Action-Centred Leadership - Essay Example

?COMPONENT 1A Introduction (200words) LEARDERSIP BEHAVOUR Context of my leadership—working/social environment Two leadership approaches that I exhibit: Situational Leadership (Hersey et al., 1996); Action-Centred Leadership (Adair, 1979) Introduction. Leadership can be described as behaviour that is associated with authority. Situational interaction, function, behaviour, power vision and values charisma and intelligence among others (Richards & Engle 1986 pp. 206) In order to be effective, a leader has to influence activities of an institution by putting in place achievable goals that will oversee the success of the group. Behaviour as exhibited by all leaders does reflect or does not reflect their personalities. As an individual, I display Situational Leadership (Hersey et al. 1996) and Action-Centered Leadership (Adair 1979) in addition; I am an introvert though my work environment has really changed the way I relate with colleagues. Heifetz (1994), said “different situation called for different characteristics” (Heifetz 1994 pp.16). What a leader should do is dependant on the situation. In addition, the Fiedler contingency model is based on leadership effectiveness that relies on situational control (Hemphill 1949). As a leader, I aim to develop good relationship with colleagues in order to accomplish a task. In action-centered leadership, team leadership is vital and deployed to deal with action-oriented tasks. In this case, small groups are deployed into the field to achieve reactive tasks. The groups are created to deal with a situation and the leaders within the group will be required to negotiate the needs of group members and carry out tasks in a flexible environment Focus 1: Working with/through change (210 words) What I like most as an individual is embracing change. As a leader I have learnt to take risks by critically assessing the opportunities that exist or those that I can create, and then convert them into an advantage. As an introvert, I spent most of my leisure time away from people and this gives me time to reflect and plan. To improve quality the focus is on pre-empting hidden risks associated with the organization and working them out. Sy, Cote, Saavedra, (2005) said that leaders transmit their moods to other group members through the mechanism of emotional contagion (Sy, Cote, Saavedra, 2005 pp. 295–305). Mood contagion may be one of the psychological mechanisms by which charismatic leaders influence followers (Bono J.E. & Ilies R. 2006). Inability to be influential is a disadvantage yet a leader must transfer correct moods to the group in order to achieve a task. I am not charismatic neither am I influential, to overcome my weaknesses, I believe in delegating duties and getting the whole organization, involved in planning and execution of the plan. Honestly, sustaining my own morale is challenging. To sustain morale of others, it is important to make them understand your good intention and appreciate your effort. Focus 2: Providing leadership to colleagues (210 words) I am a workaholic and find it difficult to balance between needs of public work and family or even friends. At work, one of my driving forces is perfection and an eye for detail. I do understand that family must come first and that there is need to give family emotional and material support. To achieve a balance, I hardly carry workplace assignments home though sometimes you have to make calls related to undone assignments, write mails or respond to the same. According to Hoyle (1995) Leaders are recognized by their capacity for caring for others, clear communication, and a commitment to persist (Hoyle 1995). I influence colleagues at work by sharing personal experiences, challenges and listening to them. Humour is a tool I use to mobilize and cheer up especially in moments of doute or work related stress. I also share new knowledge with them. In addition to being considerate, am good at setting performance standards. According to Miltenberger (2004) Positive reinforcement occurs when a positive stimulus is presented in response to a behavior, increasing the likelihood of that behavior in the future (Miltenberger, 2004). I show concern to both colleagues and subordinate and treat them in a supportive manner. Listening to individual needs, demands and sometimes challenges is quite refreshing. And giving advise whenever it is needed is encouraged.. Focus 3: Working with others (210 words) Knowles and Saxberg (1971) said “Power is a stronger form of influence because it reflects a person's ability to enforce action through the control of a means of punishment” (pp. 884–89) I have a conviction that leaders believe in themselves and what they are doing. Leaders are influential, however, I run short of this as I lack in self-confidence and I am of low self esteem. Horton, Thomas (1992) said that to lead, self-confidence and high self-esteem are useful, perhaps even essential (Horton, Thomas 1992). Personal conviction and communication is key to leadership. My personal conviction is that a leader should have self-believe. Personal conviction together with communication gives leaders the authority, as they attract energy to deal with uncertainty. It’s important to have an aim in what you want to achieve as this guides decisions and inspire others to follow you. Having an aim will also help overcome obstacles in addition to making people have confidence in a leader. I normally work with a clear aim to achieve a goal. Aim guide decisions, inspire people to follow you, overcome obstacles, give you the courage to stand your ground and build confidence in your people. Conclusion (170 words) Forsyth, (2009) stated that although research has indicated that group members’ dependence on group leaders can lead to reduced self-reliance and overall group strength (Forsyth, 2009). Most people actually prefer to be led than to be without a leader (Berkowitz 1953 p.231-238) in dealing with discrepancies and finding compromise, one has to assert authority and power. As a leader, you have to evaluate, correct and offer needed reinforcement. Hardly condemn an act that was accidental. To find compromise, I rely heavily on the ‘general feeling’ of the entire group. My ideal leadership behaviour involve leading through issuing of directives has not always worked out for me. Most subordinate hate being commanded. They are critical of directives and resistant to change. There is a temptation of being personal in your approach and being carried by emotions. In such cases a good leader must control emotions that that may override their purpose. The style adopted should be the one that most effectively achieves the objectives of the group while balancing the interests of its individual members. Work cited Knowles HP Borje O 1971 Personality and Leadership Behavior. Reading, Mass.: Addison-Wesley. pp. 884–89. Berkowitz, L 1953 Sharing leadership in small, decision-making groups. Journal of Abnormal and Social Psychology, 48, 231-238. Forsyth, D. R 2009 Group dynamics (5th ed.). Pacific Grove, CA: Brooks/Cole. Hemphill, John K, 1949 Situational Factors in Leadership. Columbus: Ohio State University Bureau of Educational Research. Heifetz, Ronald (1994). Leadership without Easy Answers. Cambridge, MA: Harvard University Press. Hersey, Paul Blanchard, Ken Johnson, D. 2008. Management of Organizational Behavior: Leading Human Resources. 