Clinical Leadership and Change Management - Essay Example

?Definition Leadership encompasses so many diverse qualities and angles that defining it in just one way is quite an impossible task. The concept remains elusive even when efforts are made to define it in various ways (Barr and Dowding, 2012, p. 6). However, various definitions of leadership, covering different important aspects, have been offered. According to Rafferty, leadership is that notion in which the “vision is driven from an emotional front with some practical ability to achieve that vision” (1993, cited in Barr and Dowding, 2012, p. 6). Rafferty believes that leaders are those people who inspire others and trust in their integrity (1993, cited Barr and Dowding, 2012, p. 6). Leaders try to strengthen, promote, facilitate, help, encourage and praise the people they are leading or serving (Barr and Dowding, 2012, p. 6). By doing this, they gain the trust of their followers (Barr and Dowding, 2012, p. 6). In this way, Rafferty defines the leadership by focusing on the people oriented aspects of the leaders. On the other hand, Bernhard and Walsh define leadership as a ‘process’ in which the leaders facilitate the goal setting and goal achievement by encouraging and moving a group towards it (1995, cited in Barr and Dowding, 2012, p. 6). Stewart defines leadership as “discovering the way ahead and encouraging and inspiring others to follow” (1996, cited in Barr and Dowding, 2012, p. 6). Stewart agrees that “spirit, personality and vision” are the qualities that are involved in leadership (1996, cited in Barr and Dowding, 2012, p. 7). In nutshell, leadership can be defined as “showing the way and helping or inducing others to pursue it” (Gill, 2011, p. 9). This shows that “envisioning a desirable future, promoting clear purpose and mission, supportive values and intelligent strategies” among the followers, forms the essence of the leadership (Gill, 2011, p. 9). As achievement of desirable future is not possible without the help of the followers, empowering them and engaging all those concerned is an essential aspect of leadership (Gill, 2011, p. 9). In this way, focus on different aspects of leadership has led to creation of various definitions of leadership. Similarly, when leadership in healthcare organisations is considered, then health care related aspects come into focus. A relevantly recent term called ‘clinical leadership,’ is used to describe the leadership in healthcare system (Barr and Dowding, 2012, p. 7). According to Millward and Bryan (2005), and Stanley and Sherratt (2010), clinical leadership involves “facilitating evidence-based practice and improved outcomes through local care” (cited in Barr and Dowding, 2012, p. 6). This shows that when it comes to considering leadership in the healthcare scenario, then the focus also involves care of the patients. It is expected that leadership in the hospitals must be the part of caring (Barr and Dowding, 2012, p. 6). This is because the clinical beliefs, values and behaviours are influenced by how one views leadership (Barr and Dowding, 2012, p. 6). However, for fostering positive and effective leadership in healthcare, it is important to know in what way it is different from management, Leadership and management The distinction between the concepts of ‘leadership’ and ‘management’ appears to be unclear (Barr and Dowding, 2012, p. 8). The lack of clarity between the differences in ‘leadership’ and ‘management,’ has led people to use these terms interchangeably (Barr and Dowding, 2012, p. 8). However, even though it is not easy to form a clear distinction between leadership and management, there are some aspects associated with these terms that make it possible to differentiate between them clearly. Managers are believed to focus on short term goals, and hence, control and maintain processes accordingly (Marshall, 2011, p. 6). Managers rely on authority as they have to achieve results quickly and minimise the risk (Marshall, 2011, p. 6). On the other hand, leaders maximise opportunity as they are visionary, insightful and influential (Marshall, 2011, p. 6). To be a good leader, one does not need to be a good manager (Barr and Dowding, 2012, p. 8). However, to be an effective manager, one has to be an effective leader (Barr and Dowding, 2012, p. 8). Unfortunately, the distinctions between the managers and leaders, made by some writers, portray the managers in poor light compared to the leaders, as managers are shown as undesirable and leaders are shown as better in all situations (Marshall, 2011, p. 6). This is usually evident in the writings which are extremely enthusiastic in promoting the charismatic transformation al leadership (Marshall, 2011, p. 6). However, when leadership is considered in scenario of healthcare, then one realises that qualities of