leadership: Test 1
mentoring
- Assist and reflect, essential to learning - Most powerful in transformational and authentic leadership styles - Models behavior, offers advice and criticism, and coaches the novice to develop a personal leadership style - Confidante, coach, cheerleader, and teacher
health professions education: a bridge to quality (2003)
- Attempted to shrink the chasm between education and practice so that interprofessional teams would work more effectively together. - Exposed the issue of "silo" education and called for collaborative practice. - Increased expectation for participation in lifelong learning.
The department of health (based off of complaints)
- Can visit more frequently - Highly focused on performance improvement - Spends much more time reviewing records - Can be sent on behalf of CMS or prompt CMS visits
DNV-GL healthcare, and the quality and safety education for nurses institute
- Comprehensive resource, including references and video modules. - Defines essential competencies as patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. - creates knowledge, skill, and attitudes for students and graduates related to quality and safety
coaching
- Critique of what elements were and were not successful in problem-solving a situation - Authentic leadership style - Build cooperation - Successful communication - Effective decision-making
authentic leadership
- Deep values and beliefs as well as a strong sense of self-awareness - Shared decision-making respected - Integrity - Builds competence and confidence in new graduates >>> increases new grad retention - Resilient
coveys eight characteristics of effective leaders
- Engage in lifelong learning - Service-oriented - Concerned with common good - Radiate positive energy - Believe in other people - Leads balanced lives and see life an as adventure - Synergistic or see things as greater than the sum of parts - Engage in self-renewal
agency for healthcare research and quality
- Federal agency devoted to improving quality, safety, efficiency, and effectiveness. - Provides outcomes research sections as resources for nurses. - created TeamSTEPPS 2.0
keeping pt safe: transforming work environment of nurses (2004)
- Focused on direct care nurses and supported their involvement in decision-making related to their practice. - Supported the concept of shared governance.Provided a framework for considering how nurses could determine staffing requirements. - Supported public reporting of issues related to unsafe work environments. - Moved the Chief Nursing Officer (CNO) into the boardroom as a key spokesperson on safety and quality issues.
goal of complexity theory
- Helps us develop strategies to thrive in VUCA environments - Goal = patient and organizational problems = examine a problem through multiple lenses - Information should be shared = creative problem solving
national quality forum
- Membership-based organization related to quality measurement and reporting. - provides source for centers for medicare and medicaid services' never events - serves as resource for healthcare facilities accreditation program - serves as source of nurse sensitive care standards
transactional leadership
- Most common style demonstrated by nurse leaders - Environment of power and position - Collaborative and goal directed; offspring rewards - Formal authority - Value and reward followers for high performance - Penalize followers for poor performance - Team members have little to no input on decisions
transformational leadership
- Most important outcome: positive patient outcomes; positive staff outcomes/nurse retention - Leader creates vision: interprofessional work, listens to views of others, finds way to remove barriers, fosters creativity and innovation - Magnet recognition program: share governance, empowerment values
crossing the quality chasm
- Moved care from discipline-centric to patient centered - Reinforced the disparities that occur within healthcare, which, in turn, led to a focus on best practices and patient-centered care - Addressed issues such as healing environments, evidence-based care, and transparency, which led to a more holistic environment built on evidence - Provided substantive support for information technology use.Served as impetus for "pay for quality."
to err is human (200)
- Moved safety issues from the incident report level to an integrated patient safety report for the organization - Acknowledged system errors as more common cause of error than individual - Stimulated hospital boards to include reports on quality.
