Leadership: Concept 41 Leadership: An interactive process that provides needed guidance and direction Leadership involves 3 dynamic elements ● A leader ● A follower ● A situation The leader provides: 1. guidance to followers 2. directing them toward a vision or goal 3. giving support to enable their success in the particular situation or setting. Scope of leadership Formal leadership: described as someone who has been appointed to that leadership position Ex) CEO, VP, Head Nurse, Nursing Supervisor, Elected member of CRNA, President, or committee chairperson Informal leadership: Perceived as leaders because of actions & capability Ex) Bedside nurses who are seen to ‘step up’ for patients & nurses Attributes and Criteria Followers ● Followers & leaders are interdependent ● Leaders use different approaches to motivate, support & reward followers ● Follower behavior can be viewed on a continuum with responses from resistance to passivity & active participation ● Org. success is tied to the relationship between leaders and followers Vision ● A leader’s ideological statement of a desired, long-term future for an organization ● It is the future that the leader is looking to create, to be worked on over time ● A leader’s goal is to guide and direct followers toward the vision ● To move followers toward a vision, a leader will use several processes ● 3 commonly used processes are: communication, decision-making, and change Communication ● Leadership can be described as an ongoing conversation between leaders and followers ● Leaders communicate with their followers, other leaders, the organization’s clients, and people outside the organization to give and receive information ● Communication will be influenced greatly by leadership style Decision-making ● All leaders make decisions that affect other’s and their organization’s success ● Good decisions are important, and often invisible ● Decision-making is also greatly influenced by leadership style Change ● Transition process from an old state, to a new state ● Leaders guide the change process by working with followers to move toward the established vision & goals ● Change management skills are essential ● Aspects of leadership that affect change are: using effective communication skills, understanding organizational culture, considering alternate paths to the goal, identifying and addressing differences among followers, and creating leverage to move towards the vision Social Power ● The potential influence of one individual over another ● Leaders derive social power from a variety of sources ● A leader’s style influences how power is used Theoretical Links – 1st wave (Great man/Trait theory) Great man/Trait theory: oldest theory, leaders are born… not made. Evolved into ‘trait theory’ 4 attributes that were found to be identified around the world as admirable in leaders are: 1. Honesty 2. Forward-looking 3. Inspiring 4. Competent Behavioural Leadership – 2nd wave of theory ● Core assumption is that effective leaders use different behaviours than ineffective leaders ● Effective leaders demonstrate high concern for employee needs, feelings, and morale as well as task accomplishment and productivity ● Emotional Intelligent (EI) is an example of a contemporary behavioral leadership theory ● EI highlights the importance of knowing one’s self, reflection, openness to feedback, and continuous learning in the leadership role Situational and Contingency Theory – 3rd wave ● Considers the subtle and complex interaction between: ○ leader’s traits and behaviours (preferred style) ○ Follower’s needs and values (novice, experienced) ○ Situational parameters (crisis) ● There is no ONE BEST WAY to lead under this theory Charismatic and Transformational Leadership – 4th wave ● Assumption: leaders inspire, intellectually stimulate, and recognize the contributions of their followers ● Charismatic leaders influence followers through their personality and charm, they develop an emotional relationship and inspire & motivate ● Transformational leaders rouse others to achieve something of significance, they challenge the idea of what can be attained, they positively affect initiative and accomplishment ● These types of leaders are associated with high nurse satisfaction, low nurse turnover, empowerment, and high productivity and effectiveness Focus is on organizational goals, leader holds the power, promotes “male” leadership styles (problem solving, delegation over supportive, mentoring), self-reported charisma, emphasis on formal leadership roles, does not require the leader to be effective or have integrity, overlooks employee welfare. Complexity Leadership – the newest ● Derived from complexity science ● Assumes interconnectedness among the parts of the system and between the system & environment ● Assumes nonlinearity, unpredictability ● Assumes self-organization – employees at the front line will ‘self-organize’ to adapt to change, innovate, and create new capacities ● Leaders invite workers to connect with each other to find a solution ● The leader will provide resources, help them recognize their ability to find a solution (including innovations), set parameters for action & boundaries for the solution & remove organizational barriers Clinical Leadership Characteristics of clinical leaders: ● Clinical characteristics: practical skills, expert knowledge, use of evidence-based rationale and rapid thinking skills ● Follower/team: effective communication skills, role modelling, behaviors that support colleagues, team empowerment ● Personal qualities: positive attitude toward the profession, reflective practice, leadership of change Clinical leadership influence… Based on: Referent power: power due to strong interpersonal