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Case Study
Leadership for Health Professionals: Theory, Skills, and Applications
Third Edition
Gerald R. Ledlow
It’s always a problem when you have famous personalities come into your hospital. I’ve had a governor’s wife deliver babies.
I’ve had a Saudi Arabian princess deliver a baby. I’ve even had a Grand Dragon from the Ku Klux Klan admitted as a patient.
Probably one of the more interesting cases was a religious singer who had won several Grammys and Dove Awards for religious music. She became a very good friend of the health system. We even sponsored a golf tournament together to help fund
a children’s clinic in a low-income area of the city. She delivered twins, which became worldwide news. We set up half a wing
for her in order to have space for her communications spokesperson, a living area for her and her family, and an area for
the two babies who stayed with her 24 hours a day because of our labor delivery room (LDR) floor concept. We put security
all over that floor to make sure that nobody could come in and try to steal either of the two babies. Generally, whenever you
have a well-known personality, you put a lot more expense into their health care and coverage than you get back in reimbursement. They usually are very expensive to take care of because of the notoriety and the extra security details you have to
take. Interestingly, we were getting so many calls from newspapers, television stations, and other media outlets that we had to
put up a hotline where we gave daily update reports on her and her two babies. In 3 days, we had 1,200 calls on this hotline.
Another interesting aspect of this case was that her admitting OB-GYN was in California when this singer came into our
labor room. The admitting OB-GYN was actually in the cockpit of an airplane giving medical orders to our nurses and to the
OB-GYN who was covering for him. At some point, the covering OB-GYN decided to insert some intravenous lines. When
the admitting physician came in from the airport, he was very upset that the covering physician had ordered the IV lines,
and he actually ripped them all off of her. Anyway, we were able to manage the 3 days and the media hype, and we ended up
developing a long-lasting relationship with this famous singer. My wife and I became personal friends with her, and I even
employed her husband at the medical center.
Content Link:
Ledlow & Stephens, Leadership for Health Professionals: Theory, Skills, and Applications, 3rd Edition, Jones & Bartlett Learning,
Chapter 6: Leadership Competence II
Chapter 12: Understanding Executive Leadership Roles
Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
2   ❚ Case Study
E5. Case Study Questions
1. As a CEO, would you want well-known entertainers and other famous people to be admitted to your medical center?
Why or why not?
2. Is there any need to take action against the admitting physician for removing the IVs from the patient that the second
OB-GYN had installed?
3. As CEO, what arrangements would you make to protect and handle internationally well-known patients?
Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Leadership for
Healthcare Professionals
College of Health Sciences
University of Wisconsin-Milwaukee
Instructor: Kourosh Ravvaz
Spring 2018
Chapter 6
Leadership Competence II: Application of Skills, Tools, and Abilities
Leadership Competency
• Planning
• Situational Assessment and Environmental Scanning
• Decision Making and Decision Alignment
• Training
• Cultural Competencies
• Ethical and Moral Competencies
Leadership Competency
• Planning
• Situational Assessment and Environmental Scanning
• Decision Making and Decision Alignment
• Training
• Cultural Competencies
• Ethical and Moral Competencies
• Planning is an 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
• Planning occurs:
• Formally,
• Informally,
• Strategically,
• Operationally.
• Strategic Planning is 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.
• The 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 re-tested to ensure “buy-in” from all
stakeholders, including external and internal.
• 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.
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 (steps/levels
of planning).
The Leader’s Role in Planning
• The vision provides the motivational guidance for the
organization and typically is defined and promoted by senior
• Vision is how the organization intends to achieve its goals (e.g.,
“Provide people with better health care than they can get
anywhere else.”)
• Mission defines why the organization pursues the goals it does
(e.g., “We help people live well.”)
• Both vision and mission are ‘directional strategies.’
• The mission statement is the organization’s reason for being,
its purpose.
The Leader’s Role in Planning
• Goals are broad statements of direction that come from
• Desired outcomes. General intentions. Not specific enough to be
• Goals further refine the strategies focused on the mission. They are
expected to be general, observable, challenging, and untimed.
The Leader’s Role in Planning
• Objectives, in pursuit of achieving goals, are very specific.
• SMART, objectives must be ‘Specific, Measurable, Attainable, Rewarding,
and Timed.’
• Goals are general in nature; objectives are highly specific.
