Unit 5: Directing and Supervising the Laboratory

(hours)

Introduction:
An effective leadership and good management ensure the delivery of good
health care services. These elements play an important role for a laboratory to
work efficiently. Clinical laboratories exist for the purpose of providing
laboratory health services which are in accordance with the standards set by the
government.
Leading/Directing refers to the means employed to encourage all personnel in
the organization to accomplish whatever assignments may be given them by
management in order to achieve the objectives in the manner they were planned
and organized. It can only be effective if it is preceded by a well-designed
strategy developed in the planning and organizing stages of the management
process, and if it is followed through with a strong controlling phase.

Unit Learning Outcomes

Upon completion of this module, you should be able to:
1. Discuss proper laboratory supervision.
2. Describe leadership within the context of the management functions.

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 Chapter 5: Directing and Supervising the Laboratory

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 Activating Prior Knowledge

“When people are doing well, make sure you tell them so,” Lorsch says. “When
things are going slowly, make sure you give encouragement along with advice.”
People are more likely to be productive and create high-quality work when they
are happy and working toward a goal. As Barker puts it, “share interests, not
issues.” These rewards do not need to be significant or monetary; what matters
is that they are sincere”
- Excerpt from “How to become a good laboratory manager”

Do you agree with the excerpt above? Why or Why not? Let’s see how
directing and supervising takes place in the lab

Presentation of Contents

OVERVIEW OF THE DIRECTING

PROCESS

DIRECTING is said to be a process in which the managers instruct, guide and

oversee the performance of the workers to achieve predetermined goals.
Directing is said to be the heart of management process. Planning, organizing,
staffing has got no importance if direction function does not take place.
Directing is the means employed to encourage all personnel in the organization
to accomplish whatever assignments may be given them by management in
order to achieve the objectives in the manner they were planned and organized.
Leadership is the most active part of the directing function and directing can
only be effective if it is preceded by a well-designed strategy, developed in the
planning and organizing stages of the management process, and if it is followed
through with a strong controlling phase.

Direction has the following characteristics:

1. Pervasive Function - Directing is required at all levels of organization.

Every manager provides guidance and inspiration to his subordinates.
2. Continuous Activity - Direction is a continuous activity as it continuous
throughout the life of organization.
3. Human Factor - Directing function is related to subordinates and therefore
it is related to human factor. Since human factor is complex and behavior is
unpredictable, direction function becomes important.
4. Creative Activity - Direction function helps in converting plans into
performance. Without this function, people become inactive and physical
resources are meaningless.
5. Executive Function - Direction function is carried out by all managers and
executives at all levels throughout the working of an enterprise; a
subordinate receives instructions from his superior only.
6. Delegate Function - Direction is supposed to be a function dealing with
human beings. Human behavior is unpredictable by nature and conditioning
the people’s behavior towards the goals of the enterprise is what the
executive does in this function. Therefore, it is termed as having delicacy in
it to tackle human behavior.

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 LEADERSHIP

Leading is the process by which the manager communicates with and

influences others in the pursuit of common goals.
Leadership is the most active part of the directing function. It is employing
management skills, people skills, and vision to accomplish the work of the
organization. Its purpose is to produce change by establishing direction,
aligning, motivating and inspiring people. It originates from personal
characteristics and career experiences (both that promotes or inhibits
leadership).
A leader is responsible for providing the conditions necessary for employees to
accomplish the work of the organization (Figure 5-1).

For organizational leaders, leadership provides the framework for planning,

organizing, leading, controlling and evaluating.

Leadership has two connotations in health administration. First, it is a process

by which a manager influences the activities of a group of people toward goal
setting and achievement. And, it is a conception and execution of the more
fundamental changes in the organization.

Figure 5-1 A section head discussing with the medical laboratory scientist

INFLUENCE

Influence is a process by which behavior of staff or personnel are affected or

modified.
Sources of influence:
1. Position based influence:
Your influence as a manager can be derived from the authority of your
position
2. Non-position-based influence:
Is the informal relation you have established with others and the qualities or
traits you have which others admire.

