Leadership in Health and Social Care - Essay Example

The Importance of Good Leadership in Health and Social Care for Elderly Patients Total Number of Words: 3,202 Table of Contents I. Introduction ………………………………………………………………. 3 II. Definition of Terms ……………………………………………………... 5 III. The Main Function of the Health and Social Care ……………..…… 5 IV. Existing Health Legislation and Standards in Hong Kong’s Health and Social Care ………………………………………………… 6 V. Leadership Issue in Context …………………………………………… 7 VI. Analysis of the Situation ………………………………………………... 9 VII. Discussion ………………………………………………………………… 12 VIII. Conclusion ………………………………………………………………… 14 IX. Reflective Summary ……………………………………………………… 15 References ……………………………………………………………………. 16 – 19 Introduction Over the past few years, it has been noted that Hong Kong is experiencing a rapid demographic ageing (Chan & Pang, 2007). Therefore, most of the public and private health care sector in Hong Kong immediately responded to the sudden increase in the elderly population by increasing the number of residential aged care. As a result of trying to narrow down the gap between the supply and demand of health care facilities and services, the Health and Social Care (H&SC) for older people is facing a lot of problems when it comes to the standardization, provision and inspection of appropriate and coordinated care for the elderly people (Bartlett & Phillips, 1995). For instance, the health care services related to health promotion, health prevention and rehabilitative care being extended to elderly patients in private residential aged care function badly because of integration problem. Based on the actual experience of health care services in England suggests that the lack of integrated care between the health and social care services for the elderly individuals often arises due to poor communication among the health care professionals (England & Lester, 2005). Likewise, the ineffective leadership approach or inability of the health care managers to delegate and integrate tasks and responsibilities among the members of H&SC services is also a common factor that causes integration problems (Jasper & Jumaa, 2008; Thomas & While, 2007). Leadership is important primarily because of its role in terms of defining the character, values, and direction a health organization is heading. (Mastura, 2008) In the absence of having a good leadership approach, the managers of H&SC organization would unlikely meet the organizational goal or increase the organizational performance by motivating the health care professionals to work towards one goal. I have intentionally selected this topic because of the serious need for Hong Kong’s Department of Health to standardize the H&SC services that is being extended to the elderly patients that are admitted in the private residential aged care. As a student nurse, part of my duty is to provide a holistic care to patients. Since it has always been my passion to render my service to the elderly individuals, it is crucial for me to be knowledgeable and be capable of applying some strategic ways on how to properly use a good leadership approach in my profession. To give the readers a better understanding subject matter, definition of terms and the main function of the H&SC will be briefly tackled. Eventually, the existing health legislation and standards in Hong Kong’s H&SC situation in Hong Kong including some of the strategic ways used to improve the quality of H&SC services rendered to the elderly patients will be thoroughly discussed. As part of analyzing the H&SC situation in Hong Kong, significant contribution of having good leadership skills over the success of integrating the role and responsibilities of the H&SC services will be elaborated. Likewise, ways in which a good leadership could minimize and lessen the number of medical errors and incidence of preventable deaths and the differences between transactional and transformational leadership style will be tackled. Definition of Terms Allied Health – “healthcare practitioners with formal education and clinical training who are credentialed through certification, registration, and/or licensure; collaborate with physicians and other members of the health care team to deliver high quality patient care services for identification, prevention, and treatment of diseases, disabilities, and disorders.” (Health Professions Network, 2008) Health Care Services – provision of primary and secondary care like health prevention, treatment for illness, mental retardation or physical injury and matters related to maternity and fertility problems. (Department of Health, 2008) Private Residential Aged Care – a private health care home exclusively designed for the elderly patients who could not afford the high costs of long-term hospitalization. Public Residential Aged Care – government funded residential homes. (Bartlett & Phillips, 1995) Social Care Services – services related to care homes, care rendered in patient’s own home (domiciliary care), specialist services, and the provision of meals for the disabled people. (Comission for Social Care Inspection, 2008) The Main Function of the Health and Social Care (H&SC) H&SC is focused on improving the standards and quality of care for the elderly patients by strengthening the provision of physical care