Leadership within a Residential Care Home

In our society it is rather common for every person of diverse backgrounds and experiences to converge and interact with each other. It is a challenge for a group of heterogeneous nature to act efficiently and to act as an organic whole. Thus, here comes in the challenge of an efficient leadership. This essay will describe a scenario within a UK residential care home, which demonstrates effective transformational leadership via a systems and organisational approach. Before describing the scenario, the difference between management and leadership will be outlined.

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Leadership and management are similar concepts, but each comprises unique components that make them distinct (Marquis and Huston, 2006). Primarily, the key purpose of management is to achieve results through the efficient use of people and resources, hence an approach that is usually autocrative. Management is largely concerned with operational issues, such as planning, analysis and problem-solving (Bennis & O’Toole, 2005).

Leadership, on the other hand, is more participative, one definition of clinical leadership being: ‘Leadership is a dynamic process of pursuing a vision for change in which the leader is supported by two main

groups: followers within the leader’s own organization, and influential players and other organizations in the leader’s wider, external environment’ (Goodwin,2006, p. 22). The integration of leadership skills into management approaches shows that although there is a difference between managers and leaders, there is an overlap whereby both are needed for an organisation to be successful.

The integration of distinct leadership and management skills were demonstrated in the following scenario:

A Filipino carer was promoted to a higher position, as a lead carer within a residential care home, which caters to approximately 40 service users diagnosed with dementia. From the start, he exudes potential to be a leader. Unlike others, he does less talking and does more work that produces very productive output. He is well respected because of his ability to inspire his colleagues to do better by setting himself as a good example. Prior to his promotion, the care home was subjected to be inspected by the Care Quality Commission (CQC), an independent working body which aims and works to regulate all the care homes, hospitals and other sectors to warrant that they rightfully comply and adhere to the specific standards to ensure that optimum care and safety of the service users/ patients are justly given, due the home’s inadequacies. Poor management, lack of sanitation, and inadequate staffing were among the observed shortfalls, along with the absence of a holistic, person-centered approach to care. As a newly assigned leader of the home and a novice in this position, the said Filipino carer is faced with an arduous challenge not only to help improve the quality of service the care home has to cater to its service users but most especially to be able to shepherd its subordinates to the best of his ability for the success of its whole organization.

The lead carer, in his new position, adopted a transformational leadership style, the focus being on achieving change through teamwork. Transformational leadership moves away from the superior/inferior dyad towards an emphasis on the importance of relationships in the achievement of long-term goals (McGee, 2007). This style places emphasis on the importance of communication and team-building (Whitlock, 2009), which supports the Creating Capable Teams Approach (CCTA) of encouraging teamwork and staff involvement in decision-making and action-planning (Hollingsworth, 2009).

The lead carer demonstrated good communication skills, which are fundamental to effective leadership (Barrett, 2006). Assessing the problem encountered, he demonstrated the ability to prioritise necessary action and delegate tasks to those capable of achieving the desired goals. Then, rather than take an autocratic approach and merely instructing staff as to their given task, he encouraged participation in the decision-making process. This strategy was used to enhance staff commitment by allowing a certain level of bureaucratic leadership, where regulations and policies were adhered to, without being autocratic. Similarly, this approach encouraged staff participation without being laissez faire, a leadership style that allows employees to deal with the situation entirely on their own regardless of skill and capability (Shaw, 2009). Whilst the latter can be an effective learning tool, it is also highly risky within the clinical setting where patient safety is paramount.

Recognising that staff would require a strong role model in order to achieve such drastic changes, the lead carer provided a learning environment for the staff, as well as a senior model from whom to learn. This was beneficial in terms of continued professional development. Indeed, taking advantage of teachable moments is another skill demonstrative of effective leadership (Scott & Mouza, 2007).

