Leadership in Nursing - Stacey L. Klein BSN, RN, CCM



Leadership in NursingStacey KleinFerris State UniversityLeadership in NursingAccording to Webster, the definition of leadership is the capacity to lead, or the act of leading. ("Leadership," 2012) One might surmise the ability to lead is extremely important in the profession of nursing and the development of nursing leadership is invaluable in today’s health care climate. (Swearingen, 2009) The development of leaders is essential for the future of health care because it can positively affect the bottom line for a health care organization, as well as aid in job satisfaction and patient satisfaction in care delivery. (Sanford, 2011) Future leaders in health care must choose a mentor from today’s leaders, (Evans, 2011) one who can “model behavior and offer advice” (Evans, 2011, p. 42) to the novice. For this learning opportunity in leadership I was able to interview Jan Mathews, RN, MPHA, CPHQ, CNAA, BC. She is a leader in the health care community, a woman who is passionate about health care delivery and an advocate for patients not only in her hospital system but the nation as well. Background and EducationJan pursued her Associate Degree in Nursing from Indiana University, and started her career in the post open heart unit at St. Vincent’s hospital in Indianapolis, IN. A move to Michigan led her to accept a position in the trauma unit at Butterworth Hospital in Grand Rapids. While there she pursued her BSN at the University of Michigan and moved into a leadership role as Director of Surgical Intensive-Care Unit (SICU) at Butterworth Hospital. Soon after this she was named Director of SICU and Medical Intensive-Care Unit (MICU) at the same hospital. When two hospitals in Grand Rapids merged to become Spectrum Health, Jan was named Director of Critical Care Services including Medical, Surgical Neurological Critical Care Services as well as the Regional Burn Center. After completing a Masters Degree in Public Health Care Administration and a move to Charlotte, NC Jan accepted a position as Director of Patient Care Services and was interim Chief Nursing Officer for a year. Since then Jan has had the opportunity to pursue the issues of quality and safety as they affect all areas of patient care. She is certified in health care quality (QPHC through the National Association for Health Care Quality) and advanced nurse executive (N.E. A., BC through the American Nurse Credentialing Center). She is currently working directly with the Corporate Executive Officer (CEO) of a large health care organization as the Corporate Executive Director of Quality and Safety and is a state and national Baldrige Examiner. She has earned her Six Sigma green belt and is currently working toward her black belt. She states, “In all areas of my career it has been essential to understand a health care organizations opportunity to improve through concurrent, reliable metrics that can be converted to knowledge to help improve the overall care of the of the community they serve.” Most recently Jan has had the opportunity to help in the certification of Patient Centered Medical Homes and the development of processes involved in moving a hospital toward becoming an Accountable Care Organization.Job Duties The health care organization where Jan is employed utilizes a Functional Structure in that the departments are “arranged according to specialty.”(Mancini, 2011, p. 146) As a Corporate Executive Director Jan reports directly to the Chief Executive Officer (CEO) of the organization with a dotted line to the Corporate Chief Nursing Officer (CNO). Dotted line reporting means that while Jan and the CNO work closely together and the CNO may supervise certain projects, the CNO is not Jan’s boss and this is an indirect reporting line.The main focus of the role of Corporate Executive Director is continuous quality improvement focusing on the areas of Infection Prevention/Control, Core Measures, and Disease Specific Certification. Another large part of Jan’s role is dashboard development incorporating the “Triple Aim” of the Institute for Health Care Improvement. The “Triple Aim” includes Quality of Care, Cost of Care and Patient Experience. (Institute for Health Care Improvement:IHI website, 2012) It is interesting to note, while the overall structure of the health care organization where Jan is employed is Functional, her position takes on the look of a Matrix Structure. In the Matrix structure, both function and service are reflected in an “integrated organizational structure.” (Mancini, 2011, p. 147) In this structure Infection Prevention/Control, Cardiac, Heart Failure, Orthopedic and Stroke product lines report directly to her.CollaborationIn the role of Corporate Executive Director of Quality and Safety it is essential to communicate openly and directly. Collaboration with all departments in the organization is critical when the focus is quality and safety. The first step in leading improvement teams is to decide who must be at the table. Leaders from all disciplines are involved as well as staff from the bedside. These teams include managers and sometimes directors as well. Jan’s teams use Gantt chart development to set goals and milestones, and then assignments are made. Accountability on assignment deadlines is determined as one of the key ground rules. Jan uses DMAIC and Six Sigma as quality methodology for these team processes. According to Jan, “You don’t know if you are successful unless you measure it,” is essential to the design of project improvement. Each of these team projects are approved and monitored by the Senior Leadership. The ability to collaborate successfully across an organization is a true test to a leader’s ability to communicate. Leaders in today’s health care climate are leading by example, (Evans, 2011) if a health system wants to have effective communication, it must be modeled by all levels of leadership but especially the senior management team.Legal and Ethical IssuesAccreditation and Certification fall under Jan’s role and with these there is continual emphasis related to valid and reliable data as well