There is a world of difference between ownership and management.

A leader is one who persuades others to work toward a common goal. Leadership has traditionally been thought of as an inherent ability, one that could not be trained or taught. New research, however, indicates that leadership skills can be taught and identifies several different types of leadership.

Emotional Intelligence by Daniel Goleman, PhD, is a book and a concept that identifies six leadership styles that derive from an individual’s own traits of:

• knowing and managing one’s emotions;

• motivating oneself;

• recognizing emotions in others; and

• handling relationships.

Goleman’s concept is that emotional reasoning is akin to intellectual reasoning (thus, the term Emotional Quotient, or EQ) and that EQ is a more valid predictor of success than is IQ in areas like job satisfaction and performance, marriage, and family relationships. A high-EQ individual is not necessarily a good leader, but a low-EQ individual is unlikely to make an effective leader in a setting like the physical therapy clinic.

The six leadership styles are the following:

• Authoritative style—mobilizes followers toward a vision;

• Affiliative style—creates emotional bonds and harmony;

• Democratic style—builds consensus through participation;

• Pacesetting style—expects excellence and self-direction;

• Coaching style—develops people for the future; and

• Coercive style—demands immediate compliance.

Leadership Skills

The physical therapist (PT) is a leader in the clinic because of his or her clinical skills and special knowledge. The therapist is the leader of the rehabilitation team that may be comprised of a PTA, aide, LMT, ATC, other PTs, OTs, and others. The therapist-patient interaction also gives PTs influence over the patient. All this being true, however, there is nothing in a physical therapist’s education or inclination that, de facto, makes him or her an automatic or natural leader for staff, peers, or patients.

My biggest eye-opener was when I first attained a leadership position in the clinic and I noticed the difference between the aspect of leadership that governed individual behavior (responsibility and personal accountability) and the aspect of leadership that governed organizational behavior (productivity, absenteeism, turnover, organizational citizenship, and job satisfaction). Needless to say, I had plenty of the former, by dint of my schooling, training, experience, and personal attributes. I had, however, almost no knowledge of the latter. I had to learn the hard way.

Leadership Style

Leadership style is a concept that is important in a discussion of physical therapist management and education, because there is increasing evidence that effective styles are learned and, more importantly, can be trained. Rather than learning “under the gun” through “trial and error,” why not inculcate physical therapy students with basic leadership and management information in PT school? There are many examples of personal leadership in each person’s life (work, family, church, and school). It is the recognition and study of our own individual traits that will enable us to develop these in a way that leads to organizational leadership and the improvement of performance and outcomes in the physical therapy clinic.

Examples

To clarify the six styles, I have drawn six illustrations of people with whom I have known and worked. I have chosen them for their distinct characteristics that exemplify one of the six leadership styles.

Molly is an Affiliative leader. She makes a special effort to connect or bond in a friendly way with each employee. For example, she might spend extra time on Monday to find out how her employees spent their time on the weekend. She organizes “get-togethers” after work in less formal settings. Birthdays and Christmas are opportunities to hand-make simple crafts or greeting cards that recall events from the past year. 

All of Molly’s efforts communicate to her employees, “You are important.” Molly’s extra effort pays off because she fosters a sense of belonging. When Molly receives a surge of new referrals from newly established physician relationships, she needs to get those patients into therapy as soon as possible. Her efforts to foster a sense of belonging and her special relationships with the therapists enable her to ask for longer work hours and more patient visits without antagonizing her entire staff.

Molly is able to excel as an Affiliative leader. She has never read a book or taken a class to become who she is, but the rest of us can take heart from the new research that indicates that her Affiliative style is able to be learned and taught.

Ben is an example of a Coercive leader. He is the owner of a physical therapy clinic inside a health club. Ben can be charismatic and charming. He is also a weight lifter with an imposing physical presence. He prefers a top-down decision-making style, and he will gather all the employees together for big meetings when he has ideas to share or when he needs to motivate his staff. Usually, Ben’s meetings occur just before month-end, if sales quotas haven’t been met or when lease payments are due. The rest of the time, Ben prefers not to be bothered by business matters. He considered salespeople who can’t meet their quotas “lazy” or “stupid.” His incentive system is solely tied to cash and prizes for meeting or exceeding quotas, and his company is driven almost entirely by sales. Little attention is paid to the quality of the product.

The Coercive leader is usually a negative style, as in our example. Ben is able to intimidate many of his low-skill, low-wage employees; but he has had problems keeping professional staff in his clinic. His company is constantly in “crisis mode” because of poor day-to-day management. Ben feels justified to come in at month-end and rally his employees with displays of cash, promises, and thinly veiled threats.

Goldman states that the Coercive leader is effective during true emergencies, such as natural disasters, or in a business turnaround, when bankruptcy is otherwise imminent. Otherwise, coercion is a negative trait that reduces performance and antagonizes employees.

Jim is a Pacesetter. This is another leadership style that is usually negative. Jim knows exactly what he wants and how he wants it done. Jim’s problem is that he can’t or won’t communicate his vision to the rest off his staff.

At first, everybody loves a leader like Jim. He can treat more patients more quickly, and his outcomes are usually excellent. His lack of feedback, however, leaves employees and peers guessing at his expectations and requirements. The rapid work pace leaves little time for the important personal exchanges that solidify a team and ensure open lines of communication.

Jim’s clinic is the busiest in the company, with the most staff—both clerical and professional. Jim and Betty (a newly graduated physical therapist) together manage about 200 patient visits per month, while Jim also handles day-to-day clinic management. Jim opens the clinic at 7 AM, and is usually the last to leave at 6 PM. Jim is proud of his effort and feels justified in his management style.