9th ed Horton, Thomas 1992 the CEO Paradox New York Miltenberger, R.G, 2004 Behavior Modification Principles and Procedures (3rd ed). Belmont, CA: Wadsworth/Thomson Learning. Sy, T. Cote, S. Saavedra, R 2005 "The contagious leader: Impact of the leader's mood on the mood of group members, group affective tone, and group processes". Journal of Applied Psychology 90 (2): 295–305. doi:10.1037/0021-9010.90.2.295. PMID 15769239. http://www.rotman.utoronto.ca/~scote/SyetalJAP.pdf. Bono J.E. & Ilies R. 2006 Charisma, positive emotions and mood contagion. The Leadership Quarterly. Lewin, K. Lippitt, R. White, R.K. 1939 "Patterns of aggressive behavior in experimentally created social climates". Journal of Social Psychology 10: 271–301. Richards & Engle, 1986, p.206) 5. Heifetz, R. (1994). Leadership without easy answers. Cambridge, MA: Harvard University Press. Hoyle, John R. 1995 Leadership and Futuring: Making Visions Happen. Thousand Oaks, CA: Corwin Press, Inc. COMPONENT 1B OF THE ASSIGNMENT This part of the assignment consists of two elements: A coherent action plan that details how your leadership potential may be realized within the medium-term future. A supporting rationale which links your planned action back to what you Have learned during the module 1. The action plan Goal: to be an effective leader through further studies I am going to briefly outline the steps I will follow in developing my action plan. The diagram bellow presents a simplified view of my action plan. ACTION PLAN LEADERSHIP MEASURABLE RESULT Priority action Persons responsible Resources needed(human/finance) TIMELINE Further studies Myself, family, friends Finance, Technological Time lecturers 1st year 2nd year activities Masters PhDs resources Finance, stationeries finance stationeries Here are the main steps to the action plan. Defining the fundamental statements: Goal: to be an effective leader through further studies Mission: is to be the best servant by providing world class leadership. Vision: to encourage openness’ to unique and creative solutions. Core values include: integrity, humility and honesty. Objective: to apply various concepts tools, and techniques to improve leadership My vision is embedded in the mission statement. The vision; ‘to encourage openness’ is what I want to do, where I want to go. It is my leadership philosophy. My mission; ‘to be the best servant by providing world class leadership’ is the direction that I want to take. The values embedded in attainment of the mission are related to my core values. In writing this philosophy, I am aware of the factors that normally kill a vision. These include; tradition, fear of ridicule, stereotyping and short time thinking. Ogbonnia (2007) defines an effective leader "as an individual with the capacity to consistently succeed in a given condition and be viewed as meeting the expectations of an organization or society" (Ogbonnia 2007) this definition of effective leader highlights my mission and vision statements Determining the current status: In determining my current status, I undertook an analysis of the environment in which I am currently operating. To achieve this, a SWOT analysis was done. Its objective was to identify weaknesses and minimize them, identify opportunity and capitalize on them. The table bellows will demonstrate this effectively. SWOT analysis for the action plan. strengths Weaknesses Financial support from sponsors of my education. Technical support from my family Inadequate financial options Previous experiences in leadership position. Unclear sponsorship funding procedure. opportunities Threats Relatively stable educational environment Fevourable work place policy for further education. Improved economic growth and educational opportunities in my area of study Family consideration Distance- extra cost will be incurred Formulating the action plan: The action goal, objectives and key result areas basing on the information gathered in step 1 and 2 of this plan will guide this process. The action plan for each action will involve; working within a strict budget. I plan to go for masters in community health and prevention. This is a management course that involves public health. Part of the course will involve human resource management and will address my leadership context namely; working/social environment. “..as the leaders do not "take charge", they can be perceived as a failure in protracted or thorny organizational problems” (Van Wormer, Katherine, Besthorn, Fred Keefe, Thomas 2007). Leaders ability is judged by once ability to take care of a situation. In extreme situations, I have found my self in self doute in my work situation. Attending Tutorials will provide conceptual and theoretical analysis of my leadership context. It’s expected that assignments given during tutorials will directly address leadership in working/social environment. PhDs in Community Health and Prevention will boast knowledge acquired during my masters program. I will carry out a research on working/social environment and write a thesis on the same. This experience will be refreshing as I will use theoretical and conception knowledge accumulated over the years for this experience. Financial sustainability: a financial budget needs to be developed to support the goals and objectives arrived at in step three. As outlined in step two, (SWOT analysis) 30% of the funding will be through sponsorship. My education will partially be funded by USAID sponsorship program and will cater for 30%.of the total cost. Equally important is my savings which will account for 50% of the total cost. Family resources will also be used if need be. To guard against any uncertainty, my current job security offers me accessibility to education loans. In addition, other avenues of income will be exploited and these include support groups and other financial organization. Monitoring and evaluation: monitoring and evaluation of the plan will enable me evaluate progress and update the plan on a regular basis. The action plan is a two-year plan starting from September, 2012. To monitor and evaluate the plan, gap analysis-strategic formulation will be put into use. In this case, performance gaps are identified that is; the gap between the current state and the desired future state of my accomplishment. The three critical questions to be asked periodically include; 1. What am I doing that I need to stop doing? 