Leading The Way In Health Care
To prepare for this Discussion, review this week’s Learning Resources related to leadership and emotional intelligence.
By Day 4, post a comprehensive response(250-350 words) to the following:
• Explain what is meant by “Leaders are not born, they are made.” What are the key differences between a manager and a leader?
• How do the components of emotional intelligence (EI) influence decision making and leadership in health care? (See Table 1, EI article.) What can you do to develop EI in your current or future managerial role?
*APA style but no cover page.
Reference to E I article below:
Freshman, B., & Rubino, L. (2002). Emotional intelligence: A core competency for health care administrators. The Health Care Manager, 20(4), 1-9. Retrieved from http://auth.waldenulibrary.org/ezpws.exe?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12083173&site=ehost-live&scope=site
Emotional Intelligence: A Core Competency for Health Care
Administrators
The contemporary concept of emotional intelligence (El) a.s a critical set of management skills is traced through time to it.s current application for health care administration. El is defined us proficiencies in intraper.sonal and interpersonal skills in the areas of self-awareness, .self-regulation, .self-motivation, social awareness, and stxrial skills. The contributions of HI to effective management are supported by empirical research in the field. The importance of developing these skills in health care organizations is further clarified with examples familiar to health care administrators. Training suggestions and assessment resources are pruviiled. Key words: emotional intelligence, health care admitnstration. leadership trainitig. nuiiuif^cnicnt skills
Brenda Freshman, PhD Visiting Assistant Professor School of Public Health University of California, Los Angeles Lo.s Angeles. California
Rubino, PhD, FACHE Assistant Professor of Health
Administration Department of Health Sciences California State University. Northridge Northridi^e. California
EMOTIONAL INTELLIGENCE (El) iscurrently a hot topic in management consulting and leadership training circles. As an example, when the Harvard Bit.’iine.’is Review printed an at tide on El in 1998, it gained a greater percentage of readers than any previously published article in that jour- nal for the last 40 yeais.’ In the early 199()s, science writer for the New York Times on brain and behavior, Dan Goleman, began investigating the topic. In 1995, his book. Emotional Intelligence, was published and became a widely read and much-cited refet- ence.- Since that time, there has been plenty of excitement, confusion, and raised eye- brows with respect to emotional intelligence in general and, more specifically. El and its value as a corporate training objective.
El is now considered fundamental for get- ting along in the workplace and is a primary leadership and managerial cotnpetency.’ Health care lends itself to having leaders with high El. Some of the most significant prob- lems facing society are health-related. Health administrators must contend with providing quality service to their customers
Health Care Manager, 2002. 2(ll4i. 1-9 02002 Aspen Publishers. Inc.
2 THE HEALTH CARE MANAGER/JUNE 2002
during a period of limited fiscal and human resources. How do we give access to our health care delivery system when there is a large percentage of the population with no ability to pay? The bioethical considerations surrounding human genetics, patient protec- tion, and privacy necessitates having health care administrators who can look beyond the immediate need for answers and understand the potential long-term impact on individuals. Having the sensitivity to recognize these very human issues and to act on them in an effective manner requires a leader with high El.
This article is presented to fulfill three intentions. First is to clear up some of the confusion about El, what it is, and what it is not. Second, we will discuss why developing El skills and competencies are applicable in health care leadership. Third, we will review some ofthe key components of successful El training policies and how to best implement them, bringing investment benefits all the way to the bottom line.
EMOTIONAL INTELLIGENCE: WHAT IS IT?
Many of the skeptics of the El trend say, “Oh this is nothing new, just academics and managetnent consultants repackaging old stuff for our consumption.” So, is it some- thing new, or just common sense, age-old wisdotn, personality theory, and cotnmuni- cation skills repackaged as the next training trend? Yes and no is our response. Even though the term emotional intelligence was officially coined in 1990 by Salovcy and Mayer, philosophical and religious texts have been attempting to focus humatiity on the importance of developing awareness and tnonitoring behavior for centuries. To clarify, interpersonal skills such as compas-
sion, empathy, and tmst, and intrapersonal skills such as self-knowledge, observation, and contemplation have been refiected on throughout written history.
