Leadership and Management in Health Visiting - Essay Example

Leadership and Management in Health Visiting "Globally healthcare is moving towards a primary care approach For a greater public health role, health visiting has to change from one of independent practitioner under a GP surgery to work as a team which shares the vision and goal of a primary care trust. "Sure Start Children's Centres" are at the heart of the government's Every Child Matters: Change for Child Programme. They should be seen as portals of delivery of primary health needs of the community concerned. This can be achieved using a skill mix team working under multi agency settings. Now for a better understanding first we will define the terms Leader, Manager, and Health visiting. "Leader is a person who leads, commands, or precedes a group, organization or a country". "Manager is a person who manages an organization or a group of staff. A person who controls the professional activities of a performer or a player is also called a Manager or a person in charge of activities, tactics, and training of a team." Oxford Dictionary Leadership is a process by which a person influences others to accomplish an objective and directs the organization in such a way that makes it more cohesive and coherent. They carry out this process by applying their leadership attributes such as beliefs, values, ethics, character, knowledge, and skills. Although the position of manager gives one authority to carry out certain tasks, and objectives in the organization, this power does not make one leader, but it simply makes you 'Boss'. Leadership differs in that it makes followers wish to achieve high goals, rather than simply bossing people around. Basis of good leadership is honorable character, selfless service to your organization. In your employee's eyes, your leadership is everything you do that effects organization's objectives and wellbeing. Respected Leaders concentrate on what they are (such as beliefs and characters) what they know (such as job, tasks and human nature) and what they do (such as implementing, motivating, and providing direction). Health Visitors are community health professionals (midwives, community nurse) who are easily accessible, and readily accepted by community. They do a good deal of health and support work with families and children. Health Visiting is thus at the heart of services for children. Their work is highly valued across the system, and with their public health nursing and family support skills, they are an integral part of children's services. Principles of health visiting are the search for health needs; create an awareness of health needs, influence on the policies affecting health, and facilitation of health enhancing activities. Universality of health visiting service is vital for the early identification of problems. In partnership with health visitors families will continue to receive a health needs assessment. For families with no identified needs, a minimum program is proposed. This will allow Health.Visitor. to target their service to most vulnerable families. Health visiting team can be made fit to respond to the changing needs of health and service care agenda, by building skill mix team with greater responsibilities and accountability. . Sure Start is the cornerstone of government's drive to tackle child poverty and social exclusion. Sure Start works to provide childcare, early education, health and family support services for children below 5 years. These integrated services are delivered through children's centres,which are concentrated in most disadvantaged areas till date.By this year (2006) they are planning to come to the mainstream since local audit has shown that 30% of the country's (U.K.)vulnerable children are living outside this area. This guidance is given in 3 parts to Local authorities, Primary care trusts, Children's Centre Managers and Practitioners. - Section 02 deals with planning and running a centre, Section 03-10 focus on the delivery of services, Section 11-14 focus on the working with different groups. In brief practice guidance states that local authorities can improvise the Children's Centre functioning using the information and guidance, to suit the local needs. Greater importance should be given to reach the families and homevisiting.Team has to be properly guided how to reach the families who fail to come. Children's centre should offer services which are attractive to parents, but not loose sight of the primary purpose, that is improve life chances of children. Better integrated and joined up working inside the centre and between the centres, sharing of information where families live, improved personalization of services, providing them ways which meet their individual needs, and encourage the families and children to accept the advantages offered by the centres ,all these demand a lot on the team leader. Children's centres will provide in 30% of the most disadvantaged areas 1. Early years provision 2. Child minder network, 3. Parenting education and family support services, 4. Education and Training and Employment services, 5. Health Services, 6. Access to wider services. In areas where only a few deprived families which comes to 40% of the total people, or already better services are available the work of the centre is to provide basic services only without duplicating, and coordinate the work like identify families who need additional support and direct them to the right person, give help for care takers, concentrate on parent education, training, and employment services. In the middle category between the most and least disadvantaged families, services need to be individualized according to the area and personal needs. Children's Centre manager has to keep track which families are utilizing the services. Such data will helpful in assessing performance management. "The core leadership challenge for Children's centres is establishing and managing a multi-agency approach to service delivery."2 Here we discuss on the Team Manager's point of view on leading a team. He is moving a team at present working from private office not attached to GP Surgery, to a Children's Centre which is part of Sure Start Programme.This is totally different consisting of skill mix team working in multi-agency set up. Consisting of Health Visitor Practice Teacher, Health Visitor, Community Nurses and Children Nurse. As a Manager of a Multi Agency Team, my main goal is improving services for children and developments in leadership practice. I will be pioneering a venture which is customer oriented and participating. Much of this involves breaking down boundaries and challenging the status quo. Common challenges met by multi agency team leaders are3 1. Help practitioners understand their new professional role, how to cooperate and coordinate in a group. 