Despo S. Neumeyer, BS, RD, Clinical Nutrition Manager

Introduction

It is an exciting and challenging time for us. The paradigm has been shifting, and many of us find ourselves in a new milieu of management and leadership. How do we assess ourselves in the context of today's definitions and messages for leadership? Oftentimes we find ourselves in a white-water turmoil attempting to navigate unruly waves and currents, uncertain if we have a crew that is prepared and a course that will take us to our destination.

Leaders need to be going somewhere. John Maxwell (1) tells us “Anyone can steer a ship but it takes a leader to chart the course.” What course are you charting with your team? Some leaders make thing things happen. Some leaders watch things happen. Some leaders let things happen. Some leaders ask, “What happened?” Which are you?

We are no longer just managers: We wear two hats simultaneously, those of Manager and Leader. Maxwell (1) notes reports that our culture is confuse s d between m m anagement and leadership.

“Leadership is set apart by the ability to influence; to get followers. Making sure that the work is done by others is the accomplishment of a manager. Inspiring others to do better work is the accomplishment of a leader.” He contrasts the differences between the leader and the boss: “Real leadership is being the person others will gladly and confidently follow. A real leader knows the difference between being the boss and the leader.” The boss drives the workers; the leader coaches them. Leadership requires an ability to influence. Management makes sure that the work is done while leadership provides the inspiration to do things better. People enthusiastically follow real leaders; leaders understand the difference between “leading” others and “managing things” or “being bossy.” While many people may feel confident in steering the ship, a devoted leader is required to chart the course. As Maxwell puts it, “The manager does things right, the leader does the right thing.” (1)

• The boss depends upon authority; the leader on goodwill.
• The boss inspires fear; the leader inspires enthusiasm.
• The boss says “I”; the leader “we.”
• The boss fixes the blame for the breakdown; the leader fixes the breakdown.
• The boss knows how it's done ; the leader shows how.
• The boss says “Go; the leader says “Let's go!”
• The manager administers; the leader innovates.
• The manager maintains; the leader develops.
• The manager counts on controls; the leader counts on trust.
• The manager does things right, the leader does the right thing.

It becomes very clear that the difference between the definitions rests in the extent to which the leader engages with the employee. Only when the leader is engaged can he/she influence and inspire.

Much has been written recently about the “engaged employee” in the work situation. Buckingham and Coffman (3) report the results of a Gallup study that demonstrated that engaged employees provide the foundation for top performance. Jack Welch, former CEO of General Electric, likewise tells us (4) that we must figure out a way to engage the mind of every employee. The question for each of us today as we lead our teams in healthcare is, “How do we assess our own leadership in terms of our engagement with each employee?”

The The Essence of Excellence Assessment Model, as shown in Figure 1, places the leader at the center of the wheel fully engaged with each employee at each spoke of action and activity.

The figure represents a seamless continuum and requires that the manager/leader model specific behaviors while assuring work experience engagement on a one-to-one basis with team members. Thus, to encourage, to educate, to enable, to energize, to empower, and to execute become the criteria, the crucial elements that serve to achieve excellence.

To Encourage

To encourage is to inspire with confidence, to provide support, guidance and influence. Each employee requires an approach to encouragement that is individualized and personalized. There is no single prescription for encouragement, but you will know what works; you will see the difference, the smile, the appreciation, the efforts and outcomes. This is the trust building that sets the foundation for team building. How can you make this happen? Schedule a breakfast appointment with all team member members within the first 45 days of employment, repeat at 90 days, and then once a year thereafter. Take time to actively listen and reflect on what they tell you about their personal concerns, their families, their ideas for programs and processes, their observations, their thoughts about performance improvement activities. Be fully engaged at this level; it sets the foundation for top performance and retention.

To Enable

Oftentimes discouragement occurs when we do not enable, when we fail to release the potential, the energy that could result in a meaningful and outstanding outcome. To enable requires us to collaborate with senior management, with other disciplines and within our own team and organization. What are the options and tools that allow you to enable? Have you looked outside the box when funds to attend conferences are not available? Can you provide a project day off site to enable development of a new project or process? Are you willing to flex schedules or provide an alternative plan that will not compromise patient assessments or timeliness of response when short-staffed? Are you willing to pick up patient assignments or work an occasional holiday or weekend? Your effort to enable will build trustworthiness and team spirit.

To Educate

“In a time of drastic change, it is the learners who will inherit the future; the learned will find themselves equipped to live only in a world that no longer exists.” This quote from the philosopher Eric Hoffer is timeless. Educating the team begins with recruitment, interviewing and selection. Inattention to this crucial responsibility will hamper the development and growth of your team, and it can disrupt team collegiality. Hiring is a task that no manager/leader should delegate. In a time of considerable healthcare challenges, it is imperative that we surround ourselves with team members eager to learn and be motivated. Jeffrey Fox (5) advises us how to approach today's challenges in recruitment and retention:

• Hire slowly and with care.
• Personally spend time with background and references.
• Focus on the candidate's energy, accomplishments, implementations.
• Select for attitude and ability.
• Select for talent; you cannot teach talent but you can educate for skills and knowledge.

