A different age for leadership, part 1: new context, new content.

Abstract

This is Part 1 of a 2-part article on the new and emerging characteristics and elements of leadership for changing, fast-paced organizations. As we leave the 20th century workplace and are increasingly driven by innovation and technological transformation, new roles are demanded from everyone. Leadership expression now calls for a different emphasis and skill set from those that predominated in the past century. The first article focuses on the context of leadership affecting what leaders do and how they must now behave. Part 2 will center on the activities of leadership and the new learning and skill set development that will increasingly be required of leaders in a fundamentally altered work environment.

Full text

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JONA • Vol.33,No.2 • February 2003105
This is Part 1 of a 2-part article on the new and
emerging characteristics and elements of leadership
for changing, fast-paced organizations.As we leave
the 20th century workplace and are increasingly dri-
ven by innovation and technological transformation,
new roles are demanded from everyone.Leadership
expression now calls for a different emphasis and
skill set from those that predominated in the past
century.The first article focuses on the context of
leadership affecting what leaders do and how they
must now behave.Part 2 will center on the activities
of leadership and the new learning and skill set de-
velopment that will increasingly be required of lead-
ers in a fundamentally altered work environment.
If you want to build a ship, don’t drum up people to
gather wood and nail the planks together.Instead,teach
them a passionate desire for the sea.
—Antoine de Saint-Exupery
The rules of leadership are changing. Clinical and
structural shifts in healthcare occur so swiftly that
leading in their presence is overwhelming. Many
managers are expressing concern regarding their
own ability to manage the vagaries of a health sys-
tem in the midst of this chaos.1
Out of the chaos are signs of a pattern of
changes that give us a glimpse of the direction of
change in healthcare. Some of these factors are as
follows:
1. Healthcare is moving from residency-based
delivery models of health service to mobil-
ity-based approaches as medical therapeu-
tics become more portable, less invasive,
and require less treatment and recovery
time.
2. Much of the emerging medical care models
do not require that patients stay for a long
time to get service;however,much of nurs-
ing education is still based on learning and
practices that require patients to stay
around long enough for nurses to do the
work they learned.
3. There is an accelerating movement from in-
patient care structures to a fast growing out-
patient care marketplace where service is
speedy and patients do not stay long.
4. Much of the aftercare following procedures
is now rendered in the patient’s own envi-
ronment instead of in the healthcare facility,
shifting accountability for subsequent pro-
cedure and activity from professional care-
givers to patients and their significant oth-
ers.
5. Payment models are changing their form
and application.Those processes once paid
for without question are now subject to re-
view driven by the shift in technology,loca-
tion, and procedure affecting both the sub-
stance and amounts of remuneration.
6. Staff shortages of all kinds are contributing
to the stress of providing services and
scheduling and assigning sufficient staff to
meet the demands of a changing population
and shifting therapeutic environment.
7. The behavior of the worker is now chang-
ing from an “institutional” model to a “mo-
bility”model of work.The conflict emerging
between the mature worker, inculcated in
loyalty to the workplace, and the new
worker,loyal only to the work,increases the
stress in the work relationship.
JONA
Volume 33, Number 2 pp 105-110
©2003, Lippincott Williams & Wilkins, Inc.
A Different Age for Leadership,
Part 1
New Context, New Content
Tim Porter-O’Grady, EdD, PhD, FAAN
A Au ut th ho or r a af ff fi il li ia at ti io on n: : Tim Porter-O’Grady Associates, Inc., Otto,
NC;School of Nursing,Emory University, Atlanta,Ga.
C Co or rr re es sp po on nd di in ng g a au ut th ho or r: : Tim Porter-O’Grady, EdD, PhD, FAAN,
Tim Porter-O’Grady Associates, Inc., 529 Crystal Creek Rd, Otto,
NC 28763 (tim@tpogassociates.com).