• Action steps or tactics represent a fifth level of planning and
provide the most specific approach to describing who, what,
when, where and how activities will take place to accomplish an
The Leader’s Role in Planning
• Planning can be described as an ongoing process of thinking and
implementing at multiple levels.
• At each level, health leaders are directing, staffing, organizing,
controlling, and rewarding.
• Health leaders must remember that what is measured gets
done; all planning objectives and action steps must be
measureable, assigned to an accountable and responsible
person and be set within a time period.
Situational Assessment and
Environmental Scanning
• Situational assessment and continuous environmental scanning
are crucial for organizations to survive in the dynamic health
• 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.
Situational Assessment and
Environmental Scanning
• Forces 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.
Situational Assessment and
Environmental Scanning
• Macro-Environmental Forces:
• Legal, [regulatory, executive orders, case law, etc…] and Ethical
• Political (including government policy) forces;
• Cultural and Sociological (including values [beliefs and
attitudes]) forces;
• Public Expectations (including community, interest groups and
• Economic forces; and
• Ecological forces.
Situational Assessment and
Environmental Scanning
• Micro-Environmental Forces (Health Care Environmental Forces):
• Planning and Public Policy (regulation, licensure and
accreditation) forces;
• Competitive forces;
• Health Care Financing (third-party payers, public and private,
and financial risk);
• Technology (equipment, material and supply entities) forces;
• Health Research and Education;
Situational Assessment and
Environmental Scanning
• Micro-Environmental Forces (Health Care Environmental Forces):
• Health Status & Health Promotion (wellness & disease); and
• Public Health (sanitation, environmental protection, etc…)
Situational Assessment and
Environmental Scanning
• Leaders of health organizations should consider the changes in
the macro and micro environment by assessing them against the
following assessment constructs for the community members
they serve:
– Cost,
– Quality,
– Access
Situational Assessment and
Environmental Scanning
• Multiple forces cumulatively contribute to change in the health
• The Rand Corporation suggests that immense pressure of costcontainment and speed of change are the leading factors in the
health industry at this time.
Situational Assessment and
Environmental Scanning
• Kotter suggests eight steps to transform organizations in dynamic
• Establish a Sense of Urgency by examining market and
competitive realities and identifying and discussing crises,
potential crises or major opportunities;
• Form a Powerful Guiding Coalition by assembling a group with
enough power to lead the change effect [from any level of the
organization] and encourage the group to work together as a
Situational Assessment and
Environmental Scanning
• Create a Vision to help direct the change effort and develop
strategies for achieving that vision;
• Communicating the Vision by using every vehicle possible to
communicate the new vision and strategies and by teaching new
behaviors by the example of the guiding coalition;
Situational Assessment and
Environmental Scanning
• Empowering Others to Act on the Vision by getting rid of
obstacles to change, changing systems or structures that seriously
undermine the vision and encouraging risk taking and
nontraditional ideas, activities and actions;
• Planning for and Creating Short-Term Wins by planning for visible
performance improvements, creating those improvements and
recognizing and rewarding employees involved in the
Situational Assessment and
Environmental Scanning
• Consolidating Improvements and Producing Still More Change by
changing systems, structures and policies that don’t fit the vision,
hiring, promoting and developing employees who can implement
the vision, and strengthening the process with new projects,
themes, and change agents; and
Situational Assessment and
Environmental Scanning
• Institutionalizing New Approaches by articulating the
connections between the new behaviors and corporate
[organizational] success and developing the means to ensure
leadership development and succession.
Leadership Competency
• Planning
• Situational Assessment and Environmental Scanning
• Decision Making and Decision Alignment
• Training
• Cultural Competencies
• Ethical and Moral Competencies
Decision Making and Decision Alignment
• 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.
Decision Making and Decision Alignment
• Methods of decision making are:
• Quantitative methods: use tools such as multiple attribute
value, probability-based decision trees, analytical mathematical
models, linear programming and similar tools;
• Qualitative methods: use tools such as focus groups, interviews
(formal and informal), normative group techniques and similar
tools; and
• Triangulation methods: combine both quantitative and
qualitative methods where, classically, qualitative methods are
‘theory building’ and quantitative methods are ‘theory testing,
validating or confirming.’
Decision Making and Decision Alignment
• Decision making is not as sterile and ordered as most have
been taught.
• Willful choice (rational) decision making models together
with Reality-based (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; and
• Combinations of willful choice and reality-based models.
