The importance of leadership in the face of an ever PDF

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Essay based on nursing leadership and management...

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The importance of leadership in the face of an ever-changing NHS. Student ID number: 21516035 Module title: Leadership and Collaborative Inter-professional Practice Module code: NS622 Module leader: Helen Ayo-Ajayi and Michael Farquharson Seminar leader: Michelle Boot Actual word count: 3,121

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This essay will establish a thorough understanding of the leadership skills required within collaborative inter-professional practice in order to engage and reflect the ever-shifting delivery of health and social care. This piece will discuss relevant leadership theories and the style of leadership that is applicable to the case study attached in the appendix of this essay. This essay will address the term ‘leader’ more frequently than ‘manager’, this is following on from the beliefs of Ellis and Bach (2015) that anyone can be a leader but not everyone can be a manager, this statement is dependent on the given persons situation and position. The composition will then evaluate and analyse the advantages as well as the obstacles of interprofessional collaborative practice, particularly looking at the role of the student nurse within the attached case study. This paper will proceed to examine the role of self in relational leadership and problem solving when dealing with multi-disciplinary teams, service users, families, carers and significant others. Finally, the text will evaluate the involvement of various approaches that pervade inter-professional and collaborative practice. All of the above learning outcomes will be achieved and related to the case study. This piece of writing will also examine current policies, literature and research in relation to leadership and management within the nursing field. All aspects of leadership and management and inter-professional and collaborative practice discovered within this essay will adhere to the Nursing and Midwifery Council (NMC) (2018) code of conduct. Yoder-Wise (2011) defines leadership as the use of distinctive characteristics to positively and ethically impact patients, families and staff through a process in which clinical and organisational results are achieved through mutual efforts. The National Health Service (NHS) needs efficient and effective leadership now more than ever. NHS England (2014) believes that this is due to the ever-growing challenge to try and advance patient care and experience in a generation of increasing financial and work mass pressures which can cause immense levels of stress amongst staff. Thus, it is stated that there is now a substantial need to meet these requirements and to preserve a competent NHS. In order to accomplish this the NHS England (2014) explains it will take a combination of professional commitment and active leadership. Taylor and Webster-Henderson (2017) describe management as the action that facilitates the accomplishment of tasks through an authoritative role. Ellis and Abbott (2011) believe that managers differ from leaders as leaders do not hold the power to enforce their authority upon others. Although management is present within nursing with both matrons and ward managers, leadership is an ever-growing concept within the NHS. Sherring (2012) states that efficient leadership is essential to the delivery of exceptional care by the NHS, and how such leadership also constructs effective and safe care in the clinical area. Therefore, this high level of patient care is improved when staff feel they are of value, when the feel supported and also when they feel empowered by this effective leadership as discussed by the NHS (2015) in the NHS Constitution.

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An effective leader, as defined by Ellis and Bach (2015) is a leader who understands their own goals and knows how they want to achieve them. They are able to communicate these goals to their followers which in turn allows them to successfully delegate assignments. There are many relevant theories and models in regard to effective leadership within nursing, three of these theories include transformational leadership, situational leadership and the Great Man theory. Doody and Doody (2012) define transformational leadership as an action that inspires followers by engaging their ideas and values and inspiring followers to execute tasks beyond expectations for the benefit of the organisation rather than their own interests. Surakka (2008) states that transformational leadership is viewed as the most effective model as it allows followers to engage both intellectually and emotionally. Sullivan and Decker (2009) believe that the aim of transformational leadership within nursing is for the leader to encourage employee’s commitment to the area’s vision and long-term goal rather than their own personal achievements. Situational leadership, unlike transformational leadership, focuses more on the follower’s own inclination to perform. Sullivan and Decker (2009) describe situational leadership as four leadership styles combined and used in accordance to the follower’s willingness to perform the delegated assignment. These four styles include: a telling style, a selling style, a participating style and a delegating style. Sullivan and Decker (2009) believe that each area is used in accordance with the follower’s personal traits. The telling style is used with followers who are unable or unwilling to perform an assignment, the selling style is used with followers who are not able yet eager to perform the given task, the participating style is used with followers who do not have the confidence to perform the given assignment yet are able to do so and the delegating style is used with followers who are both ready, eager and confident in themselves to complete the task at hand. The case study attached exemplifies the situational leadership theory as the student uses the delegating style in order to complete the task at hand effectively and efficiently using staff who are qualified and trained and can confidently perform the assignment given. The Great Man theory contrasts both transformational and situational leadership due to the belief that specific people are genetically born to be leaders (Stodgill 1948 as cited in Yoder-Wise 2011). The Great Man theory focuses on the perception that certain individuals are born with leadership qualities which results in their own automated success. This theory has been further developed into the Trait theory which was developed by Kirkpatrick and Locke (1991) who recognised that there are many different traits of quality leadership which they believe can be developed in order to become a successful leader. However, Kirkpatrick and Locke (1991) also believed that these skills were not substantial enough on their own to emulate such success. The leadership style that has been identified within the attached case study is democratic leadership. Sullivan and Decker (2009) states that democratic leadership establishes a shared view and individuals are involved in decision making in order to get the task done. The democratic leader allows for a group participation and 3