2. What do I need to do that I am not doing? 3. How can I get resources from activities that I have to stop to that that I am doing? The critical questions will ensure that I stick the philosophies outlined in step 1 of this action plan. In addition, I will be able to adjust accordingly in the event of any eventualities in due course. Lastly, I will be able to know alternative sources of resources at my disposal. At the end of two year period, it is expected that I will be an effective leader who encourage openness’ to unique and creative solutions. Consequently, I will offer leadership in healthcare with confidence and high self esteem. 2. The supporting rationale Goal: to be an effective leader through further studies This plan outlines how I will carry out my Vision. That is; to encourage openness to unique and creative solutions. From this day it will guide every thing I do. I am well aware of my weaknesses as far as leadership is concerned. In view of my personality, action centered leadership and situational leadership will be suitable in my practice of leadership. In situational type of leadership, two types of leaders are defined: those who tend to accomplish the task by developing good relationships with the group (relationship-oriented), and those who have as their prime concern carrying out the task itself (task-oriented) (Fiedler 1967). The objectives of this action plan include; applying various concepts tools, and techniques to improve leadership. Together with my critical friend we noted that I have a series of weaknesses that I have to minimize in order to achieve my vision. It was also noted that there is a series of strength to capitalize in order to provide effective leadership. Montana and Charnov, (2008) said that “Information Power is gained by a person who has possession of important information at an important time when such information is needed to organizational functioning” p. 253. Education is aimed at empowering an individual to function in a society. In pursuing further education desirable qualities are attained. As a leader, I have learnt with concern that I am not innovative enough to achieve the best in an organization. Having worked on how to improve on this, there is a mid-term plan to go for further education to pursue masters in community health and prevention. This is a management course that involves public health. Part of the course will involve human resource management and will address my leadership context namely; working/social environment. Attending Tutorials will provide conceptual and theoretical analysis of my leadership context. Bass (1986) added to the initial concepts of Burns (1978) to help explain how transformational leadership could be measured, as well as how it impacts follower motivation and performance (Bass 1986). Measurement of leadership is important to any leader. If one is able to take care of a patient satisfactorily then success can be measured. My long term plan to work as a health provider in Brazil will be refreshing as opportunities to measure transformational leadership will be in plenty. It’s expected that assignments given during tutorials will directly address leadership in working/social environment. In addition my leadership context in health care provision will be boasted. As a care giver in my current job, I have had many misgivings during my leadership practice. A woman whose daughter had passed on came to me for guidance and direction, and I had to call a friend to attend to her because I was blank. As a leader one is supposed to give direction, the woman came for it and I just could not do that. PhDs in Community Health and Prevention will boast knowledge acquired during my masters program. I will carry out a research on working/social environment and write a thesis on the same. Bass & Bass (2008) said that 30 years of research and a number of meta-analyses have shown that transformational and transactional leadership positively predicts a wide variety of performance outcomes including individual, group and organizational level variables (Bass & Bass 2008). Every leader strives to be a top performer at individual, group or even organizational level. Social environment is essential as it’s a chance to display leadership abilities. PhDs in community health and prevention is research oriented and it will consolidate my knowledge of leadership since this course covers group dynamics as a unit that focuses on working as group members. It is directly related to my weaknesses namely; low self esteem and lack of confidence. According to Bishop (2009) managing a patient should be done effectively and with care. Taking done notes while offering first aid is essential (Bishop 2009). To decide on further education, I came up with a SWOT analysis that sought to examine my strengths and weaknesses as a leader. The main strength was organizational ability as well as being keen on details. I noted that my weaknesses resulted from naivety and that further education was the most viable plan. After settling on education as solution, I came up with an action plan that will see me achieve my dreams that included consolidation of knowledge. In addition to furthering my education, I also intend to work as a healthcare provider in Brazil in order to put into practice the accumulated knowledge and skills. Knowles and Borje (1971) said that “the need to identify with a community that provides security, protection, maintenance, and a feeling of belonging has continued unchanged from prehistoric times. This need is met by the informal organization and its emergent, or unofficial, leaders.” (Knowles, Borje 1971). Working as community health provider will be an advantage because of the varying leadership context that will be available. The community in Brazil is relevant to objective of my leadership. In developing this plan, I engaged in an unprecedented effort that directly involved my family, close friend and workmates which included web chats, posting the action plan on the work place web comments came in and all proved vital for the plan. My action plan is about providing effective leadership. George J.M. (2006) ?defined emotional intelligence as follow “the ability to understand and manage moods and emotions in the self and others, contributes to effective leadership within organizations”. (pp. 778 – 794)In going to further my education, I seek to overcome low self-esteem and to boast my confidence in work scenario. Leadership in healthcare is not all about leading because at the end of the day, one has to measure success depending on how controlled patients’ condition. To provide effective leadership in community health, being open and giving creative solutions is essential. For instance humility is much into community health when giving health care (Barr and Dowding 2008). In going to further my education, working in groups in order to complete assigned tasks will be one of my accomplishments. This will enable me to share experience, and explore new avenues of leadership in healthcare. Group assignment may be a simple task but it offers an avenue to test leadership skills and ability to work in groups. It also exploits action centered leadership style focus on given tasks. The action plan is about doing what works. Lewin, et al. (1939) said that “The style adopted should be the one that most effectively achieves the objectives of the group while balancing the interests of its individual members.”