relationships (reverence) Expert power: based on the belief that the leader has a high level of knowledge in the area Informational power: the individual has information that others need, this is a short-term form of power Developing Clinical Leadership Skills Stage 1: I am aware, can distinguish between positive and negative nurse leader Stage 2: Identify own personal strengths and weaknesses and identify a role model Stage 3: Active leadership with patients, families, and colleagues. Begin identifying own leadership style and competencies Stage 4: Active leadership with the team. Mobilizing teams, acting as a resource, adapting leadership style to context Stage 5: Embedded clinical leadership extended to an organizational level and beyond Interprofessional Leadership ● Nurses are called on to become full partners in the interprofessional care environment ● Interprofessional collaboration reduces the use of redundant services and develops more creative solutions to complex patient care problems: interprofessional care has been proven to IMPROVE PATIENT OUTCOMES Interrelated Concepts Healthcare Organizations: most nurse leaders play an important role in operations, and clinical nurse leaders usually emerge at the front lines Care Coordination: the process of connecting health care services and resources to patients (this is a distinctive contributions that clinical nurses make in patient care) Communication: clear communication is important and messages should be unambiguous and consistent Collaboration: within & among organizations, disciplines, and is essential to organizations Health Care Quality: They are involved in improvement initiatives and other change processes to meet the quality goals of the organization Evidence: formal leaders use evidence about different leadership and management approaches Ethics: ethical integrity is a core element of all types of leadership Autocratic: leader makes all decisions. most concerned with the task to be accomplished and maintain distance from their followers. motivate followers through the threat of punishment and may also offer rewards as incentives. Democratic: Leader involves followers in the decision making process Laissez-Faire: leader does not interfere with the employees and their work. Transactional: focus on the daily operation of an organization and develop an exchange relationship with their followers. Transformational: process that changes or transforms individuals. communicate an organizational vision to their followers. Authentic: leaders are seen as genuine or "real" Shared: employees are empowered to distribute leadership responsibilities broadly within a group. Lead each other. Relational Leadership ● Relational leadership means recognizing the entwined nature of our relationships with others. ● Relational leaders see communication not as an expression of something pre-conceived, but as emerging and open, as a way of working out what is meaningful and possible. Eight Practices of Relational Leadership: How to Nurse (Doane & Varcoe. 2014, p.. 434) 1. Get on the balcony: get a distanced perspective, see how the context surrounding the issue is impacting it. Notice interpersonal interactions 2. Find out where the people are at: undertake a targeted inquiry to extend your understanding of what is of meaning and concern to different people and the situation 3. Listen to the song beneath the words: Listen to what is said and what is NOT being said, notice behavior that is incongruent with people’s statements or disproportionate reactions 4. Distinguish technical from adaptive changes: technical problems have known solutions, but adaptive changes can only be addressed through changes in people’s priorities, beliefs, habits, and loyalties 5. Anchor yourself: connect to your nursing purpose and commitments, this enables you to thoughtfully consider how you might be a contribution. 6. Diagnose the situation: let things be before jumping to a solution 7. Create a sanctuary: look for allies so you are not alone, distinguish allies from confidants 8. Enlist your relational inquiry toolbox to help you choose your actions: intentionally connect with the values, beliefs, and anxieties of the people with whom you are working Leadership to Create Healthy Work Environments ● Minimize workplace bullying: bullying may be generated in stressful workplace situations, intolerant organizational climates, or where leadership is tyrannical or avoidant ○ Leaders should be positive, have high EI, and pay attention to the moral climate ○ Leadership that is fair and supportive is deemed adequate ○ Forcing solutions and avoiding conflict are linked to more bullying ○ Problem-solving solutions are linked to less bullying ● Moral distress: occurs when a nurse cannot practice nursing in accordance with professional values and standards. ○ All players must contribute to the creation of social contexts in which health and health care are viewed as a right for all, and it is widely understood that social position and the conditions in which people live shape health and access to health care resources ● Reducing burnout: burnout is linked to vicarious trauma & compassion fatigue. Burnout consists of overwhelming exhaustion, cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment ○ Burnout: associated with the intention to leave the profession and is predictive of leaving ○ Burnout is linked to organizational stressors and the prevention is linked to positive organizational climates and positive leadership Technology & Informatics Technology: the use of knowledge, tools, machines, materials & processes to solve human problems Health IT involves the management of health information and its secure exchange between