decision when setting and working towards an end goal. Stonehouse (2011) explains that within democratic leadership the focus of power in this situation is removed from just the leader to the collaborative team as a whole. This is a positive aspect of democratic leadership as it promotes commitment within the inter-professional team and motivates them as a collective. This is relevant to the case study as the student took leadership of the given situation however, they alongside other colleagues delegated tasks to those who were competent to do so and made decisions as a collective group. This is a positive aspect of the case study as it adheres to the NMC (2018) “The Code” requirements of working within one’s own limitations. Hocken (2009) (as cited in Stonehouse, 2011) states that such ownership of any decision that has been made is approved and accepted by all involved instead of decisions being made by a leader or manager alone. However, democratic leadership poses negative aspects also. Stonehouse (2011) explains that this specific style of leadership can cause conflict and disagreement within the inter-professional team in the event that no decision can be made or agreed upon. Stonehouse (2011) states that autocratic leadership contrasts democratic leadership completely. In the event of the case study, autocratic leadership would have been an inappropriate style for the student nurse to follow. Autocratic leadership is defined by Stonehouse (2011) as a leader who informs others what to do and restricts discussion ideas and when communicating, communicates only in one direction, from the leader to the followers. This would have been a negative approach for the student to take because of the lack of knowledge and skills based compared to that of a qualified nurse or doctor. However, if the situation arose with a qualified nurse taking the lead, autocratic leadership may have been a desirable choice. Huczynski and Buchanan (1999) (as cited in Stonehouse, 2011) believe that in certain events, autocratic leadership can be what is needed, especially in the case where the leader has the most knowledge and the time to act is limited. This is because in an emergency situation, the collaborative team needs a leader who will take charge and give direction in a manner that is timely yet swift. The World Health Organisation (WHO) (2010) define collaborative practice as numerous healthcare providers from contrasting professional backgrounds working together to deliver extensive services by co-operating and supporting patients, patients’ families, caregivers and the community to provide the highest standard of care possible. Collaborative practice is becoming more important within nursing and other healthcare professions when it comes to patient safety, Marriot (2014) discusses how by collaborating together staff can help to assist earlier and safer discharges of patients from the secondary care sector, decrease avoidable hospital admissions and shorten the length of hospital admissions for patients. However, although collaborative practice can bring about positive effects it also generates some challenges. WHO (2011) stated that communication was described to be the largest issue among teams, this was down to not sharing relevant information. WHO (2011) highlights that in order to enhance team interactions and increased level of communication is needed.

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Gardener (2003) (cited in Rawlings et al, 2014) states that there are numerous elements that are affecting inter-collaborative working, some of these obstacles include: lack of understanding of one’s role within the multi-disciplinary team and uncertainty of accountability within the implementation of policies. An example of such obstacles comes about in the form of the Francis Report, a public enquiry chaired by Robert Francis (2013) that examines the Mid Staffordshire NHS Trust and how it failed to recognise the suffering of their patients and the failing levels of care for patients by staff. Within the report Francis (2013) recognised the trust had a negative culture and their acceptance of unacceptable standards of care as they were too focused on meeting targets. Munro (2011) believes that a ‘systems approach’ will help to overcome this generation of ‘blame culture’. A systems approach is defined by Kaplan et al (2013) as an approach that aims to improve healthcare by examining the numerous elements that are involved when it comes to caring for individual patients and the multiple factors that are influencing their health. Munro (2011) (as cited in Rawlings et al., 2014) believes that this approach will help establish a way or working that inspires the multi-disciplinary team to work collaboratively and effectively together. The impact of multi-disciplinary working collaboratively within the given case study is vital as without it the patient may have suffered. Ndoro (2014) believes that multidisciplinary working is important to help provide the highest quality of evidencebased care. Evidence based practice is defined by Aveyard and Sharp (2009) as being practice that is supported by a justification that is clear and up to date, taking into account the patient and one’s own judgement. The case study shows how crucial communication is within nursing and also in leadership, without communication the outcome of the scenario could have been different. Weiss and Tappen (2015) believes that as leaders, nurses must plan a quality agenda and communicate it clearly and effectively in order for a level of safety to exist. Communication allows for the multi-disciplinary team to plan and execute effect care that is patient centered. Patient centered care is defined by Fredericks et al (2012) as an individualised and effective pathway to deliver safe and essential care. The case study exemplifies the importance of patient centered care and how inter-professional working is essential when it comes to focusing care specific to the patient. The Kings Fund (2016) believes the key to the implementation of patient centered care is having a team of medical professionals who have a wide range of skills among them. Leadership plays a role in patient centered care within the case study attached, this is because nursing leadership is needed to meet the demands for patient focused care as The Kings Fund (2016) explains, there are now expectations for an improved level of safe and quality care and practice that is evidence based. However, the responsibility of patient centered care should not fall on nurses alone. Marquis and Huston (2011) state that nurses are not solely responsible for leading patient centered care, but they must act as a catalyst to integrate and initiate patient focused care in daily practice. This impacts the case study as without the multi-disciplinary team the