standards, the quality of care and life indicators, the control on financial charges, and the training and educational requirements of the health care providers. (Bartlett & Phillips, 1995) Since the boundaries between H&SC services for elderly individuals remains a barrier in the delivery of competitive and highly integrated services (Leathard 2003, p. 186), the field of H&SC services becomes fully responsible in carefully analyze the positive and/or adverse impact of selecting a leadership style when managing several group of health care professionals that renders either health or social care service. Existing Health Legislation and Standards in Hong Kong’s Health and Social Care It is a common knowledge that the health legislation and the standards of H&SC in Hong Kong has been based on the Western-style medical sector. (Bartlett & Phillips, 1995) In line with the effort of standardizing the H&SC for elderly patients, the private residential aged care in Hong Kong was regulated when a volunatry code of conduct was developed and implemented back in 1986 (Social Welfare Department, 1986). The continuously increasing number of available private residential aged care resulted to the the increase in the public concern regarding the possibility that the quality of H&SC given to elderly patients would eventually decline (Bartlett & Phillips, 1995). For this reason, there was an attempt to strengthen the control over the quality of care for elderly patients being rendered in private residential aged care by publicly introducing the Residential Care Homes Ordinance [1994] (Hong Kong Government, 1994). To ensure that each residential homes would comply to he H&SC standards, all public and private residential aged care are required to apply for a licence from the Social Welfare Department since January 1995 (Cheng & Chan, 2004). With regards to the proper licensing, it is the Licensing Office of Residential Care Homes for the Elderly (LORCHE) that is responsible for the enforcement of the statutory provision based on the said ordinance (Social Welfare Department, 2008). Despite the implementation of the Residential Care Homes Ordinance which requires the strict regulation, monitoring, and continuously upgrading of private residential homes in Hong Kong, problems related to low quality care service being rendered to elderly patients remain inevitable due to the existence of substandard public and private aged care homes that exists regardless of whether or not the health care institution was able to apply for a license from LORCHE (Kwong & Kwan, 2001). Leadership Issue in Context Since the late 1990s, most of the health care institutions such as the local hospitals and the community health services such as in the case of the private residential aged care adopted the ‘integrated decentralisation model’ such that the health care professionals render their services to the elderly patients through a team-based internal service agreement (Leathard 2003, p. 63). As explained by Boyce (2001), the ‘integrated decentralisation model’ was derived out of the ‘division of allied health model’. In general, the allied health services are mainly responsible for the delivery of health care services throughout the primary, secondary, tertiary and rehabilitation care centre (Tasmanian Department of Health and Human Services, 2008). It means that the health care professionals that works behind the delivery of the elderly patients’ health care services is composed of a large group of medical practitioners who may either be directly or indirectly involved in the rendering of patient care services. Aside from assigning part-time and full-time registered geriatric nurses and physicians in providing a direct health care for the elderly patients, other medical professional groups like the nutritionists/dieticians, occupational or speech pathologists (therapists), physiotherapists, podiatrists, and social workers may also be responsible depending on the specific health care needs of each patient (Paterson, 2008). Given that there are several medical professional groups working behind the provision of H&SC services to the elderly patients strongly requires the need to successfully integrate the role and responsibilities of each members of the medical team. This can be done by effectively developing and implementing a unified H&SC system. Social changes particularly the shift of women’s role from being domesticated to their active participation in the labour forces has a significant impact over the increasing demand for private residential aged care. (Kwong & Kwan, 2001; Bartlett & Phillips, 1995) Back in 1983, there were only 28 private residential aged care available in Hong Kong (Leung et al., 1993). Eventually, the number of private residential homes increased up to 405 in 1994 (Barlett et al., 1994). Since the number of the available private residential aged care and the Chinese elderly individuals who are admitted in the public and private home care institutions is continuously increasing (Lee, 2001; Bartlett & Phillips, 1995), developing and implementing a unified H&SC system that could enhance the quality of care rendered to elderly patients becomes a very challenging situation. Basically, the development of H&SC policy that will standardize the delivery and