Nursing - Critically Reflective Account of a Leadership Issue Pertinent to Your Own Work Role - Research Paper Example

 Nursing — Critically reflective account of a leadership issue pertinent to your own work role Leadership has been an important issue in healthcare organisations for more than a decade, partly because healthcare services across the United Kingdom have been going through a period of intense change. The leadership issue selected for this paper is behaviour and team work. The structure and culture of a healthcare organisation are two major factors that play important role in its success. Whether dealing with individual departments or selecting a suitable leadership style to communicate a change, it is significant to know your audience and be aware of what works best for them. Research supports the concept that there is no one specific method or style that works all the time. Rather, the leader of a healthcare organisation should understand and identify with employees and tailor his or her approach accordingly. Recent reforms have required healthcare organisations to implement new ways of operating and to redefine their purposes, the nature of their work and the relationships between employees. Old-style, top-down bureaucracies are being replaced by organisational structures and cultures in which shared vision, partnerships, patient empowerment, and collaboration across professions and agencies, are emphasised. “Effective clinical leadership is essential in delivering the high-quality, person-centred care envisioned by health minister Lord Darzi in the final report of the NHS Next stage review, High Quality Care for All” (department of health (dh) 2008). Lord Darzi says in his report, that “it is through unlocking talent that we will achieve high quality care across the board”. ‘Unlocking talent’ involves tapping into the leadership abilities and potential of all front line staff to deliver high-quality, safe and efficient care to patients and service users. There are four key ideas that should be understood and explored in the creation of an appropriate workplace for health professionals in the new environment. They are patients, management, staff performance and leadership. The changing requirements and concerns of patients demand that healthcare be delivered in integrated care patterns spreading across some clinical disciplines. (Edmonstone 2005, 10-11) A look into the future of healthcare points clearly toward an integrated approach to the dispensing of health services, from hospital care to health and community agencies. Healthcare in future will be considered from a whole systems approach with appropriate inter-agency partnership to ensure faultless care. The new workplace must allow for project-based teams, with core teams and provisional specialists who move from one core team to another. It should allow professionals to come together and collaborate, creating a sense of connectedness. Networks will be incorporated across organisations and institutions, and employees will need to work more flexibly to meet patients’ needs. There is no doubt that an open environment promotes connectivity among staff. Thus, leaders must be delegated to different levels of staff so that all the needs of the healthcare organisation and its patients are met. (Andersen 2006, 129-136) In various cases, some nurses may not think of themselves as leaders since they equate leadership with authority or with specific job titles rather than as a way of thinking and behaving. Any assumption that everyone with 'leader' in their job title is a leader should be challenged because it implies that those who do not have such titles are not leaders and have no responsibility to lead. Leadership is not just granted to individuals. It is not about responding passively to events. Leadership is about making possibilities that were impossible before. Any nurse can proof that he or she has ability to become a leader. He or she can be a leader by taking responsibility for their leadership action, instead of waiting for others to do so, and by envisioning change and making it happen. The first stage of patient’s care is the main administration of a healthcare organisation, consisting of the leaders of the organisation. These leaders are responsible for the strategic planning essential for a successful healthcare organisation. Some of their major concerns are finances, legal matters, and the overall operation of the organisation. These leaders are not necessarily healthcare professionals. Though, because of this fact, they need to delegate responsibilities to a director of nursing and a chief of medicine, both of whom have medical knowledge. The work delegated to these leaders entails instructing the medical staff in the policies and procedures of patient care. Because of the vast array of patient needs, specialized departments within the organisation are also developed. Departmental leaders are delegated by the administration to handle the issues specific to their departments and report back regarding their progress toward the strategic goals. However, since leaders cannot always be present in a 24-hour facility, the leaders and administration must delegate nursing supervisors and charge nurses to assist in the management of the department. (Brown 2007, 1-7) This level of management, also referred to as frontline management, is responsible for micromanaging the general staff during specific shifts. In fact, this is the stage where leadership abilities are checked. Frontline managers are responsible for the day-to-day affairs that will enable the organisation to meet its strategic goals. The final stage in patient care involves the delegation of responsibility to the nurses’ aides. There are three key areas of leadership: Setting direction — as a leader, one should create a vision of the kind of services he/she wants available for patients and service users, and be able to communicate this vision to inspire and motivate others to work with him/her. Leadership at any level must be based on an understanding of the context in which one works, including the wider political context, and of the relationships he/she must develop to make the vision a reality. Delivering services — delivering services requires the energy to cooperate with each other, including patients and families, to make the vision a reality and empower