Leadership in Academic Medicine - Uniformed Services University

Report
Bldg. E/ Lecture F
Kent A. Corso, PsyD, BCBA-D
Walter Reed Bethesda
USUHS Department of Family Medicine
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To describe the leadership theories that are
most applicable to leadership in academic
medicine.
To apply one leadership theory to a project,
work relationship, or future planning endeavor
within your academic medical center.
Distribute Learning Probe
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20 Oct 11:
 Lecture and Discussion
 Administer MLQ Form 6S
 Discuss results and limitations
 Experiential learning assignment
27 Oct 11:
 Review experiential learning assignment
 Discussion: reasons to continue working on these
leadership skills; exchanging ideas about leadership
 Case study of 4 hospitals using transformational
leadership
 Complete feedback forms/course evaluation
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Where do you work?
What is your role?
Do you have a management/supervisor
position?
Any prior experience with leadership
training/development that you found
particularly beneficial? If so, please explain
briefly.
What did you hope to gain today?
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Introductions
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Leadership Theory Overview
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Leadership in Academic Medicine
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Relevant Primary Literature Findings
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Assessing your own level of development as a
transformational leader
Experiential Learning Assignment
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The Anglo-Saxon etymological origin of the
words lead, leader and leadership is laid, which
means 'path' or 'road'. The verb læden means 'to
travel'. Thus a leader is one who shows fellow
travellers the way by walking ahead (Kets de
Vries, Vrignaud, & Florent-Treacy, 2004).
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Management produces order and consistency
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Leadership produces change and movement
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Assigned versus Emergent
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Think of a time when you implemented
leadership skills and it did not go well.
What went wrong?
 What are THE pitfalls?
 What are YOUR pitfalls or areas for improvement?
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Leaders exert Power and Influence
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How?
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Persuasion
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Power
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Subtle versus obvious
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Systematic versus sporadic
Legitimate/Positional
 Reward
 Coercive
 Expert
 Referent
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(French and Raven, 1959)
Why is power important when you are the leader?
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What are the unique aspects of academic
medicine that demand leadership?
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What type of leadership would best fit? Why?
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Trait Theory
Style Theory
Contingency Theory
Situational Theory
Path-Goal Theory
Leader-Member Exchange Theory
Psychodynamic Theory
Transformational Theory
Team Theory
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Charismatic Leadership
Servant Leadership
Transformational Leadership
Full Range Leadership Model
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These leaders effect their followers in a way which
suggests that they have superhuman or
exceptional powers, the result is that the person is
treated like a leader by the followers (Weber, 1976)
Recall a person you’ve known who was treated in a
“special” way due to his/her natural disposition?
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This is similar to trait theory in that you either
have it or you don’t – it is not something that can
be taught
Personality Characteristics
-Dominant
-Desire to influence
-Confident
-Strong values
Behaviors
-Strong role model
-Shows competence
-Articulates goals
-Communicates high
expectations
-Expresses confidence
-Arouses motives
Effects on Followers
-Trust in leader’s ideology
-Beliefs become similar to
the leader’s
-Unquestioning acceptance
-Affection toward leader
-Obedience
-Identification with leader
-Emotional involvement
with leader
-Heightened goals
-Increased confidence
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“The ultimate measure of a man is not where
he stands in moments of comfort, but where he
stands at times of challenge and controversy.”
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“Everyone needs to be valued. Everyone has
the potential to give something back.”
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“Ask not what your country can do for you...”
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“Yes we can…”
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Emotional involvement with the leader
Identification with the leader
Heightened goals
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Emotional involvement with the leader
Identification with the leader
Heightened goals
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What unique benefit can charismatic leadership
deliver to academic medicine?
To your specific role/job?
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Charismatic Leadership
Servant Leadership
Transformational Leadership
Full Range Leadership Model
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Term arising in the 1970s by Robert Greenleaf
Premise: a just society is dependent on leaders
who should care about all who are affected by
their enterprise
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Most applicable to directors and administrators
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Leader leads by example
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Emphasizes:
increased service to others
 a holistic approach to work
 promoting a sense of community
 sharing power in decision making
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It’s a long-term transformational approach to
life and work that creates a more positive
society
What does this concept remind us of?
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According to Greenleaf the true test of whether
or not one is a servant-leader is to ask the
following questions:
Do those served grow as persons?
 Do they, while being served, become healthier,
wiser, freer, more autonomous, more likely
themselves to become servants?