As an example, the Hindu text Bhagavad- Gita, composed centuries before the com- mon era, makes a good arguinent for the awareness and management of emotional reactions by stating. “That man is disciplined and happy who can prevail over the turmoil that springs from desire and anger, here on earth …” With the expansion of the field of psychology in the early twentieth century, emotional responses and behavior began to be theoretically and empirically explored. The point to be made here is that the value and importance to human relations of what we are now naming El competencies or skills is not new. Therefore, working on develop- ing emotional intelligence can bring up feel- ings of deja vu in people related to their experiences with similar topics.
However, what is new and promising about the work being done with El is that now these competencies are being viewed as skills to be developed rather than personality traits that are considered less malleable. Cur- rent consultants and acadetnics are drawing from psychological studies throughout the years that in hindsight appear to be aspects of EI.^This growing focus on research investi- gating psychological and emotional skills adds support to the value of El in work settings. For example, Rosenthal found that people who could better identify the etno-
EI is being viewed as skills to be developed rather than personality traits that are considered less malleable.
Emotional Intelligenci
tions of others were also more successful at work and in social settings.’ Bachman’s study on leadership in the US Navy found warmth, emotional expression, and sociabil- ity to be key factors of effectiveness.* A study of retail chain managers revealed that the ability to handle stress predicted net profits and sales per square foot and per employee.^
GENESIS OF TODAY’S El CONSTRUCT
With the dawn of the twentieth century and the development of scientific methodolo- gies, researchers began to focus on investi- gating the benefits of socio-emotional skills. In 1937, psychological researchers Thorn- dike and Stein began describing and evaluat- ing .social intelligence.* In the 1940s, David Wechsler wrote about two forms of intelli- gence, “intellective” and “non-intellective,” referring to the traditional intelligence quo- tient (IQ) set of skills and the social emo- tional set of skills, respectively.** Wechsler described the “non-intellective” skills as “af- fective and conative abilities”; in other words, psychology skills having to do with attitude, behavior, and change.
In the 1950s, scientists researching effec- tive leadership were finding that human rela- tion skills, such as consideration, trust, re- spect, and mutual warmth, were important qualities in a successful executive.'” Empiri- cal research and theoretical development of similar types of skills sets continued through the 1960s, 1970s, and 1980s. Self-develop- ment was looked at in the 1960s by Shostrom in terms of “self-actualization.”” Coleman looked at the corresponding relationships between psychology and behavior.’^ In the 70s researchers such as Sleek and Bass looked at “personal adjustment” in stu-
dents,’^ and At ieti investigated the cognitive components of human conflict and uncon- scious motivation.”’
In the 1980s, “self-assessment” was found to be correlated with superior performance among managers in 12 different organiza- tions.’^ Delognis, Eolkman, and Lazarus in- vestigated how psychological and social supports can influence the impact of sttess on health and mood.’* Also in the 1980s. Gardner began discussing “multiple intelli- gences,” with “interpersonal” and “intra- personal” dimensions being just as impor- tant as the intelligence components previously associated with IQ.”’ Gardner’s terminology set the stage for viewing the set of emotional skills as intelligence in the decades to follow.
As previously stated, the phra.se emotional intelligence was formally coined in 1990 by John Mayer and Peter Salovey. Mayer and Salovey discuss four hierarchical abilities that lead to high El: (1) the accurate percep- tion, appraisal, and expression of emotions: (2) generating feelings on demand when they can facilitate understanding of yourself or another person; (3) understanding emotions and the knowledge that can be derived from them; and (4) the regulation of emotion to promote emotional and intellectual growth.'” More recently, a report issued by The Con- sortium for Research on Emotional Intelli- gence in Organizations describes emotional intelligence as “about two dozen social and emotional abilities that previous research has shown to be linked to successful perfor- mance in the workplace. These abilities can be grouped into five core areas: self-aware- ness, self-regulation, self-motivation, social awareness, and social skills.”^ We feel com- fortable with this broad, yet developmentally focused, definition.