monitoring of the quality of care for elderly patients is not sufficient in addressing the problem related to the declining quality of care services given to elderly patients. Aside from developing a more concrete H&SC policy, choosing an effective leadership style is also necessary to ensure that the implementation of the said policy will be successful. As a common practice, different groups of health care professionals work together in terms of providing the best H&SC for the elderly patients. As being practiced in both the local hospitals or in a private residential aged care, the elderly patients’ general practitioners (GPs) who are working directly in the provision of care for elderly patients serve as a consultants to primary physicians aside from having a role in the development of health care planning, health carers’ training program, health teachings, and the monitoring of the quality of care rendered to the elderly patients (Ka-hay Luk, 1999). Since the GPs are commonly assigned as the manager in elderly health care institutions, their leadership skills significantly affects their abiliy to manage the active supporters including geriatricians, geriatric nurses, social services, and the community health teams. Analysis of the Situation Upon analyzing the entire H&SC situation, the challenge behind the development and implementation of a successful unified H&SC policy lies behind the fact that effective leadership approach is needed in order to effectively engage the members of each medical team to actively participate in the implementation of a new health and social care program or policy. In line with this matter, the ability of the GPs to win the support of geriatric nurses, geriatricians, physical therapists, occupational therapists, and other medical professional groups highly affects the GP’s work performance in terms of being able to accomplish their role and responsibilities when implementing a new H&SC policy that will uplift the quality service for the elderly patients. The Institute of Medicine (ICM) revealed that a lot of patients suffer and die within the hospital and residential aged care homes due to medical errors and preventable deaths caused by infection and other health complications each day. (Institute of Medicine, 1999) In the case of Hong Kong local hospitals and private residential aged care, the limited number of GPs and geriatric nurses together with the increasing number of admissions among the elderly patients could result to ‘burnout’ employees. Therefore, studies have shown that one of the best solutions in preventing the main causes of human errors in the field of medicine is to develop a good leadership skill. (Moore & Simendinger, 1999) Winston and Patterson (2006) defined a good leader as someone who could not only influence, select, equip and train his/her follower(s) with different sets of abilities and skills but also enables these people to willingly participate in terms of achieving the H&SC organization’s goal. Managers with competent leadership skills are individuals who are capable of inspiring other people and has the “drive to achieve their goals; the desire to lead; self-confidence; cognitive ability; honesty and integrity; as well as having sufficient knowledge in doing business.” (Dessler, 2001) Aside from being able to influence other people without having the need to use coercion (Huth, 2001), a good leader can easily communicate, motivate, and encourage other health care professionals to work well. In general, there are a lot of different leadership approaches that are commonly used in health care settings. With regards to the different leadership approaches, several studies reveal that either the application of a transformational and/or transactional leadership style could be beneficial when managing health care professionals within the residential aged care system (Aarons, 2006; Longenecker, 2006; Gullo & Gerstle, 2004). Basically, the use of these leadership styles does not only create a peaceful working environment but also increases the morale of GPs, geriatric nurses, and other health care professionals working for elderly patients. As a result, the overall quality of H&SC services given to elderly patients significantly improved. Leaders that are classified as transformational leaders are the ones that do not practice positional authority. Instead, these people are committed to train the subordinates to become a leader in their own way by being able to work under less supervision and express themselves freely within the business organization. In most cases, transformational leaders and followers are equal in the sense that they work towards one organizational goal as a team. Aside from inspiring and motivating the team members to use their creative imagination to enable them to construct and develop the best solution that will enable the whole team to reach the organizational goal (Burns 1978, p. 4), transformational leaders are known for being capable of implementing a new idea or a solution to a problem (Johannsen, 2004). The only difference between a transformational leader and his/her subordinate is the fact that each of them has a different set of activities played within the organizational group. (Kelly, 1995) Contrary to transformational leadership style, transactional