Leadership Chapter 1

What are Disch's three ways to approach developing new solutions?

(1) Embrace paradox. Health care is full of paradoxes, that through confronting rather than ignoring a situation, solutions can be developed. (2) Seek ambiguity. By obtaining input from others and accepting that multiple perspectives of any situation exist, leaders can begin to identify broad solutions. (3) Reframe situations. By taking a new perspective on a problem, the solution often becomes more evident.

What are the key traits to leaders?

(1) articulating a vision for the desired future state (2) seeing possibilities during challenging, complex, uncharted, or even dire circumstances (3) communicating effectively, sometimes powerfully, with others (4) adapting to new situations and environments (5) using experience and knowledge to judge reasonable risks

What traits are needed for effective managers?

(1) the ability to identify recurring problems and design evidence-based routines to create structure and improve work efficiency (2) persistent and vigilant behavior in self and others (3) communication that maintains esprit de corps in the face of repetitive work tasks.

Bleich's tasks associated with followership

1. Demonstrate individual accountability while working within the context of organizational systems and processes; do not alter the process for personal gain or shortcuts. 2. Honor and implement care to the standards and specifications required for safe and acceptable care/service. 3. Offer knowledge, skills, and abilities to accomplish the task at hand. 4. Collaborate with leaders and managers; avoid passive-aggressive or nonassertive responses to work assignment. 5. Include evidence-based feedback as part of daily work activities as a self-guide to efficiency and effectiveness and to contribute to outcome measurement. 6. Demonstrate accountability to the team effort. 7. Take reasonable risks as an antidote for fearing change or unknown circumstances. 8. Evaluate the efficiency and effectiveness of systems and processes that affect outcomes of care/service; advocate for well-designed work. 9. Give and receive feedback to others to promote a nurturing and generative culture.

Bleich's tasks of management

1. Identify systems and processes that require responsibility and accountability, and specify who owns the process. 2. Verify minimum and optimum standards/specifications, and identify roles and individuals responsible to adhere to them. 3. Validate the knowledge, skills, and abilities of available staff engaged in the process; capitalize on strengths; and strengthen areas in need of development. 4. Devise and communicate a comprehensive big-picture plan for the division of work, honoring the complexity and variety of assignments made at an individual level. 5. Eliminate barriers/obstacles to work effectiveness. 6. Measure the equity of workload, and use data to support judgments about efficiency and effectiveness. 7. Offer rewards and recognition to individuals and teams. 8. Recommend ways to improve systems and processes. 9. Use a social network to engage others in decision making and for feedback, when appropriate or relevant.

What is necessary to maintain the perspective, focus, and energy of an effective leader?

A balanced diet, adequate sleep and exercise, and other wellness-oriented activities

How do leaders treat newfound opportunities to represent the group?

A leader treats these newfound opportunities with respect and represents the group's interests with openness and integrity

What does collaboration require?

A set of special conditions between leaders and followers Among these conditions are the ideas that each voice will be valued in an equitable manner, that power is evenly distributed among the stakeholders, and that conditions allow for innovation

What is one thing required in leading, managing, and following?

A willingness to communicate and explain—again and again

Systems thinking

Ability to do this is a central concept in adaptive leadership because of the broad perspectives needed to understand a situation

What must be considered by patients, providers and payers?

Access to care and cost of care

Management theories

Address planning, organizing, directing, and controlling aspects of work design, were also included and sometimes were cited as leadership theories

What is expected of all team members?

All team members are expected to fully participate, using their knowledge, skills, and experience to help deal with complex clinical and organizational issues

What is required of some institutional formal positions, such as nurse manager or charge nurse?

An advanced set of attributes and know-how to establish organizational goals and objectives, oversee human resources, provide staff with performance feedback, facilitate change, and manage conflict to meet patient care and organizational requirements

How do new nurses typically think of management?

As it relates to either direct patient care or nursing unit management

What is theory development based on? What is an example of this?

Assumptions that by reducing something into its component parts, its functioning could be better understood For example, departments of a healthcare organization, such as laboratory, pharmacy, and dietary, all have leaders and manager (Decision will have complex ripple effect on rest of organization)

Why should nurses be involved in planning and implementation?

Because nurses are often the end users in the rollout of new care processes, it is important that they are involved in the planning and implementation as well An example of a situation where nurses can contribute greatly to overall project success is planning for implementation of a new electronic health record.

Why are emotionally intelligent nurses credible as leaders, managers, and followers?

Because they possess awareness of the individual, family, or community that is the locus of caregiving, have enhanced organizational skills because they have invested in relationships, and are able to collaborate, show insight into others, and commit to self-growth

How does Goleman refer to emotional intelligence?

Being characterized by self-awareness, self-regulation, empathy, and social skills that help people harmonize to increase their value in the workplace

What is one thing required in being an effective manager?

