How Leadership Can Be Pivotal to Creating High-Performance Clinical Teams - Essay Example

How leadership can be pivotal to creating high performance clinical teams Organisations including healthcare settings are structures with a ‘collage’of humans doing their allocated work under the supervision of a leader, for the benefit of the organisation as well as them. These workers will normally be apportioned into different departments for better arrangement or streamlining of work. These workers or employees will be apportioned into different departments or roles according to their educational qualifications, experience, skill, knowledge etc. Then after the recruitment and apportionment is over, it is the duty of the leader and organisation to provide the employees an optimal working environment, in which they will work effectively. Role of a leader From time immemorial, the success or failure of an organisation or any other human activity depends on the role, the leader plays. The leader is the one who can lead humans under him/her to ‘heaven’ or ‘hell’. If the leader follows a set of traits he/ she can ‘sprinkle’ success on many lives, including the workers in his/her organisation as well as other people who are under their care. A leader will normally take over or preside over or manage an existing organisation. That is, the building or recruiting of the ‘group’ of workers as well as the installation of infrastructure, set up etc, would have already taken place, with the leader only leading and managing the organisation and servicing the people or customers. This job of taking an existing set up and managing it, brings in set of challenges, which can be taken care by formulating certain strategies or solutions. That is, challenges can be overcome by the leaders themselves by implementing the various leadership styles according to the situations and needs. Leadership styles and theories Leadership is considered as the art of motivating and leading a specific group of people to function in a certain optimal way, to achieve the set targets. A competent and able leader can actualize an apt working environment for the employees including nurses in a healthcare setting, according to the needs to the situation. Needs of the situation in the sense, in an organisation the situations, targets and even the obstacles will not be the same. Each day organisations including health care organisations would need to set new goals, face new challenges and so initiate new processes. A leader consciously or unconsciously adapts any one of the leadership styles according to the processes or situations. Then with the adapted and relevant leadership style, the leader can adjust the employees to the new processes. Leaders cannot and should not exhibit same leadership style in all the situations. Different situations might necessitate different styles and so the leader like a person having a ‘positive multiple personality’ should adapt and exhibit different leadership styles. Some of the leadership styles that can be adapted by the leader are Autocratic leadership, Transactional leadership, Transformational leadership and Situational leadership. Each leadership style has certain pros and cons, which can ‘aid’ as well as create ‘roadblocks’ to the leader. Autocratic leadership is a type of leadership style in which the leader will exert high levels of influence, power and even pressure on the employees to get the work done. He/she will have maximum control over all of the employees and also over all the processes including the medical as well as social processes that happens inside an organisation. Autocratic leaders will formulate strategies and take decisions on their own, without seeking or accepting any opinions from their subordinates, which could include even their next level management team. Apart from taking decisions unilaterally, they will also strongly impose those decisions on the employees and will push them to reach the goals with a short time frame, expecting quick results. They would not allow any dissenting and opposition on the part of the employees, having strong hold on the employees as well as the processes. Transactional leadership was first propounded by James MacGregor Burns in 1970’s building on the earlier leadership related works by Max Weber. Transactional leadership is a ‘toned down’ style of Autocratic leadership. Transactional leaders instead of forcing will ‘tune’ or even ‘buy’ the employees to obey him/her. That is, this style starts off under the condition that the employees will listen to the leader and obey him/her while undertaking the assigned work and importantly finish the work and achieve the goals within set timeline. For accomplishing the work within the set time, the leader needs to pay the employees extra rewards or could ‘punish’ the employees, if they do not meet the pre-determined high standards of care and even deadline. This type of preset transaction deal between the leader and the employees, gives the tag of Transactional leader. Transformational leadership, considered as an antithesis of Transactional leadership, was also formulated by James MacGregor Burns in late 1970s, when he introduced the Transformational leadership concepts as part of his research on political leaders. Transformational leader is one who will create a positive change in the functioning of the employees and thereby the organisation as well. He/she will positively ‘transform’ the employees to be focused, co-operative and productive. This way, Transformational leader will make the employees focus on the organisational goals, support each other, optimize their physical and mental abilities and energy thereby physically and mentally caring the people. Transformational leaders tend to be a visionary and will have a clear time line to achieve the goals. Focusing on long-term goals and setting a relaxed deadline, they seek to achieve change and transform the organisation, sometimes missing short term targets. Transformational leaders are often charismatic and possess a collection of virtues and competences, including strong self-belief. (Avolio and Yammarino, 2002) Situational Leadership style was first proposed by Ken Blanchard and Paul Herschey in 1969. The main concept behind this leadership style is that leaders should adapt and adjust their leadership style, according to the ability and the dedication of their employees. Although, imposition of leader’s views as a form of common organisational culture is a good leadership style, it cannot be the norm all the times. In organisations new situations and new problems will keep on arising with the employees at the crux, necessitating