2. Manage anxiety of professionals who are anxious that their job is shared by staff who are less qualified 3. Manage the unqualified support staffs who think that their skills are unrecognized by their professionally qualified colleagues. 4. Overcoming cultural and practical barriers to achieve common goals and maximum productivity. 5. The development and delivery of services involving children, young people and families "When people join the team, I have to help them remove their professional badges, and identify as a member of this team, working to a common goal." Manager, BEST. Team Building deals with 1. Identifying team members, 2. Sorting out any work force issues, 3. Managing the change. 1. Identifying Team members Apart from technical proficiency, a variety of social skills are also needed for a successful team work, like 4 1. Listening- to other people's ideas, 2. Questioning- ask questions, interact , and discuss objectives, 3. Persuading- individuals are encouraged to exchange their ideas, defend them, and rethink their ideas. 4. Respect- others and to support their ideas 5 Helping - help one's co workers, 6. Sharing - with team to create an environment of team work, 7. Participating - in the team Bruce Tuckman's "Forming- Storming- Norming- Performing" model of team development is a widely acclaimed one, where team building and leadership development are long goals. Team membership selection is also influenced by National Guidance, like Youth Offending Team (YOTs) which includes representatives from police, social service, health, education, drugs and alcohol misuse service, housing officer. (BEST) Behaviour and Education Support Team includes education, social service, and health staff addressing mental health issues, educational psychology and psychotherapy staff. In line with local audit of needs, the purpose of team and available resources, team leader has to decide the precise balance of skills in the concerned team. Each member will use their own specialty and expertise where appropriate. Team Leader or other staff has to coordinate conditions where, (1) interagency consultation and advice may be needed, (2) the children and young people have multiple additional needs requiring integral support. Sometimes need for secretary and I.T. Support for administrative work also arises. Location - Children's Centre has to be located in the right place, so that Children, young people and families find it easy to reach and use the services. Team with Preventive and Early Interventional services (immunizations) has to work closely with schools. In remote areas or situations where clinic attending is difficult, home visiting has to be arranged. 2. Leader has to manage work force issues- Such as Staff recruitment, sorting out terms and conditions, assist in their retention, and career development. Leader has to feed Team Spirit in the group which can make others forget their differences and help in meeting key challenges. Knowledgeable team members who are sincere, devoted to work, goal oriented and passionate about their success are a boon to the team. Identification of such persons and their retention is important so that they get well knit with the society they are catering and develop a bond. This will bear fruits in the long run. Performance Appraisal is an important issue in multi agency set up. Consistent messages have to be given in the right time about staff performance. Additionally due weightage has to be given to their training, carrier development, and promotion which will work as good incentives for better performance. Motivation for leadership- A successful leader should be all in all. In case of emergency, leader should remove his badge and join with the other staff to tackle the situation .This will instigate Respect, Feeling of security, better personal relations with the leader and between the staff. They should look up to the leader as a role model .All staff members should have the potential to develop leadership skills and given opportunity to influence ,shape redesign services and roles. Health visitor practice teacher will manage skill mix teams, delegate work based on sound clinical assessment and play a vital role in influencing and strengthening leadership in the profession. There should also be a system to handle complaints and carry out disciplinary procedures. 3. Managing Change- Change from a private practice in a small set up and coming to multi agency setting is another real challenge. They will be working with new people, in a new locality, new setting, and in a new way, they will be dealing with children and families. Seven stages of bereavement described by Elizabeth Kabler Ross 1969 -can be applied to situations like this. As a Team Leader it is important to understand these stages, so that staff psychology can be dealt with properly and can help them come out of these stages. They are- 1. Shock - that this is happening, 2. Denial- that this is happening, 3. Frustration- often expressed as anger and outrage, 4. Depression- As anger turns inwards, 5. Experimentation- Exploring possibility of new reality, 6. Decision making- choices are made between options prescribed by the new reality 7. Change is internalized and made sense of. Slowly the player will discover the new realities from their work with children and young people, thus slowly adapt to the change. There are different models of change management 'Kotter Model' used within Every Child Matters: Change for Children Programme.There are 8 critical steps an organization has to go through to see the change happens and sticks. 