both, the managers and the leaders, are equally important for success of the healthcare organisations. Achieving the organisational goals in effective and efficient way is the responsibility of the management (Barr and Dowding, 2012, p. 10). Hence, controlling important aspects of organisation like planning, vision, staffing, direction and resources, comes under the management responsibility (Barr and Dowding, 2012, p. 10). This shows that managers are an important part of an organisation. It should be remembered that in order to achieve a common aim of effective quality patient care, management and leadership needs to work together (Barr and Dowding, 2012, p. 10). Hence, the reality is that the wisdom to develop and use the qualities of both, the manager and the leader, in different situations, is needed by anyone who is in charge of a group of people working towards achieving the common goals effectively (Marshall, 2011, p. 6). Millward and Bryan have pointed out that if a real difference in the care delivery process is to be made, then in the healthcare sector, “the clinical leadership must involve a judicious blend of effective management in the conventional sense with skill in transformational change” (2005, cited in Marshall, 2011, p. 6). This shows that for effective leadership, the characteristics of both, the manager and the leader, are equally needed (Marshall, 2011, p. 6). At the same time, it is important to note that as leadership is an informal role and is based on sharing, it should be a “part of every health care professional’s responsibility” (Barr and Dowding, 2012, p. 9). Hence, practicing a positive and healthy leadership style is essential to gain respect from followers. Leadership styles The lack of clarity about what leadership actually means has made it difficult to know the effective leadership traits (Gill, 2011, p. 71). Hence, to identify and understand the traits of effective leaders, the focus of attention was shifted from “who the effective leaders are” to “what the effective leaders do” (Gill, 2011, p. 71). This shift in focus led to the study of what different leaders do to achieve their goals, i.e. what style do they adopt while leading people. According to Bass and colleagues, there are five styles of leadership (cited in Gill, 2011, p. 73). They are discussed below. 1) Directive: In this style of leadership, leaders initiate action by telling the subordinates what to do, how to do it, the expected results under the standards specified by him and the deadline set by him (Gill, 2011, p. 73). Leaders with this style ensure that rules are being followed diligently and people are working in the way he has asked them to work (Gill, 2011, p. 73). He also ensures that subordinates are delegating the work in order to balance the workload (Gill, 2011, p. 73). 2) Consultative: Leaders with this style discuss the matters with the subordinates, and listen to their opinions, feelings, ideas and suggestions, before telling them what to do (Gill, 2011, p. 73). 3) Participative: To reach a consensus on what to do and how to do it, leader with this style discusses and analyses the problems with his subordinates (Gill, 2011, p. 73). Subordinates have as much responsibility and participation in the decisions as the leader, as it is the group as a whole who takes the decisions and not just the leader (Gill, 2011, p. 73). 4) Negotiative: In order to achieve desired results, leader with this style employs political means and bargains, makes political alliances, promises rewards to subordinates if they meet expectations, releases information that suits his interest, ‘bends’ the rules, maintains social distance, encourages competition between subordinates and sells his decisions to them (Gill, 2011, p. 73). 5) Delegative: Leader with this style leaves it to the subordinates to decide what to do and how to do things after describing the problem or the need to them, giving suggestions and telling them about the conditions that have to be met (Gill, 2011, p. 73). The work environment is greatly influenced by the person’s leadership style (Barr and Dowding, 2012, p. 58). For many years, it was believed that there was a consistency in dominant style employed by the leaders (Barr and Dowding, 2012, p. 58).. It was felt that democratic leadership was most acceptable by the subordinates (Barr and Dowding, 2012, p. 58). That is, the consultative and participative styles were thought to be accepted more than directive or negotiative styles (Gill, 2011, p. 73). However, researches have revealed that there is a lot of inconsistency in the effectiveness of different leadership styles (Gill, 2011, p. 73). It was found that in order to handle new situations effectively, leaders move dynamically between styles, leaving aside their dominant style for a time being (Barr and Dowding, 