Nursing Leadership
in Global Health
The art & science of articulating the change
David C. Benton RN, PhD, FRCN
Chief Executive Officer
International Council of Nurses
26th February 2014
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Archimedes - 220 BC
Mechanics Magazine published in in 1824
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Areas to be addressed
• Changes to enable
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Nursing’s voice to be more integrated into shaping
health policy
–
Nursing to have greater involvement in decision
making, programme planning and strategy
implementation
–
Nurses to become more responsive and effective
as advocates for patient populations
• .
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Nursing’s Voice
• What do we know ?
•
Few countries have nursing and midwifery personnel
providing professional and policy level services in
WHO country offices.
•
Data from the WHO human resources annual report of
January 2013 reveals nursing specialists represent
0.6% of staff in professional and higher categories.
Medical specialists represent 90.7% and dieticians
and nutritionists (at 2.6 %) and pharmacists (at 2.0%)
have greater representation than nurses.
•
The situation has deteriorated over the past 40 years.
In 1968 there were more than 200 nurses working for
the World Health Organization and the representation
of nursing specialists was 2.9% in 2001. Since May
2010, the position of Chief Scientist, Nursing and
Midwifery has been vacant.
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Nursing’s Voice
• What do we know ?
• More diverse than
ever before.
• Level of preparation.
• Certificate to Masters
• Nurses or Nursing
• Variation in scope.
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Nursing’s Voice
• What do we know ?
• Not all bad news.
• Nurses in wider government and
intergovernmental position
• More Nurses as part of WHA
delegations
• Increasing availability of BSN,
MSN and Doctoral provision
• Diversity can provide strength.
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An experiment in perceptions
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What Did You See?
?
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An experiment in perceptions
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The Nursing Context
•
•
•
•
•
•
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Clinical Practice
Professional Associations
Regulators
Academia
Trade Unions
Public and Private
Governmental and Nongovernmental agencies
• Other Disciplines
• Patients, families,
communities and
Populations
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The First Three Messages
• Have the facts but don’t stick to a single
solution
• Agreeing the key message also provides
the potential for synergistic leverage
• See diversity and differing perspectives as
multiple opportunities.
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How is Policy Made?
• In a galaxy far far away?
• In a Government near you?
LAW MAKERS
Making Policy
GOVERNMENT
AGENCIES
STAKEHOLDER
INTERESTS
The Iron Triangle
Model
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How is Policy Made?
• In the Eighties, Ninety's and alive & kicking!
Kingdom’s Agenda
Setting Process
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The Game Changer?
• Brutal criticism
Systematic reviews and concise summaries of
findings are rarely used for developing
recommendations.
Instead, processes usually rely heavily on experts in a
particular specialty, rather than representatives of
those who will have to live with the recommendations
or on experts in particular methodological areas.
Oxman, Lavis and Fretheim (2007)
Lancet 2007; 369: 1883–89
DOI:10.1016/S0140-6736(07)60675-8
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The Game Changer?
• Brutal criticism
"This is a pretty seismic event," Lancet editor Dr. Richard
Horton, who was not involved in the research for the
article.
"It undermines the very purpose of WHO.”
"If countries do not have confidence in the technical
competence of WHO, then its very existence is called into
question," said Horton.
"This study shows that there is a systemic problem within
the organization, that it refuses to put science first."
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Some WHO Resources
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How is Policy Made?
• The complexities of today’s reality
Policy Networks
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A focus on health - missed opportunities?