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106 JONA • Vol.33,No.2 • February 2003
8. The pace of technology creates a demand in
process and procedure that changes faster
than providers can cope.When a new tech-
nique is learned,even newer technology ar-
rives that makes the recently engaged learn-
ing obsolete, often before the provider has
had time to entrench previous new learning.
9. Managers are leading temporary workers
employed by others,yet are accountable for
the care these workers render in the insti-
tution. Issues of managing people you do
not employ raise the stress level of leader-
ship and affect the ability to assure quality
and positive outcomes.
10. The demands of management work appear
to be increasing, taking the manager away
from the unit and service much more fre-
quently to address systems issues.The staff
is on its own more often, problems remain
unresolved, and crises emerge more fre-
quently because the manager is not able to
anticipate them, accelerating the degree of
stress in the manager’s role.2
This partial list of challenging and transitioning
circumstances is just a sample of the pressures in-
fluencing the role of the manager.And it doesn’t
look as though they will let up any time soon.They
present an entirely new context for work and lead-
ership that now requires different skill sets to ad-
dress the needs of facilitating and advancing clinical
work.This effort requires a more professional and
emotional maturity from practitioners regarding
their relationship to their own work and their will-
ingness to change their practices.
The Move From Employee-based
Leadership
Perhaps one of the most significant shifts that has
occurred in the workplace relates to the change in
the workers themselves.For the entire 20th century,
most work was exemplified by the relationship be-
tween employers and employees.This relationship
between people and their organizations reflected an
interaction that characterized work in the context of
a defined workplace with all the rules, regulations,
policies, and procedures that implied. Much of the
structural and regulatory processes associated with
this dynamic reflected a compelling and subsidiary
relationship between employer and employee.Al-
though this relationship still predominates in much
of the workplace, considerable change is occurring
at the periphery of this organizational model, and
will ultimately alter the nature of the relationship be-
tween organization and worker.3
As we move into the knowledge economy,what
people know and how they translate it into the in-
novations and practices of work and revenue pro-
duction are critical to the continuing viability of the
organization. Increasingly, the knowledge obtained
by the worker creates in the worker an opportunity
to be individually valued regardless of the work envi-
ronment where that knowledge or value is ex-
pressed.In short,the worker is no longer dependent
on any one workplace for continuing life sustenance,
personal expression,or satisfaction.Knowledge is the
single major value the worker now brings to the
workplace. Knowledge is owned by the worker and
is obtained through his or her own efforts and activ-
ities.And that knowledge is increasingly portable.Be-
cause the value of the worker is embedded in the
knowledge that the worker brings to the organiza-
tion,the workplace has a greater need for the worker
than that individual has for the workplace.4This
portability of knowledge has created a foundation
that significantly alters the content and character of
the relationship between worker and organization.
This new reality can be seen in the critical short-
age of knowledge workers and the unbelievable
growth of outsourcing and contracting knowledge
work.There are several large international compa-
nies whose entire role is to provide services and
workers to other organizations that contract them
for specific knowledge functions. In fact, the out-
sourcing of knowledge work and the contracting of
companies managing knowledge workers is one of
the fastest growing areas of work in the 21st cen-
tury.5Many of these organizations are designed
around managing professional workers in a way that
allows these workers to maintain their indepen-
dence, choice over intensity of work, mobility, and
specific work opportunities that suit their interests.
Furthermore, these professional management ser-
vices handle all of the tax, financial, management,
and process issues that such independent workers
might otherwise have had to handle for themselves.
These intermediaries are now becoming,in essence,
the employers and managers of knowledge workers
and their work. Such agencies have always existed,
but their growth in the last 5 years has outstripped
all such growth over the whole of the 20th century.
In healthcare, perhaps the most significant ex-
ample of this is the traveling nurse agencies that are
increasingly attractive to professional nurses.These
agencies allow the greatest possibility of flexibility

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JONA • Vol.33,No.2 • February 2003107
in schedules, assignments, and remuneration, giving
nurses as much control over their choices as possi-
ble.These agencies are increasingly forcing health-
care organizations to contract with them as the nurs-
ing resource becomes scarcer and as nurses are less
satisfied with the limitations of direct employment.