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student may not have been able to base the action of care on what the patient needed as an individual. The role of relational leadership within the inter-collaborative team was taken up by the student nurse. Cardiff et al. (2018) defines relational leadership as a process of caring for co-workers and enabling them to perform, accept and learn from their own mistakes. Relational leadership is a theory that focuses on the building of relationships and as stated by Uhl-Bein (2006) it removes leadership from management and more hierarchical roles. Relational leadership is beneficial as it does not focus on individual relationships but rather the relationship of the collaborative team. The scenario displays the strength of the relationships built by the student nurse with the inter-professional team as there is a sense of reliability amongst the staff. Uhl-Bein (2006) believes that relational leadership as a view of leadership and the organisation as a collective that focuses on our own social constructions that evolves from connections and interdependent relationships between members of the inter-professional team. Relational leadership is important as without the building of strong interdependent relationships patients would suffer. Cardiff et al. (2018) explains that person-centered care is based not only on the relationships between the collaborative team and the patient but also the relationships within the multi-disciplinary team and their own mutual respect and understanding. Without stable work based interdependent relationships there is a risk that patients may suffer as patient centered care does not only involve the individual nurse-patient relationship, but it also requires the multi-skilled approach of the inter-professional team. Wong et al. (2013) states that specific processes or mechanisms of relational leadership can influence patient outcomes. The working environment is the main concern developed by Wong et al. (2013) as it is believed that failing to promote positive working conditions can in turn affect safe patient care. A lack of communication between staff to advocate these standards and negative relationships amongst staff can also affect the outcome of patient focused care. The evidence of patient focused care within the case study exemplifies the presence of relational leadership. Uhl-Bein (2006) states that the relational focus is one that moves beyond leader/follower relationships, but it focuses more on a leadership as a system that is present in both environmental and organisational aspects. This is present within the case study as although there is a delegated leader of the scenario, it is organised and the members of the collaborative team work effectively together due to their trusting interdependent relationships. With the positive direction of relational leadership within the case study it allows for the team to focus primarily on patient focused care. Komives et al (2013) believes that relational leadership requires the interprofessional team to have an understanding and awareness of ‘self’ and their own role in the care of the individual patient. It is important for all members of the multidisciplinary team to have self-awareness of their own role and where they stand 6

amongst the team. Ellis and Abbott (2011) state that each team is composed of people with a range of different competencies and abilities as well as strengths and weaknesses. It is also important for members of the collaborative team to recognise that without one role, the team may suffer problems which could result in issues for patients and their families. The scenario focuses on the student nurse and her ability to lead the team, in regard to Belbin (2001) (as cited in Ellis and Abbott, 2011) the student nurse could be seen as the ‘coordinator’. The coordinator can be described as a person that can inspire others to work together and aim for a shared objective (Belbin, 2001). The student was able to delegate tasks effectively and push the team to work towards a shared goal. The student performed well under pressure, gave instructions well under supervision of her mentor and was able to practice safely within her own limitations and competencies (NMC, 2018). The student’s confidence within the scenario will help her as she transitions from student to a qualified staff nurse. However, it may be more appropriate to assume a different role once she is qualified as she will then have an increased knowledge and skills base which may result in raised expectations from other members of the inter-professional team. Ekstrom and Idvall (2015) explain that newly qualified nurses struggle to lead nursing care during, particularly during the transition period from student to qualified nurse due to a lack of experience in this area. Thus, the student should reflect on the role they may assume within the collaborative team and as future leaders. In conclusion, it is essential that healthcare professionals work together, despite the challenges and pressures the NHS is facing which includes a growing population, shortages of staff and increased workloads. Professionals must adapt within these situations and support and value each other’s decisions and contribution in order to provide a more harmonious level of care for patients and their families. Leadership presents itself in many different forms, and it is important to remember that anyone can be a leader. From nurse in charge to student nurse; each member of the interprofessional team has an important role to play in the care of patients and their families and without the collaborative team the patients would suffer. Collaborative practice allows for patient and family focused care and thus, inter-professional practice should be appreciated and valued. Having self-awareness and understanding the role of ‘self’ within a multi-disciplinary team and using this to aid person centered care will aid the student nurse in her transition from student to qualified nurse. Although leadership faces many difficulties and challenges it is essential for the safety of patients and allows for better patient experience. The lack of leadership can result in failings as seen in the Francis Report (2013) which shows the extreme downfall in patient care due to lack of understanding and clinical effectiveness. This commitment to improve standards of care must arise from all members of staff in their actions, skills...