different strategies from the leader, and importantly different and apt leadership styles. This process of leader selecting an apt leadership style and adapting into his/her functioning constitute Situational leadership. Giving importance to the employees, Situational leader will adapt goals, set flexible timeline according to the employees’ abilities, constantly communicate with the employees and also mentor them when they have certain shortfalls. “I believe leadership is a combination of communication, mentoring, and focusing on the needs of the project or business.” (Kantz) This way, Situational leaders will be able to unite all the employees as a team. Impact of leadership on nursing practice/performance Absenteeism Absenteeism is a major problem many healthcare organisations are facing, and the chief contributing factor for this problem is the drop in the motivation level of the employees including nurses. That is, it is the duty of the organisation and importantly the leader to provide the employees an optimal working environment both in the physical sense as well as in the mental sense. Physical sense means the physical structure of the organisation should not be overtly hierarchical and the situational leader can allow interaction and participation among the employees. The situational leaders will only understand the competencies of the employees and will improve it, when he/she sees potential in some sections of employees, by giving them major roles. This will surely increase the motivation level and thereby will minimize absenteeism. Also, when the situational leader mentally encourages and rewards the performing employees, then also motivation will increase, decreasing absenteeism. That is, situational leader will not follow set pattern to reward the employees, instead he/she will follow and analyze the employees’ performance and will reward them appropriately through promotions or even financial rewards. Sometimes the organisation will not be able to provide a best working environment leading to de-motivation and absenteeism. But, if the leaders follow the situational leadership theory, they can look at the working environment and change what is wrong in it. That is, they will not hold on or justify the failing working environment and instead will focus on changing the working environment, so it suits the mental thought process and the capabilities of the employees, which will surely reduce absenteeism and will improve retention, productivity and profit. Nurse shortages In recent times, a shortage of Nurses is happening, putting the patients as well as organizations in trouble. The research suggests that shortage in nurses are happening due to the diminishing prospects for nursing students including a declining salary (compared to other profession), raise in population in certain states, rise in aging population, etc. If this shortage is allowed to continue, it could surely have a negative effect on the health of the people. “… the crisis in the nursing profession as nurses desert the profession in droves. (Bureau of Labor Education, 2001). As mentioned in the case of absenteeism, staff shortages can be minimized by using rewards as a confidence booster. Allocating rewards and status to the deserving and apt candidates or workers is an important trait the leader should have. In any organisation, the workers will do their duties for personal motivations like salary, looking after their family, etc, however when the salary declines, extra rewards and promotions needed to be given to retain them. Biologically, it is mind of the worker, which will make the worker ‘work’. That is, only if the mind of the worker is filled with positive thought process, it will get motivated and make mental as well physical organs work for the benefit of the organisation. The motivated mind will only ‘configure’ the mind as well as the physical body, to function in an optimum way or even ‘push’ them in a maximum way to derive beneficial outputs for the workers themselves as well as the organisation. According to Maslows Motivation theory which includes the Hierarchy of needs, the humans will be insecure and less motivated to do their work when certain financial needs of them are not met. Rewards and promotions to deserving and ‘success achieved’ workers will motivate them to give better results and motivate others also, to reach that status. So, implementing a logically and ethically correct incentive program is the key to retaining the employees and making them productive Errors in Drug Administration Acquired competency in drug administration is an integral criterion for entry to the professional register. However, it is not a skill that professional nurses reflect on daily, unless a problem arises due to related or potential errors. While, acknowledging that administration of medicines needs attention, Scott (2002) notes that a lack of stringent management on drug policy in recent years has led to a relaxed attitude amongst those nurse professionals who prescribe and administer drugs. This in turn has led to an increase in errors being reported by the Audit Commission (2001). Approximately 1200 people died in 2001 in England and Wales as a result of drug errors, a rise of 500% over the last decade. To promote public confidence, leaders should play a key role in training the nurses and thereby correcting all the potential, near misses and actual errors. Leaders following and actualizing teamwork, consensus decision making, etc can contribute to the reduction in drug errors. Nurses could also prevent errors by using safety checklists formulated by the leader or even by their department leader. Unfortunately, according to the DOH (2000) the NHS is notoriously bad at learning from past mistakes and implementing changes to overcome these errors. A starting point in overcoming this is to examine Lewin’s change theory in order to understand why the nurses resist change and how the leaders or even nurse managers can overcome this by playing an influencing and corrective role in order to develop a more effective and safer NHS for everyone. Effective and successful leaders will always recognize the fact that excess freedom would be a bane to the organisation, so discipline will be implemented thoroughly to correct the errors. And, it is one of the important leadership traits because in some situations and in some departments, discipline was essential to getting things, done. So, the common acknowledged concept is, the leader should function as a brilliant, demanding, but supportive and charismatic father figure among the nurses. That is, the nurses should be given the space and freedom