By Toni Cesta, PhD, RN, FAAN

Introduction

In the last issue of Case Management Insider, we reviewed some of the leadership issues and challenges specific to the role of the leader of a case management department and discussed five traits of an effective leader. This month, we will conclude with the final five traits of effective leaders and examples of how they apply to case management.

Trait 6: Successful Conflict Resolution

One cornerstone of effective leadership is the ability to handle conflict. In case management, there is no shortage of conflicts that can arise. Conflicts can mean vulnerability or strength for a case management leader, depending on how they are handled. Conflicts can be turning points for issues that have been ignored. These areas of discord are a consistent element of case management and something one should expect to find on a regular basis.

As a leader of a case management department, you will encounter conflicts involving case management staff, physicians, payers, other departments, patients and families, post-acute providers, and even transportation companies. You likely will be asked to address these conflicts when your staff is unable to resolve them. As these events are unpredictable and unplanned, they may interrupt your day and require that you quickly get up to speed on the issue.

In order to resolve these conflicts, you must be comfortable enough to jump feet-first into issues as they come up. Do not allow the conflict to become counterproductive — instead, use it as an opportunity for growth or improvement. As you solve the problem, include your staff in the resolution process so that they might be able to correct it themselves the next time something similar happens.

Conflicts also will arise between staff members. These conflicts can be equally challenging. My recommendation is to bring the two staff members together to work the issue out face to face. This will avoid a “he said, she said” situation. Once resolved, discuss takeaway lessons with the staff members so that in the future they can address such conflicts themselves.

As a case management leader, you will experience your own conflicts, usually between you and senior management staff, physician leaders, other department heads, and outside agencies and payers. Each conflict is your own learning opportunity, and compromise often is the best solution. Remember that each party in a conflict has his or her own point of view that may be as valid as yours. Listen to the other party and take his or her point of view into consideration. Validate it and be reasonable.

It will sometimes be true that you or your staff were incorrect; consider this before you dig your heels in. You will not win every conflict, nor should you expect to.

The key is to be prepared for conflict and to harness it to your advantage whenever possible.

Trait 7: Asking the Right Questions

Asking good questions is a leadership trait that often is overlooked. Many leaders do not know how to probe the thought processes of their direct reports, colleagues, or bosses — instead, they make assumptions about their actions when those actions are unclear. When those assumptions are wrong, dysfunctional patterns can be created. When someone finally helps by asking the right questions, a plan can be formulated and the problem resolved quickly, allowing the solution to move forward.

You may wonder why asking a question is important, or you may feel that asking questions demonstrates lack of knowledge or incompetence. In fact, asking the right questions can be an effective tool for improved communication, strategic planning, or conflict resolution. Conversely, do not ask questions just for the sake of it or to appear participatory in a meeting. Formulate your questions using some basic rules of thumb.

First, select your questions carefully and thoughtfully. A good question is one that unlocks a situation, or brings it forward for a bigger discussion. You can think of asking questions as a strategy to use when you want, or need, to get an issue out in the open without appearing too aggressive. Good questions can help the other party to look at the issue from a different point of view.

In more controlled situations, like a committee meeting, you may want to think of your questions in advance. Think of three great questions, jot them down, and interject them into the conversation when and if appropriate. By asking questions in this way, you can guide a discussion in a particular direction.

Use good questions as part of your leadership strategy. Ask questions about yourself, plans, projects, or initiatives you are working on, and ask questions about the organization.

When asking questions of yourself, consider how you might do things better or differently. When asking questions about projects or initiatives, try to pose them in a way that not only advances the work but also builds relationships and helps to get others involved and committed. Probing questions should be posed in the spirit of moving the project forward in a collegial way.

Finally, asking questions regarding the organization can help you to think of the organization as a whole and better ensure that you are in sync with the organization’s strategic plans and goals. Think carefully about them in advance whenever possible. Bring them forward in meetings or with colleagues. Select questions that provoke thoughts or actions.

Trait 8: Making High-quality Decisions

Making decisions is one of the fundamental roles of any leader. While it is easy to make a decision, it is much harder to make a quality decision.

Start by reflecting on your decision-making process. Do you make quick and spontaneous decisions, or are you more deliberate? Do you seek guidance before making a decision, or do you usually fly by the seat of your pants?

The challenge for case management leaders is to make both quality and timely decisions. Sometimes the work of a case management department does not allow for a long period of deliberation, as many decisions are time-limited and need to be addressed right away. Conversely, others may allow you the time needed to work through your decision by gathering information that you need to support the decision.

Let us review a process that can help you to improve your decision-making skills. The first thing to do is to identify the decision you need to make as well as the objectives or outcomes you are trying to achieve. Whenever time allows, do your homework by gathering as many facts and as much information as you can to assess your options and choices.

Next, brainstorm and come up with several possible choices. Many decisions can lend themselves to different solutions, so explore what those are. Look at your options and determine if they are compatible with your values, goals, and abilities.

