HS3051: Leading and Managing in Professional Practice:3211
Within this essay a discussion will be held regarding the importance of leadership and management within healthcare practice. This will maintain a specific focus upon resource management, and the impact this can have on compassionate care and ethical practice. Then, a reflection on the formative assignment will take place, followed by a reflection on the learning from this module, and how this can influence future practice.
Identification of chosen topic:
The area of focus this essay has is on resource management, and the impact this can have on compassionate care and ethical practice. This topic was chosen because it is most commonly seen within clinical practice as it affects day-to-day ward running. Marchington et.al. (2016) demonstrates this stating that the division of resources can affect clinical decision making, and impact upon successes.
This topic encompasses three main terms of resource management, compassionate care and ethical practice. Wright and McMahan (1992) define resource management as a planned distribution of resources, for example workforce or finances, in order to achieve goals. The two other terms, compassionate care and ethical practice, are woven throughout governing literature such as The Code (NMC, 2015) and hospital policy as they are vital to achieving NHS aims and values. Compassionate care is defined by Chochinov (2007) as an acknowledgement of the suffering of another person, and the aspiration to alleviate it. Ethical practice is defined by the Advanced Nursing Practice Toolkit (2012) as the difference between right and wrong, which in nursing practice focuses upon non-maleficence and beneficence.
Effective leadership and management and its importance has been outlined by Armstrong (2012). He explains that effective management defines goals, allocates resources and instigates change to achieve goals, whereas effective leadership inspires people to do their best, act differently to achieve goals and communicate a shared vision. Within the NHS, having leaders and managers able to recreate this process is important as it ensures that services meet the needs of the public (Armstrong, 2012).
In relation to the NHS aims and values, effective leadership and management is vital. The central aims of the NHS include providing high-standard care to all, patient-centred cost-effective ethical care and accountability (NHS Constitution, 2015). To achieve these aims commitment from leaders and managers is crucial as this provides an example to their workforce (Ong, 2010). The NHS values which include being respectful and compassionate, maintaining dignity, providing high-quality care, improving lives and being accessible, also need good leadership and management to be upheld (NHS Constitution, 2015).
The importance of effective resource management is highlighted by the Kings Fund (2017). They explain that 98.8% of the Department of Health (DoH) funding is from taxation and National Insurance, and 1.2% from user charges. They also explain that the total DoH budget is £124.7 billion for 2017/18, which does not cover increasing demands on the NHS, so is expected to reduce standards of care. This therefore shows the importance of good resource management by healthcare leaders and managers as tasks need to be completed to a high-standard whilst staying within resource and budgetary limits (Hooijgerg & Antonakis, 2014).
Critical evaluation of key issues:
Within this section an evaluation of the theoretical principles of leadership and management will be related to resource management, compassionate care and ethical practice, using examples from the authors experiences to illustrate this.
One key issue within the literature regarding leadership and management is that a link between effective leadership, improved patient safety and outcomes has been found (Hendricks, Cope and Baum, 2015). In relation to resource management it can therefore be argued that nursing leaders who effectively make use of resources, such as equipment or workforce, can positively impact the care patients receive, whereas if resources are managed ineffectively, patient care can be compromised (Aiken, Sloane and Griffiths et.al. 2016). An example of ineffective resource management affecting patient care comes from the authors real-life experience. On a day shift there were four Dynamap machines, which are used for completing clinical observations, for 24 patients. Many of the patients needed hourly observations which, due to the lack of equipment, were completed late or rushed to ensure that all observations on the ward were completed, therefore impacting upon patient care. The Ward Manager was aware of the situation, however did not intervene. In this situation there is a lack of compassionate care as the nurse is rushing to complete the observations, meaning that they will not have time to converse or build a rapport with the patient, so they are left feeling insignificant (Verwoerd, 2015). Relating this to ethical practice, this example shows how important effective leadership and management skills are when allocating resources by showing how poor resource management can negatively impact the patient. Despite completing clinical observations being the 'right thing' to do for a patient, due to lack of equipment the clinical observations were rushed, which may have caused important clinical data to be overlooked or managed inappropriately, therefore calling ethical practice into question (Holt and Convey, 2012). This highlights the importance of good leadership and management skills when allocating resources as mismanagement of these resources can lead to negative impacts on compassionate care and ethical practice, which ultimately has adverse impacts upon patient outcomes.
Another key issue identified within the literature is the impact a leadership style can have upon staff performance and satisfaction, which in turn has a direct impact upon patient outcomes (Aiken, Sloane and Griffiths et.al. 2016). Seminal research into leadership styles such as Lewin et.al. (1939) identifies three leadership styles, including autocratic (authoritarian), democratic (participative) and laisses-faire (delegative) leadership. This was developed further by Cope and Murray (2016) whom sub-categorises these styles into task-focused leadership which includes transactional, autocratic and laissez-faire leadership, and relational leadership, which includes transformational, emotional intelligence, resonant and participative leadership.
