Leadership
Less of a gift than an acquired skill which requires knowledge, communication, and commitment
Process of influencing people so that they will strive willingly and enthusiastically toward the achievement of organizational goals
Using individual traits and
Changes in Health Care Environment
population, chronicity of illness, administrative costs of insurance, technology, gov regulation, new diseases, information management, salaries, % of GNP
Issues in Health Care
Availability and affordability of care, effectiveness/outcomes, regulation, quality and safety, balance of service ethics with business profitability, episodic vs continuum of care, human resources management
Management
1. Planning
2. Organizing
3. Staffing
4. Directing
5. Controlling
Transactional Leadership
Occurs when one person takes the initiative in making contact with others for the purpose of an exchange of valued things
Transformational Leadership
Shapes and elevates the motives, values, and goals of followers through the vital teaching role.
Desired Outcome of Leadership
-Productivity
-Group cohesiveness
-Job satisfaction
Efficiency
Doing things right
Effectiveness
Doing the right things
Managers
-Work inside organizations
-Have legitamate power
-Carry out specific functions
-Focus on control, decision making, results
Leaders
-Can work outside formal organization
-Often without positional power
-Have wider roles
-Focus on process, feedback, empowerment
The hard part
-Management
includes: processes, measurements, tools, structures, procedures
The soft part
-Leadership
includes: resistance, fear, attitude, creativity, buy-in
Management
The act of any individual who guides others through a series of routines, procedures, or practice guidelines
Followership
A complementary set of actions that contribute to problem solving, task attainment, and evaluation with the use of health and assertive behaviors to support those who are leading or managing
Emotional Intelligence
Possession of social skills, interpersonal competence, psychological maturity, and emotional awareness devoted to helping people work well together
-What helps people see others in a positive light.
The 5 domains of Emotional Intelligence
-Having self-awareness
-Managing emotions
-Motivating self
-Being empathetic
-Handling relationships
Trait Leadership Theories
People were BORN leaders
Style Leadership Theories
Focus on what leaders do in relational and contextual terms. Supervisors pursue effective relationships with their subordinates while comprehending the factors in the work environment that influence outcomes
Situational- contingency theories
Leadership effectiveness depends on the relationship among the leaders task at hand, his or her interpersonal skills, and the favorableness of the work situation.
-3 factors: the degree of trust and respect between leaders and followers
-the task structur
Transformational leadership theories
Process where the leader attends to the needs and motives of followers so that the interaction raises each to high levels of motivation and morality.
-The leader is a role model who inspires followers through displayed optimism, provides intellectual stim
Hierarchy of Needs Motivational Theory
-People are motivated by hierarchy of human needs, beginning with physiologic needs and then progressing to safety, social, esteem, and self-actualizing needs.
-Similar to Maslow's Hierarchy of Needs
Two Factor Motivational Theory
Hygiene factors, such as working conditions, salary, status and security motivate workers by meeting safety and security needs and avoiding job dissatisfaction.
-Motivating factors such as achievement, recognition, and the satisfaction of the wrok itself,
Expectancy Motivational Theory
Individual's perceived needs influence their behavior. Motivated behavior is further increased if a positive relationship exists between good performance and outcomes or rewards, particularly when these are valued.
OB modification
An operant approach to organizational behavior. OB modification follows a 3 step ABC model: A- antecedent analysis of clear expectations and baseline data collection. B- behavioral analysis and determination. C- consequence analysis, including reinforceme
Complexity Theory
-Promotes the idea that the world is full of systems that interact and adapt through relationships.
-Nurses must be flexible and dynamic to be in tune with the ever-changing systems of people, health care, public policy, and human relationships.
Gardner's Tasks of Leadership
-Envisioning goals
-Affirming values
-Motivating
-Managing
-Achieving workable unity
-Developing trust
-Explaining
-Serving as a symbol
-Representing the group
-Renewing
Bleich's Tasks of Management
-Identify systems and processes that require responsibility and accountability, and specify who owns the process
-Verify minimum and optimum standards/ specifications and identify roles and individuals responsible to adhere to them.
