Leadership_and_Management

“I declare that this work is all my own.” “I certify that confidentiality has been maintained by the use of pseudonyms.” 1 Leadership in Health and Social Care. The style and quality of leadership within a team has been shown to impact upon its effectiveness (Covey, 1992), indeed within the healthcare setting it is important for the care team to be well led in order to provide optimum patient care (Martin, 2000 and Borrill, et al. 2000). For this assignment I am going to critically analyse and reflect on the theoretical perspectives of leadership pertinent to teamwork within the healthcare setting in which I work. I will critically appraise the external and local drivers which influence the styles of leadership in the department. This will be achieved by using a combination of reflective models. I have recently become a sister in a busy paediatric A&E department and feel that the constantly changing client base and frequent changes of personnel within the A&E team on each shift, present unique challenges and necessitate a broad range of leadership skills. By reflecting on the qualities, attributes and skills which I and others possess and utilising the leadership qualities framework, I hope to develop into a more effective team leader. Martin (2006) states that the leadership practice should be a reflective. According to Reid (1993) reflection is a process which involves describing, analysing and evaluating a situation or incident, reviewing it and then reviewing practice as a result of the learning. I have found that reflection assists me to assess a particular shift or incident within a shift and analyse what happened and what the implications are. By doing so, I find I can identify the positive and negative aspects of a situation and thus apply what I have learnt from this to my future practice, thereby enhancing both my role as a clinician and as a leader. For this assignment I have chosen to combine Ghaye, et al.’s (1996) model of reflection with Driscoll’s (1994) ‘What'’ model of reflection (Appendix 1). I have frequently used the latter reflective model and find it straight-forward to apply. However, the model proposed by Ghaye, et al. (1996), which is 2 Leadership in Health and Social Care. based on an open spiral of learning rather than a closed circle, is one with which I readily identify. I agree that learning involves progression; one rarely returns to the same point and starts again. Boud and Walker (1991) believe that it is important for nurses to learn from their experiences and move on in order to take on greater responsibilities, thus the application of these reflective models to a leadership issue should lead to better practice in my role as a leader. Johns (1996) feels that reflective practice helps the nurse see themselves as a significant person, who has values and feelings that will aid in the giving of care. The analysis of an issue can be used as part of the process which helps an individual become an experienced practitioner (Ghaye and Lillyman, 1997) and so it is important for me to realize this, as the skills of reflective practice appear to be prerequisite to becoming a successful leader. One of the challenges that I see within my department is that of leading a frequently changing team with an ever changing client base. Most literature concerning teams considers more static examples, for instance, Arnold, et al. (2001) based their research on a group which stayed together for 20 months. Belbin (1993) suggests that teams should stay together unless there are valid reasons for changing them, since this improves team understanding and morale. However, in order to keep the department adequately staffed, the team I work in changes seven times a day. This can make it difficult to establish mutual trust, which Huber (2006) thinks is the foundation stone of a team. I have also found this to be a barrier for teams to get beyond the ‘storming’ or ‘norming’ stage of Adair’s (1987) stages of team development, which suggests the team may not reach its maximum potential. Within my department it might 3 Leadership in Health and Social Care. be useful to consider how teams could work together more often, for example by the implementation of a fixed rota system. According to Blanchard and Bowles (2001) teamwork is far more effective then individuals working alone. Research by Borrill, et al. (2000) and West, et al. (2002) has even shown that effective teams can improve the mortality rate of patients within acute healthcare settings. Whilst I can agree with these findings, I feel that a rapidly changing team does not always work together very coherently as they can lack the cooperation, cohesiveness and mutual trust which Yukl (2002) says is essential. Blanchard and Bowles (2001) also remark that as a team all can benefit from the utilization of other team members’ knowledge and experience and this is confirmed by Belbin, (2004) who says that a team is made up of a group of people who understand one another’s role. I believe that in order to understand each other’s role we need to get to know one another better and identify each members’ strengths and weaknesses, supporting one another and providing feedback and joint action on a situation. Faulkner and Laschinger (2008) found that