This fundamentally alters the employer-employee re-
lationship.6
Professional nurses in these circumstances no
longer owe allegiance,loyalty,or affiliation to the in-
dividual workplaces.This changed relationship af-
fects the organization’s ability to have direct, imme-
diate, and disciplinary control over professional
workers.This also affects the organization’s ability to
control the work itself. Not having direct employ-
ment control over the worker removes direct man-
agement control over the work. In short, it changes
the nature of the relationship to such an extent that
it alters the very context for work itself. Leading
workers that the manager does not employ directly
changes the required skill sets necessary to both in-
teract with and to manage the worker. Because
knowledge is increasingly specialized,the likelihood
of outsourced knowledge workers continues to rise
as the demands of technology expand.These highly
specialized and independent workers represent
such a wide range of technical specialties that it is
now less expensive and more viable for organiza-
tions to contract for these services.As the pace of
technology accelerates,it will be increasingly less vi-
able for organizations to continually attempt to em-
ploy the growing myriad of technological specialists
required to apply this technology.7
This significant new reality requires a shift in
how people are managed. Different skills will have
to emerge for organizations to remain viable as they
manage in an environment where the work and the
workers are increasingly differentiated from the
workplace. Some of these new skills are described
below.
1. Organizations now must work to standard.
Without a standard format on which to base
performance expectations for workers who
predominantly come from the outside, there
is no foundation for clear performance ex-
pectations, sustainable outcomes, attracting
competent workers, and work evaluation. If
contracting with external professional con-
tract organizations is to remain viable over
time, agreement on standards, performance,
and expectations will need to be a part of the
contract relationship. It will be the leader’s
obligation to assure that these elements are
in place.
2. Establishing relationships with workers not
directly related to the organization requires a
higher level of interactive skills:the ability to
obtain compliance, build worker relation-
ships, problem solve, manage conflict, and
obtain positive work outcomes will be criti-
cal to the leader’s success.This means more
clearly defined and specifically identified per-
missible leadership styles. Right leader be-
haviors with clear enumeration of manage-
ment performance will be required to assure
positive work relationships and to sustain
meaningful service outcomes. Many more
shared decision-making models will need to
emerge to address the needs of these new
workers to control their own practice.
3. A higher level of performance proficiency in
the worker will need to be exemplified by in-
creasing focus on efficiency, economies of
scale,and work effectiveness.The removal of
nonessential, extraneous, and redundant
tasks and functions will be a critical element
of sound work design.The costs associated
with these new worker models are signifi-
cant, and require managers to assess the es-
sential character and content of work to as-
sure that outcomes can be obtained through
an effective economy of work activity.
4. A new and growing emphasis on worker re-
lationships and goodness-of-fit between the
activities of various knowledge worker cate-
gories or specialties will become increasingly
important to the viability of the service orga-
nization.As this new worker model emerges,
this goodness-of-fit becomes as important an
element of the work as individual profi-
ciency. Productivity models in this scenario
will increasingly reflect the interaction and
comprehensive synthesis of interdisciplinary
work efforts. The result: aggregated, inte-
grated professional activity that reflects a sig-
nificant and sustainable impact on patient
care with clearly enumerated positive clinical
outcomes.8
Relationship Leadership
As the role and the position of the worker are chang-
ing,so also is the relationship of the leader.No longer
can the broad range of leadership behaviors often as-
sociated with style or approach be passively permit-

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108JONA • Vol.33,No.2 • February 2003
ted in the contemporary role of the leader. In older,
more traditional,models of leadership,personal style
or behavior patterns were viewed as a part of the ap-
propriate structure of leadership.No more.9
Daniel Goleman’s work on emotional intelli-
gence has revealed the importance of relational and
emotional integrity.10As a subset of this work,it has
become clear that the role of the leader has particu-
lar behavioral and performance requirements that
have specific important and enduring impact on the
organization.The importance of the leader to the
culture and context of the organization is increas-
ingly evident.