consumers, providers and government. Informatics: the science that studies the process, management, and retrieval of information Health informatics: the discipline in which health data are stored, analyzed and disseminated using technology Electronic Health Record (EHR) ● This is an individual’s official, digital health record and is shared among multiple facilities and agencies ● In Alberta our EHR tool is Netcare ● Enable a practitioner to access information and to assemble data in a way as to provide a chronology of health information about the individual in care. ● An EHR is a maintained system that captures, processes, communicates, secures, and presents data about a client ● A fully functional EHR is a complex system that serves as a primary source of information for client care ● Data capture: the collection and entry of data into a computer system ○ Data can come from client-monitoring devices, from telemedicine applications, directly from the recipient of the health care, and from others. ○ Data capture also encompasses authentication to ID the author or an entry ● Storage: Access protocols permit only authorized users to obtain data for legitimate uses ○ Unique Lifetime Identifier (ULI) are required for integrating health data across multiple systems as different sites Other aspects of the EHR ● Information processing: example flagging abnormal lab results ● Information communication: interoperability of systems and linkages of data across disparate systems (example – local, regional, provincial, national systems) ● Security: address confidentiality of system and integrity of data ○ Privacy: right of individuals to keep information from being disclosed ○ Confidentiality: limiting disclosure (HCP keeps private) ○ Security: controlling access (who) Other Tools ● Electronic Medical Record within one facility ● ● ● ● Decision support tools (alerting of a med allergy if prescribing) Patient Portal myHealthrecords Physiological monitoring (blood glucose for diabetics) Wellness monitoring devices (Fitbit) ○ These allow patients, especially those with chronic illness such as heart disease, stroke and diabetes to be monitored remotely and to manage their health. Attributes & Criteria ● Hardware and Software ● Clinical Information Systems (CIS) offer the best set of tools for achieving quality outcomes ○ ConnectCare ● Information and Technology that is applied at the point of clinical care ○ Drs. Appointment, lab, bedside ● Include EHRs, clinical data repositories, decision support programs, handheld and mobile devices for collecting data and reference material, imaging, allows communication between patients and providers The specialty of Nursing Informatics Education: formal & informal ● Formal: a double degree in Nursing and Science in Health Informatics exists at University of Victoria in BC ● There are numerous Health Informatics programs in Canada ● Informal: accessed through Speciality Interest Groups, organizations such as the Canadian Information Processing Society (CIPS), health computing such as the Canadian Institute for Health Information (CIHI), user groups (of a software, vendor, etc…), or local groups such as nursing informatics special-interest groups Theoretical Links Organizational Science ● Understanding an organization and particularly understanding how culture, behavior and social change impact an organization are essential requirements for successful implementation of health IT and health informatics within and among organizations (McCarthy & Eastman, 2010, in Giddens pg. 440). Context to Nursing and Health Care ● Consider Public Health Informatics ● Information systems are used for: ○ Biosurveillance ○ Outbreak response ○ Electronic laboratory reporting Informatics in Nursing Practice ● Nurses document within EHRs ● Guidelines and alerts for providing care are found in the EHR ● EHRs are accessible to patients, families, caregivers and consumers ● EHRs allow for faster and more accurate diagnoses and treatment and improved coordination of care. Exemplars ● ● ● ● ● ● Computerized Nursing Documentation Bar Code Medication Administration Clinical Decision Support Systems Electronic Health Record Systems Patient Portals Chronic Disease Management Apps Canada Health Infoway ● Independent non-profit to foster & accelerate the adoption of electronic health systems with compatibility forward ● 5 key priorities: 1. complete current work on EHRs, telehealth, public health surveillance, 2. implement EMR systems in physician clinics and Provider Order Entry in hospitals, 3. deploy wait time management systems, 4. implement consumer health solutions to support self-care, 5. integrate chronic disease management systems Professional Use of the Internet ● ● ● ● Purpose: Why you are doing the search? Why you need the information? Focus: broad and general, layperson or professional, narrow or technical Approach: Brute force or quick and dirty: GOOGLE ○ Good starting point, find info in a short amount of time ○ Decreased quality of information, inefficient strategy ● Medline, consumer health organizations such as the Canadian Cancer Society ● Professional Associations (CRNA, CNA, CNIA) ● Data bases (CINAHL, CADTH), literature sources Application of PLEASED: evaluation of information found on the internet Purpose: what is the author’s purpose in developing the site? Links: Are the links working? Do they link to reliable sites? Editorial: is the information in the site accurate, comprehensive, and current? Author: Who is the author and are they appropriately credentialled? Site: Is it easy to navigate, does it download quickly? Ethical: Is contact information available for the site developer and author? Date: When was the site last updated