By taking into consideration the needs and capabilities of individual staff members, a sense of teamwork was harnessed, which in turn acted to motivate and empower staff. Using this leadership style also buffered any stress of the working environment because staff needs were being supported (Newton & Maierhofer, 2006). The lead carer also buffered the stress of a demanding workload and a changing working environment by being consistent in his manner, providing praise where it was due and, where necessary, suggesting alternative courses of action in an understanding manner. Such high levels of support and feedback from supervisors has been found to increase staff well-being (Newton & Maierhofer, 2006).

Of particular inspiration was the leader’s ability to adapt to an ever-changing situation, succeeding to maintain service user safety whilst also providing ample learning opportunities from which all staff could gain knowledge and hone their skills. Flexibility has been reported to be essential for effective leadership, as is the ability to adopt different styles of leadership under different circumstances (Sims, Faraj, & Yun, 2009). In this scenario, the lead carer was flexible enough to teach by example, being fully involved in the changes being made.

The effective implementation of the changes highlighted within this scenario was largely dependent on the leadership skills of the lead carer. Indeed, transformational leadership has been found to be positively associated with higher employee satisfaction and performance, as well as higher service user satisfaction. These, in turn, correlate positively with less adverse events within an organisation (Wong & Cummings, 2009).

The charisma of the lead carer reflects characteristics described by trait theory (Zaccaro, Heinen, & Shuffler, M. 2007), which proposes that leaders are born with inherited personality and behavioural traits that are suitable for leadership. This indicates that this leadership role might have come naturally to the lead carer within this scenario thus clearly supported by the fact his charms and wits managed to provide a positive output both for his colleagues and the entire organization. Interestingly, Filipino leaders do show a preference for relationship-orientated as opposed to task-orientated approaches (Mujtaba and Balboa, 2009). It is their innate characteristic and instilled value to give importance and utmost respect to the people they are around with, regardless of their social status, beliefs ,opinions. On the other hand, the leader also demonstrated problem-solving skills that suggested he was continuing to utilise circumstances in order to strengthen his leadership skills, learning from the present experience. This supports the theory that leadership skills can be taught (Parks, 2005). Covey (2000) purports that principle-centred leaders are continually learning from their experiences. Principle-centred leaders are also synergistic ‘ they can work with change and improve almost any situation they are. They emanate a positive energy and optimistic attitude, which also manifests in a belief in others. Along with his transformational style of leadership, the lead carer within this scenario also demonstrated characteristics of a principle-centred leader.

In terms of management skills, the lead carer acted according to the three independent roles that Mintzberg, Ahlstrand and Lampel (2010) propose for managers: interpersonal; informational; and decisional. By taking into consideration individual staff needs and providing information to encourage active involvement in decisions, the leader chose to use influence rather than authority to manage inadequacies within the home. This strategy has been recommended by Crevani, Lindgren and Packendorff (2007) who also advocate moving the focus away from the manager and towards the team as a whole. This is demonstrative of the system approach to management.

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The system approach to management was first introduced by Bertalanffy (1968) as ‘general system theory.’ Such an approach endorses organisational theory, whereby the organisation (in this case, the residential care home) is viewed holistically ‘ as a whole system comprising many subsystems, and within the context of the larger external environment. Madara (2008) defines a system as ‘a composition of several components working together to accomplish a set number of objectives’ (p.1). The lead carer, using the system approach, sought to resolve issues around poor management, lack of sanitation, and staffing problems, by working on the organisation as a whole and not merely targeting these three subsystems. Indeed, system theory purports that the activity of any subsystem of an organisation affects, in varying degrees, the activity of every other subsystem. In this case, improving staffing was likely to positively impact staff output, such as the provision of adequate sanitation. Furthermore, using a holistic approach to leadership and management, whilst also acting as a role model, was likely to enhance the presence of a holistic approach to care within the home.