In support of these principles we need to conduct multidisciplinary (administrators, physicians, nurses, pharmacists, speech therapists, child guidance workers) panel interviews where both competencies and behavioral responses can be assessed and evaluated.

Education and development requires constant engagement. Know your employees' individual strengths, and place them in positions that utilize their strengths (6). If you are unable to manage around their weaknesses, assist them in seeking other opportunities for placement. If you need to terminate the employment relationship, dismiss them with dignity, and affirm their contributions. Do not let a weak employee dilute your team's morale, spirit, and performance. Trust your professional instinct, and do not unfairly carry an employee for an extended period because you find it difficult to terminate.

Assess how much time you actually spend daily in developing and mentoring staff. Musicians, dancers, fire departments, and the military, for example, must train continuously. Set a goal for yourself and your team. Devote 15 minutes per workday on teaching, training or learning together. This is a time investment that will yield a high performance team, a team prepared to inherit the future.

To Energize

So often the demands of our profession, financial, staffing, meetings, recruitment, and regulatory requirements leave little time for renewal, let alone energizing our staff. But the requirement to energize is much like the prescription to exercise, with the benefit of renewed vigor and healthier attitude. To energize releases everyone's potential. It activates and invigorates, it affirms and applauds. Central to the process of energizing is communication. The very heart of communication requires that you be engaged. Let people know in a variety of ways how important they are. Recognition and applause celebrate their efforts and outcomes.

How do you celebrate your team and its accomplishments? Bob Nelson has written an outstanding guide for rewarding employees (7), a must-have reference for every manager/leader. Recognition for a job well done is the top motivator in employee performance. Thoughtful, personal recognition that is reflective of sincere appreciation and positive reinforcement is the key to performance at higher levels. Nelson advises us to match the reward to the person, the reward to the achievement, and to be timely and specific.

How do you recognize and energize your team? Try celebrating your Clinical Nutrition Team during National Nutrition Month. Showcase your team as the “nutrition experts.” Feature portrait-style professional photographs of each team member in a prominent location, where the display will receive high visibility. Highlight their years of service, their education, training, specialty, areas of assignment. Follow up with a special catered luncheon celebration in your facility's board room, and invite the hospital CEO, board chairman, medical directors, multidisciplinary department heads, physicians, and other senior leadership members to join. Commend your team for its contributions to the care and positive outcomes of patients. Have your senior clinicians share their reflections and accomplishments. Invite your guests to comment on the team successes. Reinforce with certificates and plaques. Recognition is part of servant leadership, demonstrating caring and compassion.

To Empower

To empower is to trust, to invest with power and to commission. Empowerment can only occur after you have engaged your team through your efforts to encourage, to educate, to enable, to energize. At this point the “heart role” of leadership takes over, the point where the engaged manager/leader walks with the team, sharing ownership and vision with a highly skilled and satisfied team that out-performs their leader's expectations. Be sure that your team members see in you your trust in them, your passion and advocacy for them, and your clear vision. When the team vision is blurred (and on occasion it may be) or when team confidence wanes, team members will draw strength and empowerment from the clarity of your vision and confidence.

To Execute

Execution is the discipline of getting things done. Execution results from a culture of passion and engagement (8). Your team can only execute if their hearts and souls are engaged. To execute is to demonstrate and model positive expectancy, which is rooted in the belief that problems are solvable and success inevitable. This is the point at which you fulfill the team's mission and visions. This is the time when your “great expectations” are met and pioneering missions accomplished. This is the moment when you recognize that you have taken a group of people to a place where it didn't think it could go. This is when you, as a leader, lead best by walking behind your team.

Summary

All managers and leaders have their own style, but all share the same goals: to turn each employee's talents and strengths into performance fully executed. This is accomplished by being actively engaged with each employee at each spoke of action on the continuum. You earn your leadership by your commitment to your work. This is the essence of excellence in leadership. It is the culmination of acting, caring, inspiring, educating, affirming and persuading others to act.

Contact Despo at Long Beach Memorial Medical Center / Miller Children's Hospital, 2801 Atlantic Ave., Long Beach, CA 90806. 562/933-0525, dneumeyer@memorialcare.org

References

• Maxwell JC. Developing the Leader Within You. Nashville, Tenn: Thomas Nelson Publishers; 2000.
• Brown HJ Jr. A Father's Book of Wisdom. Nashville, Tenn: Rutledge Hill Press, Inc.; 1988.
• Buckingham M, Coffman C. First, Break All the Rules . New York: Simon & Schuster; 1999.
• Slater R. Jack Welch & The G.E. Way: Management Insights and Leadership Secrets of the Legendary CEO. New York: McGraw-Hill; 1998.
• Fox JJ. How to Become a Great Boss. New York : Hyperion; 2002.
• Buckingham M, Clifton DO. Now, Discover Your Strengths. New York: The Free Press; 2001.
• Nelson B. 1001 Ways to Reward Employees. New York: Workman Publishing; 1994.
• Bossidy L, Charan R. Execution, The Discipline of Getting Things Done. New York: Crown Business; 2002.