if efforts are recognized and rewarded, a feeling of mutual respect and greater job satisfaction is generated, which in turn leads to better patient care and a higher level of staff retention. Hardacre (2001) points out that the climate within a team can affect the performance. I have witnessed this within my department when personality clashes arise within teams. Belbin (2004) sought to address this by suggesting a list of eight different roles, that when combined would enhance the team effectiveness. However, this could be difficult to achieve in my work environment because the teams change so often. By studying the Self-Perception Inventory (Belbin, 2004) (Appendix 2), I realized I do not have one particular team role but have three areas in which I am stronger. This knowledge should 4 Leadership in Health and Social Care. enable me to adapt my role amongst different teams to establish the most balanced and therefore effective team. In order to discuss the leadership in my department it is important for me to define what I understand by the term of leader. I have found it interesting to learn about the differences between leaders and managers and also about the various styles of leadership. Managers and leaders roles are similar since both require working with people and influencing them in order to achieve goals (Jasper, 2006) however authors agree that whilst a manager should be a leader, a leader is not necessarily a manager (Beech, 2002). The dictionary definition of a manager is ‘a person controlling or administrating a business or part of a business’ (Concise Oxford Dictionary, 1993:720). Covey (1992) defines managers as people who prevent role conflict and ambiguity in a team whereas he also suggests a leader should provide vision and direction. Mackay (2006) notes that the path to leadership begins long before one is appointed a leader, in fact some authors believe that people are ‘born’ leaders. Blank (2001) argues that whilst such individuals have personalities and inborn traits that others will automatically follow, leadership is something we can all learn, whatever our background. I feel that outstanding leaders are produced by a combination of the principles and beliefs they have been nurtured with and the desire to learn to lead. However I also agree with Cook (2001), who suggests that we can learn to be good leaders through watching those around us, because I have learnt some of my leadership skills by observing both successful and poor leaders. Through this course, I have come to realize that leaders are not just those in authority, but that we can all be clinical leaders if we are, “An expert clinician, involved in providing direct clinical care, who influences others to improve the care they provide continuously” (Cook, 1999:306) 5 Leadership in Health and Social Care. Over the last decade various authors have attempted to identify the prerequisites of a good leader and the issue continues to be discussed (NHS Institute for Innovation and Improvement, 2006). This emphasizes the difficulties there are in defining the role of leadership. Cook (1999) comments that the time wasted on trying to define the traits, skills and abilities of the outstanding leader should be directed towards giving the individual the opportunities to grow and learn by experience in the role whilst being supported by others. Whilst I can agree with this, I feel it is difficult if there are no good role models to follow (Scarnati, 2001) and no access to leadership training. The New NHS: Modern, Dependable (Department of Health, 1997) document, Making a Difference (Department of Health, 1999) and the NHS Plan (Department of Health, 2000) all highlighted the need for developing effective nursing leaders. This has been echoed by Lord Darzi (2008) and I agree this is imperative for providing excellent patient care. Adair (1988) showed that there are three core responsibilities of a leader: achieving the task, building (and maintaining) the team and developing the individual. By observing different leadership styles within my work place, I consider that some teams are less effective because their leaders concentrate on one area at the expense of another. Not only does this erode team morale, but it also renders patient care less effective. Hewison and Griffiths (2004) agree with this and they comment that good leadership is a key feature in the delivery of high quality care. The National Health Service Leaders Quality Framework (NHS LQF) (NHS Institute of Innovation and Improvement, 2006)(Appendix 3) was provided as a standard for leadership 6 Leadership in Health and Social Care. within the NHS. I have concerns that the framework was devised by senior executives, without consulting the opinions of staff from a cross section of healthcare levels. By benchmarking myself against the competencies (Appendix 3), I can determine the level I am currently working at and where I aspire to be in the future. The NHS Institute for Innovation and Improvement (2006) advocate that leaders draw upon their personal qualities to fulfill their role within the team. Through benchmarking myself against the NHS LQF and through feedback from my personal development plan, I am aware that whilst my personal qualities are mostly at a positive level and I