 What is the effect on the least privileged in society?
Will they benefit or at least not be further deprived?
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Ten Central Characteristics:
1) Listening – listening to others, coupled with
regular periods of reflection
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2) Empathy – accept others; assume good
intentions of others even when their behavior is
unacceptable
3) Healing – emotionally building/healing self
and others
4) Awareness – awareness of self and others in a
way which helps the leader to better
understand values and ethics
5) Persuasion – convincing others instead of
coercing others; persuasion versus use of
positional authority/power
6) Conceptualization – examining a problem and
envisioning the relevant future variables;
delicately balancing conceptual thinking and a
day-to-day approach
7) Foresight – involves intuition, but also involves
the ability to learn from past mistakes, the
reality of the present and the best future actions
8) Stewardship – “holding something in trust for
another”
9) Commitment to the growth of people – premise
is that people have intrinsic value beyond their
contribution as workers; commitment to
nurturing employees’ growth
10) Building Community – predicated on the idea
that our community helps shape us; we have a
responsibility to cultivate positive communities
(Spears, 2004)
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Many current corporations utilize this model as
their primary training module for higher level
staff:
 The
Toro Company (Minneapolis, Minnesota)
 Synovus Financial Corporation (Columbus, Georgia)
 ServiceMaster Company (Downers Grove, Illinois)
 Men's Wearhouse (Fremont, California)
 Southwest Airlines (Dallas, Texas)
 TDIndustries (Dallas, Texas)
 The Herman Miller Company
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The concepts have been adopted within
corporate/business circles in response to the
idea that business organizations only hold
interest in the bottom line
Addresses the need for organizations to
become better social assets
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Applies to corporations, hospitals, churches,
universities, governments etc.
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The institution must be regarded as socially
responsible to all parties involved:
Employees (including administrators) – safety,
rights, privileges, regulations
 Customers – product descriptions, services, and
benefits
 Suppliers - positive working relationships, cultivate
faith and trust
 Local agencies – government, university, church
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Make the good of society the focal point of the
organization
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Helps the entire workforce focus on one end-state and
helps them excel in this direction
Place honest and highly capable people in charge
Directors in assuming their positions, must act
socially responsible
There is the acceptance that their role creates a challenge
or problem for the rest of the organization
 Directors and administrators must welcome this
adjustment
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What unique benefit can servant leadership
deliver to academic medicine?
To your specific role/job?
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Charismatic Leadership
Servant Leadership
Transformational Leadership
Full Range Leadership Model
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Coined in 1973 by Downton
Burns expanded on this in 1978
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Transformational leadership is the process by which
a leader creates a connection with others which
raises the motivation and morality of the leaders and
followers.
Transformational leaders are attentive to the needs
of their followers and try to help followers reach
their fullest potential.
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Is different from transactional leadership, in
which the focus is the exchange of constructive
(rewards) and corrective (consequences)
between leader and followers
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Transformational leadership refers not the content
that each person exchanges, but instead, the process
by which they exchange interactions and the
outcome of this process on both follower and leader
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Transformational leadership changes and
transforms individuals
It is concerned with values, ethics, standards,
and long-term goals
The process involves charismatic and visionary
leadership skills (Bryman, 1992)
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Transformational leadership sits on one end of
a continuum with laissez-faire leadership at the
other end and transactional leadership lying in
between.
Transformational leadership motivates the
followers to:
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Raise their consciousness about the
importance/value of specific, idealized goals
Transcend from self-interest to group interest
Address their higher level needs (Bass, 1985)
Who comes to mind when you hear these descriptions?
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Factor I: Charisma/Idealized influence
Leaders are role models, followers emulate them
 High ethical and moral standards
 Deeply respected by followers
 Provide followers with a sense of purpose
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Factor II: Inspirational Motivation
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Leaders communicate high expectations and inspire
followers to become committed to a shared vision
Use of symbols and emotional appeals to focus the
followers on interest in the group
Enhances team spirit and camaraderie
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Factor III: Intellectual Stimulation
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Leaders stimulate creativity and innovation among
followers
Leaders encourage followers to challenge their own
beliefs and values, while also challenging the leader
and organization
Perpetuates critical thinking, innovation, and
problem-solving
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Factor IV: Individualized Consideration
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Leaders create a supportive climate in which they
listen carefully to the needs of the followers
 What does this remind you of?
