operational planning, decision-making alignment, employee assessment and empowerment, and knowledge management and organizational learning (process constructs).

• Based on predetermined organizational culture, mission, vision, and strategies, consistency of leadership and management are paramount. • Situational and environmental assessment and scanning are key to adjusting organizational culture, mission, vision, and strategies. • Transformational leadership (including transactional leadership approaches), provides the best approach to lead people and manage resources in a dynamic world. SLIDES ON P3, L8

Resume/Interviewing Advice

• Be able to tell your story! • Just saying intelligent, hard working, leadership is not sufficient • Why - because "everyone is" • Need to be specific and prove with a valid example. • Must stand out in a positive way!

Bolman and Deal's reframing leadership and management in organizations model

• Bolman and Deal suggest that leaders must be situational/contingency oriented; critical variables assist leaders in choosing the emphasis and style they need to use to be successful. • Four constructs are considered important. Each construct is important in its own right, but some more than the others at critical times. The constructs are: 1. Structural 2. Human resources 3. Political 4. Symbolic

Contingent Organizations

• Contingent organizations are more flexible and rely less on rigid policies and practices. • These organizations utilize more loosely established internal best practices. • This organization will be loosely coupled. • Within this type or organization, a leader's success is based on a unique amalgam of internal and external factors. • Organizational and environmental factors are contingent on each other. • The leadership approach is always based on the organization's current situation. • The underlying assumptions of contingent organizations are based on the premise that organizational structures are open and are not organizationally egalitarian. • There is no one best way to organize, and any one way of organizing is not equally effective in another organization. • The contingent view utilizes a scenario-based methodology.

Dynamic Factors

• Dynamic organizations are those that do not qualify as either vertical or horizontal organizations. However, there is a tendency for many dynamic organizations to fit into the open and horizontal architecture. • Different possibilities in the environmental characteristics constantly require the creation of new and different ways of positioning the organization for success.

When a devision of decisions need to be made, a health organization leader must:

• Evaluate the priority and risk of the decision to be made and determine if this is a standardized decision or a decision that needs to be worked through. • Evaluate time available, resources available, participant attention, goals, and incentives.

CH 7 Begins: Cycles of Leadership Development

• Explain the leader development and training crawl-walk-run (CWR) approach. • The chief executive officer (CEO) of a health organization did not get to this position overnight. She or he engaged in years (perhaps decades) of incremental training and education that prepared her/him to assume such a complicated position of responsibility.

Goals

• From the mission, strategies to achieve the mission and ultimately, the vision, are devised. • Goals are broad statements of direction that come from strategies. This multilevel approach focuses and narrows effort for each section within the health organization. • Goals further refine the strategies focused on the mission. They are expected to be general, observable, challenging, and untimed. Goals are general in nature; objectives are highly specific.

Goals

• Goals translate the broad strategies of the vision into specific statements for organizational action by focusing the organizational resources to achieve the strategy to build the vision. • Goals are broader statements, sometimes aspirations, and are hierarchically above objectives.

Horizontal Factors

• Horizontal organizations are organizations that have cooperative relationships, affiliations, or ownership rights with multiple outside agents and actors. • Horizontal organizations seek to maintain a level of homeostasis with all elements internal and external to the establishment.

Responsibilities of Leadership when forming a group: Resource • According to Locke this process can be summed up in seven steps:

• In Resourcing, the inter-professional team sets goals and expectations both for individual members and the team as a whole and provides needed resources as appropriate. 1. Specifying objectives or tasks to be completed by the team 2. Determining how the performance will be measured 3. Specifying the standard to which the tasks or objectives must be completed 4. Specifying the time period in which the goal must be accomplished 5. Placing a priority on goals when more than one exists 6. Rating goals as to their difficulty and importance 7. Determining requirements for coordinating with team members

Human Resource Leadership

• Leaders believe in people and communicate that belief. • Leaders are visible and accessible. • Leaders empower: They increase participation, provide support, share information, and move decision making as far down the organization as possible.

Political Leadership

• Leaders clarify what they want and what they can get. • Leaders assess the distribution of power and interests. • Leaders build linkages to other stakeholders. • Leaders persuade first, negotiate second, and use coercion only if necessary.

Structural Leadership

• Leaders do their homework. • Leaders develop a new model of the relationship of structure, strategy, and environment for their organization. • Leaders focus on implementation. • Leaders continually experiment, evaluate, and adapt.