The basic components of any system or organisation are: Input, Process, Output, Controls and Feedback loop. The input within this residential care home comprise care standards, scheduling of care, individual care needs, staff recruitment, staff supervision, staff abilities, and absenteeism and turnover. The process comprises the strategies used to determine issues such as required staffing levels and training needs, or limits in the number of service users who care can be accommodated. The output comprises these processes being put into action somehow, such as, for example, developing a care schedule for each service user. Controls are procedures put in place to ensure the planned input and output is achieved, such as the development of policies, procedures, and contracts. The feedback loop then enables the achievement of goals, such as improving sanitation and thus service user satisfaction, which can feed back positive input and output into the system.

System theory enabled the lead carer, using a transformational leadership style, to look at the organisation as a whole for achieving overall effectiveness, to provide staff with a shared focus to strive towards, and to consider the environment in which an organisation works. In this sense, the lead carer demonstrated an ability to analyse a situation, action plan, and motivate people to achieve organisational goals.

However, the leader might have benefitted further from a consideration of how different environmental and cultural dimensions relate to the type of leadership style adopted. The cultural dimension most often researched in terms of leadership is individualism-collectivism (Gelfand, Nishi, & Raver, 2007). This dimension is related to the integration of individuals into primary groups as well as the degree to which individuals look after themselves or remain integrated in groups. The leader within this scenario used a collective management practice, but needs to be mindful of staff from individualistic cultures, who value autonomy and personal needs above group needs. The importance of such considerations is highlighted by Kwantes and Boglarsky (2007), who found that organisational culture is strongly perceived as being related to both leadership effectiveness and personal effectiveness.

In terms of transformational leadership, as used within this scenario, Ergeneli, Gohar and Temirbekova (2007) provide cultural insight into this. By examining transformational leadership in Pakistani, Kazakh and Turkish business students they found that some aspects of transformational leadership are culture-specific, especially the aspects of inspiring a shared vision and being a role model.

The effectiveness of a chosen leadership approach is also influenced by gender. For example, Paris, Howell, Dorfman, & Hanges (2009) have demonstrated that preferred leadership styles differ between genders and across countries, cultures, and industries. In general, female managers showed greater preference for participative, team-oriented, and charismatic leadership styles than did males. On the other hand, both males and females valued humane-oriented leadership.

This scenario provided valuable insight into the importance of self-development and continued professional development in terms of leadership skills. Key factors described as effective in nurturing transformational leaders include provision and access to effective role models, as well as mechanisms for mentoring and clinical supervision (Davidson, Elliott & Daly, 2006). It is clear that an understanding of one’s own personal values and goals through personal insight and a willingness to reflect carefully on working relationships with others are necessary for developing the transformational leadership approach.

Gained from this scenario is a better understanding of leadership and the fact that it comprises a complex range of factors reflective of skills, characteristics, context and people. Furthermore, leadership is not merely a series of skills or tasks, but more so an attitude that entails adequate innate or maybe acquired leadership behaviour and dedication. The leadership skills currently possessed include good communication skills, effective team working, and strong problem-solving skills. The characteristics currently possessed that contribute to effective leadership include motivation, goal-focus, and a passion for continual learning. It is anticipated that these skills and characteristics, along with a working environment comprising people with a shared vision will facilitate the development of those skills and characteristics that require further nurturing.

It is clear that dynamic leaders and supportive environments are essential in the development and achievement of best practice models. The discussed scenario has provided further insight into the importance of this. It has also highlighted how the systems framework is fundamental to the organisational theory of leadership and management, since organisations are complex goal-oriented processes. In addition, cultural factors that might influence leadership effectiveness have been acknowledged and integrated into the learning experience. Effective leaders manage through a balance of both task and relationship focused behaviours, and thus it is important that the relationship-orientated approach that comes so naturally to this leader does not prevent task-orientation where necessary Huang and Mujtaba, (2009). This new insight and understanding can be harnessed for future leadership practice.

The author also firmly believes that all leaders are confronted to make their own personal choices of their leadership style to meet the needs of the many situations with respect to their organizations. Though there is no absolute uniform style to lead one situation or scenario from the other, effective and efficient leaders, based on their own discretion opt for a certain style which they think would work best for the entire organization.