"I not only use all the brains I have, but all I can borrow." Woodrow Wilson

Introduction

Quality Practice Management starts with the execution of sensible leadership. The most important part of leadership is in the delegation. Delegation, when exercised properly, is an important management skill defining a boundary of responsibility which works as a two way street. Good delegation saves managing time, develops people, grooms a successor, and motivates other staff. Poor delegation will cause frustration, de-motivates and confuses the counterparts, and fails to achieve the task or purpose. Hierarchal structure of management tends to hold more responsibility at the higher level while the counter parts are waiting for the directions and orders of the upper parts. Empowerment and motivation may come from when staff knows what is her/his job and they can execute their job with confidence. The class will be devoted to "How delegation is practiced and what it will bring to the organization.

As you may find from the diagram below, 4 Stages Model of Leadership develops as follows. Dr Bruce Tuckman published his model in Forming Storming Norming Performing Model for Leadership & Delegation Process. Leadership in practice is not the status of an entity but it is the process of education and training as well as constant procedural effort of relationship building.

The progression of the Delegation may go as follows:

1.  Forming (State of Introduction)

2.  Storming (Stage of Exploration)

3.  Norming (Stage of Teaming)

4.  Performing (Stage of Agreement)

The model of the management and leadership style here illustrates the ideal development of a team from dependency (Stage 1) through independency (Stage 2 &3) and to maturity of being inter-dependency (Stage 4). During this stage progression the leadership style progressively develop a form of early state task-directing (1), through the more managerially-involved stages of explanation (2) and participation (3), to the final stage of relatively detached delegation and observation (4), at which time ideally the team is largely self-managing, and hopefully contains at least one potential management/leadership successor. The aim of the leader or manager is therefore to develop the team through the four stages, and then to move on to another role.

Here are the features of each phase:

Forming (Introduction) - Stage 1

Observation: This is a stage of high dependence on leader for guidance and direction. Little agreement with low level understanding is made on team direction other than what was received from leader. Individual roles and responsibilities are unclear. Leader must be prepared to answer lots of questions (if any) about the team's purpose, objectives and functional relationships of individuals. Time should be spent on the rationale for the new proposal and the person involved in the new approach should be full educated. Processes are often ignored. Members may test tolerance of system and leader. Leader directs mostly.

Examples

Proposal is to get every clients educated for the blood test on patients over 6 weeks of age and all patients for visiting for annual checkup as well as all geriatric patients over 7 years of age. Since staff have never been educated about the importance of preventive medicine through annual or base-line blood testing procedures, they will only consider that this new procedures might be extra steps for the management to increase revenue. As a result some staff complains that they are reluctant to the new proposal with an excuse that she/he wants to protect the financial pocket of the poor clients.

Action

Staff education is started on the indispensable need of base-line blood test (as in human medicine) regarding the advantages in healthcare of pets as well as rewards to the clients through the early detection of the ailment especially in puppy stage pneumonia and kennel cough that might not even be detected only with visual examination and auscultation at the initial visit. Incubation stage of illness is explained fully. One of the staff acts as a model in expanding the new decision with successful outcomes that show abnormal hemogram although the patient did now exhibit any clinical symptoms of illness during visual and acculturation.

Result

Staff begins buy into the benefit of the base-line blood work and geriatric screening even when the patients do not show the symptoms of illness. Although it is not fully and positively understood in terms of absolute benefit of the process to the patients there is not much objections and/or negativity of the system perceived by the staff in general. So, staff agreed to try it out to study about the outcomes that might benefit patients. Decision is to have the process revisited in one month and every team will have their own results to be discussed during the following staff meeting.

Storming (Discovery) - Stage 2

Decisions don't come easily within group. Team members vie for position as they attempt to establish themselves in relation to other team members and the leader, who might receive challenges from team members. Clarity of purpose increases but plenty of uncertainties persist. Opinions and dislikes may form and there may be power struggles also. The team needs to be focused on its goals to avoid becoming distracted by relationships and emotional issues through competitions. Management need to stay supportive if there is any disruption in the process of trial and errors.

