The AmericanOccupational

TherapyAssociation’s

93rd AnnualConference

& ExpoAPRIL 25–28, 2013SAN DIEGO, CALIFORNIA

from heartfelt leadershipto compassionate care

Assembly of Student Delegates:Power & Leadership

Florence Clark PhD, OTR/L, FAOTA, AOTA President

Components of My Talk

Preparing for Power

Occupational Therapy’s Relationship With Power

Ways of Understanding Power

Defining Professional Power

Abraham Lincoln: A Powerful Leader

Cultivating Power

The Centennial Vision

We envision thatoccupational therapy is a

powerful , widely recognized,science-driven, and

evidence-based professionwith a globally connected

and diverse workforcemeeting society’s occupational needs.

PREPARING FOR POWERAmerica’s elite boarding schools

Preparing for Power:America’s Elite Boarding Schools

Socialization for power• Insular community of “American aristocracy”• Discourage individuality in order to form collective class

identity• Exclusive: “You go there to be separated from ordinary

people” (p. 53).• Academically rigorous & highly competitive• “Privilege must appear to be earned, because the only real

justification for inequality is that it is deserved.” (p. 125)

Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

The Boarding School Classroom

Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

“At the center of an Exeter education is the Harkness classroom—twelve to fourteen students and a teacher seated around a table for the purpose of forming and expressing ideas rather than dispensing and receiving information, a classroom in the Socratic manner where maximum participation is encouraged, pretense and careless preparation readily perceived.” (p. 96)

“Students who haven’t read the day’s assignment have little hope of escaping detection. There is no back row at prep school, as almost everyone sits around a table or in a circle.” (p. 98)

Life After Prep School Significantly higher acceptance rate into Ivy League Colleges

Graduates make up high proportion of leaders in business, law, politics, and corporate boards• “Nearly 90% of all U.S. cabinet officers between 1897-1973 were

members of either the business or the social elite.” (p. 200)• Influence on media

• “Inner-circle business leaders go out of their way to be available to the press, to communicate ‘the private enterprise perspective on a variety of critical issues’.” (p. 202)

• Involvement in the arts, museums• Volunteerism

Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

The Chosen Ones

“With none of the other American children I have worked with have I heard such a continuous and strong emphasis put on the “self.” In fact, other children rarely if ever think about themselves in the way children of well-to-do and rich parents do—with insistence, regularity, and, not least, out of a learned sense of obligation. These privileged ones are children who live in homes with many mirrors. They have mirrors in their rooms, large mirrors in adjoining bathrooms. When they were three or four they were taught to use them; taught to wash their faces, brush their teeth, comb their hair. Personal appearance matters and becomes a central objective for such children.” (p. 55)

Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

The Chosen Ones: Prep Poise

Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

“The first step on the road to ‘being somebody’ is to ‘act like somebody,’ even if you are not quite sure who that somebody is.” (p. 56)

Groton Video:http://www.groton.org/academic/academic_experience?rc=0

OCCUPATIONAL THERAPY’S RELATIONSHIP WITH POWER

Power vs. Leadership

Power:Ability to achieve one’s goals

VS.Leadership:Process of influence to achieve a goal

Types of Power

Reward power: based on the ability

to reward others

Coercive power: based on the ability

to punish others

Legitimate power: based on position or official power

Referent power: based on

identification, charisma

Expert power: based on knowledge or skill that

can help another to meet his or her goals

(French & Raven, 1959)

Occupational Therapy’s Relationship with Power Historically, OTs have not been comfortable with

being powerful

Why the unease?• Opposite of caring• Masculine attribute• Association with domination

Getting Comfortable With the Idea of Being Powerful

Power is neither good nor bad The ethics of power lie in its use

Power

1) Ability to do or act; capability of doing or accomplishing something

2) Natural strength

3) Political control in the government of a country, state, etc.