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Social Networks – Existing Structures
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Social Networks
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Social Networks
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Social Networks –
Impact of LFC (Before)
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Social Networks – Impact of LFC (After)
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Social Networks – GNLI
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Social Networks – GNLI
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The Next Three Messages
• Know how policy is made
– Who decides, when is it decided, does it get
implemented
• Understand the starting landscape
– Knowing where you are helps in setting
challenging but achievable targets
• Remember topography can change
– It is sometimes easier and more effective to get
others to carry your message
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Nurses as Advocates
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•
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Power
Principles of Influence
Competencies
Opportunities
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Sources of Power
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•
•
•
•
•
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Resource Power
Information
Expertise
Connections
Coercion
Position
Personal Power
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The Six Principles of Influence
•
•
•
•
•
•
Contrast
Commitment & Consistency
Scarcity Value
Social Proof
Linking & Integrating
Emotion
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Nurses as Advocates
• Competencies
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–
–
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Leadership – Vision, passion, commitment
Media skills – right story for the right audience
Economics – makes the world go round
Evidence – in god we trust everyone else
brings data
– Alliances – achieve more
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Who should we influence?
• Governments
• Intergovernmental structures
– WHO, UNFPA, UNHCR, etc
– WTO, UNESCO
– World Bank
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•
•
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Regional entities (The EU but the rest?)
Employers
GAVI, Global Fund, Gates
National and Transnational Corporations
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Transnational Corporations Opportunities?
• Funding – many have
foundations
• Population for health
improvement
• Target for carrying your
policy message (they often
spend a lot on lobbying)
• Raise our profile and our
image
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Final Four Messages
• Map where the power lies in your universe
– You don’t need to be the head of the organisation to hold
power
• Use different strategies to influence and remember
that you can use more than one at a time
– Using a hammer to cut a plank is not a good choice
• Integrate policy competencies into pre-registration and
build upon them in post registration
– Policy is set and implemented at various levels
• Understand the new policy landscape and who has
control of resources
– Talk is cheap – implementation is a further opportunity but
requires funding
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Just in Case You Want to Move
the World
http://www.starstryder.com/2008/02/18/with-a-lever-i-move-the-earth/
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Bibliography Part 1
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Benton D.C. (1999) Seize the moment: opportunities for parliamentary lobbying in Scotland.
Nursing Standard 14:5,16-17
•
Benton DC. (1999) Assertiveness, Power and Influence Nursing Standard 13:52, 48-52
•
Benton, D.C. Fernandez-Fernandez, M.P. (2014) Social network analysis: A tool for the
identification of next generation trainers. Collegian: The Australian Journal of Nursing Practice,
Scholarship and Research. http://dx.doi.org/10.1016/j.colegn.2013.08.001
•
Borgatti,, S. P., Everett, M.G., and Johnson, J.C. (2013) Analyzing social networks. London,
Sage Publications Ltd.
•
Lavis, J.N., Oxman, A.D., Souza, N.M., Lewin, S., Gruen, R.L., Fretheim (209) Health Research
Policy and Systems 7(Suppl 1):S9 http://www.health-policy-systems.com/content/7/S1/S9
•
National Collaborating Centre for healthy public policy (2012) A Framework for Analyzing Public
Policies: Practical Guide. Québec, Institut national de santé publique.
http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf
•
Oxman, Lavis and Fretheim (2007) Lancet 369: 1883–89
DOI:10.1016/S0140-6736(07)60675-8
ICN - Advancing nursing and health worldwide
www.icn.ch
Bibliography (Part 2)
•
UNCTAD (2007) The universe of the largest transnational corporations: UNCTAD current studies
on FDI and development No 3. New York, United Nations.
http://unctad.org/en/docs/iteiia20072_en.pdf
•
Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R. Gilson, L (2008) Health Policy and
Planning, 23:5, 308-317.
http://heapol.oxfordjournals.org/content/23/5/308.full.pdf
•
WHO (2009) Systems thinking for health systems strengthening. Geneva, WHO.
http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf
•
WHO (2010) WHO Country Cooperation Strategies: Guide 2010. Geneva, WHO.
http://www.who.int/countryfocus/cooperation_strategy/WHOCSS_Guide2010_Eng_intranet_24sep10.pdf
•
WHO (2012) Changing Mindsets: Strategies on health policy and systems research. Geneva,
WHO. http://apps.who.int/iris/bitstream/10665/77942/1/9789241504409_eng.pdf
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