2012, p. 58). Although a leadership style, which is people or relationship oriented, is often associated with improvements in results, no one style has been found to be consistent in producing results (Gill, 2011, p. 73). It has been found that as external factors affect the impact of leadership style, it is difficult to identify, and study the style in isolation (Gill, 2011, p. 73). However, one should remember that as people oriented leadership styles lead to improvement, it should be a dominant style for a person who aims to be an effective leader. Characteristics of effective leaders Effective leadership in healthcare sector is an essential aspect of achieving the healthcare goals set by the government. According to the ‘NHS Improvement plan,’ the vision is creating an NHS “which is fair to all of us and personal to each of us by offering everyone the same access to, and the power to choose from, a wide range of services of high quality, based on clinical need, not ability to pay” (DH 2004, cited in Jumaa, 2005, p.33). This vision proves that the characteristics of an effective leader in pre-hospital care involve adhering to this vision and working towards its achievement. Moreover, the leader should have humanistic approach towards care services because one of the main aims of the Government is to provide “a national health service ‘and’ a personal health service for every patient in England” (Jumaa, 2005, p.33). In order to achieve this goal, the leader should ensure that the patient always comes first in the services that he and his team is providing, by implementing the humanistic approach in services (Jumaa, 2005, p.33). The characteristics that define the transformational leaders are totally in sync with the desired characteristics of an effective leader. Effective leaders have the inspirational characteristics that drive their team members to work effectively. Effective leaders set extraordinary goals and inspire others to achieve them (Marshall, 2011, p.3). Effective leaders encourage the participation of others, and they engage, raise and inspire each other while working towards the goals (Marshall, 2011, p.3). Leaders having these qualities are known as transformational leaders. Effective leaders are role models for trust as they are charismatic, visionary, inspiring and dependable (Marshall, 2011, p.3). Study by Bowles and Bowles has revealed that for a decade, transformational leadership has been promoted by nurses in practice (2000, cited in Marshall, 2011, p.3). Studies by Naylor (2006) and McHugh et al. (2007) have revealed that despite of having leadership qualities, many doctors fail to become effective leaders as they lack sufficient emotional intelligence (cited in Parkin, 2009, p.86). This shows that in the nursing and healthcare sector, effective leaders are those who give as much importance to the emotional and spiritual aspects of the patients, as they give to the physical and mental aspects (Marshall, 2011, p.3). The effective leaders make sure that the decision making is being driven by the views and needs of the patients (Wilson, 2013). This also means that effective leaders admit when they realise that they have made mistake (Kilroy, 2013). They take responsibility for their mistakes and take immediate steps to correct it. Moreover, effective leaders have the ability to look at old problems in new ways, challenge boundaries, encourage creativity, and to go beyond the clinical practice while finding a solutions to the problems (Marshall, 2011, p.5). Effective leaders are characterised by their risk taking and fearless attitude (Marshall, 2011, p5). They know how to look beyond self and see the larger picture of the situation (Marshall, 2011, p.5). This makes them humanistic in their approach, and hence, successful in gaining trust and faith of both, the team members and the patients. For being an effective leader in healthcare sector, one has to create unity within entire team, and create a culture of sharing and celebration by recognising and promoting other people’s contribution in achievement of goals (Marshall, 2011, p.5). These characteristics not only help a person to become an effective leader but also promote a healthy and positive environment in hospitals and clinics, which is extremely helpful in increasing the chances of improvement in patients’ health. At the same time, effective leaders are those who are excellent in managing change. Change management Warren Bennis has said that the only thing that is constant is ‘change’ (cited in Gill, 2011, p. 24). In today’s fast paced world, change has become a common phenomenon. Hence, the organisations, industries and societies need to change, and keep changing, to meet the challenges in the future (Gill, 2011, p. 19). However, change is unpredictable in nature. “Change may be