(P.271–301) To be an effective leader through further studies is the goal that I want to achieve. Situational leadership focus on characteristics of the situation a leader finds himself in. a leader has to identify the situation that suite there style. One can be task oriented and carry out the task or can be relationship oriented by developing good relationship within the group (Fidler 1967). Yukl (1994) came up with guiding tips for transformational leadership: 1. Develop a challenging and attractive vision, together with the employees. 2. Tie the vision to a strategy for its achievement. 3. Develop the vision, specify and translate it to actions. 4. Express confidence, decisiveness and optimism about the vision and its implementation. 5. Realize the vision through small planned steps and small successes in the path for its full implementation (Yukl 1994). Further studies will enable me learn how to develop relationship as it is a style that works for me. Good leaders are led by a challenging and attracting vision. Work cited Montana and B. H. Charnov, 2008 Management, Ch. "Leadership: Theory and Practice", p. 253 George J.M. 2006. Leader Positive Mood and Group Performance: The Case of Customer Service. Journal of Applied Social Psychology  Lewin, K. Lippitt, R. White, R.K 1939 "Patterns of aggressive behavior in experimentally created social climates". Journal of Social Psychology 10: 271–301. Bass, B. M, (1985), Leadership and Performance, N.Y. Free Press Bass & Bass 2008, The Bass Handbook of Leadership: Theory, Research, and Managerial Applications" 4th edition Free Press Yukl, G, 1999 An evaluation of conceptual weaknesses in transformational and charismatic leadership theories. Leadership Quarterly, 10, 285-305 Van Wormer, Katherine S.; Besthorn, Fred H.; Keefe, Thomas (2007). Human Behavior and the Social Environment: Macro Level: Groups, Communities, and Organizations. US: Oxford University Press. Fiedler, Fred E. 1967 A theory of leadership effectiveness. McGraw-Hill: Harper and Row Publishers Inc. Knowles H.P and Borje O.S 1971. Personality and Leadership Behavior. Reading, Mass.: Addison-Wesley. pp. 884–89. Van Vugt, M., Hogan, R., & Kaiser, R. 2008. Leadership, followership, and evolution: Some lessons Ogbonnia, SKC. 2007 Political Parties and Effective Leadership: A contingency Approach from the past. American Psychologist, 63, 182-196. Burns, J. M. 1978 Leadership. New York: Harper and Row Publishers Inc.. Barr,J. and Dowding, L. (2008) Leadership in Healthcare,London:SAGE Bishop, V. 2009 Leadership for Nursing and Allied Health Care Professions, Maidenhead: Open University Press Component 2A Title: Exploring the Rationale for Change The manager’s role in initiating and maintaining patient safety, in a Kings College hospital emergency setting in South East London To analyze the role of the manager, this component will begin by looking at the history of health care and its supporting theories, models and concept. The component will then assess healthcare risk monitoring and risk management and finally explore the role of healthcare design to militate against error and adverse incidents. Patient safety can be defied as focus which report, analyze and prevent medical errors resulting from adverse healthcare events. According to Jim Conway "Leaders play an extraordinary role in patient safety." First and foremost, he explains, leaders must "provide focus; make patient safety not just another ‘program de jour’ but a priority corporate objective. You must make everyone in the institution Understand that safety is part of his or her job description." (Jim Conway website) History of healthcare and safety 1990s saw many countries report soaring numbers of patients maimed and others killed because of medical errors. World health organization declared patient safety an endemic concern (world alliance for patient safety website) scientific theory is now building on patient theory and so it has drawn wide attention from both the society and healthcare provider. Knowledge in this area of focus has grown and health institutions are taking it seriously (Palmieri, et al. 2008). It is refreshing to note that this type of knowledge is growing as emphasis is placed on learning from the incidents, applying the right technology, and developing error reporting system. In 1982, the public in America learnt sadly of growing death cases that resulted from anesthetic accidents. It was reported that 6,000 Americans died yearly on account of human error. The establishment of anesthesia patient foundation in 1982 was the closest practical step to recognizing error in healthcare and safety. Janice (1983) said that a symposium on death and injuries from anesthesia was sponsored by the Royal Medicine and the Harvard Medical School and resulted in a pact to share statistics and conduct studies (Janice 1983). Anesthetic patient foundation (APSF) was established in 1984 by the American society of anesthesiologist and was the first to use the term “patient safety” Gaba (2000) reported that Likewise in Australia, death toll was just too high and in 1989 the Australian patient safety foundation was founded for anesthesia error monitoring. Health and care organizations started taking medical error seriously because of the increasing injuries and death (Gaba 2000). Social learning theory Ormrod (1999) Said that social learning theory derived from Albert Banjura provide a model for learning new behaviour and achieving behavioral change in an institution. Sincero (2011) Proposed that observational learning can occur in relation to three models: • Live model – in which an actual person is demonstrating the desired behavior • Verbal instruction – in which an individual describes the desired behavior in detail, and instructs the participant on how to engage in the behavior • Symbolic – in which modeling occurs by means of the media, including movies, television, Internet, literature, and radio. This type of modeling involves a real or fictional character demonstrating