Health Leadership - Case Study Example

Running Head: Health Leadership Health Leadership Name Course Lecture Date Employee issues in Mid Staffordshire Trust Health Care Employee Attitudes The issue of health staff attitudes towards patient has received a lot of attention in health leadership. In the Francis (2010) study, the attitudes of nursing staff to their patients range from caring and compassionate to utter rudeness. The attitudes of nurses to patient in the Mid Staffordshire Trust NHS can be summarized by a number of patient/staff interactions quoted in the Francis (2010) study. On the one occasion, a patient whose mother was resisting medication was met with a rude reaction when she asked for her mother’s medication (Francis, 2010). Attitudes towards female patients are also very bad with some male nurses being unpleasant them and insisting on taking them to the toilet. The unsympathetic attitudes of nursing staff are shown in an incident where a nurse told a person who had just attempted suicide that it was a ‘selfish act’ (Francis, 2010). This was done in the presence of the patient’s relatives. According to Francis (2010), the patient who had made a suicide attempt received poor care after the suicide attempt. The Francis (2010) survey, support a firm stand while handling patient concern but most importantly nursing staff should show sympathy and understanding for those who are under their care. According to Francis (2010), staffs are also religiously intolerant. In one case, a nurse mocked a patient’s belief in God by commenting negatively about the palms that are on the cover of his bible. On other occasion, nurses openly discussed the personal issues of patients with other staff members and other nursing staff and in the presence of other patients. Some patients say they just felt like numbers in the hospital and did not receive quality care. Staff morale The staff morale of the nurses sampled by the Francis (2010), study was found to be very low. According to Francis (2010), the increased scrutiny by the Healthcare Commission was causing staff morale to go down. In the views of Francis (2010), negative publicity towards nurses in commission reports and the press had eroded staff morale. The CEO complains that unprecedented scrutiny of their work had left nurses bruised and battered from the constant criticism. Some nurses feel angry as they think they have been treated unfairly. According to Francis (2010), painting a picture that the whole nursing community was not offering quality care is a major cause of low morale among employee who performs above expectation. In the report, nursing staff who had been performing above and within care standards felt that they did not want to identify with working for the Mid Staffordshire Trust NHS. Other causes of low staff morale included low remuneration and job cuts. Others say that low staff morale is linked to the inability to deliver expected standards of care to the patients. According to Francis (2010), the target-driven culture in the Mid Staffordshire Trust NHS, was also causing a strain on staff and negatively affecting their morale. The lack of job security in the trust was also a major cause of concern for the nurses who thought that they would soon lose their jobs. Staff turnover at Mid Staffordshire Trust NHS is another indicator of low staff morale and some of the senior nurses had already left to work for other employers (Francis, 2010). The leadership and or workforce issues under consideration: Attitudes towards patients by nursing staff can affect the pace of patient recovery. For example, a patient who has attempted suicide and receives quality care from those nurses recovers faster (Liggins and Hatcher, 2005; Reed & Fitzgerald, 2005), In contrast most nurses think caring for patients who have attempted suicide is a waste of valuable time that may be used to care for patient with more serious health issues (Camilli and Martin, 2005). According to Reed & Fitzgerald, 2005), negative attitudes in a healthcare setting affect both nurses and patients. Reed & Fitzgerald (2005), argue that negative attitudes lead to other nurses feeling inadequate and anxious as they are unable to deal with the care deficiencies arising out of the negative attitudes of colleagues. According to Camilli and Martin (2005), improperly expressed frustrations affect the morale of other nursing staff and the attitude towards a particular patient. Higgins and Hatcher (2005) argue that attitudes lead to the perception among patients that they are receiving inadequate care and make them feel uncomfortable, disadvantaged and unfairly treated. Patients link negative staff attitudes with feelings of being silenced, ignored and their concerns not being given priority (Liggins and Hatcher, 2005; Reed and Fitzgerald, 2005). Studies of negative attitudes and how they impact health management are rare. In some cases, patients defend the attitudes of nursing staff and therefore their