planned, proactive and about creating the future” or it may be “unplanned, reactive and about adaptation” (Gill, 2011, p. 19). This uncertain nature of change makes it a challenge. In such a scenario, how the organisation deals with the change depends on the leader of the organisation. According to Warren Bennis, leaders have to “create an environment that embraces change, not as a threat but as an opportunity” (cited in Gill, 2011, p. 19). Previously, responding positively to the need for change used to be a challenge (Gill, 2011, p. 19). However, now “it is a need to actively ‘create’ a change” (Gill, 2011, p. 19). In fact, nowadays change is being considered so important that it is being considered an important trait of leadership. This shows that the role of a leader in change management is to bring change in the organisation that brings about a positive transformation. Sadly, change is not accepted that easily by people. It has been found that at work, it is change, and not money, that generates the most negative reaction in people (Gill, 2011, p. 20). There are various reasons for which people resist change but most common have been found to be lack of trust and lack of respect for person promoting change (Gill, 2011, p. 20). In such case, leader plays an essential role as he can ensure people about the results and the benefits of change, and can gain their trust and respect (Gill, 2011, p. 20). Providing flexibility in the creation of new relationships, roles and expectations, where none may have existed, is the role of the leader (Foster, Goertzen, Nollette, C. and Nollette, F., 2013, p. 89). According to James O’Toole, an effective leader must “adopt the unnatural behaviour of ‘always’ leading by the pull of inspiring values” (Gill, 2011, p. 20). By adopting a selfless and democratic attitude with the team, a leader can play a role of initiator of positive change in the organisation (Gill, 2011, p. 20). A leader can find new and better ways of motivating people to meet the challenge of resistance to change (Gill, 2011, p. 23). It has been found that healthcare organisations can not only save time and money, but also improve patient experience, by introducing simple changes in hospital procedures (Penlington and Marshall, 2013) The leader can make people accept change by finding effective methods to satisfy their needs and expectations, and by winning their hearts and minds (Gill, 2011, p. 23). According to John Kotter, there are other ways a leader can manage change effectively (cited in Gill, 2011, p. 23). For example, a leader can manage change by creating the guiding coalition, developing vision and strategy, communicating the change and its importance to the employees, empowering people for action, generating short-term wins, embedding the new approaches in culture etc (Gill, 2011, p. 23). In this way, leader plays an essential role of preventing people from resisting change by harmonizing them with change with the help of creative strategies and communication skills. Only an effective leader can empower his people to adapt to change positively, and to embrace it happily. However, for that he needs to have excellent communication skills. Demonstrating communication skills According to Dimbleby and Burton, communication skill can be defined as “an ability to use means of communication effectively, with regards to the needs of those involved” (1985, cited in Dickson, Hargie and Morrow, 1997, p.16). Communication helps in clarifying various points and ideas which may be misunderstood if there is a lack of communication between team members. It is a quality of a competent leader to listen to others and understand their perspective on certain issue (NHS Leadership academy, n.d.). Communication with colleagues can be made effective with the help of listening skills and by ‘putting self in other’s shoes.’ In order to build trust and harmony with colleagues, it is important to empathise with them, and take their needs and feelings into consideration while communicating with them (NHS Leadership academy, n.d.). This enhances the feeling of openness and trust between people. Acting as a positive role model, and communicating effectively with both, the individuals and the group, is highly important if one aims to achieve a desired result through communication (NHS Leadership academy, n.d.). These effective communication skills can help a person in gaining and maintaining the trust and support of colleagues (NHS Leadership academy, n.d.). Moreover, positive communication strategies like regular team meetings are found to be effective in bringing improvement in the quality of care, clear understanding of job roles of others and promotion of positive teamwork (Sapon, 2009). In order to bring desired results, communication with colleagues has to be goal directed, should display