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Introducing the first leadership model for LTC administrators

August 1, 2009
by Susan Gilster, PhD, Fellow, ACHCA and Jennifer Dalessandro, BS, NHA
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S.E.R.V.I.C.E. is the acronym, and spelling it out explains its value

As the long-term care (LTC) field is discovering, leaders are key to culture creation, culture change, and organizational success. As reinforced in the business literature for decades, leadership is critical in establishing a successful organization or business, and long-term care is no different.

Although scores of professionals have discussed the importance of leadership, they have not defined leadership or instructed leaders on how to create an effective culture. Experience and research has demonstrated that many leaders in long-term care desire an enhanced and more successful workplace, but are too overwhelmed and not educated sufficiently in the skills or mechanisms for doing so.

This article, therefore, serves as the starting point for an administrator or designated leader interested in this issue. A definition of leadership and the first leadership model developed for long-term care will be shared in an effort to assist leaders to learn through the experience of others who have been successful. Concepts, programs, and processes will be described, as well as a means of implementation so that others may replicate programs that are meaningful to their organization.

Defining leadership

Many authors have defined leadership in a variety of ways-there probably are as many definitions of leadership as there are authors. However, a new definition of leadership has emerged, developed specifically for LTC leaders. Leadership for this purpose and the model consistent for this leadership is defined as “the art of influencing and engaging colleagues to serve collaboratively toward a shared vision.”1 Leadership, many believe, is an “art.” Like effective art, leadership requires education, training, exploration, experience, and practice. Leadership is creative and innovative. It requires a person who, like an artist, is willing to see things from a different perspective and encourages others to see things that way too.

Leadership must engage staff-give them a reason to believe, something to work toward. Visioning is a means of accomplishing this. Visioning, both shared and collective, gives everyone a common ground, a solid understanding of what is to be created, and it enhances staff selection. For example, one needs to hire only those who can and will be supportive of the vision and want to work to see it to fruition.

Effective leadership uses a collective approach. It is not about one person having all the answers or power. While one person may initiate an idea or plan, many people are involved in its ultimate design and decisions. Tapping into the knowledge of others with direct experience enhances outcomes and helps make everyone part of the organization.

Passion and consistency

Central to this model is the overarching theme of passion and commitment. To be an effective and successful leader, one must have passion, be committed to the work, and encourage others to feel the same. Passion is the fuel; it is the burning desire to succeed, the belief about something that you want or care about. Passion breeds commitment. When people are passionate about something, they are committed. Tasks and skills can be learned, but passion comes from within. It is what makes an organization exceptional.

Commitment and consistency enhance the smooth running of a facility over time. Philosophies, values, actions, and programs, when committed to consistently and practiced continuously, give the staff the constant basis they need to work well.

The LTC leadership model

The specific leadership organizational model is S.E.R.V.I.C.E, an acronym for the seven domains: Service, Education, Respect, Vision, Inclusion, Communication and Enrichment. Each is defined and explained in the table on page 34. Implementation of the model has been addressed by coauthor Gilster in previous articles and two books: Changing Culture, Changing Care: SERVICE First (Cincinnati Book Publishing, 2005) and A Way of Life: Developing an Exemplary Alzheimer's Disease and Dementia Program (Cincinnati Book Publishing, 2006).

The S.E.R.V.I.C.E. Leadership Model®




Using all gifts and talents to serve others and the vision.

  • Working for a purpose higher than self with hope and optimism

  • Serving others, rather than being served and seeing everyone as a customer

  • Being a servant, teacher, coach, mentor, role model for others

  • Living by the Golden Rule: Do unto others as you would have them do unto you

  • Valuing the empowerment and growth of others

  • Taking personal ownership of your work-“Running it like you own it”

  • Caring about others


Valuing and promoting education and learning as a lifelong process for self and others.

  • Being skilled and knowledgeable-the best for self and others, the expert

  • Providing educational mentoring and role modeling

  • Preparing staff for their roles

  • Facilitating on-going personal and professional education and support programs

  • Challenging and encouraging others to achieve goals and grow

  • Choosing education over discipline

  • Creating opportunities for collective learning


Valuing and promoting respect, dignity and personhood of others.

  • Establishing respect as a core value

  • Conducting all discussions in a private space

  • Maintaining fair, consistent practices