others to challenge traditional ways of thinking and working. Personal qualities — any complex change requires leaders to draw deeply on their personal qualities to see them through the demands of the job. One key attribute is the determination to overcome obstructions in the pursuit of your vision and to move from small successes to ever bigger ones. Development of behaviours Values and beliefs play important role in making a leader. Behaviours of people are influenced by their values and beliefs. They shape how an individual thinks and sees the world, and the meanings they attribute to their experiences, actions and relationships with others. The values and beliefs of individual nurses can have an effect on patient care in ways that may not be recognised instantaneously. Nurses in general work according to two sets of values: professional values, which are determined by their code of professional conduct, and personal values. If individuals realize their values, they can gain insight into their needs and motivations; if they clarify their values, they may be able to see why problems occur and how to resolve them, which can help to challenge routine approaches to responding to situations and relationships. As chief nursing officer for England dame Chris Beasley says: “We carry our values within us independent of the setting or organisation in which we work” (DH 2006). Strict adherence to values and beliefs is important for the success of a team. For any team to work efficiently, its members should share the same basic values and beliefs. Team members who have even worked together for a long time and are of the view that they know each other very well must not assume that they share entirely the same values, and should spend some time exploring these. There are some values clarification exercises which help team members to share their values and beliefs clearly, and can promote greater understanding between team members. Teams can then develop explicit statements about their common purpose that can be used to strengthen their work. This influential reminder of a team’s values and purpose contributes to a sense of unity, and to what Lord Darzi refers to as a “shared endeavour” in which “all of us matter and stand together” and “every member of the team must be pulling in the same direction” (dh 2008). Nurses can become more powerful by adopting a joined approach and a united voice. This is significant because the nursing profession’s contribution to healthcare and good health outcomes is often underestimated and undervalued in the healthcare literature (Buresh and Gordon 1995, 2000, Kitson 1997, Meier 1999). The role of values and beliefs in leadership Values and beliefs have important effects on leadership abilities. They affect how leaders perform responsibilities and how they respond to challenges. If nurses recognise themselves as lacking in leadership qualities, this is likely to become a self-fulfilling prediction. Self-doubt can hamper their performance (Honey 2000). In an atmosphere of constant change, nurses can choose to be victims who are buffeted around, blown off course or even left stranded, or they can accept that change is a constant and foreseeable phenomenon, and help to set the agenda for change and determine a way forward (Kitson 2005). In a changing healthcare system, nurses should be willing to rise to the challenges of leadership. According to the DH (2008), “where change is led by clinicians, rather than directed from the centre, and based on evidence of improved quality of care, staff … are energised by it and patients and the public are more likely to support it”. There are many potential barriers to leadership action and some of them concern self-belief and can therefore be overcome. Beliefs about leadership can be ‘positive’ or ‘negative’. Positive beliefs imply choices, negative beliefs do not. Nurses who hold negative beliefs about leadership often constrain themselves from succeeding in leadership roles. Positive beliefs, on the other hand, can help nurses fulfil their vision. According to Knight (2002), people who act on positive sets of beliefs usually achieve what they set out to do and get excellence in their field. Successful leaders typically hold positive beliefs about the world, which increase rather than reduce their choices of action. Individuals who think that each person is unique can begin to understand and accept differences in character and behaviour between people, and become more respectful and co-operative. Individuals who do not think the statement risk becoming inflexible, dogmatic and unconcerned. They often become frustrated and stressed, and can generate the same feelings in others. There is a positive purpose behind behaviours. It is often easier to reject people as incompetent, violent or uncooperative, than to explore other explanations for their behaviour that can lead to more productive relationships. Identifying positive intention can help individuals respond positively to such behaviour. The role of Communication In some cases, individuals become frustrated when their intentions are misunderstood, particularly when they thought they are clear. If such individuals regard those who misunderstand them as perverse or stupid, they get nothing. But if they adopt the belief that, in their own actions, they are responsible for the reactions of others, they become liberated. They no longer think that the source of their problems lie in other people, and no longer regard themselves as the sufferers of other people's behaviours. When individuals are misunderstood, then, they should take the opportunity to explain their ideas and to focus on communicating more plainly. By assuming personal responsibility they can empower themselves and forge more constructive relationships with their team members. Leaders should keep in mind that there is always a solution. Adopting this approach can be liberating for those individuals who tend to become weighed down by problems and who focus on how things can go wrong. Such self-limiting beliefs can hamper performance. Empowering beliefs associated with excellence, on the other hand, can help individuals react in authentic ways (Knight 2002), and can open their minds to new and creative ways of thinking (de Bono 1990). Individuals, who act on the belief that there are always solutions, are more likely to find