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Lesson Plan CHL 316
No Basic Leadership Style Is Always “Best”
[Reprinted from Communiqué: November/December 2009]

Four basic styles of leadership can be used by managers as they direct (facilitate) the work of their employees. Each style creates conditions that can affect their employees’ motivational levels. Note: the term “motivation” relates to an employee’s internal desire to attain a personal goal. Because motivation occurs within a person, managers cannot technically motivate their staff members. Instead, they can create and maintain an on-job environment that enables staff members to attain their goals.

Effective managers do not need to determine the “best” style of leadership and utilize it all of the time. Instead, they have some flexibility to turn leadership styles into strategies to facilitate the work of their employees. In other words, they can modify their leadership style to fit the situation in which they find themselves. Seen as strategies, leadership styles become tools to create conditions in which employees become motivated to achieve departmental goals.

In this lesson, we will explore the four basic leadership styles and consider how their use
in specific situations can help Central Service managers improve the work of their
staff members.

Autocratic Leadership

An autocratic leadership style is a classical approach to managing people, and those using it generally make decisions without input from their employees. They give orders to employees without explanation and expect their orders to be obeyed. A structured set of rewards and punishments is typically used to ensure compliance with the manager’s directions. Autocratic managers believe they must focus on results above all other possible goals, including those relating to the employees and their concerns. They believe the employees are already motivated (after all, they are on the job!) or, at least, the managers believe their staff members are motivated sufficiently enough to follow simple orders.

Autocratic managers accept the authority (power) and responsibilities delegated to them by their own bosses, but they are generally unwilling to delegate any authority to those they supervise. In their view, there is a specified and identifiable amount of power and, if some power is delegated, less power will remain with the manager. These managers may also believe that they must continuously reaffirm their hierarchical position, and that the delegation of some decision-making opportunities will convey weakness to employees. Employees supervised by an autocratic manager often become dependent upon him/her because they are given little, if any, discretion about how to perform their jobs.

When utilized in the wrong situation, autocratic leadership can create significant problems, such as low employee morale, high absenteeism and even work stoppage.

There are, however, times when an autocratic leadership style is necessary and effective. For example, if a healthcare facility is confronted with a community emergency, staff will need fast and specific instructions about how to vary normal operating procedures to best serve an increased number of patients very quickly. In this situation, many employees would expect the supervisor to give them focused directions: “This is what must be done, and here is how to do it. Now, let’s get to work!”

Autocratic leadership techniques are best used when:

• A manager knows how to do the work of the employees being supervised so they can provide very specific work instructions.
• There are new, untrained staff members who do not know which tasks to perform and/or which procedures to follow.
• Supervision involves detailed instructions. Example: If a new, very complex, and difficult-to-clean instrument is purchased, close supervision and coaching of processing protocols may be necessary even after training to ensure that proper decontamination, cleaning and other procedures are followed.
• An employee does not respond positively to another supervisory style.
• The supervisor’s authority (power) is challenged.

Bureaucratic Leadership

Managers using the bureaucratic leadership style focus on rules, policies, regulations, and procedures, and they rely on higher levels of managers to make decisions about issues that are not covered “by the book.”

Perhaps these managers are not confident in their own decisions. They may feel that they lack the knowledge, experience, and/or “common sense” to make decisions and to solve problems in unique situations. They may perceive that their employees already know what to do and, in turn, might be insulted if direction is suggested. Bureaucratic managers may not know what to do and become overly reliant upon their staff members to fill this leadership void, and, still, others might be disinterested in their work, lazy, or focused on other priorities.

Normally, this “enforcement” style of leadership is only used when other styles are inappropriate, or when staff members cannot be given discretion about selected decisions that must be made. Example: There are specific procedures required for the operation of sterilization equipment that must be consistently utilized without any variance from required procedures. A bureaucratic leadership style may, then, be most useful in situations requiring the use of specific procedures that have been established for staff members who perform routine or repetitive tasks. Even when this occurs, though, the dynamics of a fast-paced CS department require that non-routine and creative decision-making is required.

Bureaucratic leaders looking for assistance in the status quo (how things have always been done), and/or who must always consult with their own supervisor will not likely be providing the best leadership for their staff members.

Democratic Leadership

The democratic leadership style (also known as participative leadership) is one in which the manager keeps employees informed about the matters directly affecting their work. Democratic managers also share decision-making and problem-solving responsibilities whenever practical with the use of delegation and/or empowerment strategies.