impacts and their causes are not understood. Morale is defined as the attitude, emotions and feeling of satisfaction and the outlook of employees about their work environment (Saari and Judge, 2004). The productivity of an organization is directly linked to the morale of its employees. It is therefore imperative for leaders in the medical field to ensure staff morale remains high. In contrast, the employees of Mid Staffordshire Trust NHS are dissatisfied and negative about their work environment. The issue of nursing morale has received a lot of attention in health leadership. According to Callaghan (2003), almost everyone who has been to a hospital in the UK is aware of low staff morale among nurses. Organizations are finding it difficult to attract and retain the most talented nurses. In the views of Callaghan (2003), nurses think they are undervalued, overworked and underpaid. Similar concerns are expressed by the nurses whose views were collected by Francis (2010). The search for a solution to the nursing morale problems has been a subject of policy debate in the UK and other countries. According to Callaghan (2003) there is limited research and lack of an effective solution to the problems of nursing morale. Casteledine (1997, 1998), a columnist in the British Nursing Journal has highlighted the problems of negative attitudes, low morale and problems in recruitment and selection as areas where health leadership would have a great impact. According to Casteledine (1998), nurses accuse hospitals of concentrating on making profits instead of ensuring quality patient care. In the view Casteledine (1998), poor performance and professional negligence are the negative effect of poor staff morale in care environments. He calls for better working conditions and remuneration of nurses as possible solution to the nursing morale problem. This paper has taken Casteldine’s call to analyze why nursing morale is low and provides solution from a health leadership perspective. Morale and attitude issue in other contexts A recent report from the UAE show that most nurses in the country felt dissatisfied with their work (Hannawi and Salmi, 2013). The UAE is experiencing problems in recruiting and retaining talented nurses as a result of the morale problem. The nurses in the UAE link low staff morale with being overworked and feeling undervalued (Hannawi and Salmi, 2013). These sentiments are similar to those expressed by nurses working in the Mid Staffordshire Trust NHS. The nursing morale problem is also a major issue in South Africa. According to Population Council (2006), nurses in South Africa felt that they were not motivated to work as hard as they should. The nurses in South Africa expressed concern that they felt burnt out and were considering leaving their jobs as they felt overworked (Population Council, 2006). Nurses in South Africa were more likely to take sick breaks and off days than people in other professions. Some nurses expressed a feeling of dread at having to face another day at work. High worker turnover was also experienced in South Africa where nurses are increasingly leaving for jobs overseas. Nurses associated low staff morale with poor pay, lack of opportunities for career advancement, lack of support by management, bad working relationships with other staff members which led bad attitudes towards patients and the lack of desire to stay on the job (Population Council, 2006). South African nurses were showing concern that their basic needs were not being met. According to nurses in the 30-49 age group with children below the age of 18 were more likely to want to go overseas (Population Council, 2006). These nurses needs included financial needs to pay for their children’s school fees which could be a motivating factor (“Management and Leadership Theories”, 2013). South African nurses were also concerned about the risk of catching a communicable disease at work. Nursing morale is affected by the lack of equipment and resources to prevent the spread of communicable diseases in care environments. For example, 37 per cent of South African nurses were concerned they might catch HIV, while 15 per cent said that they risk of contracting HIV had made them think of leaving their jobs (Population Council, 2006). Aims of the Improvement Strategies The main objective of the leadership strategies to be implemented is to change employee attitudes and improve staff motivation to produce a self-motivated workforce. According to Saari and Judge (2004), effective leaders have the skills to turn employee into self-motivated, effective employee. In this context making sure nurses take care of their nursing responsibility without any need of supervision would be the aim of the improvement strategies. According to “Management and Leadership Theories” (2013), most employees are not intrinsically motivated. A leader in the care environment should aim to ensure that their employees are self-driven. In a workplace environment