The next step is to weigh the probabilities of the potential outcomes. Ask yourself what is the worst that can happen. If you pick one potential solution over another, can you live with the consequences of that decision?

Take the time to write a list of pros and cons. Prioritize which considerations are more or less important to you. If time allows, solicit feedback from those you trust or those who may have had experience with your problem. By gaining feedback, some factors that you had not considered may come to light.

Once you have made your decision, monitor the results and check that your desired outcome was achieved. Remember that hindsight is always 20-20. Some people become paralyzed with the fear of making a mistake. If you make a mistake, think of it as an opportunity to learn, and do not second-guess yourself. At the end of the day, all you can do is the best with what you have.

Also, do not underestimate the power of intuition, or your gut feeling. After all the facts are weighed and evaluated, it can be the final determinant. Quite often, it may be all you have to go on.

Trait 9: Being a Trusted Leader

When all is said and done, the vast majority of employees want to do a good job. Very few people go to work saying, “I’m going to do a bad job today.” People also want to follow and accomplish great things. Your staff knows that you are their link to senior leaders and that you are their face and their voice. They need to trust that you will protect them, advocate for them, and fight for them when necessary. If they lose their confidence in you, their morale and work will suffer.

A trusted leader will get more from their staff and have a strong following. Think about leaders you have known over the course of your career. What made you want to do your best for them? What were the traits that elicited your trust and confidence? Was it their support, their charisma, their ability to teach you, their kindnesses, or their fairness? It was more than likely all of these. You knew in your heart that your leader had your back. He or she told you the truth and followed through on promises.

It also is important to remember that trust is earned. You do not gain trust simply by being hired into a position — it is a fragile thing that can be earned and lost. Once it is lost, it will be much harder to earn it again. Trust will build over time as you work on making it happen.

When you first take a new leadership position, your staff may challenge you in a variety of ways. They may push the limits of the rules to see if you will let things go or hold them accountable. As a leader, you are not the staff’s friend. If you approach your role as a friend, you will have trouble when there are issues that need to be addressed — or you may be tempted to ignore the issues altogether. This is dangerous and could ultimately lead to your own failure. Your staff wants a leader who sets rules and holds everyone to them equally. You must be diligent every day and never take your eye off the elements that will gain trust.

The four key traits of trusted leaders are selflessness, safety, service, and sacrifice. Real leadership, the kind that inspires people to pull together and achieve something great, can only be exercised when a leader is trusted.

Trust also arises when someone is seen acting selflessly. This may not sound like news; indeed, the centuries-old concept of servant leadership is based on it. But if it also sounds vague and hard to apply to your own leadership setting, let us break it down further: People in an organization perceive selflessness when a leader concerns him- or herself with their safety, performs valuable service, and makes personal sacrifice for their benefit.

Trait 10: Clear Communication

As you review all the traits discussed in our two articles on leadership, there is one theme that carries through them all: Communication. It has been said that communication is the glue that holds organizations together. It also is one of the fundamental leadership skills.

So much of our work is performed through communication. It is how initiatives are launched, outcomes are reported, patients are case-managed, and teams are built. Interpersonal communication skills are what we use when we are engaged in face-to-face communication with one or more individuals.

These skills are needed to speak appropriately with a wide variety of people. They also involve maintaining good eye contact, demonstrating a wide vocabulary, and tailoring your language to your audience. As a case management leader, you must listen effectively, present your ideas appropriately, write clearly and concisely, and work well in groups.

Although presentation skills may be used infrequently, there will be times when you will need to present information to a group or committee, either in a formal or informal setting. Be sure to work on presentation and public speaking skills.

Communication skills are not limited to direct interaction with other people and the spoken word. Writing clearly and effectively is a skill that is not limited to journalists or professional authors. Poorly written communication can be frustrating for the reader and potentially damaging for you. Spelling mistakes, even in emails, can give a bad impression and may result in the reader not taking your message seriously. If you need help with your writing, there are many workshops you can attend to improve your skills.

Communication is a two-way street. As a leader, you are constantly giving and receiving information. It can be verbal or written. In fact, written communication has accelerated with the advent of electronic communication. Information is coming at leaders from all directions at all times. It is a lot to juggle for even the most seasoned leader. You must consciously remember to listen as well as to speak.

Listening is an active process that requires as great an effort as speaking, so do not give it short shrift. If you are not a good listener, practice honing your skills. When staff members speak to you, give them 100% of your attention. Do not read papers on your desk, respond to emails, or answer the phone. It is difficult for us to do two things at once, even though we think we can. While you are reading an email, you are giving your staff member the message that you are not completely present and that they do not warrant your full attention.

Summary

Leadership style sets the tone and approach for an organization. Think of it as the classic “follow the leader” situation: People will watch and mimic how things are done by their leaders. You always should lead in a way that you want to be copied — because you will be. I hope you will consider these traits so that you can be the very best leader you can be.