the behavior. (Sincero, 2011 website) This model emphasizes that a person’s behaviour is influenced by the environment and personal qualities. Attention, retention reproduction and motivation are mentioned by Sincero (2011), as part of the modeling process. To exploit this theory in Kings College hospital emergency setting, it is in the mind that human beings tend to avoid negative outcomes but desire positive effects. People will engage in such behaviour that elicit positive result and if motivated it will be sustained. Mineka, & Zinbarg, (2006) Studied anxiety and said that “people learn fear from others.” (Zinbarg 2006 p.10-26.) Managers can exploit this theory by sending verbal instruction to elicit a desired behaviour in Kings College hospital emergency setting. The manager has to be the live model described by Sincero (2011). He has to demonstrate the desired behaviour for other to copy. Managers can also copy the symbolic model and apply it in Kings College hospital emergency. Desired behaviour can be posted on Kings College hospital emergency website, and other forms of media the demonstrated behaviour on health and safety will be a good slogan for the hospital. Theory of reasoned action The theory of reasoned action Predicts behavioral integration and makes predictions of behaviour. This theory was developed by Fishbein and Ajzen (1975, 1980), Hale, Householder & Greene (2003) said that the theory was "born largely out of frustration with traditional attitude–behavior research, much of which found weak correlations between attitude measures and performance of volitional behaviors" (p. 259). The theory has three important components namely; behavioral intention, attitude and subjective norm. It suggests that behavioral intention result from attitude about the behaviour and subjective norm. "the person's perception that most people who are important to him or her think he should or should not perform the behavior in question" (Ajzen & Fishbein, 1975). Miller (2005) said of Fishbein and Ajzen. "Indeed, depending on the individual and the situation, these factors might be very different effects on behavioral intention; thus a weight is associated with each of these factors in the predictive formula of the theory. For example, you might be the kind of person who cares little for what others think. If this is the case, the subjective norms would carry little weight in predicting your behavior" (Miller, 2005, p. 127). Thus, Sheppard et al. (1988) concluded that the model "has strong predictive utility, even when utilized to investigate situations and activities that do not fall within the boundary conditions originally specified for the model. That is not to say, however, that further modifications and refinements are unnecessary, especially when the model is extended to goal and choice domains" (p. 338) Theory of reasoned reaction has three important facets that Kings College hospital emergency setting can borrow from. To begin with, a distinction is made between a goal and a behavioral intention. Availability of options has an influence on the nature the process of forming intentions. The role of the intention that performs the behaviors also highlighted. In the hospital scenario the manager and policy makers will predict intentions and elicited behaviour to come up with appropriate policy that provide for safety and healthcare. Through the theory, we are able to explain predictable behaviour. We can explain behaviour as impulsive, habitual, mindless or spontaneous. The manager of the kings’ college hospital can make use of this knowledge to understand needs of his staff. Transtheoretical Model of Behavior Change (TTM) is focused on assessing a persons readiness to act in a better way and an individual's readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance. Armitage (2008) pointed out that it is "arguably the dominant models of healthy behaviour change, having received unprecedented research attention, yet it has simultaneously attracted criticism" (Armitage, 2008pp.195–210.). Procheska James and colleagues developed the Transtheoretical Model beginning in 1977 Prochaska, and DiClemente (2005). p. 147–171. Prochaska and colleagues refined the model on the basis of research that they published in peer-reviewed journals and books. The model consists of four "core constructs": "stages of change," "processes of change," "decisional balance," and "self-efficacy." It is important that the manager should know the stages of change and the dynamic change process together with the principles that relate to each stage. Use of TTM-based intervention for behaviour change is seen effective and can be borrowed for Kings College hospital emergency setting. In the Transtheoretical Model, Prochaska, JO and Velicer, WF (1997) defined change as a "process involving progress through a series of stages:" 38–48. Change in healthcare and safety should be gradual, balanced and with self-efficiency. The manager should initiate improvement in healthcare and safety to achieve desired behaviour Kings College hospital emergency setting. And of most importance is sustaining the action while preventing relapse. Patients too can be involved in the process. People should be thought of the healthy behaviour and be encouraged to think of the advantages of behaviour change. Structuration theory This theory has been used to facilitate the understanding and improvement of health culture in the hospital. Patient health care in places of health care is an important problem worldwide. Important values are shared by members of a given healthcare organization as they communicate and put the needed values in place. In effect, an organizational safety culture will guide safety and healthcare procedures. The theory stipulates that culture within the system will lead to reciprocity and enable the action of members in terms of patient safety. The theory provides a broad rationale for improvement in safety culture. The manager should be cognizant of competing value based culture system in Kings College hospital emergency setting. Managers are required to meet management demands and all forms of communication. Safety culture in an Kings College hospital emergency setting is the basis the manager would use to ensure safety. All members are part of the organizational safety culture and have responsibility of guiding healthcare procedures. University of Kentucky hospital model. (Brockopp et al 1992) The University Of Kentucky Hospital Model of case management uses a problem solving process. Case managers are masters-prepared nurses to whom cases are referred by quality monitoring groups. Case managers verify problems, designs strategies to fix them and evaluate outcomes. The priority in this model is efficient movement through the health care system. Case managers