Everything seems to be going along fine, until one day Betty hands Jim her 2-week’s notice to resign. She barely speaks to Jim during her last 2 weeks, but one of the things she does indicate is that she needs feedback and conversation from her employer. While Jim is excellent at the “nuts-and-bolts” of his job, he has neglected the small details, the personal niceties of working together; and as a result, he has allowed Betty to feel unappreciated and unwanted.

The Pacesetting style may be appropriate for well-defined projects that have a beginning and an end, where time is of the essence and the team members have already-established lines of communication. A good example might be a project that brings together disparate members from various skill areas that clearly understand their work and their reward, for which the project’s completion provides some immediate feedback. This is essentially a leaderless group for which the Pacesetter is especially qualified.

Larry is an Authoritative leader. He begins the Board of Directors meeting with a summary of the company’s financial performance. He then talks about equipment needs or repairs, staffing needs, discipline problems, payroll, and bonus history. He caps off his report with the debt position and the coming profit picture. In this way, Larry establishes himself as an authority on the financial and administrative aspects of the physical therapy companmy (a corporation). When the Board has questions, Larry replies with thoughtful and deliberate answers. He relies heavily on experience and has been heard to say, “This is the way we’ve done it before.”

More than his day-to-day decision-making, however, Larry leads because he has a vision of the company that inspires the Board. Larry’s vision of the company, 18 employees strong, is that it is a family. Larry’s sense of responsibility to the employees is what guides nearly every decision by the Board of Directors

Goldman says the Authoritative leadership style is very effective in the business setting. The health care setting, in particular, is one that requires and rewards authority figures. One drawback to the Authoritative style is when the leader is working with peers or experts who are more knowledgeable or experienced than he is. They may perceive the Authoritative leader as being overbearing. Larry counters this threat by assiduously cultivating the opinions and input of many interested parties, such as owners, clinicians, key staff, and the eventual end-user of the decision or equipment affected. The Authoritative leader retains all decision-making power, and employees are willing to follow because of the trust that has built up after seeing the leader’s wise and careful decisions.

A Democratic leader seeks to build consensus before making a decision. This serves to align all the interested parties and prevent disagreements after the fact. David is a Democratic leader who has just opened his first physical therapy clinic. At 24, David is young and untested. He is, however, popular among all his employees; and everyone is hoping for his complete success. Privately, however, David is uncertain about his abilities, and every new situation requires a new decision. The Democratic style is ideal in situations where the leader needs guidance and direction from able and experienced employees.

At first, David meets with success; and his Democratic style creates consensus among the employees. As the months roll by and the “shine” wears off of the new clinic, David finds that his Democratic style is not as effective. The sheer mass of decisions he needs to make every day require him to act more quickly. He is unable to consult his advisors and his stakeholders at every turn. Out of necessity, David becomes more Authoritative, like Larry. The Democratic style is too cumbersome for day-to-day management.

Another situation where the Democratic style would be effective is when the decision affects every stakeholder in the clinic. In Shaun’s clinic, bonus pay is given every quarter based on a percentage of collections over a certain quota. Every employee with a year of service is eligible for bonus pay. When Shaun thinks the clinic is seeing enough patients to hire a new therapist, he asks everyone how they feel about the decision. Obviously, another person to share the bonus money will reduce everyone’s bonus until that new person begins producing at a high enough level to offset their share of the bonus. To ensure a smooth transition, Shaun makes sure that every stakeholder (therapists, PTAs, aides, front desk staff) is involved in the decision and has a chance to state their preference. Shaun retains ultimate decision-making authority; but by consulting his employees, he has reduced their uncertainty over any change in their bonus pay. Shaun is an Authoritative leader who uses the Democratic style as the situation warrants.

Joe is an example of a leader who uses the Coaching style. When one of Joe’s physical therapists went over budget on a promotional program, Joe was there to cover the shortfall. Rather than punishing the therapist, Joe talked about the goals of the promotion and the importance of staying on budget. Joe emphasized the long-range nature of the program and the presence of the clinic within the community. He asked the therapist how he would handle the situation differently next time. When the therapist saw that he was not being punished and that Joe was not trying to place blame, he began to examine his actions objectively and he realized that several of his decisions led to extra and unnecessary costs. Joe used the therapist’s error as a learning opportunity.

The Coaching style is unlikely to contribute directly to bottom-line results, but its action on key employees should expand their skills and make them more productive and loyal. This style require more of a commitment from management, first to observe employees and then to instruct them in the correct action. The challenge for management is to put the interests of the employee over those of the firm, since it is the employee that is being coached. An orientation toward short-term results would dictate an old-fashioned management style that puts the needs of the firm above those of the employee. However, the coaching style works because it produces better employees in the long run.

Applied Knowledge

Leaders tend to use each of these styles as the situation warrants, but only four of the six are consistently positive. The Authoritative, Affiliative, Coaching, and Democratic styles are positive; while the Pacesetting and Coercive styles are generally negative but may be used in some specific instances, as described above. It is important to realize that effective leaders use each of these styles and are often adept at shifting back and forth from one to the other.

The take-home message of Goleman’s work is that we as physical therapists have some of these leadership styles already. It is the recognition and study of our own individual traits that will enable us to develop these in a way that leads to organizational leadership and the improvement of performance and outcomes in the physical therapy clinic.  

Tim Richardson, PT, is a physical therapist with 12 years of experience and an adjunct faculty member at Manatee Community College in St. Augustine, Fla. He can be contacted at timrich00@hotmail.com.