There are limits of influence in the health care settings which are organizational
culture, expertise and experience, professional autonomy and education,
collective control of professional work and information system.

There are also various methods on influence according to the source of

influence:
1. By authority:
Influence by authority is given to persons with the right to influence others
by virtue of their position, by law or contract, expertise or relational factors.
2. By coercion:
By means to threaten the other person’s options if orders are not followed.
The means employed include superior physical strength, sheer number or

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 punishment, etc. It is illegal and is usually resisted.
3. By manipulation:
It is getting people to do what you want by making them feel that is what
they want.
4. By collaboration:
The person being influenced recognizes and accepts the need for change,
considers the alternatives, decides on alternatives and act on it.
Organizational Factors that Influence Leadership Success (Corporate
culture, Management style and, situation)

1. Corporate Culture and Delegation of Authority. The way things are

done in an organization such as habits, traditions, customs, processes and
social morals of the institution. It is the interaction between institution and
individual, between role and personality, and between job expectations and
need-dispositions. The individual has a personality and needs-dispositions
that should be matched with the institution’s role and expectations. If the
match is compatible, both the institution and individual will be satisfied.
(Figure 5-2)

Figure 5-2 Matching Institution with Individual

2. Management style
It is the general behavior and philosophy of a manager or an organization
toward the employees, particularly the degree of participation allowed in the
decision-making process.

Likert’s 4 Discreet Management Styles:

a. Exploitative and Authoritative Managers view workers only as tools
and means of production and feel no further obligation to them.

b. Benevolent and Authoritative

A paternalistic approach, managers feel they know what’s best for their
employees and need only to inform and direct their actions without
seeking any feedback

c. Consultative
The manager feels the opinion and advice of the staff are useful, but all
decisions remain the exclusive purview of the manager. (Figure 5-1)

d. Participative
Input and responsibility for decision-making and performance are
placed directly on the staff, or as close to the production process as
possible, with only general guidance and oversight from management.
This is an inclusion team approach in which the worth of all members is
recognized.

There are several leadership styles published in 1988 by “Career track”,

namely:

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 a. Directing: presents rules, orders or defined instructions to the
individual.
b. Coaching: provides high support and direction
c. Supporting: provides physical and personal resources so that an
individual can accomplish their duties.
d. Delegating: provides low support and direction

3. Situation
The style used by the leader may vary according to the situation. The effective
leader must be able to analyze the situation and develop a satisfactory strategy
for intervention.

LEADERSHIP MODELS

There are 3 factors involved in leadership: Leader, Follower and Situation

Leader:
1. Personal traits of leaders – studies failed to establish common personal
traits of good leaders.
2. Leadership behavior models– researches made next focus on behavior of
leaders instead of personal traits

a. Employee-oriented versus production-oriented leadership styles

Employee Oriented: Supervisors with the best productivity levels had

strong ties to their employees, spent more time in actual supervision rather
than production in work, supervised less closely while allowing workers
more latitude in performing their duties, and demonstrated concern for their
people both on and off the job –

Production – Oriented: Supervisors who tended to emphasize high

productivity at the expense of all other factors. They viewed their workers
as only tools for use by the company in the manufacturing process and spent
the majority of their time on production related problems –

b. Structure-consideration leadership styles

Initiating structure: marked by emphasis on actively directing the staff

toward getting the work done: paying attention to assigning particular tasks,
specifying and clarifying what is expected of subordinates and the
uniformity of the procedures to be followed and personally deciding what
and how work will be done.

Consideration behavior: manager’s effort to explain their actions, treat

workers as equals, listen to subordinates’ concerns, look out for their
personal welfare, give advance notice to changes and be generally friendly
and approachable.

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 Figure 5-4 The OHIO STATE LEADERSHIP QUADRANT: (Ralph M.
Stogdill)

Behavior of an individual leader is, in practice a mix between two patterns and
these two dimensions are complementary. Leaders who score high in both
dimensions usually demonstrate the best overall performance.

c. Managerial Grid
It is developed by Blake and Mouton. It shows (Figure 5-5) a relationship
between a concern for people (consideration orientation) and concern for
production (structure orientation). Management style is influenced by five
factors:
i. The attitude and assumptions of the manager
ii. The policies and procedures of the organization
iii. The day-to-day operational situation
iv. The social and personal values of the manager
v. Chance

The attitude and work attributes of managers can be plotted on the matrix to
reveal their leadership style. Once known, managers can then take appropriate
action to improve their leadership abilities.