consult with finance personnel, administrators and healthcare provider; they collaborate with physicians, primary nurses, and other healthcare providers and they establish therapeutic relationships with patients and families. Clinical problems are surveyed by board members (Brockopp et al 1992 pp.23-27). Case managers follow up the clinical problems with diagnosis and procedures codes specific to the cases with verified problems. This theory is based on problem solving the manager in this case is a nurse who is prepared to handle the problems strategically. They work hand in hand with other personnel to establish relationships with patients and family members. Kings College hospital emergency setting can use this model for efficiency. The Manchester Patient Safety Framework (MaPSaF); offers a theory based framework for assessing safety culture, designed for use in NHS. This framework is said to cover multiple dimension of safety culture in areas of relative strength and challenges which can be used to identify focus issues for change and improvement. MaPSaF provides a useful method for engaging healthcare professionals in assessing and improving the safety culture in the organizations as part of risk management. The role of and impact of the manager in safe health care system is so important. . Leonard et al (2004) “Approximately 80 percent of medical errors are system-derived.” (p. 5). To achieve managerial function, the manager in Kings College hospital emergency setting ought to examine the system as whole. Focus is on dimension of safety culture that need change the manager and improving the existing. Law et al (2010) said that the frameworks’ ten dimensions of safety culture namely; continuous improvement, priority given to safety, system errors and individual responsibility, recording incidents, evaluating incidents, learning and effecting change, communication, personnel management, staff education and teamwork) at five progressive levels of safety maturity. (Law, Zimmerman, Baker, & Smith, 2010 website) Risk monitoring and management According to Gipson et al. (2003) and Gawande (2002) Patient safety also encompasses the concept of “reliability.” Reliability in health care is defined as patients getting the intended tests, Medications, information, and procedures at the appropriate time and in accordance with Their values and preferences (Gibson et al. 2003, pp. 60-68, and Gawande 2002, pp. 55-56). The key components of risk monitoring include; assigning delicate subject matter to professionals, integrating corporate policy and procedures assigning project specific risks, monitoring regulatory requirement for reliability. Kings College hospital emergency setting has a systematic procedure that track and identify risks. This is through daily inspection, short induction courses, and maintenance of the facilities and equipment. Once the risk has been identified, one has to decide whether they can be able to eliminate it and in this case relevant professionals will facilitate eliminating procedure. If this is not practicable, then they should consider reducing its impact or severity. This could be done through assessing available options. According to Helmreich (2000) Risk management is identification, assessment and prioritization of risks. Management of risk is accompanied by maximization of the realized opportunities. The strategy to manage risk could include transferring the risk, avoiding the risk, reducing the adverse effects or even accepting part of the risk. In risk management, prioritization process is followed and in this case the risk that has greatest impact is prioritized. This is to say that risks with the highest probability of occurrence are prioritized and risks with lower intensity are handled in descending order. Intangible risk management is the rationale for identifying types of risks that have 100% chance of occurring yet ignored by the hospital because they lack identification ability (Helmreich 2000 pp781-785). Relationship risk occurs when ineffective collaboration occurs. Process- engagement risk may be an issue when in effective operational procedure is applied. Risk management in Kings College hospital emergency setting should therefore create value resources to mitigate risks to be less than the consequence of inaction. The gain should exceed the pain. The process should be systematic and structured and take into account patient’s safety. Work cited Leonard M, Frankel A, Simmonds T, with Vega K 2004, Achieving Safe and Reliable Healthcare: Strategies and Solutions. Chicago, Illinois: Health Administration Press; Gibson R, Prasad Singh J 2003 Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. Washington DC: LifeLine Press; Gawande A 2002 Complications: a Surgeon’s Notes on an Imperfect Science. New York, New York: Picador Improving the Reliability of Health Care. 2004 IHI Innovation Series white paper. Boston, Massachusetts: Institute for Healthcare Improvement Brockopp, DY, Porter, M kinnard S. and Siberman, S 1992 fiscal and clinical evaluation of patient care. Journal of nursing administration, 23-27 Ajzen, I & Fishbein, M 1980 Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Fishbein, M & Ajzen, I 1975 Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley Hale, JL Householder, B.J. & Greene, K.L. 2003 The theory of reasoned action. In J.P. Dillard & M. Pfau (Eds.), The persuasion handbook: Developments in theory and practice (pp. 259–286). Thousand Oaks, CA: Sage. Miller, K. 2005 Communications theories: perspectives, processes, and contexts. New York: McGraw-Hill. Sheppard, B. Hartwick, J. & Warshaw, P.R 1988 The theory of reasoned action: A meta-analysis of past research with recommendations for modifications and future research. Journal of Consumer Research, 15, 325–343. Armitage, CJ. 2008 Is there utility in the transtheoretical model? Br J Health Psychol 2009;14(Pt 2):195–210. Epub Oct 14. Accessed 2012 April 01 Ormrod, J.E. 1999 Human learning (3rd ed.). Upper Saddle River, NJ: Prentice-Hall Sincero, S. 2011 what is social learning theory? Retrieved from http://www.experiment-resources.com/social-learning-theory.html Prochaska, JO. DiClemente, CC. 2005 the transtheoretical approach. In: Norcross, JC; Goldfried, MR. (eds.) Handbook of psychotherapy integration. 2nd ed. New York: Oxford University Press. Prochaska, JO Velicer, WF. 1997 The transtheoretical model of health behavior change. Am J Health Promot 12(1):38–48. Gaba David M (2000). "Anesthesiology as a model for patient safety in health care". Medical Care 320 (7237): 785–788. Mineka, S., & Zinbarg, R. 2006. A contemporary learning theory perspective on the etiology of anxiety disorders: It's not what you thought it was. American Psychologist, 61, 10-26. Law, R.P., Zimmerman, R., Baker, G 1982.R., & Smith, T. (2010). Assessment of Safety Culture Maturity in a Hospital Setting. Healthcare Quarterly, (13). Retrieved from: http://www.longwoods.com/content/21975 Palmieri, p. et al. 2008 "The anatomy and physiology of error in averse healthcare events". Advances in Health Care Management 7: 33–68.  