"informal leader"/effective follower
- Patient advocates - Influence and motivate others - Innovate ideas supporting their organizations mission and goals - Experience driven suggestions regarding patient care - Positive attitudes = contagious = increased morale = increases productivity = patient outcomes - Self-awareness to challenge leaders (respectively) - Courageously challenge or champion out leaders based on complex situations - Develop into effective and authentic leaders Proactive about learning - Can either advance the leaders goals OR divert and limit the progress - Frontline workers who critically think - As probing questions
moral courage
- Speaking up for our against issues within the team - Leaders have an obligation to make ethical decisions when speaking up regardless of fear of rejection or ridicule of peers
nurses leaders
- Staffing and budgeting decisions - Personnel policies and change - Delegation decisions Information technology - Benchmarking: always improving and knowing what every hospital is doing so you can improve
the joint commission
- Visits every 3 years - Accredits healthcare organizations - "Deemed" status from the centers for medicare and medicaid services - Organization that meets TJC standards is deemed to have met the CMS standards of participation
complexity theory
- an approach to understanding complex systems - help us develop strategies to thrive in VUCA (volatility, uncertainity, complexity, ambiguity)
ruiz 4 agreements (1997)
- be impeccable with your word - don't take anything personally - don't make assumptions (when communication isn't clear) - always do your best (staff should think this too)
National Database of Nursing Quality Indicators (NDNQI)
- comparisons w/ ranks, nursing focus, helps with benchmarking - nurse sensitive if patient outcomes improve with greater quantity or quality of care within nursing scope of practice
steps of QI process
- identify standards - assemble team - collect data - establish measurable - select and implement plan - analyze and discuss/adjust
institute for healthcare improvement
- independent, not-for-profit organization focused on advancing and sustaining better outcomes in health and healthcare. - adopts triple aim framework - supports innovation
principles of QI
- managers and workers are committed, - goal is to improve system and processes not assign blame (blame-free culture) - blame-free culture
benefits of quality improvement
- overcome resource contraints - reduced malpractice suits enhanced job satisfaction - decreased adverse events
performance improvement expectations
- patient outcomes focused!! tell a story not only data - quarterly actions and analysis, - daily discussion at huddles - end of year summary and plan
emotional intelligence
- understanding and managing our own emotions w/ added social awareness of discerning w/ emotions of others, - higher EI=more successful, being self-aware - based on skills we use everyone - leads to better patient outcomes - positive work environment - higher quality of care
quality management in healthcare
-demand for quality improvement (expected) - recognize survival and improved outcomes - philosophy of organization
the future of nursing recommendations
1. Remove scope-of-practice barriers. 2. Expand opportunities for nurse to lead and diffuse collaborative improvement efforts. 3. Implement nurse residency programs. 4. Increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 5. Double the number of nurses with a doctorate by 2020. 6. Ensure that nurses engage in lifelong learning. 7. Prepare and enable nurses to lead change to advance health. 8. Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.
Magnet Recognition Program
A designation signaling excellence in nursing and obtainment of successful outcomes within healthcare agencies
international council of nurses (ICN)
A federation of more than 130 national nurses' associations, representing millions of nurses worldwide and designed to be the voice of nursing internationally.
health professions education: a bridge to quality (2003)
Addressed the issue of silo education among the health professions in basic and continuing education. Identified need to provide patient-centered care, work in interprofessional teams, employ evidence-based practice, apply quality improvement, and utilize informatics.
future of nursing 2020-2023: charting a path to achieve health equity
Expanded vision of original Future of Nursing publication to charge the profession to create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century
future of nursing: leading, change, advancing health (2010)
Identified 8 recommendations based on evidence that the profession must attend to, including improving nurse education, ensuring that nurses can practice to the full extent of their education and training, providing opportunities for nurses to assume leadership positions, and improving data collection for policymaking and workforce planning
keeping pt safe: transforming work environment of nurses (2004)
Identified many past practices that had a negative influence on nurses and, thus, on patients.
crossing the quality chasm (2001)
Identified the six major aims (safe, effective, patient-centered, timely, efficient, and equitable) for providing quality healthcare.