Democratic managers emphasize their employees’ roles in the facility, and they provide opportunities for their staff members to develop a high sense of job satisfaction. They solicit the opinions of their employees and seriously consider their recommendations as decisions are made. For example, these managers are likely to encourage employee input for staff member performance evaluation, and they will encourage their staff to help define goals and action plans for corrective activities, if necessary, to improve their performance. These managers also encourage their employees to grow on the job and to advance with promotional opportunities, and they recognize and reward these achievements.

There are limitations and potential disadvantages to use of the democratic leadership style, however. It may take longer to make decisions or to determine solutions when staff members are involved, and special concern arises when the manager cannot utilize (accept) the recommendations offered by employees. For example, it will be necessary to explain, defend and justify reasons for non-acceptance, and the manager must assure that there is a reasonable history of incorporating employee input into “the way things are done” in the department. Beyond that, it may not be cost-effective to involve employees in issues that are straight-forward and which can easily be resolved by the manager.

The democratic leadership style is often used with highly-skilled and experienced employees, and it can be effective when managers implement operational changes in the workplace or resolve individual or group problems.

Laissez-Faire Leadership

The laissez-faire leadership style involves the use of a “hands-off” approach by a manager who, in fact, does very little leading. Managers who use this style allow employees as much freedom as possible by delegating all authority (power) to the employees who, in turn, then establish goals, make decisions and resolve problems.

There are, probably, relatively few times when this approach can be effectively used in a healthcare facility; however, it may be appropriate when CS managers interact with highly-skilled and/or experienced employees, such as technical specialists and consultants who have been trained in the use of the necessary decision-making and problem-solving techniques required when more assertive leadership is not forthcoming. This leadership approach may also be useful for some highly-motivated staff members with exceptional levels of skill and abilities.

Factors Affecting Use of Leadership Styles

The manager’s personality, knowledge, values, and experiences shape his/her feelings about and reactions toward the employees who must be supervised. Some managers prefer to delegate work and enjoy involving several employees in a team approach to define and resolve problems.
Others, by contrast, prefer to do things themselves, and they do not like to interact with employee teams. A manager’s feelings about appropriate leadership are of obvious importance in determining the specific leadership style that will be used. Also, one’s previous experience (level of success) with a style likely affects the willingness to utilize a different style.

Characteristics of the employees being supervised also impact the choice of leadership style that is applied. Employees are individuals with differing personalities and backgrounds who, like their supervisors, are influenced by specific factors. Some employees desire independence and decision-making responsibility. They often identify with the facility’s goals, they are knowledgeable and experienced, and they will work well under a democratic leader. Conversely, employees with different expectations and experiences may require a more autocratic leader. The ability of employees to work effectively in groups also affects the choice of specific leadership styles used.

The organizational culture, composition of the workforce, the type of work to be done, and related factors also influence leadership style, and the traditions and values of the facility typically influence the manager’s behavior. For example, top-level facility leaders may stress human relations concerns while those in other facilities may focus on “bottom line” financial concerns, even if this reduces the use of employee participation in the management process.

Managers who are most effective in any organization are those who consider (and probably adopt) the prevailing organizational philosophy and culture.

Implications for Central Service Managers

How exactly can one use the leadership principles just discussed in day-to-day operations? First, it is unlikely that many supervisors actually use any one of the basic leadership styles exactly as they were defined and discussed.

In an ideal work situation, managers would know each employee and his/her motivational goals, and they would adapt the appropriate leadership style to the specific employee in the specific work situation. In this context, the term “appropriate” refers to the leadership style that would best create a work environment where motivation can occur.

However, managers are individuals who develop attitudes, beliefs and personalities based upon their own experiences. It is not, therefore, easy for typical managers to easily move between the use of differing leadership styles. They can, however, learn about basic leadership styles and understand when each might be applied. It will still be an ongoing challenge to review a situation, consider the leadership style that might be “best,” and consistently apply principles of that style to the unique work situation. Effective leadership requires managers to be flexible, and they must consider the needs of their employees and their employer as they do so.¹

1. This lesson is loosely adapted from:
   Jack Ninemeier. Supervision Principles: Leadership Strategies for Healthcare Facilities.
   Second Edition. Chicago, IL. International Association of Healthcare Central Service
   Materiel Management. 1997, Chapter 3.
   

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