have reached the appropriate level in the Knowledge and Skills Framework (Department of Health, 2004) for delivering the service, I score lower in the qualities within ‘setting direction’. This is to be expected at the stage I am at in my career since the higher levels are aimed at executive level (NHS Institute for Innovation and Improvement, 2006) but is the area I need to work on for the future. Within the department the team running each shift is small (3 and 12 members of staff), however the overall size of the nursing team is 50 – 60. It is therefore important to establish effective communication to remain productive (Ohler, 2004). We utilize various media with varying degrees of success measured by the response of the team (MacKay, 2006): for example meetings are not as successful as they could be due to the dynamic nature of the department, which means that staff can not always be spared to attend them and express their opinions. Henderson (2003) agrees that the pressures of a job can reduce participative communication within the team. In my experience this can result in people feeling undervalued and resentful that they are not able to express their opinions. Ultimately this could lead to poor job satisfaction and low morale and as Thomas and Hynes (2007) point out this can result in 7 Leadership in Health and Social Care. the breakdown in the team as an effective unit, therefore priority should be given to ensuring that staff meetings occur. In order to fulfill my role as a Band 6 nurse and progress through the Knowledge and Skills Framework (Department of Health, 2004) it is essential that I develop not only my own leadership skills through learning and practice, but that I also assist the development of other members of the team (Adair, 1988 and Rushmer, et al. 2004a). By keeping up to date with current research and questioning practice, I can help to ensure that the quality of care that is given within the department is constantly improving. Senge (cited in Rushmer, et al. 2004b:392) proposed that learning takes place at three levels, and within our department I can detect that the first two of these levels; looking at the current situation and correcting inefficiencies (single loop learning) and being prepared to change practice (double loop learning) are encouraged, however the learning does not often reach the triple loop stage of learning. The frenetic nature of the department can have a detrimental effect on the departments’ aspiration to be a learning organization. Whilst being able to ‘adapt to the changing demands of the environment’ (Koeck, 1998:1268) it does not always create sufficient time for team learning as advocated by Bohmer & Edmondson (2001). Therefore it is important as a leader to make use of all other opportunities to teach. Reynolds and Rogers (2003) remark that in order to be a situational leader (someone who adapts their leadership style to suit the people and task involved (Farmer, 2005)), the nurse needs to assess each members’ capability and development levels. Goleman (1998) refers to this as Emotional Intelligence (E.I.), defined as the ability to motivate ourselves, whilst also having the capacity to recognize 8 Leadership in Health and Social Care. and manage one’s own and others’ feelings and emotions (Boyatzis and Goleman, 2008). Lucas, et al. (2008) have shown that E.I. leaders generate a higher degree of co-operation amongst their team, leading to fewer conflicts and an increase in job satisfaction. Feather (2008) comments that this leads to a reduction in nursing turnover. My Emotional and Social Competency Inventory (Hay Group, 2007) self assessed profile (Appendix 4) showed that I often use adaptability, emotional self control and teamwork in my work. However in order to gain an unbiased view of the skills I possess and how to develop, I need to confirm whether or not my colleagues agree with my findings. I could do this through peer reviewed feedback of my E.I. profile or by a 3600 appraisal linked to the Leadership Qualities Framework (Department of Health, 2002). When using the latter method, I would need to be aware that research has shown that this type of appraisal can give rise to conflict and have a detrimental effect on the team (Rees and Porter, 2003). Within my department I observe differing styles of leadership, and appreciate the importance of considering the way that I lead. Leadership theories show that there are various leadership styles, which have an impact on the effectiveness of the team (Hay Group, 2007). In the 1950’s leadership styles were grouped under three headings, autocratic, democratic and laissez faire (Huber, 2006). Burns (1978) broadened this by including two types of leaders: transactional and transformational. Within our sizeable team a large range of leadership styles have been used by different leaders. Some use a transactional or autocratic style, which Hardacre (2001) defines as primarily focusing on the daily needs of the department. In my work area I can identify this in some leaders who are very good at managing the day-to-day 9 Leadership in Health and Social Care. running of the department, but who are coercive and overbearing at times. In the past healthcare leaders often adopted an autocratic style (Lorentzon & Bryant, 1997 