Leading in Contemporary

Health Care
NRSG 5118 Fall, 2017
 ??????????????
Think about a leader who has been most influential in
your life.

Write their name down.

What role/position did they hold?

Why was this person so significant?

What about this person would you emulate?
 A Core Competency
Hamric, 2014 AONE, 2006
 ???????????
Think about a leader who has been influential in your
life.

Write their name.

What role did this person hold
Why was this person so significant. What about this
person would you emulate??
Professional Nursing Imperative
for Leading
Changes in Nursing Education
American Association of Colleges for Nursing (2011)
The Future of Nurses: Leading Change, Advancing
Health (IOM, 2010)
Interprofessional Collaborative Initiative (IPEC), 2011
IOM 5 interdisciplinary competencies
Evidence
 Class objectives
1. Examine definition of leadership
2. Examine key societal/global influences on American
healthcare system
3. Compare traditional (closed) and contemporary (open)
healthcare systems and associated leadership styles
4. Identify and discuss attributes of emotionally intelligent
leaders and transformational leadership approaches
5. Discuss strategies for developing a transformational
leadership practice.
6. Examine your own leadership practice.
 What IS leadership and what it is
NOT?
IS: Practice/Performance,
IS NOT only a position with formal authority

Leadership is a process whereby an individual

influences a group of individuals (or a single) to
achieve a goal (Northouse, 2017, p. 6).
 Societal Context for Health Care
Leaders
Information readily available/informed consumers
HC: high-exposure, transparent, quality; outcomes focus
Big Data.
Technical worker knowledge worker
educated nurses; scientific base
Tradition & stability Rapid Innovation cycle
CHANGE is constant
Clinician centric Patient/consumer centric
Brick & Mortar Digital architecture (informatics)
Systems re-design: Complexity & interdependence
 A Paradigm Shift from:
Linear to Complex systems thinking

Closed systems
 Properties
Linear Systems Complex Systems
Hierarchical Top-down leaders Dispersed leadership
Organization by others
Individual decision-making
Self-organization
Collaborative decision-
Linear problem-solving
making at the point-of-
One cause; often personal
care
Predictable
Non-linear; guiding norms
Siloed; no information exchange
Not predictable; patterns
Information exchange; Co-
evolving
How does a Open System vs a Closed
System impact working relationships?

http://ekhlas91.files.wordpress.com/2013/01/heterarchy-and-
hierarchy.gif
Network Structures
Leading is Multi-dimensional

Skills/behaviors

Traits/Styles

Interpersonal/Relational
 What are the traits of leaders that people
willingly follow?
Honest Integrity
Inspiring Charisma
Competent Intelligence
Forward-looking Determination
Sociability
Confidence

Kouzes & Posner, 2014 (Northouse, 2017)

Leadership Styles
Authoritarian

www.janto.com
www.cartoonstock.com
Leadership Style
Transactional

CARROT & STICK

 Leadership Styles
Relational (Transformational)
 Leadership Styles
Transformationalrelationship-based:
A process whereby the purposes of the leader and
follower become fused, creating unity, wholeness and a
collective purpose Barker, 1994

Transactional - task focused:

Focuses on the role of supervision, organization, and
group performance; an approach that strives for
compliance of followers through the use of punishment
and reward
 Leadership Style
Lassiz-faire: Passive-Avoidant

Imgbuddy.com
Effectiveness of
Leadership Styles Effective
in contemporary
healthcare Transformational

Transactional Active
Passive

Authoritarian
LF:
Passive/avoidant

Ineffective
 Leadership Styles
Transactional Transformational
Leader Behaviors Leader Behaviors
Hierarchical/directive Values-based; Relational
Identifies needs of followers; Inspiring & motivating,
meets needs in exchange for intellectual
performance
Effect on Followers
Effect on Followers
Shared vision
Fulfills contract or there is
consequences
Meaningful work
Coaching/mentoring
Does work for paycheck
Feels valued
Errors are corrected in
reactive manner
McGuire & Kennerly (2006)
 In summary
Leadership Trends:

Hierarchical/control Participatory

Authority Influence

Single Leader Dispersed Leadership

APRN role

Professional

Clinical

Systems

Domains of leadership
 7 Transformation Leadership
Behaviors
Empowers/Supports
Develops/Coaches
Intellectual/Innovative Thinking
Lead by Example
Vision
Charisma
 Transformation Leadership Behaviors
Empowers & Supports

Self-control; calm/comported; responds vs reacts

Gives encouragement and recognition to staff, colleagues
Encourages staff & colleagues and takes thoughtful risks
Goes beyond self interest for the good of the
patient/staff/group

Interpret situation or practice using a big picture view

 Transformation Leadership: Behaviors
Develops & Coaches

Treats staff (and patients) as individuals

Helps other to develop their practice; skills
Spends time teaching and coaching and providing
encouragement

Role Model professional behaviors; EB practice

 Transformation leadership Behaviors
Intellectual & Innovative Thinking
An optimistic striving for continual improvement
Open to new ideas, searches out challenges and
opportunities

Re-frames problems to consider different perspectives

Re-examines critical assumptions to question whether they
are appropriate
Trust intuition & then back up with facts

Gets others to look at problems from many different angles

 Transformation leadership Behaviors
Leading by Example
Is clear about his/her values and those values inform
practice/behaviors
valuesconnecting thoughts, principles and inner driving
forces that give purpose, direction and precedence to priorities

Takes initiative (anticipates) before situations unfold

and forced to act in less optimal ways

Demonstrates competence & is capable of rapid

learning in area where change is needed

Emphasizes important of collective mission

 Transformation Leadership: Behaviors
Vision
Develops, communicates a positive (clear) vision of the
future
Includes staff/followers/patients
Behaviors..
Assisting patients in the formulation of future well-being
(clinical)
Envisioning patient outcomes for aggregates of
population (administrative)
Participating in a interprofessional team to contribute
nursing perspective in the implementation of a research
protocol (professional)
 Transformation Leadership: Behaviors
Charisma
Instills pride and respect in others and inspires by
being highly competent

Motivates others
IMAGINE if in all these
scenarios

NO NURSE was
engaged/present )