Jim Conway “Health Care Leaders Leading: A Dana-Farber Cancer Institute Executive Describes the Crucial Role of Leadership in Driving Patient Safety.” Online information retrievedApril 28th, 2012. Helmreich RL 2000 On error management: lessons from aviation. British Medical Journal v 320pp781-785. Janice Tomlin (producer) 1982: The Deep Sleep: 6,000 will die or suffer brain damage, WLS-TV Chicago, 20/20. Anesthesia Patient Safety Foundation: The establishment of the APSF by Ellison C. Pierce, Jr., M.D. Component2B Title: Exploring the Rationale for Change A report exploring aspects of managing the aftermath of a patient safety incident, with a rationale for action supported by evidence. Introduction. Physical and psychological suffering that is induced by medical injuries afflicts patients, relatives and even medical professionals. According Brown and Hicks (2009) the aftermath of serious medical incident that may result from surgical adverse events including high level of distress is common. Patients, their family and Healthcare staff are affected by the aftermath. They experience severe consequences when involved in serious medical incidents. Doctors may have profound emotional effects when involved in adverse events like fear, embarrassment anger, humiliation, guilt or even depression symptoms. Patient’s safety needs bear strategic importance for all stake holders in the hospital (Brown and Hicks 2009. Pp 300-311). Questions emerge as to whether there should be in place a proactive disclosure of medical error to patients and the procedure to follow. This disclosure alone won’t be sufficient to the patient unless if there is remediation accompanying it after an adverse event. It is considered a challenge to deal with an error that resulted to death as family may turn emotional. Helping the family cope and come to terms will restore trust in the hospital. The role and impact of clinical governance in safe healthcare It is important that clinical governance in safe healthcare understand human errors. Errors may definitely occur and the key is to design a safe healthcare system to stop the harm from reaching the patient. Reason, (2000) said that “Medical errors, some times called adverse events, could include missed or delayed diagnoses, could be mistakes in the process of treatment, medication, miscommunication during transition in the hospital, delayed reporting of results or inadequate post operative care” (Reason, 2000 pp.768). Clinical governance is therefore an important healthcare facet that ensures safety of the patient. It is vital to embrace reliability in health care. In this case reliability is defined by Gipson et al. (2003) and Gawande (2002) as “Improving the Reliability of Health Care” “patients getting the intended tests, medications, information, and procedures at the appropriate time and in accordance with their values and preferences” Gibson et al. 2003, pp. 60-68, and Gawande 2002, pp. 55-56). Health care system should change to incorporate aspects of high reliability modeled by aviation and nuclear field. The role of human factors in the design of safe health care processes and equipment Human factors have a role in designing health care systems. One of the human factors that play a role in safe health care is organizational behaviour. Study by show that in an organization the focus on improving its methodology basing on previous experiences in safety work will make faster progress than one that is yet to establish a mechanism and commitment to safety and health care. In addition, senior leaders and managers have the responsibility to position safety as there first priority in the hospital. They therefore influence design of heath care system. In an institution, everyone has a role of ensuring that safety is part of their job description. To achieve this, emphasis is on the gap in the organization’s performance and its current position and where it ought to be. There is practical and symbolic agenda value in making the patient safety issues a priority for all the staff of the hospital. The key element of human factor in managing the aftermath is improving reporting of adverse events, the aftermath of a patient safety incident, to improve reporting within an organization the executives are supposed to share their organization report with other senior staff including clinical staff and integrated governance team. Perrow (1984) Clinical equipment management is important in maintenance and management of medical devices in health care settings. This equipment could be used in diagnosis, monitoring of patient and treatment. Policies and procedures surrounding the use of the equipment ensure that healthcare and safety is taken care of through effective selection, acquisition of the device and planning for it (Perrow, 1984). Clinical professional equipment management professional is bestowed with responsibility educating healthcare provider on proper usage to reduce likelihood of harm, loss or damage to patient or health worker. The role of safety culture and safety climate in the prevention and mitigation of harm The role of safety culture and safety climate in prevention of and mitigation of harm is the basis of healthcare and safety (Khatri, Chan, & Mark 2009 19-28). Institutions in early stages of improvement are likely to develop a culture that would support and advance patients’ safety. Their exist cultures that are unwanted yet exist within the tradition of medical practice. According to Amalberti et al (2005) discussion of error is the best component of healthcare and safe culture and should encourage learning from them (Amalberti, Auroy Berwick Barach 2005 pp765-764). Employees and employer in an institution have a role in facilitating a culture of trust that facilitates communication within and without the established clinical system about such issues like non punitive approach to reporting and causes of errors (Wachter, Shojania 2004, p.350). According to Wachter et al. (2004) “Physicians have been trained to act independently, to treat each patient as unique, and to tailor their decisions accordingly. It is sometimes difficult for physicians to accept standardization and opt-out protocols” (p.350). Physicians have a culture of practicing in autonomy and it is challenging to make them part of safety culture yet they are central to it. A bad and primitive culture will support fear and intimidation in places of constructive dialogue. Managers should reinforce a positive supportive environment by rewarding the middle managers when they fill