1. Directing and Leading
Dr. Thin Myat Han
Lecturer
Health Policy & Management Department
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2. References:
• BM Sakharkar 2009, Principles of Hospital
Administration (2nd Edit) Chapter 10. Directing and
leading.
• International council of Nurses (2008), “Incentive
systems for health care Professionals.”
• B S Buchbinder, NH Shanks, 2012, 2nd Edit,
“Introduction to Health Care Management. “
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3. Discussion outline
1. Directing
2. Motivation
3. Leadership
4. Induction and Training
5. Communication
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4. Directing
• Synchronizes activities and maintains momentum
towards desired objectives
• Factors determine successful directing:
1. Delegation
2. Communication
3. In-service training
4. Motivation
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5. Work Motivation
• An individual’s degree of willingness to exert and
maintain an effort towards attaining organizational
goals (Kanfer 2002)
• Motivators – factors which induce an individual to
perform well – e.g.
• higher pay, a prestigious title, recognition by
superiors
• it can be through incentives
• Financial and Non financial incentives
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6. Financial Incentives
 Salary/Wage
 Pension
 Bonuses
 Insurance (e.g. health)
 Allowances (e.g. housing, clothing, child care,
transportation)
 Fellowships
 Loans
 Tuition reimbursement
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7. Non-financial Incentives
 Safe and clean workplaces
 Vacation days
 Professional autonomy
 Sustainable employment
 Support for career development
 Flexibility in working time and job sharing
 Recognition of work
 Supervision
 Coaching and mentoring structures
 Access to/support for training and education
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8. Non-financial Incentives (cont.)
• Sabbatical and study leave
• Planned career breaks
• Occupational health and counseling services
• Recreational facilities
• Equal opportunity policy
• Enforced protection of pregnant women against
discrimination
• Parental leave
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9. Is everybody motivated?
• In most cases, motivation comes from some needs
that leads to behavior that results in some type of
rewards
• While reward may serve as incentives and those who
bestow rewards may seek to use them as motivators,
the real motivation to act comes from within the
individual
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10. • Two forms rewards – intrinsic / extrinsic
• Intrinsic reward- derived from within the individual –
e.g., taking pride and feeling good about a job well
done
• extrinsic reward-reinforcements that are given by
another person – e.g., giving bonuses to workers for
a good job they have done
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11. Intrinsic rewards
• Less tangible, are highly subjective, they represent
how the individual perceives and feels about work
and its value
1. Healthy relationship – in which employees are able
to develop a sense of connection with others in the
workplace
2. Meaningful work – where employees feel that they
make a difference in people’s lives – so manager
needs to make their jobs more interesting
3. Competence – where employees are encouraged
to develop skills that enable them to perform at or
above standards
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12. Intrinsic rewards
4. Choice – where employees are encouraged to
participate in the organization in various ways such
as by expressing their views and opinions, sharing
in decision making, participate in problem solving,
goal setting
5. Progress – where managers find ways to hold
employees accountable, facilitate their ability to
complete assigned tasks, celebrate when progress
is made
• if coupled with extrinsic rewards lead to high
personal satisfaction
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13. Maslow’s Hierarchy of Needs
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14. Maslow’s Hierarchy of Needs Theory
• Maslow (1954) postulated a “hierarchy of needs”
that progress from lowest, to highest level, once
each level has been met, individual will be motivated
by and strive to progress to satisfy the next higher
level need
1. Physiological needs- e.g., food, water and other
subsistence related needs;
2. Security and safety needs-shelter, safe work
environment, permanency in employment, access to
health care;
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15. Maslow’s Hierarchy of Needs Theory
3. Affiliation and acceptance needs - desire for social