4 THE HEALTH CARH MANAGER/JUNE 2002
During the last decade, researchers have tried linking aspects of El to business results. David McClelland was one ofthe first to note that leaders with El-type competencies were more effective than their peers who lacked these skills. This type of leader assessment of skills continues today with the consulting firm Hay/McBer, who is conducting re- search on executive leadership styles derived from the components of emotional intelli- gence and determining their impact on the workatmosphere.”’Itwasin 1995, however, when Goleman’s Emotional Intelligence was released, that El piqued interests and gained popularity in the personal growth and business press. The current flux of business management applications in research and in the field is giving the semblance of El being a trend. The argument we tnake here today is that it is not merely a fad, but rather a useful approach of applying age-old wisdom to per- sonal and organizational development. It is time to apply this wisdom to health care administration.
THE VALUE OF EMOTIONAL INTELLIGENCE SKILLS TO HEALTH CARE PROFESSIONALS TODAY
The growing interest in emotional intelli- gence in all businesses recognizes the impor- tance of savvy interpersonal skills and the ability to get along with others.-” In health care, creating virtually integrated networks have become paramount to a successful op- eration. A hospital administrator no longer ignores his or her local counterpart hoping to fend off any advances through head-to-head competitive measures. Instead, he or she must meet with the competitor and negotiate ways that their entities can both survive in the
volatile marketplace. Collaboration through “co-opetition” becomes the vehicle to pro- duce unchallenged services, shared capital, increased economies of scale, and expanded databases and market contacts.-‘
Dye does an excellent job in discussing how a health care leader must recognize his or her key personal value.s—because they dictate his or her behavior and thought pro- cesses.-^ Dye places emphasis on El, defin- ing it as a combination of emotional maturity and energy. Through a series of .self-help tools to put this concept into operation. Dye gives practitioners a practical guide to con- duct continual self-evaluation, one of the dimensions of El.
Maccoby theorizes how leaders working in the high-technology field have a high amount of strategic intelligence (made up of foresight, system thinking, visioning, motivating, and partnering), yet lack El.-‘ He acknowledges how some El makes all leaders stronger but emphasizes strategic intelligence as being more crucial for the successful technology company leader. Maccoby professes that El better serves the health professions, yet he focuses on the benefit to clinicians in his state- ment rather than administrators.
Doctoral researchers have attempted to measure a particular industry’s managers’ El quotients. Some ofthe various industries that tested their personnel for some component of El were found in global oil,̂ ‘* nonprofit foun- dations,^ and education.-” -̂ The importance of recognizing El seems to have entered into the health administration field as well. A recent tool was developed for early careerists in health care administration that included, as one of the domains, interpersonal intelli- gence and El.-” Consultants are telling hospi- tals and health care systems to expand their El when developing relationships with phy-
Emotional Intelligence
sicians to gain support and improve cost- effectiveness.-‘ Yet, there is no evidence that this is occurring.
In fact, health care has not embraced El. Only select progressive health care facilities have recently recognized the value of El training and have incorporated programs that emphasize its principles.'” Health care pro- fessionals might have a hard time believing that they need to develop their interpersonal skills. Many may have the misconception that the compassion that drew them to the industry will serve them well as they lead their organizations. They might not appreci- ate being trained in areas in which they al- ready feel competent. Or health care admin- istrators might not realize how many tasks associated with their daily routine use skills derived from the components of El. A sam- pling of health care administration’s applica- tion to El is provided in Table I.