Mission, Vision, Values, Strategies, Goals, Objectives, and Action Steps

• Leaders in health organizations utilize a strategic system of leadership and management. • The health leadership team most likely will utilize a strategic and operational planning process to derive an organization's mission, vision, strategies, goals, objectives, and action steps. Mission, vision, and values are guideposts that leaders utilize to focus the health organization's collective energy and resources. • A health organization's mission is tied to its purpose. • Purpose is what the organization does every day to meet the needs and demands of the external environment. • An extension of purpose is a health organization's mission. • Mission is why your organization exists, what business it is in, who it serves, and where it provides its products or services. • Vision is an aspiration of what the organization intends to become. • Vision is the shared image of the future organization that places the organization in a better position to do its mission/fulfill its purpose.

Symbolic Leadership

• Leaders interpret experience (transactional [exchange theory] versus transforming [inspire to reach higher needs and purposes]). • Leaders use symbols to capture attention. • Leaders discover and communicate a vision. • Leaders tell stories.

Macro-Environmental Forces

• Legal (regulatory, executive orders, case law, etc.) and ethical forces • Political (including government policy) forces • Cultural and sociological (including values [beliefs and attitudes]) forces • Public expectations (including community, interest groups, and media) • Economic forces • Ecological forces

Internal scanning, monitoring, and assessment of the health organization are vital leadership activities; effective leaders are effective internal organization scanners, monitors, and assessors.

• Most important elements of understanding the internal health organization's environment should focus on systems such as human resources management system, supply chain system, technological system, information system, and culture and subcultures. • The salient theme is one of integrated synergy among all the health organization's systems.

Objectives

• Objectives align organizational resources to meet the stated goals. • Objectives should be measurable, assigned to a responsible person or agent or owner, have timelines for completion, and be frequently reviewed by the health organization leadership for progress and resource sufficiency.

PAARP Purpose

• Responsibilities of leadership when forming a group: PAARP purpose • According to PAARP, it is the actions of leadership that give purpose to a group. • There are several theories that can assist the leader in providing this purpose: the great groups approach, goal-setting theory, and the theory of planned behavior.

The Dynamic Culture Leadership Model

• The challenge is to focus the knowledge, skills, and abilities of organizational leaders and to empower the total organization to complete its mission, to reach its vision, and to compete successfully in an environment that constantly changes. • Superb leadership is required at all levels of the health organization due to the increasingly dynamic nature of the health environment.

Vertical Factors

• The horizontal organization is in stark contrast to the vertical organization. • The vertical organization builds a monument unto itself and seeks to minimize reliance on any and all outside stakeholders and actors. • In the true sense of organizational dynamics there are actually few true vertical organizations. As a result, when we speak of vertical organizations, we refer to organizations that attempt to control the environment first rather than living in the environment and becoming a participatory member within the community.

Hargrove and Glidewell's impossible leadership model

• The more able a leader is at developing contingency plans, and the better he/she masters the ability to effectively and quickly implement contingency plans, the more effective the leader is perceived to be. • This model is based on "impossible jobs in leadership" such as those that are elected, appointed, or in the public good and service arena. In this model, coping, rather than leading, takes center stage.

Resource-Dependent Organizations

• The resource-dependent organization desires to maintain autonomy and remain relatively independent of its environment. • One of the basic propositions of the resource- dependent organization is that leaders must be aware that the most efficient or effective organizations do not always survive. Not surprisingly, organizations with the most power survive.

Yukl's multiple linkage model (MLM)

• This model embraces the contingency approach. • The key issue is the interacting effects of leader behavior and situational variables on organizational performance. • Yukl advocates a more complex and comprehensive model than earlier contingency theories. • The model proposes that leaders, in the short term, evaluate and improve intervening variable situations for effectiveness. In the long term, leaders change the situation to better match their organizational strengths to achieve the mission. • A transformational leader uses an entrepreneurial style and an articulate and clear vision to change the situation toward a more favorable environment.

The run

• When leadership trainees have progressed successfully through the crawl and walk stages, it is time for them to run. This means that they are in leadership positions, and are accountable and responsible for the diverse myriad of responsibilities and challenges inherent in every health leadership position. • When will that occur? SLIDE 22, L7 DIAGRAM

In truth, decision making is not as sterile and ordered as most have been taught. • Willful choice or rational decision-making models together with reality-based, or "garbage can," models are used in organizations along with a myriad of tools and techniques. • The major domains of decision making are:

• Willful choice or rational models • Reality-based or garbage can models • Combinations of willful choice and reality-based models