A manager is an individual who holds an office—attached to which are multiple roles.

Leadership is one of those roles (Shortell and Kaluzny, 2000).

Leading is a process, an action word, a verb.

The locus of leadership is a person; only individuals (as opposed to corporations or inanimate objects) can lead.

The focus of leadership is other people or groups. This connection must exist for leadership to take place.

Leadership necessitates influencing. It is the leader’s ability to influence others that sets apart an effective leader from an ineffective one. This may be the most critical of the leadership components.

The object of leadership is goal accomplishment.

Leadership is intentional, not accidental.

Case management is a process where the case manager (the leader) must assess multiple variables that relate to the patient, the family, the disease process, the treatment, the insurance, the psychosocial situation, and the multidisciplinary health care team.

The goals chosen are the roadmap for the creation of best outcomes; the case manager must intentionally influence the situation to bring about the best outcomes for the patient and family.

The ability to influence others may be the case manager’s “center of gravity” and most critical skill. Influence is a multipronged concept, and, on a daily basis, case managers intentionally influence patients/families to take appropriate medications, to think carefully about possible treatment choices, or to eat a diet that is best for their disease state (for examples). Case managers influence insurance companies, and other important health care team members.

Charismatic leadership—The word charisma is derived from a Greek word meaning “divinely inspired gift.” Charismatic leaders feel that charm and grace are all that is needed to create followers and that people follow others that they personally admire. Charismatic leaders pay a great deal of attention in scanning and reading their environment, and are good at picking up the moods and concerns of both individuals and larger audiences. They then will hone their actions and words to suit the situation (“Leadership Styles,” 2006).

Participative leadership—Participative leaders believe that involvement in decision making improves the understanding of the issues concerned by those who must carry out the decisions. Further, people are more committed to actions when they have been involved in the relevant decision making, and are less competitive and more collaborative when they are working on joint goals (“Leadership Styles,” 2006) (see Table 12-1).

Situational leadership—Situational leaders use a range of actions and styles that depend on the situation. This style may be transactional or transformational (see below) or any of the leadership styles discussed.¹

Transactional leadership—Transactional leaders believe that people are motivated by reward and punishment. Social systems work best with a clear chain of command. When people have agreed to do a job (the transaction), a part of the deal is that they cede all authority to their manager. The prime purpose of a subordinate is to do what their manager tells them to do (“Leadership Styles,” 2006).

Transformational leadership—While transactional leadership attempts to preserve and work within the constraints of the status quo, transformational leadership seeks to subvert and replace it and looks at the greater good (Shortell and Kaluzny, 2000). Transformational leaders believe people will follow a person who inspires them, has vision and passion, and can achieve great things. The way to get things done is by injecting enthusiasm and energy. Transformational leadership starts with the development of a vision (by the leader or by the team)—a view of the future that will excite and convert potential followers (“Leadership Styles,” 2006).

Quiet leader—The quiet leader believes that the actions of a leader speak louder than his or her words. People are motivated when you give them credit rather than take it yourself. Ego and aggression are neither necessary nor constructive (“Leadership Styles,” 2006).

Servant leadership—The servant leader believes the leader has responsibility for the followers and toward society and those who are disadvantaged. The servant leader serves others, rather than others serving the leader (“Leadership Styles,” 2006).

Promote empowerment. They emphasize the strengths and utilize the talents of others in the organization. Leaders share decision making with others, allowing those people at the point of care or service to be the key decision makers. Then they share in the success and give credit where it is due.

Promote a vision. People need a vision of where they are going. Leaders provide that vision (Manager’s Intelligence Report, 1997).

Follow the golden rule. Anyone who has been demeaned or treated with disrespect knows what effect that treatment has on the work (Manager’s Intelligence Report, 1997).

Praise others in public. And criticize others only in private.

Stay close to the action. In case management, this is the administrator who goes to the “front lines” occasionally to stay in touch with the reality of the working situation. This also means that the leader is visible and accessible.

Say, “I don’t know” when confronted with a case management problem, then assist with a solution.

Focus on what is right, not who is right.

Motivate others by:

Hold their staff accountable, but also let them do their jobs.

Avoidance

Competition (“I win, you lose”)

Accommodation (“You win, I lose”)

Negotiation (also known as compromise) (see next section)

Collaboration (“You win, I win”) (the best strategy)

It has the capacity to control costs. This is one of the primary reasons case managers negotiate.

It has the capacity to gain medically necessary benefits for the patient that the patient would otherwise not receive. This is the other primary reason case managers negotiate.

It can avoid chaos (Jones, Skelton, and Hochuli, 1998). Many case managers have lived through the frustration and chaos that results when a patient’s condition deteriorates, at least partly because the negotiation for the requested service or equipment was denied.