Accred Qual Assur (2002) 7:468–472 DOI 10.1007/s00769-002-0528-1

GENERAL PAPER

© Springer-Verlag 2002

H.M.J. Goldschmidt N.C.V. Péquériaux J. De Jongh-Leuvenink

Received: 25 May 2002 Accepted: 17 July 2002 Presented at the European Conference on Quality in the Spotlight in Medical Laboratories, 7–9 October 2001, Antwerp, Belgium H.M.J. Goldschmidt (✉) Academic Medical Center, Department of Clinical Chemistry, Room B1–237, P.O.Box 22700, 1100 DE Amsterdam, The Netherlands e-mail: [email protected] Tel.: +31-20-5662627 Fax: +31-20-6091222 N.C.V. Péquériaux Westeinde Hospital, Postbus 432, 2501 CK Den Haag, The Netherlands J. De Jongh-Leuvenink Maxima Medisch Centrum, locatie Eindhoven, Postbus 90052, 5600 PD Eindhoven, The Netherlands

The quality of leadership (QL): the EFQM leadership criterion in relation to the 360° feedback evaluation method

Abstract The European Foundation for Quality Management (EFQM) integral quality management model covers nine issues: five so-called enabler criteria and four so-called result-oriented criteria. The first enabler criterion concerns leadership and covers all kind of strategic management aspects. However, directly or indirectly, the leadership of the board of directors or its individual members is characterized and scored. An even more explicate technique, originated in a totally different way, is the 360° feedback evaluation method. In this paper both methods are compared and practiced on various individuals. A checklist was developed to facilitate scoring in the EFQM leadership submodel. Both methods, although from a different origin, could be linked easily, cov-

Introduction With an increasing awareness of the importance of the health care chain, the quality of leadership gets more exposed. The delivery of laboratory medicine services depends heavily of the fitting of any test asked for within the context of the patients’ medical history at one side, but also, at the other side, the quality of management throughout the health care chain is important. This concerns not only the management of each link but also the overall coherence. On top of that various management types and approaches are involved: logistics, human resource management, materials management, change management, style of management, etc. All of this is within the framework of human and material means.

ered very similar aspects and gave results that were in excellent agreement with each other. The scoring showed almost identical results, supporting in large the use of the integral EFQM model. Keywords EFQM model · 360° feedback evaluation method · Quality of leadership · Management style

We experienced that the quality of management is crucial, especially where it concerns the integral integrity of the chain involved. As the saying says the weakest link determines the overall strength of the chain. Although strategic management decisions can be facilitated and supported by tools such as workflow analysis and workflow simulation, the quality of management is largely defined by the manager’s presence in person and attitude. Strategic group sessions can markedly contributed to the overall level of quality of management. So management is important and with that the individual quality of the manager and his/her contribution to the departmental team and to the chain of activities. However, a measure is lacking that objectively quantifies the quality of individual management. This abstract in-

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Fig. 1 Four EFQM leadership subcriteria, one of five enabler criteria in addition to four result-oriented criteria as defined within the EFQM model. Eight core competences are addressed to each of the four EFQM leadership subcriteria. The arrows indicate the kind of interaction present between the laboratory manager and the specific group and/or item

Fig. 2 The 360° feedback evaluation method applied to the management in laboratory medicine. The employee (laboratory manager) is surrounded by all kinds of people acting in his/her environment and having an impression of the leadership of the laboratory manager. A self-assessment is part of the 360° feedback evaluation method (i.e., 50%, see [6]). To each of the contributors different weights can be added for the overall score

Methods The leadership criteria within the EFQM model, one of nine criteria, which adds up to 10% of 500 enablers points (of a total of 1000). This score is based upon four subcriteria: (a) leaders develop the mission, vision, and values, and are “role models” of a culture of excellence (drive from company, institution, ), (b) leaders are “per➝

troduces the the quality of leadership (QL) unit. This can be calculated from the EFQM model [1] but also from the calculus of the 360° feedback evaluation method [2]. Effective management is based upon a certain leader decision-making authority and a certain managerial style [3]. The QL unit can be scored upon in different quality management systems to quantify effective management of individual behavior.

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Table 1 QL unit scoring list, based upon 360° assessment technology, EFQM leadership subcriteria and core competences, an attempt to characterize the behavior of a manager through 20 questions in a single number. A “don’t know” score is also possible and is corrected for in the final calculation. Between brackets the EFQM subcriteria possibly addressed. The average total score in this example is 49.5% and is depicted in Fig. 1 (i.e., the third person in Table 2)

The updated EFQM model (EFQM excellence model) is integrally and independently built by means of a principal component analysis (see description of Nabitz [5]). This while the 360° feedback evaluation method is entirely geared towards leadership. However, the comparison between the EFQM leadership criterion, with its four sub criteria and the dedicated 360° feedback evaluation method, showed an almost complete mutual coverage of both approaches. Traditional feedback is supervisor towards employee (i.e., 0° feedback), the next step is a mutual evaluation (i.e., 180° feedback), while the 360° feedback process assures a group evaluation (one is surrounded by evaluators). This last method can result in possibly facilitating individual behavior change, cultural change, team building, self-knowledge, etc., taking into account communication skills and management style. The use of a mutual job evaluation (the 180° feedback) on a periodical, balanced way can be seen as a step on the more modern way of 360° feedback evaluation method. Both methods are suitable for self-assessment but can also be applied by independent agencies. However, one cannot avoid a certain degree of subjectivity, but the entire impression expressed as a percentage has the feeling of objectivity. Absolute comparisons are difficult to make as well as comparisons between branches, but the same person and/or organization can be evaluated trough time by subsequent evaluations in an elegant and efficient way.

