Many occupational therapists start their careers as practitioners and move into management roles over a period of time. They do not always have specific training in these roles and many develop ‘on-the-job’ experience. Occupational therapists often make very good managers because of the sound organizational skills and personal attributes they need to have to work as an occupational therapist (Griffin 2001). However, it is important to have an underpinning knowledge of management principles and theory to be a good manager in practice. An understanding of the organization worked in is invaluable as a manager. Getting to grips with its purpose, vision and direction of travel can help managers define the unique contribution occupational therapy makes to realizing an organization’s aims. As Braveman (2006) remarked ‘learning to observe an organization’s culture and values as demonstrated in the daily life of an organization can help you be more effective as a manager’ (p. 53). Knowing both the internal and external factors that can influence the environment occupational therapists work in, reinforces their ability to be aware in order to look ahead and manage with confidence.

Alongside management, the importance of leadership in health care has grown in significance in recent years. From the day occupational therapists commence practice, they are faced with many challenges associated with applying the theory of what they have learnt as undergraduates to the rigours of practice (Adamson et al. 1998; Hodgetts et al. 2007; Parker 1991). New graduates perceive there are significant gaps of knowledge and skills, particularly in the areas of communication with other health professionals and the general public, knowledge of the health industry and work place management (Adamson et al. 1998). Alternatively, managers’ views indicate that they believe management skills needed for new graduates should include time management and planning for example, but should also include skills related to leadership such as resolving conflict and difficult staff relations while working effectively in a team (Adamson et al. 2001). It is crucial that not just senior occupational therapists but newly qualified occupational therapists understand the importance of leadership and where possible take on a leadership role for the profession. Having leadership skills, particularly clinical leadership skills, will enhance new practitioners’ ability to successfully function within their teams. Learning different skills, styles and behaviours associated with leadership will only add to an individual’s effectiveness. Managers, be they occupational therapists or health managers in general, are looking for practitioners who can meet the challenges and have competencies to cope in rapidly changing work environments (Adamson et al. 2001; Morley 2009; Spyby 2012). Sylvia Rodger (2012) proposed that occupational therapists identify themselves as leaders wherever they are and position themselves within organizations or in their professional lives and take on leadership roles no matter how big or small.

This chapter explores the concepts of management and leadership, particularly the differences between the two, before examining what this means for occupational therapists working in mental health settings that exist in modern, ever-changing health and social care systems across the world. Most of the examples are from the UK – a model of leadership competence from a leading mental health trust is presented to illustrate the discussion. The examples illuminate theory but recognize that management and leadership are socially constructed (Chemers 1997) and so are influenced by different cultural contexts. The chapter presents these concepts as a useful toolkit for occupational therapists to use for management and leadership success but if not based in the UK, occupational therapists may need to think about any specific cultural issues that may shape management and leadership practices differently. Some of the examples refer to the mental health occupational therapy literature.

MANAGEMENT

In 1973, Mintzberg posed the question, ‘Why do organizations need managers?’ and provided some reasons (see Box 8-1), which are still pertinent to organizations today. Many people refer to ‘management’ as the individuals charged with running the organization and, as such, management presumes a business-oriented focus. A commonly quoted view is that management is about getting things done through others (Drucker 1955; Koontz 1961) but there are different ways of viewing management. Some assert that the aim of management is to support their employees’ efforts to be fully productive members of their organizations and citizens of the community in which they operate (managmenthelp.org 2012). Definitions generally refer, in some way, to the process of directing and leading a programme of work in an organization. Managers are the people charged with the responsibility for this process and use many different types of management to achieve this (see Box 8-2).

BOX 8-1

A SUMMARY OF THE REASONS WHY ORGANIZATIONS NEED MANAGERS

1. To ensure the organization serves its basic purpose – the efficient production of goods and services to design and maintain the stability of the operations of the organization

2. To take charge of strategy making and adapt the organization in a controlled way to the changes in its environment

3. To ensure the organization serves the ends of those people who control it

4. To serve as the key informational link between the organization and the environment around

5. To enact formal authority to operate the organization’s status system

(Adapted from Mintzberg 1973).

BOX 8-2

A SUMMARY OF THE DIFFERENT TYPES OF MANAGEMENT

■ Change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented, and that the lasting benefits of change are achieved (MindTools a). It could involve service reconfiguration and redesign, staff changes or disinvestment (budget cuts) for example.

■ Information management includes the use of both physical and electronic information. Managers need to manage all sources and formats of information for example, paper, electronic, video and audio. Importantly, it is not only about how knowledge and information are gathered but how they process them, digest them and use them to best effect.