To improve and strengthen leadership ability, the leader should go through the
following steps:
i. Identify their current style
ii. Decide for themselves the best style foe a given situation
iii. Determine what attitudes and behavior changes are required to reach
their goals
iv. Encourage management to develop the organizational culture necessary
for the preferred style to flourish

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 Figure 5-5 Managerial grid by Mouton and Blake

Managerial Grid Interpretation:

1, 1 or Impoverished Management.
Leaders in this position have little concern for people or productivity, avoid
taking sides and stay out of conflicts. They do enough to get by. It is often
referred to as Laissez faire leadership.

9,1 Authority-Compliance Management.

Managers in this position have great concern for production and little
concern for people. They desire tight control in order to get task done
efficiently. They consider creativity and human relations unnecessary. It is
also called Authority-obedience Management or Autocratic Task
Management.

5, 5 or Middle-of-the-road management.
Leaders in this position have medium concern for people and production.
They attempt to balance their concern for both people and production but
are not committed to either. Sometimes called “Organization Man
Management”

1,9 or Country club Management.

Managers in this position have great concern for people and little concern
for production. They try to avoid conflicts and concentrate on being well-
liked. To them the task is less important than good interpersonal relations.
Their goal is to keep people happy.

9,9 or Team management.

This style of leadership is considered to be ideal. Such managers have great
concern for people and production. They work to motivate employees to
reach their highest levels of accomplishments. They are flexible and
responsive for change, and understand the need to change.

d. Theory X - Theory Y model by Douglas McGregor (Figure 5-3)

It is a close simulation of the widely observed Pygmalion Effect propounded in
education circles, namely from the play Pygmalion by George Bernard Shaw. It
states that students tend to learn and perform in the manner anticipated by their
teachers. If students perceive that teachers expect them to do well, they do. If
they pick up that they are expected to perform poorly, the prophecy becomes

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 self-fulfilling.
McGregor proposes that leadership behavior is based on the manager’s
assumptions about the nature of people. Expectancy and Reinforcement
Motivational Theories also support this approach.

The Theory X Managers believe that people:

i. Are inherently lazy and dislike work
ii. Must be coerced into performing their duties by constant supervision
and maintenance of tight operational control
iii. Have no ambition and little interest in improving their efficiency on
their own and must be prodded to produce.

Managers who hold X theory philosophies tend to be autocratic and dictatorial

and allow for little input from the staff.

The Theory Y Managers believe that people:

i. Work is a natural part of life
ii. People have a high degree of ingenuity and creativity that they are eager
to apply to the job
iii. Worker potentially is only partially tapped by the company
iv. Workers are self-learners and seek responsibility for their performance
v. Workers exercise self-control and self-discipline if they are committed
to a goal, and the strength of this commitment depends on the reward
associated with the achievement.

Managers who hold the Y philosophies are participatory in their leadership

style; actively seeking advice and counsel form their co-workers and allow
employees to share in the decision-making process.

Democratic Autocratic
Style Style

Y Leader X Leader

Figure 5-3 Comparison of tannebaum and Schidmt’s Continuum and Mc

Gregor’s X and Y Theory

3. Situational leadership models

a. Contingency Theory takes into account the suitability of certain types of

behavior in certain things. The effective leader must be able to analyze the
situation and develop a satisfactory strategy for intervention. According to
Fred E. Fielder, the success of the manager as the leader is contingent on
two factors: the LEADERSHIP STYLE of the manager and the
FAVORABLENES of the leadership situation. Favorableness is the amount
of power, control and influence wielded by a manager in a particular set of
circumstances. There are 3 components that establish favorableness:
i. Leader-member relations – the level of confidence and trust between
leader and members of the staff. This is the most important factor
according to this model
ii. Task Structure – the amount of formal structure imposed on work
assignments.
iii. Position power – the degree of influence that the manager exerts on the
reward and punishment system of the institution.