approach is based on reinforcement and exchanges (Aarons, 2006). Several empirical studies revealed that male and female workers reflect different qualities that are both needed in the success of the organizational goals (Rosener, 1990; Ruble, 1983). In general, male leaders tend to use the transactional leadership strategy since men are more inclined to think rationally as compared to women (Eagly & Johnson, 1990). On the other hand, female leaders adopt more of the transactional leadership qualities since they are more charismatic and have the ability to communicate well by nature as compared to men (Bass, Avolio, & Atwater, 1996; Rosener, 1990). Therefore, a gender balance is essential in making teamwork effective. In case gender balance does not exist within the health care system, implementing a strict two-way communication line among the leaders and subordinates becomes crucial in developing and establishing a better organizational behaviour. Discussion Aside from the private residential aged care in Hong Kong, there are also other residential aged care homes that are being funded by the government. This includes: (1) homes for the aged which caters the need of elderly individuals more than 60 years of age that requires assistance when performing the activities of daily living (ADL); (2) care-and-attention (C&A) homes for elderly individuals who need personal and nursing care; and (3) the local Hospital Authority infirmaries which is designed for elderly patients that requires intensive nursing care and close medical supervision. (Bartlett & Phillips, 1995) Regardless of whether a residential aged care is a private of publicly funded, it remains a fact that having GPs with an effective leadership skill can make a significant difference in the delivery of quality care to the elderly patients. Having GPs with competitive leadership skill can prevent a lot of health care mismanagement and other medical errors which may arise out of miscommunication among the health care professionals and the lack of a structured operational system. It is given that a good leader can anytime be a good health care manager. However, a manager does not always mean that the person is a good leader or possesses a good leadership skill. For this reason, there is a strong need to promote the importance of leadership within the H&SC system. The presence of a good leadership is an essential factor that could result to a better working condition among the health care workers. In line with the positive impact of an effective leadership approach on the employees’ working environment, the health care practitioners are expected to be able to deliver proper health care provision to the patients without being burnout or experience work-related stress. As a result, residential homes are able to retain their best talents aside from preventing the incidence of unnecessary deaths and health complications caused by miscommunication, mismanagement, and neglect. Under a good leader, collaborative effort among the health care workers is necessary in order to make sure that proper medication and care will be equally provided to all in-patients. Likewise, the same effort can be use in making the implementation of a new policy and plans related to patient safety will be more effective and efficient. To improve the leadership situation, healthcare managers should be conscious about their body language since a simple gesture could give other people to have either a bad or good impression about the leader. To avoid having a biased judgment from co-workers, it is important to learn and understand the positive and negative effect of body language. Conclusion It is a good decision to safeguard the standards and quality of care given to elderly patients who are admitted to private residential aged care. To be able to maintain an outstanding quality H&SC service, it is important for Hong Kong government and the Department of Health to develop a unified H&SC plan. In line with the implementation of the H&SC plan, The importance of selecting the best leadership approach should be continuously promoted. Not only does it make the implementation of a new H&SC policy and plan more feasible but also improves employees’ work satisfaction and the overall quality care rendered to elderly patients. To improve the leadership approach, managers should pay attention towards his/her personal gestures. By being a good example towards his/her subordinates, healthcare manager can easily capture the attention and respect of the rest of the healthcare team members. Reflective Summary I believe that there is simply no ground or rules when it comes to choosing the best leadership style. In order to become an effective leader, one should be able to train and develop themselves with the search for the type of leadership skills that works best for them. Often times, choosing the best leadership style depends on one’s own personality, working environment and the members of the team as well as one’s personal choice. Since not all medical practitioners who have been successful in their chosen profession are good leaders, the human resource manager should focus not only in the applicants’ work related experiences and expertise but also their leadership skills. 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