-IOM: 7 key reports -To err is human (2000): good people are working in bad systems ex.) name and DOB -Crossing the quality chasm (2001) -Health professions education: a bridge to quality (2003) -Keeping patient safe: transforming the work environment of nurses (2004) -Improving the quality of health care for mental and substance-use conditions (2005) -Preventing medication errors (2006) -Future of nursing 2020-2030: charting a path to achieve health equity
Key safety reports
American Nurses Credentialing Center (ANCC)
Organization created by the ANA to provide certification for nurses in various specialties, nurse-driven standards for excellence
community volunteers
Organize individuals in the community to help develop a vision for the future of the community's health, healthcare opportunities, and healthcare delivery ex: health fairs
institute of medicine (IOM)
Provide-patient centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Utilize informatics
to err is human
Quantified the role of safety-related errors resulting in patient morbidity and mortality.
b.) self-management (requires that we act independently to strengthen those things that we do not do well)
a new nurse sees a flyer for a workshop on healthcare relationship building and recognizes that relationship building with those in current leadership positions is challenging for her. she deciced to attend. by making the decision to attend, what is the new nurse demonstrating? a.) social awareness b.) self-management c.) strengths-based learning d.) personal leadership
d.) an informal leader (one who does not hold title but rather leads from an informal way by actions and behaviors)
a new nurse works on a busy medical-surgical unit. while the charge nurse keeps the unit organized and running smoothly, the nurse notices that another expericned nurse is the nurse whom most of the other nurses ask questions and seek information. How does the new nurse view this experienced nurse? a.) a formal leader b.) a positional leader c.) an official leader d.) an informal leader
management
ability to plan, direct, control, and evaluate others in situations in which the outcome re known or pre-established, one or more way of performing have been agreed on based on evidence, feedback, and communication are shared to improve clinical processes and outcomes, and sustained relationships advance consistency of purpose.
nurse executive as leader
accountable for nursing practice and adequacy of staffing resources, reviews and sets EVP that ensure pt quality, creates shared vision, balances daily operations
national academy of medicine
advise the nation on issues of health, health care, and biomedical science and technology
-should make clinical decisions -consider organization in decision making -acts as advocates for pts, families, and team members
all leaders, managers, and followers
risk
analysis of data and processes to reduce error and mitigate risk, impact on facility
improving the quality care for mental and substance-use conditions (2005)
applies the quality chasm idea into specific strategies for these conditions
quintuple aim in healthcare
better care, more satisfied pts, lower total medical costs, better health equity, more satisfied providers
budgeting and finance for managers
biggest thing is having a rationale for budgetary spending and looking at the unit as a whole and filling in gaps (equipment, staff)
collaboration, communication, recognition, accountability, self-actualization (ongoing education)
build a healthy work environment by
department of health
can visit more frequently, highly focused on performance improvement, reviews records, send on behalf of CMS
strengths
capitalize on those that are tour talents and to surround yourself with people with other talent that "fill in" the total set of talents needed to accomplish work
quality
continued focus to improve care for patients we serve
cultural concepts
creating diversity, equity, and inclusion to support quality and safety in workforce
- Requires unwavering support by leaders - Culturally sensitive work environment - Allow staff to verbalize their feelings - Staff members of different ethnic organs present a patient-care conference related to their values
dealing effectively with cultural diversity
steps in risk management process
define high-risk situations that place system at financial risk, determine frequency, intervene/investigate, identify opportunities to improve
important actions to be a "formal"/effective leader
develop personally and professionally, promote patient and population centered care (least costly, highest quality outcomes), contribute something critical
near miss
didn't affect outcome, but chance of causing adverse outcome ex: almost gave med to wrong pt, need to report these to show processes that need to be fixed
followership
each group member contributes optimally to achieve outcomes, fully participate, maximal functioning, serving on committees
safe, high-quality care, active team members who stay with organization longer and are loyal