When comparing these two styles, Cope and Murray (2016) suggest that relational leadership styles, ones focusing on people and relationships, are more effective within the healthcare setting as they have been found to increase staff satisfaction and motivation, share responsibility, direct staff to a common goal, and acknowledge staff opinions (Brewer et.al. 2016, Giltiane 2016, Karimi and Rada 2015, World Health Organisation 2016). Regarding resource management, relational leaders utilise the team's full potential, which helps share responsibility more democratically (Barraton and Gold, 2012). This way of resource management maintains a focus on nurse satisfaction through fair treatment and sharing of tasks which has a direct impact upon the standard of patient care (Cooke and Bartram, 2015). An example of relational leadership styles comes from the authors real-life experience taken from one shift where the nursing staff were down by two nurses, resulting in the wrong skill-mix for the ward. As the staff skill mix was rather junior, there were only four IV competent nurses and each nurse had a heavier workload than normal. After this shift the Nurse In Charge (NIC) approached the ward manager and explained the need for more IV competent nurses, which resulted in many more nurses being funded to begin their IV competency course. Within this example the NIC used a variety of relational leadership styles to ensure effective resource management. Karimi and
Rada (2015) would suggest that emotional intelligence was used when managing resources, in this case the workforce, as the NIC was aware of the pressure upon the nurses and tried to alleviate this. The NIC also provided encouragement and motivation to the nurses during the shift, therefore showing how resonant leadership skills (Day and Leggat, 2015). The World Health Organisation (2016) would also suggest that participatory leadership was used as the NIC asked the workforce their opinions regarding the workload and made changes where possible to ensure effective resource management. After the shift the NIC approached the ward manager regarding the lack of IV competent nurses and facilitated a positive change to training levels on the ward showing transformational leadership skills (Cope and Murray, 2016). In this scenario it can be argued that the nurses were not treated compassionately as they had heavier workloads than normal, and despite the NIC's efforts to be understanding and provide support, the nurses may have felt overwhelmed and unsupported (Delwar, 2013). This could have therefore impacted staff satisfaction, which in turn can affect patient care and shows the importance of treating staff compassionately (Williams, 2016). This scenario also outlines the importance of leaders and managers providing resources for education and training to ensure ethical practice through staff being competent (NHS England, 2014). Support for this comes from Jones et.al. (2008) who has found that training has a positive effect on staff satisfaction, which in turn impacts upon patient care. Continuing from this, Church (2016) has found an association between higher levels of competence and better patient outcomes, therefore suggesting that training and education should be at the heart of leaders and managers decisions within resource management as this has an impact on staff satisfaction, which consequently impacts upon patient outcomes.
In comparison to relational leadership styles, task-focused leadership styles have been found to have lower reported levels of staff satisfaction as there is a focus on task outcomes and job completion (Cummings, 2012). Within task-focused leadership styles there is often limited communication, partial leader involvement and a focus upon the 'small picture' (Bish 2015, Cope and Murray 2016, Hooijgerg and Antonakis, 2014). Relating to resource management Giltiane (2013) suggests that task-focused leaders are often inexperienced, and only react when they deem it necessary (Anderson and Sun, 2017). However, as explained by Cope and Murray (2016) task-focused leadership styles are effective in emergency situations where clear direction is required. An example of this is a cardiac arrest, where in this situation one person is in charge and directing staff towards what they believe is the best course of action for the patient. Within this situation effective resource management is used as each member of the team is used in a way that can utilise their full potential in order to achieve the desired outcome, which would be to revive the patient (Barraton and Gold, 2012). Away from emergency situations, when task-focused leadership skills are used resources may be managed ineffectively. This is because task-focused leaders are often reactive, meaning that they only act when there is no other choice, for example if a lack of equipment threatening patient safety (Cope and Murray, 2015). Outside of emergency situations, task-focused leadership in nursing care can result in a lack of compassionate care as the focus is on task completion within short time frames. Lack of compassionate care is highlighted as an issue in the Francis Report (2013), as they state that compassion is essential in todays healthcare practice as it enables the provision of effective and safe patient care, without which can result in poor care and high mortality rates. Without compassionate care, Chivima (2014) would argue that ethical practice is also not being maintained as it is a nurses' duty to act in the patients' best interest, however if they are being treated with a lack of compassion, they may not be treated in the most ethical way.
Another key issue identified within the works of Marquis and Huston (2012) is that leaders do not always have designated formal authority. Daly et.al. (2014) echoes this as they state nurses are constantly in informal positions of leadership from which they can influence patient safety and quality of care. In relation to resource management, this informal position can ensure that healthcare settings have the resources they need to give high-quality care. An example of this is the nurse in charge, who outside of being nurse in charge for that particular shift did not have designated authority, discussing the lack of IV competent nurses with the ward manager, someone who could then potentially make a positive change to the ward. As explained by Bleich (2016), nurses in informal positions of leadership can ensure compassionate care is upheld by reporting sub-optimal care and ineffective leadership, which can negatively impact patient care. From this informal position of leadership nurses can also ensure that ethical practice is maintained as they can report ineffective leadership which can impact staff satisfaction and negatively impact patient care. Therefore, they can promote ethical practice by calling out the bad leadership and management they see.