Powerless

1) Unable to produce an effect

2) Lacking power to act; helpless

Powerful vs. Powerless Professionals

Powerful

Able to exert great influence

Can oversee work to be creative and effective

Experience less burn out and more job satisfaction Powerless

Rival and bully one another

Thwarted ambitions

Live in fear

Disbelieve in the values of their professions

Eating their young

History of OT Power In Health Care OT was constrained in establishing market control due to:

• Our difficulty in defining our commodity• Our decision to shy away from licensure

until the early 1970’s• Our lack of political presence in Washington DC

until Medicare’s establishment

As a result• When Medicare laws were passed in 1965,

OT was not made eligible to access Medicareas a primary provider

(Gritzer & Arluke, 1989)

WAYS OF UNDERSTANDING POWER

Critical Social Theory

Emphasis on Power Structure• Privileged and disenfranchised• Bases of power are prestige, status, social class, etc.• Political struggle is path to power for oppressed group.• Emancipation: women winning the right to vote• The influence of labor unions

(Bradbury-Jones, Sambrook, & Irvine, 2008)

Organizational/Management Theory Emphasis on Context/Environment

• Focus on hierarchical organization structures (particularly top/down)

• Power is the ability to get things done

Control over:• Access to resources• Access to support and decision making• Information• Opportunity for advancement or opportunity beyond one’s

job description• Where you are on the organizational chart

(Bradbury-Jones, et al., 2008; Kanter, 1993; Laschinger & Havens, 1996; Manojlovich, 2007)

Social Psychological Theories

Emphasis on Individuals’ Personalities• No matter the environment, a few “hardy”

individuals do whatever it takes to achieve their aims• Manipulate the few empowering structures they find• Personal efficacy; determination; vigilance; self-

confidence; etc.• Work between cracks• Sniff out potential power opportunities like a

bloodhound on the hunt

(Manojlovich, 2007; Spreitzer, 1995; Quinn & Spreitzer, 1997; Kuokkanen & Leino-Kilpi, 2000)

Post-structural Theories

Emphasis on Local Situations• Power is not distributed top-down. It also

works bottom-up and laterally.• Capillary form: “reaches into the very grain of

individuals, touches their bodies, influences their every action, their words, their everyday lives in everyday context.” (Foucault,1980, p. 39)

Power is negotiated continually in everyday contexts (Kondo, 1990)

Consumer alliances

(Foucault, 1995; Bradbury-Jones, 2007)

DEFINING PROFESSIONAL POWER

Defining “Professions”

“Exclusive occupational groups applying somewhat abstract knowledge to particular cases”• Control of knowledge and skill• Abstract system of knowledge: Problems and

task can be redefined and defended

Strong professional association

(Abbot, 1998)

The Medical Power Continuum

Stratification by:

Area of Medical Practice

Degree of Independence

Rank in remaining hierarchy

Academic Credentials

(Gloubermann, 2002)

Professional Power

“Ability to retain jurisdiction when system forces imply that a profession ought to have lost it”• “Interprofessional force”• Dominating conflicts and preventing

conflicts from arising• Need abstract knowledge

(Abbott, 1998, p. 136)

A POWERFUL LEADERAbraham Lincoln

Lincoln’s Legacy

Lincoln’s Leadership Qualities• Resilience• Forbearance• Emotional intelligence• Consideration of all sides of an argument

“Listening, always being present and authenticity are essential leadership qualities whether one is leading a country in wartime or a company during a period of transformation” –Howard Schultz, CEO of Starbucks

(Kohen, 2013)

Careful Listening

Listened to those inside and outside his sphere of influence

Gathered advice - even from those who didn’t agree with him

Traveled to the battlefields and held open “office” hours in the White House

(Kohen, 2013)

Resilience

Experienced many obstacles: the growing toll of the war, defeat in battle, pressures from abolitionists, personal loss

Lincoln was able to experience a range of emotions without acting on them rashly or compromising his larger goals.

He used emotional intelligence and a deep faith in his vision to navigate difficult terrain.

(Kohen, 2013)

The Emancipation Proclamation

Lincoln went on to draft the Emancipation Proclamation – A way of communicating his commitment to a larger purpose

He was able to shift tactics to meet changing circumstances without abandoning his larger goal.