where employees are self-driven performance increases manifold. According to Saari and Judge (2004), the care staff will work with zeal, enthusiasm, interest and initiative. A sense of responsibility over the organization's goals is also created with employee aiming for personal and moral satisfaction (“Management and Leadership Theories”, 2013). The improvement strategies will also ensure that employees become loyal towards the employing health institution. According to Saari and Judge (2004), employee self-motivation is manifested as loyalty and a sense of ownership towards the organization. Self-motivated employees do not rely on supervision to complete tasks as they have a personal sense of accomplishment which they pass on to other workers (Davies, Taylor and Savery, 2001). More self-driven employees will also become more disciplined and be proud of their organization (Saari and Judge, 2004). Such employees will desist from actions that may soil the positive image of their organization. Thus ensuring employee motivation is sure way of obtaining optimum performance from the interaction between physical, financial and human resource. Role of leaders and Leadership Approach The most applicable leadership approach to apply to change negative staff attitudes and contain falling staff morale in this situation is the Servant Leadership style proposed by by Robert Greenleaf (“Management and Leadership Theories”, 2013). The servant leader will put the needs of the nursing staff first, and assist them to develop their skills and careers (Davies, Taylor and Savery, 2001). In this context, the care staff greatest need is to have their work recognized. The nurses feel unappreciated and are angry at the negative publicity they have received in Healtch Commission reports and the media. The organization can develop a staff recognition scheme that awards incentives to the best performing nurses (Davies, Taylor and Savery, 2001). In the health organization the role of nurses is very important and therefore, leaders should ensure they praise their work no matter how bad others think they are performing (Saari and Judge, 2004). A servant leader will pick on the positive aspects of the performance of those under him/her and try to guide them to improve the negative aspects. Another way of ensuring the contribution of nurses in the healthcare context is recognized and appreciated is remunerating them well (Saari and Judge, 2004). Health organizations that have problems with employee attitudes and Morale must ensure their compensation packages are in line with industry and national standards. Servant leadership analyzed as leadership by meeting the needs of followers can also improve staff morale and improve attitudes by catering to their career and professional advancement needs (“Management and Leadership Theories”, 2013). Such a leader should provide clear pathways through which nurses can advance up the career ladder. Provision of opportunities to further education should be among the priority of leaders in a healthcare setting. Another attribute of Servant leadership that can lead to improved employee attitudes and morale is involvement of employees in decision making. Employees who are empowered and are also likely to innovate solutions to problems in the care environment (Mitchell, Parker & Giles, 2011). Furthermore, nurses and physicians who feel that they are involved in decision making develop a sense of personal ownership over the organization's policy on patient care (Davies, Taylor and Savery, 2001). By promoting innovation, servant leaders ensure that nurses and physicians are aware of the latest trends in development in patient care (Saari and Judge, 2004). The superior listening skills of servant leadership can also play a huge role in ensuring that staff attitudes and morale improve (“Management and Leadership Theories”, 2013). In this case study, nursing staff have very many complaints against patients, hospital administration and other members of staff (Francis, 2010). For example one nurse voices concern over not having a break or being overworked. A servant leader will listen and react to such concerns which will see attitudes and morale improve in healthcare settings. Actions Opportunities for Career Advancement According to Davies, Taylor and Savery (2001), the inability of nurses to undertake research is one of the impediments to nursing morale and elimination of negative nursing attitudes. A nurse who holds a diploma cannot research and apply new ways of improving patient care. To improve nursing morale, I would give nurses an opportunity to further their education, in turn their performance would improve and consequently attitudes and morale. According to Hannawi and Salmi (2013), most nurses in the UAE are looking for career development and research opportunities. Providing such opportunities would be a sure way of improving nursing morale and curbing negative attitudes. Feedback Program A feedback program