-Validate the knowledg
Bleich's Tasks of Followership
-Demonstrate individual accountability while working within the context of organizational systems and processes; do not alter the process for personal gain or shortcuts
-Honor and implement care to the standards and specifications required for safe and ac
Covey's Characteristics of Leaders
-Engage in lifelong learning
-Service-oriented
-Concerned with the common good
-Radiate positive energy
-Believe in other people
-Lead balanced lives and see life as an adventure
-Are synergistic, that is, they see things as greater than the sum of the pa
Tips for becoming an effective leader
-Take advantage of leadership opportunities
-Expect to stumble occasionally, but learn from it
-Take risks
What followers want
-Respect
-Control of decisions that affect them
-Rewards and recognition
-Balance of life
-Professional development
Rewards of Transactional
-Motivates through rewards for desired work
-Monitors performance and focuses on problems
-Reactive to problems
Rewards of Transformational
-Challenges the process
-Brings people together
-Empowers others
-Models the way
-Attends to personal things
Effects of Transactional
-Fulfills the contract or gets punished
-Does the work and gets paid
-Errors are connected in a reactive manner
Effects of Transformational
-Shares the vision
-Has increased self-worth
-Challenging and meaningful work
-Coaching and mentoring happen
-Feels valued
Effects of Transactional on Organizational Outcomes
-Work is supervised and completed according to rules
-Deadlines are met
-Limited job satisfaction
-Low to stable level of commitment
Effects of Transformational on Organization Outcomes
-Increased loyalty
-Increased commitment
-Increased job satisfaction
-Increased morale
-Increased performance
Surviving and Thriving as a Leader
-Balance
-Self-motivation
-Self-confidence
-Listening
-Positive Attitude
Role and Function of Management
-Focus on the person to develop strengths and abilities that lead to excellence
-Help the person develop realistic goals
-Foster an environment that promotes goal attainment
Drucker's 5 Management Functions
-Establish objectives and goals
-Organize and analyze
-Foster teamwork
-Evaluate performance of workers
-Develop self and people
Organizational Culture
-Based on the literature of healthcare environments
-Nurse manager should evaluate the work culture and how it can support the workers, taking into account the mission of the unit.
Laschinger's Study
-Structural empowerment
-Respect
-Work pressures
-Emotional exhaustion
-Work effectiveness
How did the decisions empower the staff? Did they affect their empowerment? Did the staff feel more respected as a result of the outcomes? Did the outcomes lessen w
Attributes of leaders and managers
In addition to being emotionally intelligent, effective leaders and managers have these attributes:
-use focused energy and stamina to accomplish a vision
-use critical thinking skills in decision making
-trust personal intuition and then back up intution
How to develop your own leadership style
-Select a mentor--one of most important things to do. Finding someone who is willing and able to be open to help you think through various decisions about your practice and career is important. The person does not have to work in the same area-pros and co
Role theory
-Grounded in management theories that date back to the 1930s. Include participative, humanistic approaches.
-More recently, many managers are utilizing quantum theory because it addresses unstable, unpredictable environments, as are often seen in healthca
Quality of Care and Professionalism
-Vigilance: quality of care
-Role modeling behavior that fosters autonomy, accountability, self regulation for the team
-Humanistic philosophy: reflects regard for self-determination, independence, and choice in decision making prevails for the staff as w
Steps in the risk management process
-Define high risk situations: patient falls
-Determine frequency of falls
-intervene and investigate
-identify opportunities to improve care (use steps of the QI process)
Evolution of quality management (DMAIC)
-Define opportunities-problem
-measure performance-what's happening now?
-analyze opportunity-can we make a difference?
-improve performance-did it help?