synchronisation between verbal and non-verbal language, and should be appropriate in nature (Dickson, Hargie and Morrow, 1997, p.16). When these communication skills are used effectively with colleagues, then the purpose of communication is achieved easily. Moreover, communication skills can also help the leaders in promoting teamwork. Teamwork There are various ways in which a leader can promote teamwork. When the identity, objectives, roles of team members and inter-team processes are communicated clearly to the team by the leader, then the team works effectively (Markiewicz and West, 2011, p. 16).This is because the clarity about what is expected from them and their role in the teamwork makes it easy for the team members to handle their own responsibilities. If the guidance is unclear and the roles are not known properly, then the team may experience confusion, conflict and failure in achievement of goals. It has been found that when a team has a strong identity, then the members feel safe and do their best as they feel supported (Markiewicz and West, 2011, p. 15). Also, clarity about team identity provides purpose and direction to the team members, and this reduces absenteeism, increases work motivation and produces high quality work performance (Markiewicz and West, 2011, p. 15). Hence, by developing a strong team identity which is related to the organisation’s overall purpose, and communicating it clearly to the team members, the leader can promote effective teamwork (Markiewicz and West, 2011, p. 15). Moreover, for promoting teamwork in healthcare sector, the leader should also be able to identify the learning needs of the team. This is because identifying the learning needs can enable team members to take training in those areas and increase their efficiency in that particular area of work (Rigolosi, 2013, p. 298). This enhances the teamwork as the team members become more confident and efficient in handling their job responsibilities. The notion of shared purpose, i.e. working together to achieve a common goal or purpose, is a defining feature of teams at work (Markiewicz and West, 2011, p. 15). Research has found that the level of job satisfaction depends on the clarity about the objectives of team (Markiewicz and West, 2011, p. 15). Leader can enhance the quality of teamwork by defining clearly the objectives of the team. Research by West et al. has found that in the healthcare organisations, “clarity of leadership is correlated with the amount of effective team working, levels of stress amongst team members and with levels of team innovations” (2003, cited in Markiewicz and West, 2011, p. 18). This shows that in order to promote teamwork, a leader should regularly discuss and review his role in the teamwork with the team members (Markiewicz and West, 2011, p. 18). At the same time, to foster teamwork, a leader should display the attitude of willingness and ability to perform with the team (Rigolosi, 2013, p. 158). This increases the chances of a leader to gain respect and trust from team members as they realise his potential and abilities. The clinical team leadership can be effective when the team knows who its leader is, and what his role is (Markiewicz and West, 2011, p. 18). This shows that it is highly important for a leader to practice effective communication skills while promoting teamwork. A leader should be able to communicate effectively with the team members as “communication is the bridge on which the teamwork connects” (Rigolosi, 2013, p. 158). In this way, by adopting different effective methods, a leader can promote teamwork. However, to promote teamwork, the leader should also be able to manage conflict. Causes of conflict There can be various causes of conflict in team. It has been observed that in healthcare organisations, lack of proper communication is a common cause that leads to different kinds of conflicts (Rigolosi, 2013, p. 203). According to Edmunds, there are nine general factors “that account for all possible causes” of conflict (1979, cited in Rigolosi, 2013, p. 203). First cause is ‘specialization,’ which results in groups assuming responsibility for set of tasks without consulting other groups (Rigolosi, 2013, p. 203). This results in inter-group conflict (Rigolosi, 2013, p. 203). Second cause of conflict is ‘multitasking’ by one person which results in conflict due to different tasks requiring different orientation (Rigolosi, 2013, p. 203). The third cause of conflict is ‘role interdependence,’ where a nurse experiences increase in complicated responsibilities due to shift from private practice to multidisciplinary health care team (Rigolosi, 2013, p. 203). The fourth cause is ‘task blurring,’ which results from ambiguity in role and failure in designating one individual or group with certain responsibility (Rigolosi, 2013, p. 203). The