contact and interaction, friendship, affection;
belonging to a group
4. Esteem needs – status, recognition, positive
regard;
5. Self-actualization needs – desire for achievement,
personal growth and development, autonomy
• “Satisfaction progression” while useful from
theoretical perspective, most individuals do not
view their need in this way, making this approach
to motivation a bit unrealistic
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16. Reinforcement Theory (1953)
• Individuals are motivated when their behaviors are
reinforced
1. Positive reinforcement – relates to taking action
that rewards positive behavior
2. Avoidance learning (negative reinforcement) –
actions are taken to reward behaviors that avoid
undesirable behaviors
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17. Reinforcement Theory (1953)
3. Punishment – actions designed to reduce
undesirable behavior by creating negative
consequences for the individual
4. Extinction – removal of positive rewards for
undesirable behaviors
• Criticism for this approach - Fails to account for
employees’ ability to think critically and reason, may
be applicable in animals
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18. Approaches to motivation
• Through function of leading, managers help people to
realise that they can satisfy their own needs and
utilise their full potential at the same time, to achieve
the aims of the organization
• People have : different needs, ambitions, attitudes,
desire for respect, responsibility, level of knowledge
and skills, and potential
• so need to understand the complexity and
individuality of people
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19. Assumptions
1. Motivation by formal control
1. Concept of “Rational economic man” – people are
motivated only by financial incentives
• it motivates only to a point, when money incentive
isn’t high enough or is considered to be in
equitable, it’s a de-motivator,
• Atchison (2003) calls “as soon as it predictable, it is
an entitlement, not a motivator”
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20. Assumptions
1. Motivation by formal control
2. According to Theory X, they postulated that
“People are not keen to accept responsibility,
cannot be trusted, needs to be controlled through
fear of termination of his job and other kinds of
punishments”
• Fail to motivate employees on a long-term basis
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21. 2. Through informal organization and
group dynamics
• Interpersonal dynamics of the group to a great
extent influence motivation and performance of
employee
• To encourage formation of cohesive informal groups
and group leaders, maintaining good interpersonal
relationship, and a good human relations
• Uncertain, short term approach
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22. 3. Through encouraging full utilization
of workers potential
• Satisfaction and happiness at work come from
maximum utilisation of one’s potentialities and
abilities
• If there is challenging opportunities at work for
employees for demonstrating his performance – this
will motivate him for maximum performance
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23. Balance view of motivation
• People are complex and variable, and have many
motives which combine into a complex motivation
pattern
• A part from economic rewards, they also want to
develop their capabilities, their competences, their
potential as well
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24. Motivating professionals
• More committed to their profession rather than to the
organization, like to have freedom to provide self-
direction, technical competence
• Want opportunities where they can show
achievement, can grow in their profession and get
feeling of accomplishment
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25. Leadership
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26. Leadership
• Key to effective managing
• Induces people to strive not only willing but also with
enthusiasm
• Leaders need to understand what motivates
employee
• Not all leaders are executives or administrators
• but administrators must have leadership qualities
because they have to deal with people for creating
better attitudes, arousing enthusiasm, improving
morale, and develop spirit of cooperation
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27. Leadership styles
• Theory X and Y styles of leadership by McGregor
• Four basic leadership styles
Directing
Coaching
Supporting
Delegating
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28. Theory X type of leadership
(Autocratic and authoritative)
• Based on the traditional negative assumption (of
manager) viz.