-control performance
Principles of QM and QI
-QM is most effective in a flat, democratic organization
-Managers and workers must be committed to GI
-Goal of QM is to improve systems and processes, not to assign blame
-Customers define quality
-QI focuses on outcomes
-Decisions must be based on data
QA process (quality assurance)
-Goal: improve quality
-Focus: discover/correct errors
-Major tasks: inspection of nurse activities; chart audits
-Quality team: QA or department personnel
-Outcomes: set by QA team with input from staff
QI process (quality improvement)
-Goal: improve quality
-Focus: prevent errors
-Major tasks: review nurse activities; innovation; staff development
-Quality team: multidisciplinary team
-Outcomes: set by QI team with input from staff and patients
Steps in the QI process
-Identify needs
-Assemble multidisciplinary team
-Collect data
-Establish outcomes and quality indicators
-Select and implement plan
-Evaluate
First step: Identify need
-Compliance with national safety goals
-Reduction of hospital risk/financial loss
-Reduction in LOS after an adverse fall event
-Improved patient outcomes
Second step: Assemble team
-Nurses
-Physicians
-Unlicensed assistive personnel
-Pharmacists
-Facility/environmental management representatives
-QI/risk management experts
Step three: collect data
-Define incidence of falls
-determine high risk patients: age, mental status, history of falls, medication, physical environment
Step 4: Establish outcomes and indicators
-Education of 100% of all direct care providers
-Completion of fall risk assessment on 100% of patients
-Reduction in patient falls by 25% within 3 months of program
-Medical record demonstrating 100% compliance with fall prevention program
Step 5: Establish fall prevention plan
-Consistent use of ID brachelets based on fall risk assessment score
-Implementation of bed alarms
-Staff education (toileting at risk patients routinely, etc.)
-change of environment (vertical grab bars)
Step 6: evaluation
-change in incidence of falls (through incident reports, sentinel event monitoring)--root cause analysis
-staff compliance with fall prevention plan
-patient/family satisfaction with plan
-reliability and validity of fall risk assessment tool
Standards of care: fall prevention
-Nurse practice acts
-Professional organization guidelines
-Institutional guidelines (polices and procedures, structure/process standards
-Research/evidence-based practice guidelines
-Accreditation standards (JCAHO, national patient safety goals)
National Patient safety goals
-Patient identification
-Communication among caregivers
-high-risk medications
-Infusion pumps (if they're not working correctly, they can cause problems)
-Risk of health care associated infections
-Accurate medication across continuum
-Patient falls
Risk management: malpractice
-Duty: nurse has responsibility to patient
-Dereliction: nurse did not carry out duty
-Damage: patient was injured
-Direct cause: injury secondary to the nurse's failure to carry out duties.
**things that have to be in place for malpractice to happen.
Societal factors influencing the use of research
-Rising cost of health care (aging population, lack of health insurance, etc.
-Quality improvement initiatives (National quality forum, AHRQ, magnet status, etc.
-Pressures to avoid errors
-Research about the costs of not implementing evidence
-Publicity
Research
-Diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge
Types of research designs
-Basic vs. applied: applied research is when we take the basic research and apply it to a problem. Applied is harder
-Qualitative vs. Quantitative
-Cross-sectional vs. longitudinal
-Descriptive vs. experimental: descriptive-listen and try to find trends,
Research application
-Some research is ready for application
-Some research is not yet ready for application
-Readiness for application is not necessarily dependent on the research design
-A single study may provide sufficient evidence for implementation.
Requirements for the development of evidence based practice
-A clearly written clinical question
-More thorough search of the literature
-Review of single studies, meta-analysis, critically appraised topics, systemic reviews and/or clinical guidelines
-Appraising the evidence
-Placing evidence in the context of pa
Reseach utilization
-Use of knowledge from research to make a change in practice
-Example: reading a research report on how to most effectively teach new mothers how to breast-feed.
-Reading a research report on how to most effectively teach new mothers how to breast feed. A
Evidence based practice
-Looking at what is out there, and finding the best evidence possible to describe that situation. Go to the literature. Always include patient's preferences--patient centered.