■ Knowledge management is a series of tools and activities to capture the range of information available to an organization. It can be used to enhance efficiency, increase productivity, audit and research and effect change. Knowledge management is a conscious strategy for moving the right knowledge to the right people at the right time to assist sharing and enabling the information to be translated into action to improve the organizational performance (O’Dell and Grayson 1998).

■ Operational management is having the responsibility for the day-to-day organizing and coordinating of services and resources, liaising with practice staff and other professionals, dealing with the public and managing complaints; anticipating and resolving service delivery issues (see NHS Operational management). In the health service, this role has often been carried out by general managers but people with a professional background, like occupational therapists, also carry out this role.

■ People management is one of the manager’s most important tasks. Managing people often involves planning individuals’ work tasks, setting work-loads, carrying out supervision and appraisal processes.

■ Performance management is about assessing a person’s ability to perform to the best of their ability (http://www.citehr.com/performance-management-f60.html). If a person, team or organization is unable to perform adequately, processes should be put in place to monitor and support improvement.

■ Personal management is about how an individual manages their own work life, goals, time management and careers development. Access to opportunities for mentoring, coaching, shadowing and further training will help develop the competencies to be an effective manager.

■ Personnel management is not to be confused with people management. Personnel management is traditionally performed by the Human Resources department and includes activities like recruitment processes, screening and interviewing applicants, developing and overseeing employment policies.

■ Professional management refers to the process of setting the standards expected for the profession in the organization, providing supervision, assessing competence and defining quality.

■ Project management is the application of knowledge, skills and techniques to execute projects effectively and efficiently (Project Management Institute 2012). It is usually a time-limited activity with an identified beginning, middle and end with an agreed remit, budget, time allocation and an intended agreed outcome.

In health and social care systems, management is seen as accomplishing a series of tasks, often through the effort of others, i.e. it is not oriented around a production line; it is about people conducting the business as well as managing the resources. Skilled managers can accomplish much more through others than they can just through their own efforts (Armstrong 2006). This means there needs to be more understanding of what managers actually do in practice to be effective. This includes the organizational processes of strategic planning, setting objectives, managing resources and deploying the human and financial resources needed to achieve organizational objectives. Traditionally, the term ‘management’ refers to the activities (and often the group of people) involved in the four general functions, i.e. planning, organizing resources, leading and controlling and coordinating. All of these four functions occur at all levels in organizations and are highly integrated throughout. Management tasks also involve recording of information, setting performance targets and measuring results. It also assumes that there is a cycle in which management activities are planned, executed and measured through a series of ongoing processes.

Planning

Occupational therapists are used to planning their work for the people for whom they provide services. They carry out assessments, then provide interventions based on those assessments in collaboration with the service user. There is an expectation that the work they do has goals that are specific, measurable (outcome-oriented), achievable and time-related, often referred to as SMART. As Kate Miller described:

When I think about what it is that we do as occupational therapists in everyday clinical practice … we apply very certain and definite kind of steps and approaches to our work, it includes listening, gaining an understanding or taking another perspective of the person we are trying to gain an understanding about. We don’t make judgements about others and don’t force our beliefs on others, we try to engage people in activities and motivate them to improve or regain function. We think outside the box on an everyday basis because we need to make situations and environments work for people so they can continually engage as they want to.

(Rodger 2012, p. 176).

This same discipline can be applied to the planning and development of occupational therapy services. Most organizations, for example, carry out an annual business planning process in order to determine the budgets they have to provide services, set targets and judge performance against the agreed plan. This is different from a strategic plan which might be more long term and visionary. For example, occupational therapy services will usually have an annual working business plan based on the organization’s goals and the budgets set for the provision of services. However, they may also have a strategy which includes a high-level mission statement and a plan that includes aims and objectives as to how the overall mission will be achieved. A good example is the UK’s College of Occupational Therapists’ (2006) strategy, ‘Recovering Ordinary Lives – A Vision for the Next Ten Years’. This document clearly describes key messages for the profession and others to work towards improving mental health services. As Recovering Ordinary Lives states: ‘the aims of this strategy are twofold: to reassert the importance of occupation to health and wellbeing, and to develop a vision and principles that will guide occupational therapy practice within rapidly changing social and political environments’ (COT 2006, p. ix). Several mental health occupational therapy services in the UK have based their strategic plans on COT’s (2006) strategy document as a way of framing their own strategy development.