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 It can be either Relationship-oriented or Task-oriented. Situations that are
very favorable or very unfavorable are usually handled best by a task-
oriented leader while relationship-oriented leaders appear to be the most
effective in situations that are considered moderately favorable or
moderately unfavorable.

b. Continuum of Leadership by Robert Tannebaum and Warren H. Schidmt.

Management style could be plotted on a continuum from authoritative to
democratic (Figure 5-3). Managers could move along the continuous line,
adjusting their leadership style to fit the situation.
Continuum leadership has seven degrees of freedom:
i. Total use of authority by the supervisor
ii. The manager makes all decision but attempts to seek and persuade the
staff of his or her view
iii. The boss makes all decisions but attempts to invite input, suggestions
and questions from the staff.
iv. Manager makes the decisions but seeks support and approval form the
subordinates
v. Supervisor gathers the data and defines the problems, then seeks
suggestions and recommendations for solutions before making a
decision.
vi. Manager provides information, supervision and guidance but requests
that the staff make the decisions.
vii.Manager focuses on setting general policies and procedures for the
department but allows total freedom and responsibility to the employees
to function and make decisions with these broadly defined boundaries.
The boss-centered leadership falls in the 1-3 range. Equilibrium-shared
boss-subordinate leadership falls in the midpoint in the scale while
subordinate-centered leadership falls in the 5 – 7 range. Those that falls
beyond 7 are the laissez faire style which is closely aligned with 1,1
impoverished management and 1,9 country club positions on the
Managerial Grid.

c. Normative Theory by Victor H. Vroom and Phillip W. Yetton (Vroom-

Yeton decision model). It provides normative guidelines and
recommendations for the way a leader should make decisions in a specific
set of workplace conditions. The theory classifies each decision-making
method as autocratic, consultative or group-oriented.

The 5 possible behavior styles identified by Vroom and Yetton:

i. A-I: Manager makes decision based on the current information available
ii. A-II: Manager seeks necessary information from subordinates before
making a decision
iii. C-I: Manager shares the problem with selected individuals before
making a decision.
iv. C-II: Manager shares the problem with all the members of the group but
makes the final decision
v. G: Manager shares the problem with the group and a decision is reached
by consensus.
MANAGEMENT APPROACHES

1. Management by Commitment:

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 It operates on the principles by values. “Doing the right things right”
2. Management by Policy:
The ability of the leader to lead and inspire people towards a vision that is
positive to them and is largely influenced by the extent to which he/she can
translate such a vision into concrete policies.

3. Management by Objectives:
It is a process of formulation, performance and assessment, and as such it
provides means of focus on pertinent factors and issues that affect the
practice of laboratory medicine

Assessing the Effectiveness of Leadership

1. Trait perspective:
a. Intelligence
b. Social maturity and breadth
c. Inner motivation and achievement drive
d. Human relations attitude
2. Behavioral perspective:
a. Concern for people
b. Concern for production
3. Situational perspective:
a. Also known as contingency model of leadership
b. Depends on the circumstances at a given time
4. Transformational Leadership:
a. Proposes that managers use influence, dominance, self-confidence and
conviction of moral righteousness to increase their charisma and
consequently their leadership effectiveness.

Path-Goal Theory by Robert J. House

This theory brings together both leadership and motivational principles. It
emphasizes the role of the leader in providing and streamlining a path by which
subordinates can achieve their own and the institution’s goals. The leader must
consider two factors in designing a strategy to deal with work the environment.
First is the characteristic of the workers which is about their training, individual
traits, personal needs, social backgrounds, etc. Second is the nature of the tasks
to be performed which is about the complexity, degree of organizational
structure, stress, danger, monotony, etc.

In path-goal theory, the leader has to address two elements; the goal component
and the path facet. In the former element, the managers enhance the number and
types of rewards (pay) that subordinates can receive for achieving work-related
goals while in the later element, the leader clarifies the routes for obtaining
these goals and removes obstacles that may impede employees from realizing
their potential.