should be developed to take up the complaints made by nurses about their work (Hannawi and Salmi, 2013). Nurses should be free to report to the CEO of the difficulties they experience in completing their tasks. Such a program will ensure that nurses do not feel ignored by the institution's administration. Regular meetings should be held to address the issues raised by the nurses. Remuneration and recognition scheme Mid Staffordshire Trust NHS should develop a staff recognition scheme to recognize and present performance rewards to the best performing professionals. Remuneration should also reflect the difficult and strenuous nature of healthcare jobs (Davies, Taylor and Savery, 2001). Timeframe This attitude and morale improvement plan is expected to produce positive results in 6 months. During the six months the actions discussed in the preceding section will be implemented. It is expected that the Mid Staffordshire Trust NHS employees performance in delivery of care will have improved substantially. Monitoring The progress made in changing staff attitudes and improving their morale can be monitored through Key Performance Indicators (KPI) which can be evaluated every month. Some of the KPI that can be applied to monitor performance in this setting include (Berler, Pavlopoulos and Koutsouris, 2005): Patient satisfaction: Improved patient satisfaction will be an indicator of improved employee attitudes and higher staff morale. Patient complaints: Lower rates of patient complaints indicate improved staff attitudes towards patients Staff turnover: Reduced staff turnover is a good indicator of improving employee morale. Staff absenteeism: lower rates of absenteeism indicate improving staff attitudes and also improved staff morale. Risk and Strategies to handle them Takes too much time Servant leadership is a long-term strategy when it comes to improving employee attitudes and motivation (Spears, 2004). Therefore, employee attitudes and morale might fail to improve significantly within the 6 months timeframe. Extension of timeframe for improvement can be used as a strategy to handle this risk. The organization will benefit from long-term improvements rather than short time fixes that later fade away. Ineffectiveness on some employees No matter the improvement theory that is applied in trying to change employee attitudes some employee will not change their negative attitudes (Tosi and Pilati, 2011).These employees can be dealt with through disciplinary action or by through employee mentorship and coaching programs. Disciplinary action may include dismissal from employment, demotion or suspension without pay. Conclusion The staff morale and employee attitude problem at Mid Staffordshire Trust NHS can be linked to lack of intrinsic motivation among the nursing staff. Similar problems are experienced by the health care institution across the world as seen in the South African and UAE cases. Indeed staff turnover is a huge problem in South Africa where demotivated nurses quit and move to other countries. In the UAE, expatriate nurses rarely renew the contracts with their healthcare institutions. Similar problems are experienced in Mid Staffordshire Trust NHS where the most qualified nurses are leaving the institution in search of other employers. The patient attitude problem is also closely linked to low levels of motivation among the Mid Staffordshire Trust NHS employees. However, the Healthcare Commission’s approach that criticizes the work of nurses within the trust has a negative effect on staff morale. Instead of criticizing the nurses Mid Staffordshire Trust NHS should reform leadership within its jurisdiction. One way of doing this is applying servant leadership theory. A servant leadership approach can be applied to solve the problem as suggested by Robert Greenleaf. Such a leadership approach will ensure the concerns of nurses such as long working hours, poor remuneration and negative publicity are given priority and addressed. Servant leadership also ensures nurses and Physicians concern about career and professional development are addressed. By applying servant leadership, health organization ensures that nurses are intrinsically motivated. With Servant leadership the quality of care offered by Mid Staffordshire Trust NHS is sure to improve. The trust can expect its employee to develop more positive attitudes towards their work and work with zeal, enthusiasm, interest and initiative. Bibliography Berler, A., Pavlopoulos, S., & Koutsouris, D. (2005). Using key performance indicators as knowledge-management tools at a regional health-care authority level. Information Technology in Biomedicine, IEEE Transactions on, 9(2), 184-192. Callaghan, M. (2003). Nursing morale: what is it like and why?. Journal of Advanced Nursing, 42 (1), 82-89. Camilli, V., &Martin, J. (2005). Emergency department nurses’ attitudes toward suspected intoxicated and psychiatric patients. 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