effective communication leads to
quintupe aim
enhancing pt experience (quality, safety), improving pop health, reducing costs, improving work-life of care providers
nurse manager as leader
face of leadership, know day-to-day operations, involving staff in changing workplace to be more satisfying, address change that being thrust on them
barriers to leadership
false assumptions that a title=power, approach problems from new perspectives (followers w/ experience jumping in to breakdown barrier)
becoming an authentic leader
focus on honest relationships by remaining true to yourself, maximize talents of others, value what each person brings helps others develops trust
formal leader
fosters a partnership of trust, shares accountability, supervisors by inspiring, caring for diverse populations
improve systems and processes, not to assign blame - improve process not the person
goal of QI
reducing costs
goals of quintuple aim - productivity - sustainability - cost-effective -comparatively effective
provider experience
goals of quintuple aim - provider satisfaction - work/life satisfaction - work/life balance - workflow optimization
population health - quintuple aim
goals of the quintuple aim - Risk management through pooling - Preventive care - Socio-economically impactful
patient experience
goals of the quintuple aim - patient satisfication - outcomes - quality - safety
difficult situations prove
good leaders and good followers
elective office in leadership
helps w/ name recognition, let's members know your abilities and you are serious about being association, allows for mentoring from those in office
skills for managers
human relations, techincal and organizational skills, motivating, controlling, following through, and inspiring
preventing medication errors (2006)
ideas such as prescriptions written and dispensed electronically by 2010, more widespread use of medication reconciliation, having pt bring in prescriptions
key actions for cultural concepts
identify and challenge unconscious bias, understand team differences, empower staff through shared governance, culturally sensitive environment, allow them to verbalize feelings
nurse's role in risk
if you didn't document, it didn't happen, only document facts not opinions, follow safety checks
understand mission and vision, translate into action plans incorporate families and/or SO into support for pt care
important aspects of nurse managers
reporting/analysis tools
incident report, failure mode and effects analysis (FMEA, high risk situations), root cause analysis (RCA, ask why to find cause)
informal leader
influence and motivate other, innovate ideas supporting their organization, suggestions regarding pt care, positive attitidues=cotagious=increased morale=increased productivity
implications for nurse leaders
info technology, benchmarking (knowing what other hosp are doing), delegation and staffing decisions, personnel policies
- Identify and challenge unconscious biases - Undestand team differences - Create a respectful practice environment - Provide flexible scheduling to honor cultural practices - Support ongoing professional development - Create social support systems - Create effective communication systems - Empower staff through shared governance
key actions
- Culture of safety is everyones responsibility - Nurses have accountability to challenge the "unsafe" - Nurses in leadership and management roles have additional opportunities to implement best evidence
key takeaways
believe and trust others, lead balanced lives, radiate positive energy, service oriented
leaders have followers who
followers and followers become leaders ppl are good @ different skills, so could benefit from followers becoming leaders
leaders will become
each person has potential to lead and share, grow your team to be leaders, formal leaders will release control to create an active learning and engaging environment
leadership is shared
leadership theories: transformational
leadership theories promotes a style of guidance that emphasizes motivating employees, and creating a vision and encouraging them to fulfill it.
leadership theories: style
leadership theories suggests that leaders aren't born successful, but can be created based on learnable behavior
leadership theories: situational-contingency theory
leadership theories every situation that requires leadership is different and requires a specific type of leader
leadership theories: trait
leadership theories leaders are born with distinct characteristics
leadership theory: Hierarchy-of-needs theory
leadership theory physiological at the bottom, safety, love, and belonging, and self-actualization (at the top)
leadership theory: expectancy theory OB modification
leadership theory: individuals are motivated to perform if they know that their extra performance is recognized and rewarded.
leadership theory: two-factory theory
leadership theory: puts forward two factors that motivate employees: job satisfaction and job dissatisfaction.