to think and act in a way that could benefit the patients as well as the healthcare settings, but at the same time should be controlled and disciplined by the leader, if that thought process and action is detrimental to the organisation as well as its common organisational culture. Some of the mechanisms that leaders use to communicate their beliefs, values, and assumptions are conscious, deliberate actions. Lewin (1951, in Murphy, 2006) talks of change in relation to three stages unfreezing, moving and refreezing. The unfreezing stage is the stage at which the nursing staff would have recognised a need for change, such as the dissatisfaction with the level of distractions on the ward during drug rounds, and the rate of medication errors and begun to develop the motivation to change the status quo. High performance can be achieved by leaders forming effective clinical teams In any healthcare organizations, successful clinical teams can be successfully set or established, if the leader put his/her thoughts, strategies and also the organisational goals for discussion among the workers. This way the workers as a form of work teams can be involved productively. That is, the workers can input their gained knowledge and experience in the decision making process. This strategy will have unexpected at the same time favourable results, because one may never know from where, when and importantly from whom a great idea could come. Lewin’s change theory (1951, in Murphy, 2006) suggests a bottom up approach, emphasising the necessity of the full participation and involvement of all staff that will be potentially affected by change, in order to increase their likelihood of accepting the change. So, involving and allowing workers to play a part as clinical teams will yield optimum results. So, if this requirement is fulfilled, successful clinical teams can be established successfully by involving employees in the appropriate stages. Clinical teams cannot be established when the workers including nurses show non-committal attitude towards the decision making process. That is, when the workers become lethargic, self-seeking troublemakers, having many bad attributes, he/she would not participate in the decision making process with full interest as a team, and will avoid contributing ideas to the process. Actually these types of employees could be the obstacles in the establishment of clinical teams. In those cases, it would be better if the leaders show his/her authority and weeds out these individuals. This way, the organisation could be placed on the path of success. ” Executives owe it to the organisation and to their fellow workers not to tolerate non performing individuals in important jobs” (Drucker). The other requirement on the part of the leader which leads to the establishment of clinical teams is that, the leader should live and work as a role model or example for others to follow. That is, they should lead the way for others to follow as a team. This aspect is one of the important traits for the leader to imbibe because it will motivate all the workers to give cent percent as a team and thereby aid the organisation to achieve optimum success. The leaders’ role will normally be visible in all the aspects of an organisation’s functioning. That is, his / hers ‘touch’ both mental and physical will be found in all aspects of an organisation, which will motivate, guide and importantly unite the workers working under them. “Good management consists in showing average people how to do the work of superior people” (Rockefeller, 2001) So, setting good examples will make the majority of the workers follow the leader in every aspect, thereby uniting as teams. Successful clinical teams can also be established if the leader leads the way and imposes his/hers assumption in the work environment among his/hers co-workers, subordinates, etc thereby create an effective work culture. As leaders are the men/women in lead, they usually have a major impact on how the group under them initially defines and sets into a team. They will, therefore, be quite comfortable in imposing those personal cultures, on their co-workers including nurses to form a work culture that will give maximum benefits. This imposition of leader’s assumptions, as a form of good culture will actualize the workers into teams because the workers will stick to the culture created, without deviating from it. So, building effective clinical team is ultimately a matter of meshing the different workers, and the leader should do this job by encouraging the evolution of common goals, common language, and common procedures for solving problems. Actualization of clinical teams will not work, when certain senior employees act in a negative way. That is, as these experienced workers will be slugging out in the same job, importantly in the same mindset for years, changing them to accept the new culture will be difficult. In the organisations, there will be workers working ‘independently’ until their retirement age with a lot of job safety, so when a new leader enters and ask them to work as teams; it will not elicit favorable response. This superior attitude will impede the process of team formation. That is, when the experienced hands show superior attitude and function independently, it will difficult to form work teams. However, with strong actions and also by productively involving them by giving a lot of responsibility, their separate and unconnected ways can be curtailed, leading to clinical team formation. References Avolio, B.J., Yammarino, F.J. (2002). Transformational and Charismatic leadership: The Road Ahead. Oxford, UK: Elsevier Science. Bureau of Labor Education. (2001). The U. S. Health Care System: Best in the world or just the most expensive? University of Maine. Retrieved November 18, 2009 from http://dll.umaine.edu/ble/U.S.%20HCweb.pdf Department of Health (DOH). (2004). Building a Safer NHS for Patients: Improving Medication Safety. London: Department of Health. Drucker, P. Leadership. Retrieved November 18, 2009 from http://photos.state.gov/libraries/newzealand/19965/eSpotlite/ESpotlite- Leadership2007.pdf. Kantz, L. Leadership Skills. Retrieved November 18, 2009 from http://www.leekantz.com/leadership.html Lewin, K. (1951). Field Theory in the Social Sciences. New York: Harper & Row, cited in MURPHY, F. (2006) Using change in nursing practice: a case study approach. Journal of Nursing Management, 13(2), 22-25 Rockefeller, J. D. (2001). Church Champions Update, Mar 13 Scott, L. (2006) Effects of critical care nurses work hours on vigilance and patients safety. American Journal of Critical Care. 15(1): 30-7. Read More