them. For leaders, no problems only challenges Individuals who see problems everywhere have a propensity to feel overwhelmed by them, while those who regard problems as challenges are more likely to be optimistic, and to achieve greater success and happiness. Each challenge suggests the possibility that it will be effectively overcome, and meeting challenges can be exciting. By adopting all or some of the positive beliefs, leaders will find that their relationships with their team members should improve. But beliefs are developed over long periods of time, and patience and determination are required to establish new ones. According to the NHS Confederation (1999), “the leader needs to develop and establish a vision of the future and a strategy to reach it through guidance rather than coercion”. “To build this vision, leaders listen, taking in the knowledge and experience of those around them. They then process this knowledge, using their imagination and judgement to create a realistic plan.” The core vision of a national health service in which “everybody in the country, irrespective of means, age, sex or occupation, shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available” (Ministry of health and department of health for Scotland 1944) has remained at the heart of UK health services over the past 60 years. A 'vision' is an explanation of what might be possible, and the ability to develop a vision is increasingly regarded as vital for effective leadership (Bennis et al 1994). For creating a vision, nurses should not allow their imaginations to be restricted. Moreover, if they hold negative beliefs rather than positive ones, they can stop themselves from achieving what they want. Create a vision is not an easy task. Leaders should undertake this task in a comfortable environment, in which they can spend as long as time they like without being disturbed or distracted. The process of identifying and creating a vision can be demanding because it requires new possibilities to be identified. Leaders who embark on this process are challenging themselves and others to make these possibilities a reality. It is significant to remember that nothing in people’s lives has to continue unless they want it to, and as long as they have the courage to change it. Leaders may find that their vision and work values match those of their organisations and that their jobs offer opportunities to develop the abilities they need to realise their vision. Where this is not the case, individuals must reflect carefully on their next course of action. They may decide to go to other organizations where they can pursue their vision more easily. Otherwise, they may decide to create change in the organisations in which they presently work. Whatever they decide, they will need courage and determination to pursue them. Peter Senge gives a wonderful illustration of leadership: “If the captain says to change course, but no rudder has been designed into the ship, then there can be no change. If an order is given to turn left, but the ship is designed to turn right only, then no amount of effort to change direction will matter” (Smith, 2001, p. 6). In such a case, despite of any efforts to implement change, nothing will happen, as this organisation is designed to resist change. Senge (Smith, 2001) says that there is something called creative tension, which is a source of energy derived from the gap between one’s vision and where it stands in actuality. The gap can push someone forward to get closer to the vision. Though, it might also discourage, leading some people to feelings of nervousness. The leaders should encourage individuals to create their own visions. Even though, these visions are not the shared vision. They are required to make it easier for individuals to accept others’ visions and the vision of their organisation. It is not necessary that the shared vision should be in written form and taught to employees, because this could institute fear. Instead, every person should adopt this vision and commit themselves to the whole vision of the workplace. Collaboration is must Whatever their state of affairs, individuals are unlikely to be able to achieve their vision alone. Although they may be able to start change, they will need others to become involved in its execution and in ensuring its success. This means that they must share their vision with others or, preferably, develop a shared vision. According to Bohm (1996), “if people are to co-operate, they have to be able to create something in common, something that takes shape in their mutual discussions and actions, rather than something that is conveyed from one person who acts as an authority to the others, who act as passive instruments of this authority”. A dialogue with stakeholders is required for developing a shared vision, including colleagues from different professions and backgrounds, patients and service users, to identify the commonalities in their ideals and objectives. Developing a shared vision takes time and effort, and is only achieved when it connects the personal visions of everybody involved. According to Senge (2006): “Listening is often more difficult than talking. It requires extraordinary openness and willingness to entertain a diversity of ideas. This does not imply that we must sacrifice our vision ‘for the larger cause’. Rather, we must allow multiple visions to co-exist, listening for the right course of action that transcends and unifies all our individual visions.” Conclusion Change is not easy in all situations, so employing an efficient strategy to apply major organisational change is critical. Development of the new patient care and delivery area at any healthcare organization would benefit from a participative leadership style. It is ridiculous to refrain from trying something because of the fear of failure. This is not to advocate carelessness or recklessness, but being prepared to learn from mistakes. Adopting this belief can help individuals to grow and develop, and to give and accept constructive feedback. References Andersen, B. and Fagerhaug, T. (2006) Root Cause Analysis: Simplified tools and techniques. 2nd ed. Milwaukee: AQS Quality Press pp.129-136. Bennis W, Parikh J, Lessem r (1994) Beyond Leadership: Balancing economics, ethics and ecology. Blackwell, Oxford. Bohm D. 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