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Leaders act as coaches and advisors while trying to
assist followers in self-actualization – the highest
stage of moral development
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Strengths of this model
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Widely researched model including qualitative
studies of prominent leaders and CEOs
It is intuitive conceptually – most people assume
that the role of their leader is to advocate for them
and to also be in front of them
The role of followers is prominent - their needs
and attributions are instrumental in helping the
transformation evolve
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Followers give leaders power
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It augments other leadership models by drawing
attention to the process
It is the only model of leadership that introduces a
moral dimension
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whereby leaders attempt to move followers to higher
standards of moral responsibility
whereby followers become interested in the group,
team, or organization over themselves
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Weaknesses of this model
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It lacks conceptual clarity and has been criticized
as being difficult to clearly define and measure
People often fail to see the model as a spectrum
and instead perceive it as either being present or
absent
It looks at leadership as a personality trait – not a
series of behaviors that can be taught
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Elitist and antidemocratic
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It is based primarily on qualitative research of
leaders who were at the top of their organizations
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These leaders play a direct role in establishing the
vision, initiating changes
What about the transformational leaders within, but not
at the top of the organization?
High potential for abuse… why?
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In summary, this model does NOT tell leaders what
to do to be successful
It does tell leaders HOW to approach their
leadership position…by attending to the needs of
their constituents, with the priority of furthering the
development of those constituents
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Examples
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Ghandi – raised the hopes and demands of millions
of his people and in the process was also changed
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Nelson Mandela – transformed the nation of South
Africa through high moral standards
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Mother Theresa – advocated for the poor and
helpless; incredible charity led others to give
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Several Corporations have been led by
transformational leaders or have invested in creating
this organizational culture:
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The Chrystler Corporation (1980s)
Wal-Mart
Apple
Target
FedEx
Jack Welch – GE (1980s and 1990s)
Studies comparing successful and unsuccessful
companies find that managers and employees within
successful companies display higher average
transformational leadership actions (Jandaghi, Matin,
& Farjami, 2008).
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What unique benefit can transformational
leadership deliver to academic medicine?
To your specific role/job?
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Charismatic Leadership
Servant Leadership
Transformational Leadership
Full Range Leadership Model
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This is the entire spectrum of leadership
behaviors ranging from laissez-faire to
transformational
Optimal model involves using each leadership
type in a “dosed” manner
Laissez-faire
Transactional
Transformational
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Laissez-faire (LF) represents nontransactional
leadership
 Inactive
/Non-leadership
 Research finds this to be the least effective (Bass &
Avolio, 1998)
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Transactional Leadership – corrective and
constructive exchanges between leader and
followers based on followers’ performance
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Contingent Reward (CR) – rewarding positive
behavior/performance with a reward
Management by exception - passive (MBE-P)
 Waits
for deviances from standards, mistakes, errors
and then takes corrective action
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Management by exception - active (MBE-A)
 Actively
monitors followers for deviances from
standards, mistakes, errors and takes corrective
action as needed
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What unique benefit can full range leadership
deliver to the academic medicine?
To your specific role/job?
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In a cross-sectional survey of 465 faculty and
chairpersons in accredited allied health programs in
the northeast US offering undergraduate and graduate
degrees (Firestone, 2010)
 Mean scores for self-perceived transactional
leadership among chairpersons were higher than
faculty-rated chairperson scores
 So What?
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In a study of 601 Finnish nurses the authors examined
how laissez-faire versus transformational leadership
among nurse managers impacted the following
outcomes: willingness to exert extra effort, perception
of the nurse manager’s effectiveness, satisfaction with
nurse manager (Kanste, Kaariainaen, & Kyngas, 2009)
 Transformational leadership led to increased
willingness to exert extra effort, higher perceptions
of nurse manager’s effectiveness, and higher
satisfaction with nurse manager – these outcomes
held at 1 year follow-up
 Laissez-faire led to lower nurse ratings on all
outcomes
 So What?
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A study of 497 physicians, nurses and residents in the
southeastern US assessed the participants’ attitudes toward
collaboration and servant leadership (Garber, Madigan,
Click & Fitzpatrick, 2009).
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RN attitudes regarding collaboration were more positive
than physicians’
RN attitudes had a more positive self-perception of
themselves as servant leaders than physicians
RN’s and physicians’ self-perceptions of servant
leadership were higher than their perceptions of their
organization’s use of servant leadership practices
Minimal differences between residents and physicians
So What?