Other types of planning also feed into both annual and strategic plans. Most common are workforce and project planning.

■ ‘Workforce planning’ refers to how an organization estimates its future workforce requirements and calculates the numbers, nature and sources of potential employees who might meet that demand. In other words, it is about getting the right number of people, with the right skills, in the right place and at the right time (Local Government Improvement and Development 2012). Occupational therapy managers will be asked to predict what numbers of staff and what grades they need to meet the work priorities and demands predicted from their business and strategic planning processes. This may also extend to influencing the number of undergraduate places that are commissioned for occupational therapy training in order to meet future workforce demands.

■ ‘Project planning’ is the application of the techniques of planning, implementing and managing the resources available in relation to a specific project. It is usually a time-limited activity with an identified beginning, middle and end with an agreed budget and time allocation and an agreed outcome. Examples of these may be setting up a new service or indeed closing a service. It might also include carrying out a feasibility study or marketing and launching a new product or intervention.

Organizing Resources

Managing resources is about being responsible for a whole range of available resources, i.e. people, finances and physical resources such as buildings and materials. Understanding these resources helps the manager maintain control of the budget allocated for their services. A budget is the sum of money allocated for a particular purpose. Budgets are usually set out on a yearly basis as described in the planning section (above) and serve both a planning and controlling function. Budgets can be a complex mix of information, pay and non-pay, overheads, etc. and appropriate training in budgetary management is advised if occupational therapy managers are to successfully utilize and maintain budgetary control.

Since the 1980s, budgets in mental health services, particularly in the UK, have been held in general management systems, not by individual professional groups (Griffiths 1983). General management was intended to offer active, strategic direction and to devolve responsibility through a clear structure of line management and devolved budgets. As a result, occupational therapy managers over the years have had less direct control of staffing budgets, as these may be held in the integrated services. Therefore the role of the occupational therapy manager is one involving much more influence in relation to making the best use of resources rather than direct responsibility for them. Workforce development is a good example of how occupational therapy expertise is essential in recommending the appropriate grades of occupational therapists to provide activity within services and how those occupational therapy resources are deployed. An example, from the UK, of organizing resources is the occupational therapy mental health indicative care packages for mental health ‘Payment by Results’, which set out potential occupational therapy assessment, interventions and outcomes for service users as well as recommended staffing levels for carrying out the activity (DH 2011; Morley et al. 2011).

Leading

Leading is about ‘setting the direction of travel’ for the organization and realizing its vision through leading teams and individuals and influencing them to follow that direction. As stated previously, this is an important area of development for all grades of occupational therapists. Examples of leadership activity include establishing strategic direction (vision, values, mission and/or goals) and championing methods of organizational performance management to pursue that direction. This is discussed further in the section on Leadership (below).

Controlling and Coordinating

Controlling and coordinating is about the processes and systems designed to manage an organization’s structures and data as effectively and efficiently as possible, to reach its goals and objectives. The analysis of data, in particular, in a modern healthcare organization can be complex and detailed. This involves the ongoing collection of feedback, monitoring and adjustment of systems, processes and structures to meet demands. Data that exist can be financial; they can be the findings from research or audit. Data can be used in producing policies and procedures, performance management processes and measures to avoid risks. The key point is to control and coordinate these data to support the delivery of services. For example, Schene et al. (2007) reported that occupational therapists enable people with mental health problems to return to work 3 months earlier, and work for longer hours, than standard mental health interventions. They also proposed that the financial benefits of service users being able to return to work sooner and work for longer hours significantly outweighed the cost of providing occupational therapy interventions. Occupational therapy managers, as well as practitioners on the ground, need to be astute in utilizing information like this to their advantage

LEADERSHIP

There has been a growing interest in recent years about the importance of leadership as well as management skills in the delivery of health and social care. In the UK, Lord Darzi’s review of the NHS’ ‘High Quality Care for All’ (DH 2008), described how there needed to be a new emphasis placed on professional staff leading as well as managing the organizations in which they work. There has been a proliferation of literature stressing the significance of good leadership, improving the quality of care as well as being crucial to the effectiveness of individuals and the organizations in which they work (Ovretviet 2009). Braveman (2006) emphasizes it is important to distinguish between the act or process of leading, i.e. leadership, and the individuals who are in the position of guiding others, i.e. leaders. Braveman (2006) proposed the following definition of leadership:

Leadership is the process of creating structural change wherein the values, vision and ethics of individuals are integrated into the culture of a community as a means of achieving sustainable change

(p. 84).

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