Being effective as a manager requires behaviors different from those associated with effective leadership, and vice versa. Ideally, those charged with managing are also good leaders and followers, because no organizational position is limited to one exclusive set of behaviors over another. Leaders, managers, and followers who are effective use all three roles to accomplish their goals.

What are the goals of the quadruple aim?

Better care, more satisfied patents, lower total medical costs, more satisfied providers

Functions of theory in nursing

Can be used to guide a nurse's approach to a situation Can be used to frame a research question and guide a research study Directs and sharpens the ability to predict or guide clinical organizational problem solving and outcomes

What is the complexity of the healthcare system marred with?

Chronic problems, information imbalance (sometimes too much, sometimes not enough), physically and emotionally intense work with little time for reflection, increased consumer and regulatory demands, and fatigue from too many cues and reminders

Where can complexity theory be used?

Complexity theory can be used by those in leadership and management roles for understanding an organization as well as in planning and executing changes within an organization.

What is generative leadership?

Concepts of complexity science and leadership combined

What is critical in a healthcare environment that is dynamic and ever changing?

Concepts of teamwork and collaborative decision making A nurse has great potential to shape those changes.

What is a skill that is essential for leaders?

Conflict resolution skills: When a dispute occurs because of conflicting values or interests, following the principles of communication and conflict resolution can help facilitate a mutually satisfying resolution.

What evolves from new ways of thinking?

Creative solutions

What are data driven outcome measurements?

Data-driven outcome measurements provide feedback on the process

What is leadership?

Defined as the use of individual traits and abilities in relationship with others and the ability (often rapidly) to interpret the environment/context where a situation is emerging and enter that situation without the use of a predesigned plan

Team members who are able to nimbly respond to changing situations and roles with little or no fanfare have what is often referred to as _______.

Emotional intelligence

What do new leaders or managers sometimes not demonstrate?

Emotional intelligence A new manager may identify with a leader who does not demonstrate emotional intelligence, so the new manager begins to adopt similar ineffective behaviors

What are abilities to manage relationships?

Empathy and social skills

What are Gardner's tasks of leadership?

Envisioning goals Affirming values Motivating Managing Achieving workable unity Developing trust Explaining Serving as a symbol Representing the group Renewing

What is serving as a symbol and how does it relate to nursing?

Every leader has the opportunity to be an ambassador for those he or she represents. Nurses may be symbolically present for patients and families, represent their department at an organizational event, or be involved in community public relations events. Serving as a symbol reflects unity and collective identity.

Situational contingency theory

Examines variables in the external and internal environment, including the nature of the work itself, worker behaviors (individual or group), the predictability or unpredictability of work, and the risk associated with work

What does complexity science refer to?

Examining how systems adapt and function—where co-creation of ideas and actions unfold in a nonprescriptive manner through promoting the idea that the world is full of patterns that interact and adapt through relationships, which could be missed by focusing solely on a single part

What are feedback reports?

Feedback reports provide a basis for improvement programs, which may include coaching and mentoring employees

What do tasks performed by followers require?

Followers must perform their assigned structured duties, which require critical thinking and decision making

What does the ANA acknowledge?

Garder's idea of renewal and supports self-care through the Healthy Nurse Healthy Nation Grand Challenge centering around five areas: physical activity, nutrition, rest, quality of life, and safety

What are generative leaders?

Generative leaders are not satisfied with the status quo; instead they are creative and curious individuals who seek new solutions to old problems

What is the ability to manage aligned with?

How an organization structures its key systems and processes to deliver service

Why is it important to give clear and repeated communication?

If instructions are not clear, employees are left to interpret them using their viewpoints. That viewpoint might be consistent with the intended message of the leader, but it may not be. When it is not, both the leader and employee experience frustration, and patient outcomes may be affected.

What is healthcare's quadruple aim?

Improving access to care, quality of care, cost of care, and work life of healthcare team

In what manner is healthcare delivered?

In a collaborative and interprofessional manner, such as that reflected in the movement toward primary care or medical homes. In this model of care, providers strive for comprehensive, patient-centered, coordinated, high-quality care This holistic approach to care delivery requires holistic leadership, emphasizing effective communication and outcomes. Healthcare today is the amalgamation of both traditional and dynamic structures

Communication in complexity science

In complexity science, every voice counts and every encounter with patients and families merges to co-create a desired outcome.

What exemplifies followership?

In essence, maximal functioning as a team member exemplifies followership. When in the following role, teamwork is palpable. Each person acts together with purpose and in a rhythm that addresses the aim at hand

Where are the concepts related to leadership found?

In nearly all professional disciplines; they are not distinct to nursing and health care

How does envisioning goals help a team?

In the case of leading peers, the leader envisions an aim while keeping it within the broad purpose of the organization An effective leader strives to engage those within the organization to embrace a shared vision of a high-performing unit and the process to reach that goal.