This acknowledgment of El as crucial to health care administration leadership seems to be consistent with several current issues facing the field. A comprehensive survey of graduate program directors’ proposed cur- riculum revisions tended to emphasize prac- tice involvement and human resource man- agement skills rather than the increased quantitative and financial competencies.^’ The most significant new development in years in health administration education is the recent push for competency assessment for newly graduated health care administra- tors.”” The industry believes that the present managerial pertbnnance in health care is inad- equate and that substantial improvements are needed to support the nation’s health care needs.^ One of the leaders in this movement, John Griffith, proposes that the field develop criteria for evidence-based health administra- tion education with the goal of providing a
systematic, outcomes-oriented, evaluation and improvement of the educational process.^’ This might include measurement of El pre- and post-education if we are serious about the value it brings to health care leaders.
EMOTIONAL INTELLIGENCE ASSESSMENT TOOLS
Several tools measuring El skills have been developed and are in use today. Bar- On’s EQ-I is a self-report instrument of 133 items designed to assess personal qualities correlated to greater well-being.’* Dr. Reuven Bar-On based this instrument on more than 19 years of research in occupa- tional settings with more than 33,000 sub- jects tested worldwide (http://www .equniversity.cotn/main-index.html).
The codevelopers of El, John Mayer and Peter Salovey, together with psychologist David Caruso, created the Multifactor Emo- tional Intelligence Scale (MEIS). in which subjects are rated on their ability to conduct tasks that involve working with emotions in an assessment center fonnat. The MEIS uses the definitions of Mayer and Salovey’s model to build an ability test that measures four branches of El: (1) identifying etno- tions. (2) using emotions, (3) understanding emotions, and (4) managing emotions.
A 360-item instrument called the Emo- tional Competence Inventory (http:// trgmcber.haygroup.com/emotional-intelli- gence/eiacc.html) was developed by Richard Boyatzis and Daniel Goleman using 20 com- petencies from Goleman”s research. A 360- item assessment asks people from different groups, such as supervisors and direct re- ports, to rate a subject. This particular instru- ment requires assessment administrators to be accredited.
THE HEALTH CARE MANAGER/JUNE 2002
Table L Healthcare Administration Application to
Component
Self-awareness
Self-regulation
Self-motivation
Social awareness
Social skills
Deflnition
Having a deep understanding of one’s emotions, strengths. weaknesses, needs, and drives.
A propensity for reflection, ability to adapt to changes, saying no to impulsive urges.
Driven to achieve, being passionate over profession. enjoying challenges.
Thoughtfully considering someone’s feelings when acting.
Moving people in the direction you desire.
Emotional Intelligence
Examples of application
1. Confidently making decisions when budgets must be trimmed in medical areas.
2. Knowing that the values of the health care system are not congruent with yours.
3. Recognizing that the late night committee meetings are affecting your family relations.
1. Knowing when to step away if having an argument with a provider.
2. Actitig to correct medical billing compli- ance issues rather than ignoring them.
3. Accepting responsibility over additional health care facilities.
1. Setting up a senior manager retreat to allow the best environment for planning.
2. Being optimistic even when census is low. 3. Embracing diverse populatiotis of patients
and employees.
1. Tliinking of the family’s perspective when involved in bioethical decisions.
2. Being compassionate when dealing with employees and their personal problems affecting their work.
3. Being patient-centered.
1. Being able to negotiate a favorable managed care contract.
2. Having employees satisfied with their performance evaluation.
3. Using good listening skills when talking with governing board members.
CIM Publishers (http://www.cimtp.com/) is distributing four competency assessment in- struments designed to measure different facets of personal, management, and emotional com- petence. The Management Development Questionnaire looks at management develop- ment needs and the Personal Competency In-
ventory measures personal and emotional competencies that are thought to be related to superb performance. CMI Publishers also re- leases the Work Profile Questionnaire-EI, a questionnaire that looks at seven emotional competencies frequently used by Goleman, and the Work Profile Questionnaire (WPQ),
Emotional Intelligence
which measures the Big Eive personality fac- tors (neuroticism, extravision, openness, agreeableness, and conscientiousness) as as- f)ects of emotional intelligence.”