Results

sonally involved” in ensuring the organization’s management system is developed, implemented and continuously improved (feedforward to workforce, ), (c) leaders are involved with “customers”, partners, and representatives in society (interaction with environment, ), and (d) leaders “motivate”, support and recognize the organization’s people (feedback from workforce, ). The items between brackets are depicted in Fig. 1. In Table 1 and Fig. 2, items 1a–1d and, provide the key to the EFQM criteria. Within the EFQM model two scoring mechanisms are applied: extent as well as coverage within an organization are scored and averaged. The INK variant of the EFQM model also characterizes the approach within the organization scoring how well systemized and structural the implementation is done. Five phases can be distinguished in doing so [4]. ➝

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The EFQM leadership sub criteria yielded the following results (see Fig. 1). The excellent leader should fit his/her organization to be in agreement with the overall phase of the organization [4]. Organizations sequentially are product, process, system, chain, and “total quality management” oriented; the scoring reaches 200, 400, 600, 800, and 1000 points respectively. The nine criteria should be within a certain band to guarantee coherence within the organization. This accounts for the leadership criterion as well. The 360° feedback evaluation method yielded the following results ([6], see Fig. 2). Define important interactions (relationships), define the core competences to be evaluated, execute the scoring, draw conclusions and subsequent actions. Repetition on a regular basis (e.g., each 6 months) a cycle of continuous improvement can be made and maintained. The arithmetical mean of the feedbacks is calculated, the model allows weighing of the various evaluators if so desired. The QL unit calculation based upon the scores within Table 1, yielded the results given in Fig. 1 and Table 2. The QL unit incorporates the mentioned four EFQM leadership criteria, equally allocated and calculated as

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Table 2 Real life QL unit scores to check on the feasibility of the proposed model, based upon the questions stated in Table 1

Discussion

QL unit score in %

Person

30 37 52 57 61 83

Laboratory manager Laboratory manager Board of directors Politician Laboratory manager Politician

The leadership criterion is crucial important because on one side the leader should be charismatic, markedly present, but on the other side coaching and participating management should be practiced. “Getting things done through people” means “to be effective without being present to markedly”. To score in any system various assessors can be used, ranging from a questionnaire, interviews, workshops, etc. The way the 360° feedback evaluation method is structured through a questionnaire provides objective, quantifiable and fast information that requires not too much knowledge about the organization and/or the (laboratory) manager involved. The 360° questions list (20 double questions covering eight core competences [9], but also the four EFQM leadership sub criteria) kind of forces one into extremes and tends to overcompensate towards higher scores on the Likert scale (five points scoring scale [6, 8]). An individual leadership profile can be found based upon others opinion and on a self-assessment. This opposed to the EFQM approach, it checks on certain criteria that are more general and one should spend time to obtain solid knowledge on the situation under study. The EFQM system tends to underestimate leadership and other human resource management capabilities. So we have the feeling that the 360° feedback evaluation method scoring system tends to overscore while the EFQM scoring system underscores.

the arithmetical mean of the four subcriteria. Fig. 1 gives respectively 1a, 41%, 1b 58%, 1c 38% and 1d 48% for this individual (or group of individuals) in the EFQM system; averaging in 49.5%. A spider-web representation of the four subcriteria scorings was designed and can be used to benchmark various leaders and the effects of leadership styles. Table 1 gives a short question list and scoring system that enables the estimation of the QL unit. The 360° feedback evaluation method gave results depicted in Fig. 2, which are linked towards the four EFQM subcriteria and are shown in Fig. 1 as well (average score 52.5%).

Practical experience These models assume an organization that is in a certain degree of balance and personalities that act professional and straightforward. If this is not the case and common management rules (e.g. hearing both sides) are violated then especially the 360° feedback evaluation method can be very destructive towards the organization and the individuals involved [8]. The scoring of groups of individuals (teams), although possible from a conceptual point of view is hard to perform and to interpret towards the individual contributors. Table 2 gives the real life results of six managers (four in laboratories and two in politics). We have the feeling that a minimal of 15 out of 20 questions should be answered or else the person cannot be evaluated. We scored the same managers by different people and the overall score was very good comparable however on a level of scores on questions differences could be rather large. The feeling one has towards a certain person certainly influences the scoring. It is simple to make the scoring system more precise.

Conclusion A comparison between the EFQM leadership criterion with the so-called 360° feedback evaluation method was performed. The advantage of the EFQM sub criteria approach is that it fits the larger picture of the quality level of the entire operation. A comparison between the two quality of management scorings systems yielded similar results: QLEFQM=49.5% (see Table 1, [7]) and QL360°= 52.5% (see Fig. 2). But from an operational point of view we prefer the EFQM method because it fits a broader quality picture. However, if specific issues are on stack, such as individual behavior change or team building, the 360° evaluation method or parts of that should be preferred.

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4. Instituut Nederlandse Kwaliteit (1998) INK Manual. Instituut Nederlandse Kwaliteit, ‘s-Hertogenbosch, The Netherlands, p 11

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5. Nabitz U (2000) The EFQM approach. In: The “quality in the spotlight” conference book. Foundation The Quality Meetings, Antwerp

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