CHAPTER FIFTEEN: LEADERSHIP IN LONG-TERM CARE

CHAPTER HIGHLIGHTS

Introduction – ONE of the most important building blocks in the foundation of successful long-term care delivery.

Leadership – the art of getting others to want to do something that you are convinced should be done.

Leaders: Who are they? There are several myths about leaders, including:

· Are leaders born – it is a set of skills that can be learned by nearly anyone.

· Leaders are prescient visionaries – They cannot predict the future, but are prepared to deal with it.

· Leaders are charismatic, possess a special gift – they have charm and appeal that arouse loyalty, but, it is not something special that only a few have.

· Leadership is associated with a superior position – not all managers are leaders.

· Leadership is a matter of control – leaders enable rather than controlling.

· Leaders are remote and distant – they are seen as approachable by their followers.

Common Characteristics of Leaders

· Honest – sincere, genuine.

· Forward-Looking – have a sense of direction and a concern for the future of the organization.

· Inspiring – make followers believe they can do things they had previously thought they could not.

· Competent – competent in their professions and in management.

Leadership Skills – there are several skills necessary to successful leadership in long-term care management.

Influencing Others:

· Skill: Managing Power/Influence – understanding kinds of power and how to use it.

· Position Power – power one has because of the position held.

· Coercive Power 

· Reward Power 

· Legitimate Power 

· Connection Power 

· Personal Power – power that comes from one’s own personality and experience.

· Expert Power 

· Information Power 

· Referent Power 

· Skill: Motivation – understanding what motivates each person and how to use it.

· Skill: Communication – knowing how to make others understand what the leader wants.

Providing Direction:

· Skill: Strategic Thinking – being able to see the big picture.

· Skill: Planning – a formal process of organizational planning.

· Skill: Managing Change – recognizing change and using it proactively.

· Skill: Decision-Making – having the courage to make decisions.

Getting Voluntary Acceptance:

· Skill: Enabling – facilitating subordinate performance.

· Skill: Providing Feedback – letting subordinates know how they are doing, and how to improve.

· Skill: Problem-Solving – recognizing problems, collecting information and making decisions.

· Skill: Conflict Resolution – understanding and dealing with two or more divergent interests.

· Skill: Negotiation – creating win-win situations.

· Skill: Mentoring – coaching and developing others.

· Skill: Team-Building – creating working teams out of groups of individuals.

· Skill: Managing Stress – understanding the causes of stress in the leader and subordinates and managing it.

Gaining & Improving Leadership Skills – ways to acquire or improve leadership skills.

· Recognize the Need for Improvement – improvement cannot take plce without recognition of the need for it.

· Assess Current Skills – involves self-analysis and use of formal analysis tools.

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CHAPTER SIXTEEN: CULTURE CHANGE IN LONG-TERM CARE

CHAPTER HIGHLIGHTS

Introduction – the term “culture change” is used in two separate, but closely related, ways. The two ways in which it “culture change” is used herein are as follows:

· As it applies to long-term care consumers (particularly nursing home residents).

· As it relates to changing organizational (corporate) culture in long-term care and other businesses, and its impact on the organizations’ employees.

What is Culture Change? – the common name given to the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected.

Benefits of Culture Change

· Resident benefits – reduces loneliness, helplessness and boredom; improves physical and mental health (e.g. reduces depression and behavioral problems); reduces unanticipated weight loss, reduces mortality, etc.

· Staffing benefits – reduces employee turnover, eliminates temporary agency staffing and mandatory overtime, reduces workers’ compensation claims/costs, etc.

· Additional benefits – significantly improves employee, resident, and family satisfaction; increases involvement with the outside community including children, students, clubs, and religious organizations, etc.

Culture Change Programs:

· The Eden Alternative

· The Wellspring Model

· The Green House Project

· The Pioneer Network

Components of Culture Change:

· Decision-Making

· Leadership

· Staff Roles

· The Physical Environment

· Organizational Design

Other Aspects of Culture Change:

· Creating a Sense of Community

· Amenities

· Transportation

· Social media

Organizational Culture:

· The collection of self-sustaining patterns of behaving, feeling, thinking, and believing, the patterns that determine how things are done.

· The workplace environment formulated from the interaction of the employees in the workplace. It is defined by all of the life experiences, strengths, weaknesses, education, upbringing, and so forth of the employees.

Characteristics: of Successful Organizational Culture:

1. Respect for all individuals, including employees, residents, and visitors.

2. Responsiveness to questions.

3. Freedom from blame.

4. Honesty.

5. Respect for scientific evidence.

Changing the Culture – any culture can be changed and is probably changing most of the time.

Implementing Cultural Change

· Change Takes Time – do not expect it to happen quickly.

· Provide Resources – it will not happen without commitment of people, funds, time.

· Change Opportunities – recognize opportunities to create change (e.g., change of administration).

Role of the Leader – every organization needs a leader to implement beneficial change.

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