The mood, attitude, and contiguous patterns of
interaction of the leader with the staff and others
have a tremendous effect on the culture, context,
and content of work. Critical care research has
shown that the peaceful invested presence of an-
other has a direct impact on a patient’s blood pres-
sure and other key physiological indicators of the
patient’s personal well being. The research has
shown that the interpersonal limbic regulation or
signals that a person transmits can affect hormone
levels, cardiovascular functions, sleep rhythms, and
immune functions in others.
In the workplace, others also are affected by
these behaviors. More importantly, the leader’s be-
haviors have a tremendous impact on the behaviors
of the team.This research further shows that when
emotions are tracked together,they are largely inter-
dependent, meaning that everyone shares the im-
pact of the emotions of any one member of the
team.Staff also takes clear emotional cues from lead-
ers.The mood and resultant pattern of behavior of
the leader creates a lasting impression reflected in
the team’s behavior.The leader’s awareness of this
impact is critical to the effectiveness of the leader in
directing and managing the team.11
Leading should never be considered as anecdo-
tal or accidental.Every moment the leader operates
in the role,he/she is influencing the role and actions
of other team members. Because of this, leaders
must have a sense of their own personal emotional
patterns and an awareness of the impact of signifi-
cant emotional events on their own leadership be-
havior.Every leader is different.However,the expec-
tations of leadership reflect the need for consistent
applications of the role so that staff can depend on
the emotional and behavioral integrity and balance
of the leader as he/she applies leadership skills.
Therefore, Goleman11further suggests the following
four skill sets now need to be an essential part of the
personal vocabulary of every leader.
Self-awareness
Good leaders are able to read their own emotional
state.They are aware of the elements of life experi-
ence that challenge or change mood or emotional
state.This awareness of one’s particular emotional
status and conscious recognition of its presence al-
lows the leader to accommodate her/his mood and
adjust for it in the expression of personal leadership.
The leader must be aware that negative moods can
be translated into staff relationships. Knowing the
impact of mood on the team’s work and relation-
ship, the manager adjusts or compensates to assure
that staff relationship is not compromised.
Self-management
Awareness of mood and emotional state is simply
the first step. It does no good to be aware if the
leader does not undertake corrective action. Mood
management assures that a negative mood or emo-
tional state is not transferred to the staff and the en-
tire team. Self-management evidences the ability of
the leader to compensate honestly and with in-
tegrity for negative mood,to work over or around it
in a way that assures it does not affect the worker or
the work.If there are particular circumstances influ-
encing the manager’s personal expression, then
frankness, openness with others regarding its
source,and an honest commitment to accommodat-
ing it is vital. Equally important is the leader’s need
to address the circumstances and conditions affect-
ing an emotional state in a way that addresses a res-
olution of the underlying factors.
Social Awareness
Equally important to leadership effectiveness is the
leader’s ability to assess the emotions and moods of
others. This more intuitive skill is exemplified in the
empathy and expressiveness of the leader in rela-
tionship to the emotional circumstances and needs
of those he/she leads and with those to whom
he/she relates. Expressing a sense of caring, con-
nection,and communication with others’emotional
states shows that the leader is sensitive and aware
of the social circumstances of leadership. This
leader becomes politically expert, anticipating the
needs of those he/she leads with a thorough under-
standing of their personal emotional and mood pat-
terns and of the appropriate responses to address
them.Thus, the leader is able to confront negative
patterns of mood and emotional expression in a
timely and appropriate fashion to prevent them
from influencing and affecting the emotional state
of the team.