Evaluation of team work:
Within this section the importance of team work and group processes will be explored, using examples from the formative group work to demonstrate this. According to Betts and Healy (2015), the ability to work in a team in todays workplace is vital as it has been associated with higher performance and a varied pool of knowledge. In healthcare this is no different, teamwork allows for difficult tasks to be shared and accomplished, and enables the support of others, which aids in the provision of the highest standard of patient care (Diggins, 2013).
Due to the importance of team work within healthcare, many theories and frameworks regarding team processes and group dynamics have been created. One of the most seminal group dynamic frameworks is by Tuckman (1965), which outlines four stages of group processes. The group starts in the forming stage, then move through the stages of storming, norming and performing. In an update of this framework Tuckman and Jensen (1977) added an additional stage of adjourning. Within the formative group work all five stages of the framework can be seen.
Within the first stage of 'Forming', Betts and Healy (2015) state that this is the stage where the group comes together, begins to interact and identifies a leader. Within the formative group work this stage came naturally as we have worked together previously. The group had difficulty when deciding on leader as everyone was reluctant, so after deliberations I became the leader. When moving into the second stage of 'Storming', Bonebright (2010) explains that it is expected that there is intergroup conflict due to the proposal of different approaches to the task. Within this stage our group conflicts revolved around being unsure of what the task entailed. Each team member had a different idea of what was required, so we went through the information again to gain clarity. The third stage of 'Norming' is the stage where the group begins to work as a team towards a single goal with an agreed strategy (Pugalis and Bentley, 2013). In this stage we decided how we were going to complete the task, and roles were allocated evenly to each team member. In the fourth stage of 'Performing', Sutherland and Stroot (2010) explain that there is cohesion as each team member understands the task and what is required of them as an individual, and as a team member. In this stage we worked together as a team to create the PowerPoint and revision tool. Each person was allocated an individual task, and we then brought each section together. In the final stage of 'Adjourning', Hall (2015)
explains that this stage is the disbanding of the group. In our formative project there was a clear end to the task as there was a deadline, however it can be argued that the group has not entirely disbanded as we are going to see each group member in social situations and during sessions at university.
During this formative work it became clear that the leadership styles I adopted were democratic and laissez-faire. Within our group these leadership styles worked effectively as we discussed most decisions in a democratic manner, often resulting in a unanimous decision, and then a hands-off approach was used when it was obvious everyone had a clear understanding of the task and their role so they could complete their section.
Effective teams are described by Williams (2016) as sharing a common goal, using good communication, having mutual respect and having a 'team spirit'. I believe that our team had this as we all knew what the outcome of this assignment should be, we communicated openly with each other using a group message, we all respected each other, and we all had a 'team spirit' as outside of university we are friends, so did not want to let each other down.
Future practice:
In order to structure this section a reflective framework by Driscoll (1994) is used, within which asks three simple questions. The first question is 'what?', which in this case is what did I learn, the second is 'so what?' to understand the context of my learning, and the third is 'what now?', as in how will this influence my future practice.
One of the main things I have learn throughout this topic is that effective leadership and management is critical within healthcare settings. This is because of the implications poor leadership and management skills can have on patient outcomes (Aiken et.al. 2016). This will impact my future practice as I am going to be more aware of the leadership and management style I am under, and I believe it will give me the incentive to challenge leadership that is ineffective and damaging to patient outcomes.
Another key issue that this module has taught me is that different leadership styles are appropriate for different situations. Before this module, it had not occurred to me how many types of leadership styles they were, yet alone how each one is more effective in different situations (Cummings, 2012). For example, when different specialities such as doctors, nurses and anaesthesiologists, are called to an emergency situation a task-focused approach is used as the primary aim is to revive the patient. If a relational leadership style was used, the instructions from the person in charge may be discussed, which could result in the patient deteriorating further. This will therefore impact my future practice as I will adopt different leadership styles during different situations.
Another main issue this module has taught me is that leadership is not always formal or designated, and that all nurses are leaders within their own practice (Daly et.al. 2014). This is because nurses advocate for their patient and have an influence over the quality of care their patient receives. An example of this is a multi-disciplinary meeting, in which the nurse gives their opinion on what the best course of action is for the child. In this they are being a leader as they are providing an influence on the care the child will receive, and could potentially impact other individuals' views on what is best for the child. This will influence my practice as I will realise how, despite not having designated leadership, I can still have an influence on the nursing care I give, and the care given around me, meaning that I will maintain a high-standard of care throughout my practice.
Conclusion:
Within this essay a discussion was held regarding leadership and management, and how it can impact healthcare practice. From this, it is therefore evident that effective leadership and management is vital within the healthcare setting as many pieces of research state the positive or negative impact that leadership can have. Leadership styles are also important within the healthcare setting with each style being most appropriate in different situations. This essay has outlined the importance of good leadership and management and has allowed for reflection on the authors own positive and negative experiences of leadership, which will be adapted into future practice as a qualified children's nurse.