– Average human beings have an inherent dislike of
work and will avoid it
– Most people must be coerced, controlled and
directed
– wish to avoid responsibility, and want security
above all
• Can be effective where task is simple in nature the
employees are unskilled
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29. Theory Y type of leadership
(participated and consultative)
• Based on an assumptions that people
– want to exercise self-direction and self-control in
achieving goals to which they are committed
– under proper conditions want to accepts
responsibility
– The intellectual and inner potentialities of the
average human being are only partially utilized
• More effective in managing the human resources
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30. Four basic leadership styles
1. Directing
2. Coaching
3. Supporting
4. Delegation
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31. Directing style
Managers are:
• highly authoritative,
• have little trust in subordinate,
• motivate people through fear and punishment with
occasional rewards,
• engage only in downward communication, and
• limit decision making to the top
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32. Coaching style
• Managers :
• Have confidence and trust in subordinates
• Motivate with reward, some fear and punishment
• Permit some upward communication, solicit some
ideas and opinions from subordinates
• Allow some delegations of decision making but with
close control
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33. Supporting style
• Managers:
• Have substantial confidence and trust in subordinates,
• Try to make constructive use of subordinates’ ideas
and opinions
• Use motivation rewards and some participation
• Engage in communication both down and up
• Make broad policy decisions at the top with specific
decision at lower levels and act consultatively in other
ways
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34. Delegation style
• Managers:
• Have complete trust and confidence in subordinates
in all matters
• Invite ideas and opinions from subordinates and
constructively use them
• Engage in communication down and up and with
peers,
• Encourage decision making throughout the
organization and operate as a group
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35. Emotional Intelligence (EI)
• A concept made famous by Daniel Golemen in late
1990s
• Suggests that there are certain skills (intra and
interpersonal) that a person needs to be well
adjusted in today’s world, include
1. Self-awareness – a deep understanding of one’s
emotions and drives
2. Self-regulation – adaptability to changes and
control over impulses
3. Motivation – ability to enjoy challenges and being
passionate toward work 35

36. Emotional Intelligence (EI)
4. Empathy – Social awareness skill, putting yourself
in another’s shoes
5. Social skills – supportive communication skills,
abilities to influence and inspire
• Leaders have needed to be more understanding of
their subordinates’ world outside of the work
environment
• Suggests a more caring, confident, enthusiastic
boss who can establish good relations with workers
• EI can distinguish outstanding leaders and strong
organizational performance 36

37. Induction and Training
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38. Induction and Training
• Induction - A new worker needs at least to be
introduced to his colleagues and shown around the
layout of his department
• to understand how his job fits into the pattern of the
whole organization – to have sense of belonging to
an organization and interest in his job
• Training – to adopt their knowledge and skills to the
special requirements of the new job (organization)
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39. Communication
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40. Communication
• Important in the function of leading
• The transfer of information from the sender to the
receiver with information being understood by the
receiver
• Means by which social inputs are fed into social
system
• Behavior is modified, change is affected
• Information is made productive
• Force for influencing - staff direction, group activity
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41. Purpose of communication
• For both internal and external functioning
• Internal
1. To disseminate goals and develop plans for their
achievement
2. To organize resources in the most effective and
efficient manner
3. To appraise and develop members of the
organization
4. To lead, direct, motivate and create a climate in
which people want to contribute
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42. Purpose of communication
• External
• Information exchange to become aware of the needs
of patients (clients) and the concerns of the
community
• Leaders have major responsibility to set the right
direction and tone for effective communication
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43. Communication process
1. Sender of message
2. Transmission of message
3. Receiver of message
4. Feedback
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44. Communication flow
• Downward –comes down the chain of command,
time consuming, oral and written
• Upward – tendency to be hindered,
e.g., reports and return, suggestion system, appeal
procedure, complaint system, group meeting, open-
door-policy
• Crosswise - horizontal flow
- Diagonal flow
• One way – ineffective in long run, but speedy, no
fear of disagreement, impressive, protect one power,
makes work life simpler
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45. Communication models
 Written
 Oral
 Nonverbal
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46. Written communication
• Can be read by large audience
• Promote uniformity
• Provide record
• No immediate feedback
• Take long time to know whether a message has been
properly understood
• A lot of effort is required for effective writing
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47. Oral communication
• 70% of communication
• Speedy interchange with immediate feedback
• Effect can be noted
• Face to face meeting –time consuming and costly
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48. Non-verbal communication
• Can reinforce verbal communication
• Through gestures, facial expression and body
language
• Attentive eye contact, active listening, a show of
confidence – mature person
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49. Art of listening
1. Physically show that you are ready to listen
2. Ignore the speaker’s appearance or manner of
delivery
3. Watch your nonverbal communication
4. Keep your mind on what the speaker is saying
5. Allow for your own bias
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50. Art of listening (cont.)
6. Visualize the situation from the speaker’s point of
view
7. Do not interrupt immediately if you hear an
apparently wrong statement
8. Evaluate the logic and credibility of what you hear
9. Do not give your last word
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51. Guideline for effective communication
• Clarify ideas before attempting to communicate
• Eliminate unnecessary details
• Plan the organizational communications in
consultation with all
• Establish two way communication
• Understand the other party’s frame of reference
• Follow-up
• Be a good listener
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