and Chiok Foong Loke, 2001) hence it is no surprise that this style is still favoured by some of the older team leaders. Murphy (2005) and Cook (2001) comment that whilst transactional leaders like to maintain the status quo, they are often able to support and lead staff in stressful situations, which I have certainly found to be true. This makes me realize the importance of utilizing the Situational Leadership Principle (Blanchard, et al. 2003) and I will aim to adopt the most appropriate leadership style for a given situation. I have been able to consider my leadership styles by the use of various tools (Appendix 5). I analyzed my predominant leadership style as transformational with the help of the Foundation of Nursing Leadership (2008) questionnaire. A disadvantage of this type of questionnaire is that the questions relate to general, rather than specific situations, therefore they do not highlight the occasions when I consider it necessary to modify or adopt a different leadership style. Research has shown that the style of leadership adopted can have a profound effect on the success of the team (Arnold, et al. 2001; Faugier and Woolnough, 2002 and Sellgren, et al. 2008). However Adair (2006) and Farmer (2005) agree that the style of leadership used should be adapted to the situation, although Grohar-Murray (2002) suggests that we do this naturally. Whilst I predominantly use a transformational style of leadership, I think this is particularly pertinent in the A&E department where t is imperative to be more transactional or authoritarian when dealing with an emergency situation such as a cardiac arrest. This is in agreement with Lindholm, et al. (2000). Hersey and Blanchard’s (1982) leadership theory proposes 4 different styles that leaders could adopt in a given situation, depending on the abilities and commitment 10 Leadership in Health and Social Care. of the staff involved. These styles involve increasing or decreasing the amount of direction and support the leader gives to the individual according to their level of competency. In my experience this allows one to encourage those who are more able whilst giving more support to those who need it. When considering the styles of leadership that I use, the Influencing Style Audit (Hardacre, 2001) highlighted my main influencing areas as those of value-driven style and needsfulfillment. Blanchard (2006) feels that it is important to recognize one’s strengths in order to fully utilize them within the team. The audit identified that my weakest area was that of visioning. Whilst my strongest traits correspond with the “servant-style” of leadership (Howatson-Jones, 2004) that I admire, I found it slightly disturbing to be analyzed as weak in the area of future vision since many of the definitions of an effective leader highlight the need for them to be forward thinking and visionary (Richards and Engle, 2005 and Huber, 2006). On reflection, I feel that my lack of visionary traits could be because I am comparatively new to my role and therefore require more support and development at present. This assignment has enabled me to better ascertain my own leadership styles and with that knowledge I now feel I can better utilise my leadership attributes in the future as well as seek to improve upon those areas where I consider myself weaker. The NHS Institute for Innovation and Improvement (2006) encourage the leader to use any mistakes made as opportunities to learn. By following this advice, I will be able to increase my level of self-awareness which will enable me to be more sensitive to the impact my actions have on the team (NHS Institute for Innovation and Improvement, 2006). 11 Leadership in Health and Social Care. In conclusion, I have looked at the issue of leadership in teams within my work environment and have considered and reflected on my own leadership skills. As a result of this course, I feel better equipped to lead my team and will endeavour to work to increase my ability to be forward thinking and visionary. I have challenged my assumption that leaders are just the people running a shift, and realize that we can all lead whatever level we are. I am aware that as I am inexperienced in my current position there will be new and different leadership challenges. However through the knowledge gained on this course, I hope to become “An expert clinician, involved in providing direct clinical care, who influences others to improve the care they provide continuously” (Cook, 1999:306).I now better understand the NHS Leadership Qualities Framework (NHS Institute for Innovation and Improvement, 2006) and appreciate it’s relevance to my role within the team and have considered areas that I aim to improve. Through this I now realize that becoming an excellent leader is not a process that will happen overnight, but is one that I can strive to work towards throughout my nursing career. WORD COUNT: 2817. 12 Leadership in Health and Social Care. REFERENCES. Adair, J. (1987) Effective Team Building. London: Pan Macmillan. Adair, J. (1988) Effective Leadership. London: Pan Macmillan. Adair, J. (2006) Not Bosses but Leaders: How to Lead the Way to Success.3rd Ed. London: Kogan Page Ltd. Arnold, K., Barling, J. & Kelloway, E. 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