as attention to maintaining HIPPA and patient confidentiality guidelines. In order for a health care organization to remain on the cutting edge of health care, it must continue to strive for excellence. The only way to measure this is to obtain data and measurements. If data is collected unreliably the results of any given subject will be sloppy and unusable. Accreditation and Certification require documentation of successful outcome with in a health care organization. A leader in this area must take the time and effort to be knowledgeable of not only data gathering and manipulation but presentation of findings as well. All these studies must maintain patient privacy and not effect day to day care of any patient. All efforts must be made to “never lose sight of the needs and expectations of our patients and their families as we make clinical decisions based on the most effective use of internal and external resources.” (Walsh, Moran, & Greenwood, 2003, p. 5)Power and InfluenceThe power and influence of Jan’s role is far reaching and involves all areas of the organization. Because all aspects of quality and safety focus on the care of the patient it is essential in the overall wellbeing of the organization. With power and influence comes much responsibility. “Some people have false assumptions about leaders and leadership… simply having a title does not guarantee a person will be a good leader.”(Evans, 2011, p. 41) It is essential for leaders to inspire those around them to achieve success. Decision Making/Problem Solving ProcessProject identification focuses on the strategic direction of the health care organization. Senior Administration assigns projects based on these strategic objectives as well as agility of the organization related to changes in government health care reform, or high risk/problem prone issue identification as well as market share changes. Jan utilizes known tools such as Value Stream Mapping or Voice of the People to problem solve in these areas. One of the biggest aspects in staff satisfaction is “control of the decisions that most affect me.” (Evans, 2011, p. 39) By utilizing tools known to be effective and valid, a leader can lay out a strategic plan to move forward in the problem solving process involving those who follow them. Management Style and Conflict ResolutionJan describes her management style as mostly participative in nature. If an opportunity exists it is incredibly important to involve the Service Line Directors, Clinical Managers and the staff as well. Such a leadership style mentors and allows creativity of the team involved. This style of leadership closely resembles Transformational Leadership. In this style of leadership all team members are valued and encouraged to be engaged emotionally. (Evans, 2011) Evan’s goes on to say, management in this style is linked to increased “staff satisfaction, staff retention and patient satisfaction.”(Evans, 2011, p. 40)There are times however, where due to time constraints, or potential harm to a patient, authoritative leadership must be utilized. This type of leadership closely resembles Transactional Leadership, where employees are expected to follow based on the fact the “boss” is telling them too. (Evans, 2011) This leadership style “reinforces the status-quo” in an organization, by offering “external rewards” for “conformity with expectations.”(Evans, 2011, p. 40) Jan believes, while this type of leadership style is important and has its place when utilized in the above situations, the leader who only utilizes this method will not be successful in today’s health care climate.At times one will encounter conflict and the ability to resolve conflict is essential to an effective leader. A good leader is able to “influence other people to work toward meeting a certain goal.”(Evans, 2011, p. 40) Conflict resolution is a big part of moving forward in a team project. Jan attempts to facilitate a meeting by the involved parties in which both sides can describe their side of a given conflict. Then and only then can a common goal be set and explained. Once this goal is set and understood it is possible to attain a consensus and move forward toward the common goal. “Success depends on persuading followers to accept a vision by using convincing communication techniques and making it possible for the followers to achieve the shared goals.”(Evans, 2011, p. 41)ConclusionBy inspiring those around them to work at a high level, leaders set the tone for achievement in the workplace. (Evans, 2011) One of the most important places this occurs is in leadership development. (Sanford, 2011) The future of health care leadership is the clinician of today. It is essential for today’s leaders to model good leadership skills, and mentor those who follow. Assignments such as interviews of today’s senior leadership allow students to seek out individuals whom they admire and examine their style of leadership. By learning and evaluating both the positive and negative aspects of leadership students of today are able to take pieces from different styles to build their own practice.ReferencesDefinition of leadership. (2012). In Merriam-Webster Dictionary. Retrieved from , M. L. (2011). Developing the Role of a Leader. In P. S. Yoder-Wise (Ed.), Leading and Managing in Nursing (5th ed., pp. 36-52). St. Louis, Missouri: Elsever, Mosby.Institute for Health Care Improvement:IHI website. (2012). , M. E. (2011). Understanding and Designing Organizational Structures. In P. S. Yoder-Wise (Ed.), Leading and Managing in Nursing (5th ed., pp. 137-154). St. Louis, Missouri: Elsevier, Mosby.Sanford, K. D. (2011, March). The Case for Nursing Leadership Development. Healthcare Financial Management, 65(3), 100-106.Swearingen, S. (2009, March). A Journey to Leadership: Designing a Nursing Leadership Development Process. Journal of Continuing Education in Nursing, 40(3), 107-114. doi: 10.3928/00220124-20090301-02Walsh, K. T., Moran, P., & Greenwood, C. (2003, Nov-Dec). A successful emergency department case management practice model. Case Manager, 6, 54-7. ................
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