Additional consideration should be given to using instruments validated to measure specific behavior or skills associated with the El competencies. Eor example, coping strat- egies have been as.sessed by several re- searchers^* •*” using a form of Eolkman and Lazarus’s Ways of Coping Questionnaire.^’ This instrument assesses eight different cop- ing strategies: (1) confrontive responsibility, (2) distancing, (3) self control, (4) seeking social support, (5) accepting re.sponsibility, (6) eseape-avoidance, (7) planned problem solving, and (8) positive appraisal.
DEVELOPING El IN YOUR HEALTH CARE ORGANIZATION
After a health care leader understands the value of El and how it can be developed within his or her organization, a training program should be started. The Consortium for Research on Emotional Intelligence in Organizations has developed a program ealled The Optimal Process for Developing Emotional Intelligence in Organizations, which involves four basic phases: (1) prepa- ration, (2) training, (3) transfer and mainte- nance, and (4) evaluation.
The main goal of the first stage is to in- crease motivation through assessment and involvetnent. The following are steps in this stage: assess organizational needs, assess personal strengths and limits, provide feed- back, maximize choice, encourage participa- tion. link goals to values, adjust expectations, assess readiness. Pha.se two is training that involves the following activities: build posi- tive rapport between trainer and participants.
maximize self-directed involvement in change, set clear goals, break goals into steps, capitalize on practice opportunities, provide feedback frequently, use experien- tial methods, build support into your sys- tems, use modeling, facilitate insight, and avoid relapse. Stage three, transfer and main- tenance, involves confronting the cures so that old habits do not resurface after employ- ees are back on the job. Recommended ac- tivities in this stage are encouraging the use of skills on the job and providing a leaming organizational culture. The fourth phase in- volves conducting continual evolution of the above processes and providing effective feedback. The key here is to create an effec- tive feedback loop in a continuous improve- ment process. The Consortium for Research on Emotional Intelligence in Organizations estimates that between $5.6 and $ 16.8 billion of the $50 billion spent each year on training is lost because most of the programs do not follow these guidelines.* A health care orga- nization developing an El training program would be prudent in assuring the four basic phases are all addressed.
TIME FOR REALIGNMENT
Perhaps today, more than ever, the devel- optnent of emotional management skills is critical. As we write after September 11, 2001, people speak of the “new world we live in”—a world in which the daily fear of events framed as “acts of war” seem to be spouted at us from all directions: multiple media out- lets, friends, colleagues, strangers in the su- permai kets, even from our own heads when we collect our mail. These bombardments take their toll on our .sense of well being. Yet, there has been a unique kind of social benefit for those who focus with an eye toward
8 THE HEALTH CARE MANAGER/JUNE 2002
learning opportunities. In times of tragedy and strain, realignments occur on individual, family, and social levels.
Victor Frankl, a psychiatrist intemed in the concentration camps of World War II, tells compelling stories of how the prisoners who could find a connection to greater purpose or meaning in their lives fared much better under the extreme, inhuman conditions than those who had lost touch with life meaning and succumbed to hopelessness.^- Emotional awareness has been empirically linked as a significant predictive factor in one’s level of experienced life meaningfulness.”” People who optimize their experience by deftly em- ploying El skills are sensing a new commit- ment to their goals.
The media, as well as people on the street, are talking about how recent events have caused a kind of wake-up call and renewed understanding of what is important in our
lives. These conversations can lead to posi- tive changes in behavior. On a societal level, it is hard not to be affected by the renewed sense of patriotism and commitment to our national ideas that also resulted from the events of September 11. El skills of self- awareness, refieetion. intuition, and compas- sion for yourself and others will be of great service toward using energy stirred up by emotional events in productive ways.
People are in need of leaders who have the ability to adapt to the unsteadiness of our new world and to manage under uncertainty. A health care leader with El will have the confi- dence to calm and strengthen his or her organi- zation during these difficult times. By develop- ing an El training program, other managers throughout the organization will also have the skills to lead their employees. Developing El in your administrative staff is one of the best choices to stabilize a shaken workforce.
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