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JONA • Vol.33,No.2 • February 2003109
Relationship Management
This role competence requires the leader to com-
municate effectively with others in a way that an-
ticipates and,as necessary,disarms the potential for
conflict.This leader focuses on establishing rela-
tional and emotional bonds in the team that de-
velop the emotional maturity of team members and
facilitate the stability of positive and effective rela-
tionships.The enthusiastic, caring, and supportive
leader generates those same feelings throughout
the team.This individual supports the power of
humor,kindness,communication,and availability to
others in a way that creates a context of inclusion
and caring.12
Adult to Adult
In addition to the four elements that Goleman iden-
tifies,another critical element must be considered in
today’s workplace.The context of relationship is as
important as the content of emotional maturity.
Much of the model of 20th century management re-
flected a parent-child system of interaction and com-
munication between managers and staff.13This func-
tional systems approach to organizational leadership
reflected a vertical notion of power,interaction,and
authority. In newer work models, these traditional
historic vertical patterns of communication and
leadership are no longer effective, nor are they sus-
tainable.14Strategies that reflect adult means of in-
teraction, communication, and relationship are the
critical context for leader-staff behaviors. These
more horizontal foundations for interaction and re-
lationship require a different means of leadership.
Skills in discourse, negotiation, collective problem
solving,setting expectations,and establishing group
norms are more adequate leader behaviors in today’s
work environment than past patterns reflecting a
more parental (“boss”) approach.15
Confronting the Impossible
During this significant transition, all work ultimately
appears overwhelming.Every leader can testify today
to the fact that he/she holds a job that,considered in
its entirety, simply cannot be done.The complexity,
content, time limit, and intensity of the work of
change is impossible for an individual to confront.Be-
sides this,the sheer volume of changes occurring in
concert overwhelms the ability of any one individual
to cope.16When seen as discrete events,the items of
change cumulatively can overtake the energies of in-
dividual leaders to address them adequately.Thus,
leaders continually feel overwhelmed.
John Kotter, former professor of organizational
behavior at Harvard University, distinguishes man-
agement from leadership by identifying managers as
people who cope with complexity and leaders as
people who cope with change.17Leaders are funda-
mentally interested in the direction of an organiza-
tion rather than simply its functions and activities.
Leaders attempt to view all activity in the context of
the major themes,ebbs and flows,and trajectories of
human endeavor.In short,leaders see their role from
the balcony rather than from the street.
Leaders operate with a sense of vision.They can
see all of the activities of work in the context of how
action coalesces and synthesizes around the
processes and direction of the organizational jour-
ney.The 21st century leader recognizes that in the
current context of movement, change is itself the
work.18
The charter of the leader, in this new world of
work,is twofold.For the leader,the primary focus of
work is assuring a sustainable future for the organi-
zation,and second,advancing the value and the via-
bility of those whose efforts lead to organizational
success.Leaders perceive their functions in the con-
text of these two priorities. Indeed, these priorities
served as the foundation or purposes of the work of
the leader.All relationships in the organization and
every activity of those working in it are perceived
by the leader as directly related to the sustainability
and viability of the organization.The leader has a
unique ability to consistently retain this insight and
have it inform all interactions, relationships, and
work behavior. This ability often sets the leader
apart from other members of the organization who
see work from a more personal and individuated
perspective.
One of the primary roles of leadership is to en-
courage and inspire others in a way that keeps
them committed to the direction and values of the
organization.This process is an essential mandate
for the leader. It is both easy and usual for workers
to become bogged down by the vagaries of day-to-day
activity.Indeed,workers frequently become captured
by the functions, problems, and daily activities of or-
dinary work. The workers’ imagination and con-
sciousness are co-opted through this process; more-
over, it compromises their ability to articulate their
work within the vision and direction of the organiza-
tion and their part in it.Here,the work of the leader
is critical.The leader calls the team back to that vision
of the longer and broader agenda,renews the team’s
awareness of contributing to it, and re-engages their
energies in fulfillment of the organization’s goals.19