Example

Each technicians and assistant (or clinician and technicians) teamed up as one unit and find out how their experiences will be when they approach every client with blood testing protocol when they visit the clinic with pets. Compliance ratio can range from 30% to 80% depending on who is actually doing client education during TPRs and examination of the patients. Frequently the CBC and General Profile are being requested by the clients at the level of receptionist before the clients are in the examination room. This is the result of the client education that has been strongly executed by the phone consulting staff during the phone calls and initial visit to the office.

Action and Subsequent Result

Staff begins to gain confidence in their ability to educate the clients since they are actually witnessing the patients appeared to be normal upon examination only to find out the blood test shows extremely low RBC and/or WBC indicating on-going non-symptomatic disease process in the body. Staff is more confident in the their effort to educate the clients especially when they find out the patient sent home become ill as a result of clients declining the blood test procedures although recommended by the hospital. Opinions are forming although there are still some that are not confident since they still can't not accept clients' decline with " No" on their recommendation. Focus is still being placed on the quality medicine through prevention of illness and wellness care that eventually helps pets and clients. Multiple outcomes of preventive treatment as a result of baseline blood test have convinced many staff to continue their effort to educate clients through their positive experience on preventive medicine. Although many staff were excited as a result they still needed a lot more support from doctors and senior staff who are successful in getting higher compliance from the clients.

Norming (Acceptance) - Stage 3

Agreement and consensus are largely formed among team that responds well to facilitation by leader. Roles and responsibilities are becoming clearer and better accepted. Big decisions are easier to be made through group agreement. Smaller decisions may be delegated to individuals or small group. Commitment and unity become stronger. Leaders many even use models to show other counterparts for the potential benefit of the newly accepted process. The team may engage in fun and social activities on their own. The team discusses and develops its processes and working style. There is general respect for the leader and some of leadership is more shared by the team.

Actions and Subsequent Results

With positive outcomes of Storming state (2) many staff are motivated to take their own initiative to educate the clients regarding many different resourced of information on disease that can be detected in the early stage of disease course. One of the leading staff who is receiving the highest compliance from the clients is appointed as a model staff in supporting others in building confidence in the education of clients with base-line blood test, geriatric screening and annual blood tests as well as pre-surgical and post-surgical blood works. Comparisons were made between the two groups that gets higher Vs. lower compliances only to find out how different the education procedures for clients from ADDS ( explanation on advantages, disadvantages when the blood test result is not available to the clinician and storytelling)

Performing (Execution) - Stage 4

The team is more strategically aware; the team clearly understands the purpose of the project based on repeated outcomes. The team has a shared vision and is able to stand on its own feet with no interference or participation from the leader. There is a focus on over-achieving goals, and the team makes most of the decisions against criteria agreed with the leader. The team has a high degree of autonomy. Disagreements occur but now they are resolved within the team positively and necessary changes to processes and structure are made by the team. The team is able to work towards achieving the goal, and also to attend to relationship, style and process issues along the way. Team members look after each other. The team requires delegated tasks and projects from the leader. The team does not need to be instructed or assisted any further. Team members might ask for assistance from the leader with personal and interpersonal development. Leader delegates and oversees with trust and confidence.

Actions and Subsequent Results

All participants feel comfortable in making their approach to the clients with baseline, geriatric and annual blood test since they are firmly believe in the procedure. Clients seem to read their mind of genuine concern on early prevention and life-longevity of the patients. Higher ratio of compliance is noticed and higher numbers of early stage detection of the illness have proved that the team effort helped clients and the patients. Without the intervention of doctors and management, staff is voluntarily educating the clients on screening procedures that doctor may recommend with benefits and outcomes. Many clients are ready to ask about the blood test before clinicians are in the examination room. This saves lots of times for clinicians so that they can spend quality time in diagnosis and treatments. Tripled use and order for in-house Kits for blood chemistry and CBC are one of the example that the team delegation is working very strong.

Conclusion

As the team matures and becomes more self-sufficient and self-directing, so the leader's style should react accordingly, ideally becoming more detached, more delegating, encouraging and enabling the group to run itself, and for a successor to emerge and join.

As the diagram shows, when exercised correctly, time will show the maturity of staff in the use of their own freedom while the amount of authority of managers is declining. When the leadership is fully in place, motivational efforts, creativity, self confident of the co-workers are expanding while supervisory activities are as required as the organization run under inexperienced leadership with low level of delegating mind.