fifth cause of conflict is ‘differentiation,’ where the conflict arises in problems-solving and decision making as a group of people have different attitude, emotional and cognitive behaviour towards the same role (Rigolosi, 2013, p. 203). The sixth cause of conflict is ‘scarcity of resources,’ which results in interperson and intergroup conflict (Rigolosi, 2013, p. 203). The seventh cause is ‘change’, while the eighth cause of conflict is ‘unequal rewards’ (Rigolosi, 2013, p. 203). The ninth cause of conflict is ‘communication problem,’ which leads to conflict due to cultural misunderstandings, miscommunication, use of wrong communication channels, ambiguity of job roles etc (Rigolosi, 2013, p. 203). The conflict can be resolved if the leader knows how to manage it effectively. Conflict management The effective leaders are those who can manage the conflict without causing any harm to the sentiments of people involved in the conflict. Fisher, Ury and Patton have identified various techniques through which a conflict resolution can be achieved (1991, cited in Runde and Flanagan, 2013, p. 170). One of their important techniques is to separate the problem from the people involved in conflict (Runde and Flanagan, 2013, p. 170). Parties involved in the conflict are never the focus of conflict competent leaders (Runde and Flanagan, 2013, p. 170). Instead of focusing on the people involved in conflict, an effective leader focuses on defining and analysing the problem (Runde and Flanagan, 2013, p. 170). In this way, he not only embraces the conflict but also protects the relationships with the people involved in the conflict (Runde and Flanagan, 2013, p. 170). The second important technique is to focus not on the positions of the parties involved in conflict, but on their interests while analysing the conflict (Runde and Flanagan, 2013, p. 170). Leaders can discover what is behind the positions of conflict parties by clearly understanding what they really desire (Runde and Flanagan, 2013, p. 170). According to Deutsch and Coleman, when a constructive method is used for conflict management, the collaborative skills come into picture (2000, cited in Runde and Flanagan, 2013, p. 173). By listening to, other’s ideas, and by focusing firmly on best outcomes rather than on winning, a leader can contribute positively in resolving conflict (Runde and Flanagan, 2013, p. 170). Such insight and analysis makes the leader capable of embracing and managing conflicts effectively in the future as it enables him to separate people from problem, and to focus on people’s interests (Runde and Flanagan, 2013, p. 170). Hence, by handling the conflict situation in unbiased, selfless and mature way, a leader can resolve and manage the conflict in team effectively. Reference List Barr, J. and Dowding, L., 2012, Leadership in health care. 2nd ed. London: Sage Publication Ltd. Dickson, D., Hargie, O. and Morrow, N., 1997. Communication skills training for health professionals. 2nd ed. Cheltenham: Nelson Thornes Ltd. Foster, D.T., Goertzen, B.J., Nollette, C. and Nollette, F.P. 2013., Emergency services leadership. Burlington: Jones and Bartlett Learning. Gill. R., 2011. Theory and practice of leadership. 2nd ed. London: Sage Publication Ltd. Jumaa, M., n.d. What is effective healthcare leadership? A case study of the NHS in England. In M. Jasper and M. Jumaa, eds. 2005. Effective healthcare leadership. Oxford : Blackwell Publishing Ltd. Ch.3. Kilroy, D., 2013. Good clinical leadership can fix urgent care. [online] Available at: Markiewicz, L. and West, M. Leading groups and teams. In T. Swanwick, and J.McKimm, eds. ABC of clinical leadership. 2011.Oxford : Blackwell Publishing Ltd, pp.14-18. Marshall, E.S., 2011. Transformational leadership in nursing: From expert clinician to influential leader. New York: Springer Publishing Company, L.L.C. NHS Leadership academy, n.d. Building and maintaining relationships. [online] Available at: Parkin, P. 2009., Managing Change in Healthcare: Using Action Research. London: Sage Publication Ltd. Penlington, C. and Marshall, P., 2013. Why junior doctors are innovation leaders. [online] Available at:< http://www.hsj.co.uk/leadership/why-junior-doctors-are-innovation-leaders/5060206.article?blocktitle=Resource-centre-archive&contentID=9251> Rigolosi, E., 2013. Management and leadership in nursing and health care. 3rd ed. New York: Springer Publishing Company, L.L.C. Runde, C.E. and Flanagan, T.A., 2013. Becoming a conflict competent leader: How you and your organization can manage conflict effectively. 2nd ed. San Francisco: John Wiley & Sons, Inc. Sapon, A., 2009. Daily team meeting- Maximising communication and improving patient flow. [online] Available at: Wilson, K., 2013. How to be an effective clinical leader. 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