Leading in Rehabilitation - Assess the Situation

Original Editor - Thomas Longbottom based on the course by Jason Giesbrecht

Top Contributors - Thomas Longbottom, Jess Bell, Kim Jackson, Jorge Rodríguez Palomino and Ewa Jaraczewska  

Introduction[edit | edit source]

Figure 1: Four Steps to Leading in Rehabilitation

A gap commonly exists between knowing about leadership and doing the leading. Bridging this gap can help persons in formal and informal leadership positions become capable and influential leaders in rehabilitation. A framework for this endeavour consists of four components:[1]

This page focuses specifically on the step of assessing the situation.

What is Leadership?[edit | edit source]

A clear understanding of what is meant by the term "leadership" is an important prerequisite to discussing how to grow in a leadership role. "Leadership is a dedicated position. Leadership is about oneself. Leadership is about people". [2] Review these comparisons of what leadership is NOT versus what leadership IS:[1]

Figure 1: Elements of Leadership

Rather than being limited to an organisational position with specific responsibilities and structural power, effective leadership incorporates characteristics of an outward focus and an ability to motivate others towards a shared vision with influence gained by trust and respect.[3] Through the display of adaptability, innovation, initiative, and a willingness to change, a leader gains credibility with followers.[4] These attributes may be found or developed in a person who is a formal leader - in other words someone who has been formally appointed to a position of authority - or one who is an informal leader with the ability to influence via inspiration, engagement, and encouragement.[1] Informal leaders can be particularly important in health care.[5]

A formal leader...[1]

  • Someone formally appointed by the organisation or elected by the members to a position of authority.
  • Someone who possesses formal authority in the organisational hierarchy.
  • Someone who may lead by authority, influence, engagement, or a combination of these; followers may respond out of respect and admiration, or out of fear and compliance.
  • Examples: manager, supervisor, team captain, director, chief executive officer.

An informal leader...[1]

  • Someone without formal organisational authority or power.
  • Someone who may possess unique skills, education, or knowledge.
  • Someone who is emotionally effective.
  • Someone who influences others by conviction, inspiration, engagement, relationship, or encouragement.
  • Examples: clinician, team member, anyone.

Distinguishing between the behaviours of supervising, managing, and leading is also useful in discussing the development of effective leadership. Supervising is the act of monitoring and overseeing the performance of others to ensure their work is done correctly. This may include the quality, the quantity, or the timeliness of the work. Managing is the employment of administrative control and authority, regulating resources to ensure the goals of the organisation are met. This involves planning, strategising, directing, executing, and problem-solving. Leading is encouraging, supporting, motivating, developing, and inspiring others to achieve a common vision. This is done through relationship, trust, mutual respect, and authenticity.[1]

Situational Leadership[edit | edit source]

Leadership style refers to the way a leader acts / behaves to get things done, how they provide direction and implement plans. There are a number of different leadership styles, including:[6]

  • Transactional style - focused on performance [7]
  • Bureaucratic style - concerned with hierarchy and duty
  • Visionary style - emphasises inspiration and progress
  • Servant style - an approach that is more humble and protective
  • Situational leadership[8]

Situational leadership was originally called the 'life cycle' approach by Hersey and Blanchard.[1] There is no "best" leadership approach in situational leadership[1] - rather the approach should be adjusted to fit the people being led and the task at hand.[8] It is an adaptive, flexible style that is situation-dependent.[9] Situational leadership contains both directive and supportive leadership behaviours, and the situational leader must find the right balance of these.

Four dimensions of situational leadership:[1]

Figure 2: Directive and Supportive Leadership
  1. Directing: The focus is on task completion with less concern for needs of the followers; requires clear instructions and supervision.
  2. Coaching: The focus is on increasing the confidence and skills of the followers, with the goal of increasing their capability and independence.
  3. Supporting: The focus is on listening, encouraging, providing feedback and guidance, with trust in the followers to accomplish the desired outcomes.
  4. Delegating: A hands-off approach, encouraging autonomy but providing support and guidance as needed.