Willful Choice Decision Making Models
• This model assumes time and information are abundant, energy
is available, and goal congruence of participants (everyone is
focused on the same set of goals) has been achieved.
Willful Choice Decision Making Models
• 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, and
4) heuristics or decision rules to choose an alternative
Willful Choice Decision Making Models
• The six-step model of decision making applies the analytic 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, and
6) Implement the solution based on the decision made.
Willful Choice Decision Making Models
• Criticism of Willful Choice Models
• Information and time are assumed to be abundant and
relatively free resources in rational and willful choice models,
as well as, organizational participants in the decision making
process are assumed to have similar (if not the same) goals.
Willful Choice Decision Making Models
• Criticism of Willful Choice Models
• Well-known leadership and management concepts consider
pre-planning (short and long-term) as the method to solve
ambiguity (not knowing what to do) in business, but as task
complexity increases and time availability decreases, the ability
to plan and problem solve increasingly become more difficult.
• The rapid pace of operations and change in health today makes
traditionally-based organizations less adaptive and flexible in
complex environments.
Willful Choice Decision Making Models
• Criticism of Willful Choice Models
• Reality suggests that preferences of participants in the decision
making process vary in, often, illogical and emotionally
dependent ways.
Reality-Based Decision Making Models
• Reality-based models, such as the Garbage Can Model, are
intended to extend the understanding of organizational
decision making by emphasizing on a temporal context (the
situation at one point in time) and accepting chaos as reality.
• Rational (willful choice) decision making models are a subset of
reality-based models.
Reality Based Decision Making Models
• In ambiguous (do not know what to ask or do) situations where
time and information are limited or constrained and ‘perfect
information’ impossible to acquire, where organization
structure/hierarchy is loosely coupled, analytical decision making
models do not fit reality.
Garbage Can Decision Making Theory
• Four basic streams influence the decisions: problems, solutions,
participants and choice opportunities.
• In a Garbage-Can situation how these streams will be mixed it is
• It is a situation where problems, solutions, and participants move
from one choice to another, frequently.
Garbage Can Decision Making Theory
• This situation leads to three kinds of decision making styles:
• Decision By Oversight: Decisions are made for the sake of
making decision without considering if they are addressing the
real problem or not.
• Decision By Flight: Decision is not made till the time problem
leaves the existing and attached choice.
• Decision By Resolution: The problems are resolved on ad-hoc
Garbage Can Model Concepts
• Loose coupling in an organization is defined as the more informal,
differentiated focus. Members of the organization focus less on
following the rules but still have structured connectivity of intraorganizational entities.
• Loose coupling in organizations foster a garbage can decision
making approach.
Organizational Coupling ~ Garbage Can Decision Making
Optimization of Decision Making
• Leaders in health organizations must develop a system of decision
making understanding that decision making is not always orderly.
To do so, they should focus on the following tasks:
• Evaluating the situation and decisions that need to be made
across the organization (or within your area of responsibility)
and categorizing decisions by quantity, urgency, information
needed to make the decision, and variance in decision
• Developing readily available information concerning core
business functions;
Optimization of Decision Making
• Standardizing, documenting and training team members on
decisions that need to be made routinely where the same or
similar decision outcome is required and by ‘pushing’ those
decisions to the lowest levels of the organization but requiring
feedback loops;
• Determining decision making load (quantity in a set time frame)
and information available to make decisions (those not
Optimization of Decision Making
• Determining the importance of a decision to the organization by
creating a system of risk determination, urgency and
technological requirements for non-standardized decisions; and
• Training team members on the decision making system and
• Determine what decision making method to use.
Tools of Decision Making
• Quantitative methods include mathematical and computational
analytical models to leaders understand the decision making
situation (data turned to information to knowledge) and produce
mathematical outcomes of solutions.
• Some models are rather simple while others can be very
complex (Quantitative models assist in putting a ‘number’ on
Tools of Decision Making
• Qualitative methods include a variety of tools from personal
intuition, discussions with team members, informal interviews,
formal interviews, focus groups, nominal group techniques and
even voting.
• Qualitative methods are very useful since experience, intuition
and common sense are used to aid decision making by
individuals as well as groups.
Tools of Decision Making
• Triangulation is a more thorough method to make decisions.
Although triangulation takes time, it brings both quantitative and
qualitative approaches into the decision making process.
• It is common for a group to use nominal group techniques to
come to a small set of possible solutions and then for each
solution to be analyzed quantitatively. …
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