occurrences reports. This culture can be reinforced by discussion of analysis of reports with collogues. Safety culture and safety climate will first be established by assessing the hospitals current situation. Singer et al (2009) said that “Patients and their families are a critical part of the care team and they play a pivotal role in the prevention of medical errors” (pp300). To be effective partners in their own care, patients need better, sometimes non-traditional, access to information and health care providers. Patients and their family members should be invited to collaborate with care providers in making clinical decisions. Patient-centered approach places responsibilities for self-care managing and monitoring in the hands of patients. Need to carry out that responsibility. In looking at methods and systems to manage the aftermath of a patient safety, a consistent course of action that seeks to achieve staff involvement in patient safety incidents is established. System failures are responsible for a majority of safety incidents. Traditionally, suspension of the clinician involved in cases of medical error was administered. Dr learpe reported that “the single greatest impediment to error prevention is that we punish people for making mistake.”Leape; 1997 the U.K government made a declaration that called for NHS to be more open in the way it dealt with adverse events. It was recorded in the Hansard (2001) recorded that “to recognize that honest failure should not be responded to primarily by blame and retribution but by a drive to reduce risk.” Need for creation of an open culture is the main aim of incident decision tree. Employees are required to report patient safety incidents confidently without fear of reprisals. Their is fear that unjust use of suspension was a common factor in a report published by the U.k’s government national audit office (NAD) Controller And Auditor General. Suspension is quite demoralizing and uneconomical because excluding a clinician from duty is costly since he is paid to stay at home. In addition, loss of professional skill during the period of suspension is a concern. NPSA came up with incident decision tree that provide a clear rationale for managers to decide on disciplinary action following a patient safety incident. It provides for consideration for an alternative to suspension. NHSC (2002) the incident decision tree is based on an algorithm for dealing with staff involved in safety errors in the aviation industry. This model is called ‘culpability tree.’ (Management of Amalberti R, Auroy Y, Berwick D, Barach P 2005 pp765-764.). Adverse events and system failures in complex and high risk areas like aviation and nuclear power. The tool tests; deliberate harm, foresight substitution and incapacity using this tool considers the actions and possible explanation given for adverse events. Recommendation and conclusion. Institute for Healthcare Improvement (2005) recorded that Simulation technique has been a success in many industries that attempt to teach people how they can recognize problems and the effects associated with their response. This technique prepares people for error prone, unusual situations on even high risk situations (Institute for Healthcare Improvement 2005 p 20). It observes that stimulation can be as simple as practicing wheeling a patient bed from one patient care unit to the ICU, and as complicated as visiting a dedicated patient safety lab used as a simulation theater. Simulation addresses not only the technical performance of individuals, but also important elements of teamwork such as listening, communicating, respect, and role clarity. (Institute for Healthcare Improvement 2005 p 20) Forty percent of medication errors are caused by cognitive mistakes by the prescribing physician and 25 percent are related to illegible handwriting (Lesar, Briceland, and Stein 1997 p. 312-317) Computerized Physician Order Entry (CPOE) system is an improvement to Organizational infrastructure that can reduce medication errors by approximately 55 percent (Bates, Leape, Cullen, et al. 1998 p 1311-1316). A more recent study suggests that a CPOE system may be able to reduce Medication errors by as much as 88 percent (Birkmeyer 2003) CPOE systems are expensive and only 2 to 5 percent of hospitals have purchased such systems (Gibson R, Prasad Singh J. 2003, p. 173) Work cited Management of Amalberti R, Auroy Y, Berwick D, Barach P (2005) Five system barriers to achieving ultrasafe healthcare. Annals of Internal Medicine 142 (9) 765-764. Brown GD, Hicks LL 2009 From a blame culture to a just culture in health care Health Care Management Review 34(4) 300-311. Perrow C 1984 Normal Accidents: Living with high risk technologies. New York, Basic Books NY. Reason JT 2000 Human error; models and management. British Medical Journal 320 768-770. Singer SJ, Falwell A, Gaba DM, Meterko M, Rosens A, Hartman CW, Baker L 2009 Identifying organizational cultures that promote patient safety. Health Care Management Review 34(4) 300-311. Hansard (united kingdom hause of commons daily debates). 2001, June 27. National Health Service confederation/national patient safety agency.2002 Creatin the virtus cicle: patient safety, accountability, and an open and fair cultuere. Comptroller and Auditor General. The management of suspensions of clinical staff in NHS hospital and ambulance trusts in England. Report HC 1143; 2002 nov 3 Leape LL. 1997 testimony united state congress, house committee on veteran’s affair Institute for health improvement "World Alliance for Patient Safety". Organization Web Site. World Health Organization. http://www.who.int/patientsafety/en/index.html. Retrieved. 29 April, 2012  Khatri Hughes LC, Chan Y, & Mark B 2009 Quality and Strength of 6 patient safety climate on medical-surgical units. Health Care Management Review 34(1) 19-28. Amalberti R, Auroy Y, Berwick D, Barach P 2005 Five system barriers to achieving ultrasafe healthcare. Annals of Internal Medicine 142 (9) 765-764. Wachter R, Shojania K. Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes. New York, New York: Rugged Land Press; 2004, p. 350. Lesar TA, Briceland L, Stein DS. 1997 Factors related to errors in medication subscribing. Journal of the American Medical Association.;277(4):312-317. Bates DW, Leape LL, Cullen DJ, et al. 1998 Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. Journal of the American Medical Association. 280 (15):1311-1316. Birkmeyer JD. The Leapfrog Group’s Patient Safety Practices, 2003: The Potential Benefits of Universal Adoption Gibson R, Prasad Singh J. 2003 Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans. Washington DC: LifeLine Press Institute for Healthcare Improvement 2005 Leadership Guide to Patient SafetyResources and Tools for Establishing and Maintaining Patient Safety. Read More