Situation Awareness[edit | edit source]

"Situation awareness is the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future." -- Dr. Mica Endsley[10]

The theory of situation awareness stems from work done in military settings where high-stress, high-stakes decisions have to be made rapidly in highly fluid environments. It involves being observant of the surroundings, understanding what is happening, and predicting what may happen in the near future. Per Endsley,[11] situation awareness precedes decision and action, and it is informed by goals, objectives, and expectations. It can be influenced by factors such as stress and complexity. Information processing mechanisms, which are impacted by factors such as experience, ability, and training, affect how situations are understood.[11]

There are three levels of situation awareness:[1]

  1. Perception, where the focus is on gathering qualitative and quantitative data about the situation.
  2. Comprehension, where the leader analyses and synthesises the information to understand the situation.
  3. Projection, where the focus is on anticipating the outcome based on the decisions made and actions taken.

In the perception phase, leaders ask questions like:[1]

Figure 3: Levels of Situation Awareness
  • What is happening around me?
  • What are the facts?
  • Who is involved?
  • Where is the situation occurring?
  • When is this happening?
  • What emotions are involved?
  • What behaviours or actions have I observed?
  • What are my expectations and goals?
  • What am I missing?

In the comprehension phase, the leader is striving to understand the situation before selecting the leadership approach, integrating new information as it arises.[1] Questions asked may include:

  • How well is the team/group/person functioning?
  • In the context of the goals, expectations, and desired outcomes, is the system on track?
  • Is the system improving, worsening, or staying the same?
  • Are there any deviations from expectations for the team/group/person?

In the projection phase, the leader is anticipating outcomes based on their decisions and actions.[1] Questions asked may include:[1]

  • How will this situation impact the future?
  • What decisions do I need to make to reach the desired outcome?
  • What action is required to course correct?
  • If I make this decision and act, what will happen?
  • What might get in the way?
  • What am I avoiding?

Social/Emotional Intelligence and Decision-Making[edit | edit source]

Figure 4: Bar-On Model of Emotional and Social Intelligence

Reuven Bar-On defines emotional intelligence as "an array of non-cognitive capabilities, competencies, and skills that influence one's ability to succeed in coping with environmental demands and pressures."[12] The Bar-On model describes the emotional and social competencies determining how effectively we understand and express ourselves, understand and relate to others, and cope with daily demands.[1] This model consists of five main composites, each with three subscales (see Figure 4). This page will focus on the Decision Making composite. This composite refers to how we go about the daily tasks of life, deciding how to handle situations and how to control our impulses. The three subscales contained within this composite are problem solving, impulse control, and reality testing.[12]

Problem Solving is about the ability to manage emotions involved with decision-making, understanding who might be affected by these decisions and taking into account the potential consequences. A person high in this subscale will tend to carefully consider options as they analyse the situation from multiple angles, tackling the problem head-on. At the opposite end of the spectrum, an individual who is low in this subscale will often put off or avoid making decisions due to the associated emotions.[1]

Impulse Control is the ability to resist impulses or temptations to act. Someone with low impulse control will tend to interrupt others, make hasty decisions, talk too much, and struggle to listen to others. They have trouble refraining from doing or saying the wrong thing or making the wrong decision. On the other hand, someone with high impulse control is able to avoid rash behaviours, maintaining a mindful approach on how to proceed. If it is excessively high, this may be seen as being too controlled, uncaring or uninvolved.[1]

Reality Testing refers to the ability to assess differences between what is experienced and what objectively exists. This involves the capacity to recognise when emotions or personal bias may cause one to be less objective. It can be impacted by the ability to focus attention while attempting to assess and cope with situations as they arise. It is also the capacity to limit the tendency to exaggerate or embellish real problems. Someone high in Reality Testing will proactively eliminate biases that influence their view of the world. They will go to great lengths to understand a situation, collecting information from multiple sources and using facts to verify emotions, perceptions, and thoughts. When this becomes excessive, the person may become paralysed by analysis. They overthink the situation or decision. On the other hand, one low in this attribute may make inappropriate or unproductive decisions due to tendencies to be impractical, prone to exaggeration, and overly dramatic.[1]

Putting It All Together[edit | edit source]

Figure 5: Reality Testing

To defend against tendencies to see situations as one wishes (or fears) them to be during the stages of Situation Awareness, a leader needs to use the lens of emotional intelligence and reality testing. With focus and attention, this ability to test and understand reality can be developed.