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A Chinese study across 59 medical/health centers,
made comparisons between personality traits and selfreports of ethical leadership among 162 directors at
varying levels. They also solicited collateral reports
from 3-4 corresponding subordinates for each director
(Xu, Yu, & Shi, 2011).
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Neuroticism was negatively associated with ethical
leadership
Conscientiousness, agreeableness, and extraversion
were positively correlated with ethical leadership
So What?
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A study of 91 college students explored the
relationship between charismatic leadership, work
engagement, and organizational citizenship behaviors
(Babcock-Roberson & Strickland, 2009).
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When a charismatic leader/supervisor was present,
there was increased work engagement and this led
to increased organizational citizenship behaviors
So What?
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A study of 72 American light infantry platoon leaders and
sergeants examined how transactional leadership (CR) and
transformational leadership correlated to unit potency and
cohesion, and how each of these predict performance under
challenging and uncertain conditions (Bass, Avolio, Jung,
Berson, 2003).
 Transformational leadership and active transactional
leadership led to performance success
 Unit cohesion and potency partially mediated the
relationship between leadership and performance
 Transformational leadership augmented transactional
leadership when the reward was based on specific
contracts or quid pro quo exchanges
 So What?
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In a study of 43 Norwegian military officers
participating in a week-long exercise (Eid, Johnsen,
Brun, Laberg, Nyhus, Larsson, 2004)
 Transformational leadership emerged as a
predictor of situational awareness and
interpersonal influence – specifically Factor 3:
intellectual stimulation
 So What?
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In a study of 324 employees in India of various
industries to include steel manufacturing, dredging,
banks, R&D, airlines, real estate, telcom, and IT firms
the authors examined age and job experience as these
relate to leadership style (Giri & Santra, 2010)
 Less experienced/junior level employees had
significantly higher mean scores on
transformational leadership
 More experienced/senior level employees had
significantly higher mean scores on laissez-faire
leadership
 So What?
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Women have reached equal rates of entry into the
medical field without proportionate entry into
leadership positions (Morrissey & Schmidt, 2008)
Among 96 medical faculty, there hierarchy of
department chairs in academic medicine reduces
transparency of decision-making, impedes
advancement by way of a bottle-neck effect, negatively
affects inclusion across professionals, and appears to be
more consequential among women (Conrad et al.,
2010)
Managing different generations, particularly with
regard to old models of “paying your dues” (Kennedy,
2003)
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Other examples??
Please take a few moments and write some examples
down. We will discuss these later.
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Assessment
Research clearly indicates that 360-degree feedback
systems give a much more accurate picture than selfassessment of what executives really do and how
executives actually behave (London et al., 1990;
Hazucha et al., 1993; Kluger and DeNisi, 1996; Walker
and Smither, 1999).
The observation of outsiders appears to be more
reliable than self-evaluation (Kets de Vries, Vrignaud,
& Florent-Treacy, 2004).
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45-item instrument
The single most widely used, heavily
researched , and empirically supported
measure of transformational leadership
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Self and other-rater forms
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Short Form is 21 questions, Form 6S
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**Earlier literature criticized the instrument’s
subscale utility for leadership training and
consultation, indicating that the constructs
overlapped; yet the entire instrument clearly
measures a unique construct
360 degree evaluation aimed at providing
feedback about your level of development as a
transformational leader (i.e., where do you
spend most of your time on the full spectrum
model?)
DISCLAIMER
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What are the benefits to developing and
implementing transactional leadership skills?
What are the drawbacks?
How important is it to you to develop your
leadership skills?
What obstacles do you see with regard to
implementing a transactional leadership project?
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Mentally review your last several meetings
with subordinates
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What tasks were you engaged in or goals did you
need to meet?
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How did you go about meeting them?
 Where were you on the full scale spectrum?
 Is that where you’d like to remain?
 Are you interested in progressing toward the active
and transformational direction?
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Transformational Leadership by definition
fosters reciprocal change between leader and
followers
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How can you see yourself changing?
What would you hate to see this reciprocal process
change about how you currently lead?
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Select a work relationship, project, team, planning
document and sketch its trajectory with the
intention of using transformational leadership
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What is your own timeline for learning, planning and
implementing transformational skills in general?
How will you assess needs of your followers?
How will you convey a shared vision?
How will you engender and maintain their trust?
How will you show interest in them?
How will you motivate them?
How will you interest them in the group priorities?
How will you raise their morality? (identify the relevant
work-place moral issues that are currently of concern)
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