Application of the General Principles in Directing and Supervising the

Clinical Laboratory:

Directing: Maybe considered a display of methods and means for getting from
one location to another.

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 Supervision: Entails responsibility for assuming that policies and procedures
are followed.

Application of Leadership responsibility

in the Clinical laboratory:
1. To formulate and document policies
and procedures that are constantly
current and relevant effective pursuit of
laboratory goals
2. To effectively communicate these plans
to all personnel.
3. To provide efficient means for assuring
compliance with policies and
procedures
4. To encourage free flow and exchange
of ideas through all levels of the
organization
5. To assure an awareness by all
personnel of current trends and
practices in the delivery of hospital
laboratory services.
6. To develop and maintain effective
relations with the medical staff and
hospital administration for assuring an
open exchange of the needs and
concerns of all parties.

Application of Leadership Method in

the Clinical Laboratory:
1. To develop and constantly update all
laboratory procedures and policies by
preparation of appropriate manual.
2. To schedule and conduct periodic
meetings with the staff for discussion
and review of policies and procedures.
3. To delegate the responsibility for
efficiently monitoring compliance with
policies and procedures
4. To conduct periodic meeting with the
laboratory staff to encourage
innovative thinking and improvement
in services.
5. To fully support and generously budget
for a meaningful laboratory continuing
program
6. To assure awareness of the laboratory
mission by requiring that appropriate
personnel attend all hospital and
medical staff meetings that call for
laboratory representation.

Application

A Study of Behavioral Leadership Model: University of Michigan Studies

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 The Institute for Social research at the University of Michigan conducted a
number of studies to identify styles of leader behaviour that result in increased
work-group performance and satisfaction. Their studies resulted in the
development of two distinct styles of leadership:
• Job-centred {task-oriented} leadership style emphasizing the use of
rules, procedures, and close supervision of subordinates, and
• Employee-centred {relationship-oriented} leadership style emphasizing
delegation of authority and responsibility and concern for employee
welfare, needs, advancement and personal growth.
The use of both styles led to increase in production, but it was slightly higher in
the case of the job-centred leadership style. However,the use of direct pressure
and close supervision led to decreased satisfaction and increased turnover and
absenteeism. The employee-centred approach led to improved work flow
procedures and more cohesion in interaction. This resulted in increased
satisfaction and decreased turnover and absenteeism. This fact would obviously
suggest the superiority of the employee-centred leadership style.

Criticisms of this study:

1. These studies fail to point out whether leader behaviour is the cause or effect.
A productive group may suggest it to the leader to adopt an employee-centred
approach. Whether the employee-centred leadership style makes the group
productive or whether the productive group induces the leader to be employee-
centred is not clear.
2. It suggests leader behaviour to be of one particular type and static whereas, in
practice, it changes from situation to situation. A particular leadership style is
appropriate in a normal circumstance and an altogether different one when there
is pressure is an extraordinary situation.
3. The use of a questionnaire completed by subordinates introduces an element
of employee bias in it and may not present the true view of the leadership style.
The individuals and groups that are satisfied and attracted towards the leader
are more likely to describe the leader as considerate than those who are
conflict-ridden and dislike the leader.
4. As in the trait approach, these studies also did not take into consideration the
nature of the subordinate’s task or the personal characteristics, group
characteristics or other situational variables.

Summary of the Unit

It is beyond doubt that the goal of a leader in the organization is to do the best job
he can at influencing his people towards a common goal. Since a leader is dealing
with a very diverse group of people, it is important to understand the different
approaches to motivate them to meet their goals.
Leadership style is the pattern of behaviors used when a leader is trying to
influence the behaviors of a group. Each leadership style can be identified with a
different approach to problem solving and decision-making. Possessing a better
understanding of the various leadership styles and their respective developmental
levels will help a leader match a given style for a specific situation. The challenge
is to master the ability to change the leadership style for a given situation as the
person’s development level changes.
There are three organizational factors that influence leadership namely: corporate
culture, management style and situation. On the other hand, there are three
leadership models namely: personal traits of leaders, leadership behavior models
and situational leadership models. The last model by so far is the most

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