  • Consider that first impressions and gut instincts may be inaccurate.
  • Don't believe everything initially thought or felt, but gather objective data before reaching conclusions.
  • Seek the perspective of others.
  • Be curious, and ask questions.
  • Be mindful of biases and assumptions that may influence decisions.
  • Take the time daily to reflect on what is happening.
  • Examine strong emotions that arise in situations, trying to understand them and their potential impact on objectivity.[1]

It is possible to effectively train emotional intelligence.[13] Development of the skill to consistently understand what's really happening will take practice, feedback, and refinement. What kind of leader will you be? Follow the guide of Endsley’s model of Situation Awareness for the process of perceiving, understanding, and predicting within a leadership situation.[10][11] Be mindful of biases and aspects of emotional intelligence. Test the reality, aiming for objectivity. Ask the right questions.

Assess the Situation: A Practical Activity[edit | edit source]

Download this worksheet to practice assessing the situation using the strategies described in this course.

Resources[edit | edit source]

References[edit | edit source]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Jason Giesbrecht. Leading in Rehabilitation - Assess the Situation. Plus Course. 2022.
  2. Luedi MM. Leadership in 2022: A perspective. Best Practice & Research Clinical Anaesthesiology. 2022 Apr 12.
  3. Kjellström S, Stålne K, Törnblom O. Six ways of understanding leadership development: An exploration of increasing complexity. Leadership 2020;16(4):434–60.
  4. Issah M. Change Leadership: The Role of Emotional Intelligence. SAGE Open  2018;8(3):215824401880091. Available from: https://dx.doi.org/10.1177/2158244018800910
  5. Lawson D, Fleshman JW. Informal Leadership in Health Care. Clinics in Colon and Rectal Surgery. 2020;33(04):225–7.
  6. 10 common leadership styles (plus how to find your own) [Internet]. Indeed Career Guide. [cited 2022Feb1]. Available from: https://www.indeed.com/career-advice/career-development/10-common-leadership-styles
  7. Richards A. Exploring the benefits and limitations of transactional leadership in healthcare. Nursing Standard. 2020 Oct 22;35(12):46-50.
  8. 8.0 8.1 Hersey, P., & Blanchard, K. H. (1969). Life Cycle Theory of Leadership. Training Development, 23, 26-34.
  9. Raza, S. A., & Sikandar, A. Impact of leadership style of teacher on the performance of students: An application of Hersey and Blanchard situational model. Bulletin of Education and Research. 2018;40(3):73-94.
  10. 10.0 10.1 Endsley MR. Toward a theory of situation awareness in dynamic systems. Human Factors 1995;37(1):32–64.
  11. 11.0 11.1 11.2 Endsley MR, Jones DG. Designing for situation awareness: An approach to user-centered design. Boca Raton FL: CRC Press; 2012.
  12. 12.0 12.1 Bar-On R. A broad definition of emotional-social intelligence according to the Bar-On Model [Internet]. reuvenbaron.org. 2013 [cited 2022Feb1]. Available from: https://www.reuvenbaron.org/wp/37-2/
  13. Gilar-Corbi R, Pozo-Rico T, Sánchez B, Castejón J-L. Can emotional intelligence be improved? A randomized experimental study of a business-oriented EI training program for senior managers. PLOS ONE 2019;14(10):e0224254.
  14. CernerEng. Situation Awareness, Mica Endsley. Available from: https://www.youtube.com/watch?v=0WaGolF2V2c [last accessed 24/03/2022]

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