(Kohen, 2013)

“Things had gone on from bad to worse, until I felt that we had reached the end of our rope on the plan of operations we had been pursuing; that we had about played our last card and must change our tactics or lose the game” – Abraham Lincoln

CULTIVATING POWER

Characteristics of Empowered People Empowered people have a sense of

• Self-determination• Meaning• Competence• Impact

Empowerment “not something that management does to employees, but rather a mind-set that employees have about their role in the organization” (p. 41).

(Quinn & Spreitzer, 1997)

Facilitating Empowerment Four levers

• Clear vision and challenge• Openness and teamwork• Discipline and control• Support and sense of security

Leaders must be empowered in order to empower others!

(Quinn & Spreitzer, 1997)

Barriers to Empowerment

Bureaucratic culture• Emphasizes status quo• Strong top-down tradition

Multi-level conflict• Divisions between departments• Conflict among peers

Personal time constraints• Downsizing• Stressful conditions

“Conform, don’t rock the boat!” (p. 43).

Failure to develop “voice”

(Quinn & Spreitzer, 1997)

Cultivating Your Power

Present papers at interdisciplinary meetings at which no one discipline dominates (e.g. GSA)

Build relationships with senior, well-respected administrators with whom you have overlapping interests who are not occupational therapists/occupational scientists

Publish! Publish! Publish!

Network! Network! Network!

Develop your voice and ability to speak incisively and concisely

Cultivating Your Power

Ensure the strategic use of your successes to give publicity to the services you provide

Invest time in public relations as a source of power that will enable you to do more of what you are good at

Build alliances with the clients that you work with

Pollard, Sakellariou, & Kronenberg, 2008)

ReferencesAbbott, A. (1998). The system of professions: An essay on the division of expert labor. Chicago, IL: University of Chicago Press. Bradbury-Jones, C., Sambrook, S., & Irvine, F. (2008). Power and empowerment in nursing: A fourth theoretical approach. Journal of

Advanced Nursing, 62(2), 258-266.Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.French, J. R. P., & Raven, B. (1959). The bases of social power. In D. Cartwright & A. Zander, Group Dynamics (pp. 150-167). New York:

Harper & Row.Foucault, M. (1995). Discipline and Punish: The Birth of Prison. Translated by A. Sheridan. New York: Vintage Books.Gloubermann, S. (2002). Structures, power, and respect: The nurse’s dilemma. North York, Ontario, Canada: Canadian Nursing Advisory

Committee. Retrieved from http://www.healthandeverything.org/files/Nursing_Paper.pdf (pp. 13-14).Gritzer, G. & Arluke, A. (1989). The making of rehabilitation: A political economy of medical specialization, 1890-1980. Berkeley and Los

Angeles: The University of California Press.Kanter R.M. (1993) Men and Women of the Corporation, 2nd edn. Basic Books, New York.Kohen, N.S.(2013, January 27). Lincoln’s school of management: Resilience and careful listening, as learned in 1862. The New York Times,

pp YBU1 –YBU7.Kuokkanen, L. & Leino-Kilpi, H. (2000). Power and empowerment in nursing: Three theoretical approaches. Journal of Advanced Nursing,

31(1), 235-241.Laschinger, H.K.S. & Havens, D.S. (2006). Staff nurse work empowerment and perceived control over nursing practice: Conditions for work

effectiveness. Journal of Nursing Administration, 26(9), 27-35.Manojlovich, M. (2007). Power and empowerment in nursing: Looking backward to inform the future. OJIN: The Online Journal of Issues in

Nursing, 12(1).Pollard, N., Sakellariou, D. & Kronenberg, F., eds. (2008). The political practice of occupational therapy. Edinburgh: Elsevier .Quinn, R. & Spreitzer, G.M. (1997). The road to empowerment: Seven questions every leader should consider. Organizational Dynamics,

26(2), 37-49.Spreitzer, G. (1995). Psychological empowerment in the workplace: Dimension, measurement, and validation. Academy of Management

Journal, 38(5), 1442-1465.

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