guiding through the uncertainty and being there to help, being mindful of workplace satisfaction (economic and physical concerns ex: cost, skills, and talents to train new nurses, want good retention)
leading change and workplace satisfaction can be done by
knowledge, integrity, ambition, enthusiasm, synergistic (see things as greater than sum of parts), self-renewal
managers must possess qualities of a good leader:
intergenerational workforce
millennial support baby boomers (technology), baby boomers provide education/mentorship to milennials
teach-back method (have pt explain), hand-off communication, SBAR
mitigation tools
the leadership challenge
model the way, inspire a shared vision, challenge the process, enable others to act, encourage the heart (positive work environment), feedback
join a professional organization (general/broad: ANA, clinical focused: AACN)
most important step into becoming a leader is
nurse managers
must understand what motivates and the different generations and use that knowledge to bring together teams to achieve department goals
joint commission (TJC)
not-for-profit organization that accredits healthcare organizations that meet standards of centers for medicare and medicaid services (CMS), come when there are complaints
staff by being respected, recognized, and appreciated, which can lead to doing more than what's expected, listen and facilitate achievable goals
nurse managers advocate for
- patient safety first always! - speak up for safety - err on the side of caution - preoccupation with failure - transparency
nurse's role in safety
1. result in patient harm 2. key position to speak up for patients 3. strong moral and ethical imperative for pt advocacy
nurses not speaking up is concerning for
their leadership to shape the vision of government to help meet health and societal needs of citizen
nurses who are elected members of governmental bodies can exert
clear vision for future and articulating a pathway to attain goals
one of leaders main characteristics is
relationships between leaders and followers
past: leaders dictated and followers were submissive present: true partnership, trust, accountability, good communication, reduces skill-based errors
preventable medical errors, high staff turnover, and low morale
poor team communication leads to
safety
prevent and reduce errors and harm through consistent processes
case management
provide care for pt by proactively coordinated w/ identified time frames to accomplish appropriate care outcome
managed care
provide needed healthcare services efficiently and at an appropriate cost
lifelong process of becoming a leader
reflection: experiences, journal (HIPPA), what to do/not to do values knowledge: past and present action: test new knowledge
bleich's tasks of management
responsibility, adheres to standards, big picture planning, eliminates barriers, offers rewards and recognition
sentinel event
serious, unexpected, involved death, permanent harm, or temporary harm with life-saving intervention
- STAR: stop, think, act, reviews - Use the IOM competencies to frame your actions - Keep current with the evidence and best practices - make sure its the right thing to do - Use only quality sources, especially websites - Read general nursing literature regarding other organizations' work related to safety
tips for patient safety
forward into leadership roles such as professional associated (legislation), policy-making arenas
to continue to lead change, nurses must
community opinion leaders
trusted professionals and have an opportunity to serve as catalysts in community leadership roles ex: school board
adverse event
unanticipated, undesirable, or potentially dangerous ex: gave med, need reversable
leadership
use of individual traits and abilities to interpret a situation and enter w/o predesigned plan influence by inspiring and enabling through advice
key traits a leader possess
vision for future, able to see possibilities, effective communication=lower medical errors, adaptable to situations, use of experience
respect, future-focused palpable direction, safe/positive healthy work environment
what leaders expect from their leaders
d.) maintain likeability (although likeability may derive from effective leadership, it may not always be the case when leaders strive hard to do the right thing)
which of the following is not a rule of leadership? a.) maintain a positive attitude b.) listen to people c.) maintain balance d.) maintain likeability
c.) increased job satisfaction (people tend to have higher satisfaction when they are motivated and intellectually stimulated, as are hallmarks of the transformational leader)
which of the following represents outcomes of transformational leadership? a.) deadlines are met b.) work is completed according to the rules c.) increased job satisfaction d.) pay tends to be higher
a.) baby boomers (more likely want to do the work themselves than to rely on someone else who may not have the same work ethic as they have)
which of the generations is challenged by sharing leaders with other generations? a.) baby boomers b.) generation Y c.) generation x d.) generation Z
complexity: healthcare is everyone (clinic in school) we work in teams=emerges as leader
why is leadership important
most common healthcare sentinel events
• Fall • Unintended retention of a foreign object • Suicide • Wrong-site surgery • Assault/rape/sexual assault • Fire • Clinical alarm response• Self-harm• Medication management