1. Establish a sense of urgency, 2. Form a powerful and grounding coalition, 3. Create a vision, 4. Communicate a vision, 5. Empower others to act on the vision, 6. Plan and create short term wins, 7. Consolidate improvements and produce still more change, 8. Institutionalize approach. Team Manager has to develop a vision which is realistic and with children centric goal and community targets which is important for integrated working. It unifies people focusing on the need for their presence there, thus helping to inspire and motivate them. Much of the difference in Multi agency setting has been traced back to lack of clarity of vision, and purpose. Each member should be made aware of the vision, discussed and understood. For successfully communicating a vision - "Keep it simple, use metaphors, analogues, and examples, Repeat, repeat, repeat, and work the talk, Explicitly address the appraisal inconsistencies, Listen and be listened to." John Kotter If you cannot communicate the vision in 5 minutes to someone and get a reaction that signifies understanding and interest, then you are not yet done with defining the vision. Purpose of Statement is also important. It describes what your service actually does, and what it is contributing to the health and wellbeing of the community it serves. The purpose of work may be given by the guiding agency or otherwise. Whatever be it, it helps to allocate the work to each individual and this helps in greater accountability to each one's work without any clash of work interests and quick accomplishments of individual targets, thus everybody contributing equally to attain the single goal. Benefits of multi agency setting5 1. Improving outcome for children and families. Primary study revealed, school staff working with child and adolescent mental health service identified that there is an increase in the happiness and wellbeing of children. Improvement in behaviour and interpersonal relationships noted. In disabled children improved quality of life, better relationships with services, better and quicker access to services, and reduced levels of stress, improved access to education, enhanced emotional and social wellbeing relating to confidence and self esteem. In healthcare better patient outcome and lower levels of stress for staff noted. 2. Benefits for staff and services-Practitioners who were working in single traditional setting reported higher level of satisfaction, with this multi agency setting. Once they get adjusted initially, they feel interacting with other specialities stimulating, and take a more holistic approach to the needs of children. Flexibility of work and carrier opportunities are other attractions to the staff. Improvement in staff recruitment and retention decreased workload. On track evaluation of staff gave (NFER2004) Less replication between different service providers Better links between service providers including a greater understanding of their practices. Professional development and carrier progress chance More involvement in community development Improved awareness of different services and changed public perception of service providers. 3. Give families what they want- families of children with additional needs will have to see different agencies and professionals. Often they don't understand the role of these different agencies. They don't know to whom to go or for what. They may get conflicting information. They may be passed from one agency to another. This can produce than alleviate stress, for parents and care takers, which will have an impact on their dealing with children. Families say they want a single point of contact and a trusted named person to coordinate assessments, information sharing. This can ensure quicker access to the right kind of support .Since health visitor is more trusted and easily accessible for families they can play a crucial role in coordinating and directing. Conclusion - Primary health care is going to revolutionize the Health Care arena through skill-mix team working with multi-agency set up. Introduction of voluntary agencies -third party participation is also gaining momentum for better results. This will be a good move if all participants are positive minded. The point to be borne in mind in this set up is if drawback occurs, it should be taken sportively and analyzed so that it is not repeated, rather than restricting to a guilt finding exercise. Thus in nutshell for the transformation to achieve desired results following suggestions may be found useful. Establish a sense of urgency.6 Encourage openness and honesty, Promote the benefits of the change and address 'what is in it for me' Find time and space to deal with the change agenda, Find time for joint training to promote sensitivity to each other and new working practices, Hold frequent and inclusive meeting for all staff, Promote positive working relationships, Get management structures right, Draw on the high level support that exists for the initiative, Leadership can be robust, continuous and determined to ensure that changes are taken seriously and are taking place, Review practice regularly to see changes are sustained, Embedding change means supporting people to do things differently by providing them with tools, training and preparation Middle managers in the contributing agencies should be fully engaged in supporting the development of new procedures and ways of working, Children and Young people should be consulted and involved in the development of new policies, procedures and working practices." 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