Complexity science

Information is not a commodity to be controlled by those in charge. Instead, it is intended to be shared with and interpreted by a wide audience, to provide varying interpretations of the same scenario. Diverse thinking leads to creative problem solving in which multiple individuals are actively engaged, using diverse skills to be part of the solution

Who developed the "quadruple aim"?

Institute for Healthcare Improvement (IHI)

What does effective management depend on?

Knowing, adhering to, and improving processes for efficiency and effectiveness

What is the follower prepared to do?

Lead or manage when circumstances demand it

What do followers compliment?

Leaders and managers with their skills; Together they work to fill gaps and to build on each other's cognitive, technical, interpersonal, and emotional capabilities

What can leaders generate?

Leaders can generate energy within and among others. A true leader attends to the group's energy and does not allow it to lose focus.

Can leaders always share all information?

Leaders cannot always share all information, it is unwise to misdirect others in their thinking and actions.

How do leaders utilize values?

Leaders influence priority setting and decision making as a means to express organizational values.

What must be demonstrated when decision making is decentralized and layers of management are compressed?

Leadership accountability

Four concepts of complexity science

Managers must be aware that employees will self-manage themselves into work groups. Rather than exerting control, effective managers stimulate creative problem solving. These groups may start as having a single purpose but may be sustained through achieving positive outcomes. Managers must be skillful in providing context. While keeping a clear vision of the objective to be accomplished, employees can be encouraged to explore and develop solutions to complex problems. Concepts of shared governance and adaptive leadership blend well with the overall aim of safe and effective patient care. Managers must adapt to the changing environment and use influence where they can have the most impact. Health care is often procedure driven, yet managers must remain cognizant of the communication and relationships necessary to carry out procedures that create positive outcomes. Managers must address sources of tension and contradiction. Disagreement and tension may be the result of creative problem solving by the group and are expected when working with diverse groups. Seeking insight and encouraging creativity and communication allow the manager to capitalize on tension for a positive benefit. By addressing this tension, new alliances may be created that contribute to high-quality outcomes

What do some key processes relate to?

Medication procurement, ordering, and administration; patient safety practices; patient education; and discharge planning and care coordination

What do most healthcare team members focus on and is this feasible?

Most focus on problems and predictable solutions that appear to be linear in nature, described as technical work This may not be feasible due to the interconnected web of physiologic processes and services

What is complexity theory?

Nontraditional theory that has emerged over time from the works of physical and social sciences

What may nurses participate in?

Numerous committees and work groups related to human resources, patient safety, and quality improvement

Who helps improve healthcare access beyond traditional hospitals and ambulatory centers?

Nurses in expanded roles (APN)

How are nurses able to demonstrate followership?

Nurses may demonstrate followership by serving on committees. Even simple activities such as completing readings and reviewing minutes from previous meetings are essential for an organization's success.

What is the concern with nursing being a "practicing discipline"?

Nurses may focus on doing rather than theoretical perspective Theory based approach can enhance performance and strengthen the value of theory

What can be done to mitigate this stress?

Nurses must learn to identify professional burnout and implement strategies that will achieve work-life balance

What do nurses offer in leadership positions and what does it represent?

Nurses offer their "voices" They are representing a group and are thinking beyond personal needs

What allows for even greater exchange of information among healthcare team members, patients, and families?

Options for technology

What allows those in administrative positions to understand characteristics of the workforce better than ever before?

Our understanding of human behavior

What do misinterpreted images associated of followers portray? Is this accurate?

Passive, uninspired workers waiting for direction Although that may be accurate for some organizations, following in a high-functioning team is an active, creative role that influences leaders and managers

What has been directly linked to preventable medical errors, high staff turnover rates, and low morale.

Poor team communication

What must professional nurses be prepared to do?

Practice within a system that is both predictable and unpredictable

What kind of organization creates opportunities for employees to participate in and foster organization?

Progressive organizations

What may new nurses also be involved in?

Project management; many efforts in health care are complex and develop over time

What creates a new level of stress for all members of healthcare team?

Providing assess to quality, reasonably priced care

What are the central factors in complex adaptive leadership?

Relationships and communication

What are the expectations of the quadruple aim?

Require all team members function at highest level possible as a team member and as an individual Must develop expanded roles congruent with societal needs through Policy development and Designing and carrying out clinical processes

What does leading require in regards to goals?

Requires envisioning goals in partnership with others

What do followers offer in times of stress?

Respite

What can reinforce desired behaviors?

Rewards for individual and team effectiveness

What care must nurses be vigilant in providing?

Scientific, State of the art, Sensitive to patient's needs, Collectively creating an accessible and cost-effective experience that leaves care providers satisfied with contributions, Respectful patient values and beliefs, Safe (Free from medical error and catastrophic events)

What is identified in the quadruple aim that is central to providing high-quality safe care?

Self care and avoiding burnout

What are examples of personal skills?

Self-awareness and self-regulation

Who are leaders proponents of?

Self-care for themselves and those they lead

Which model is expected from nurses?

Shared decision making with collaborative action

What findings were associated with early research?

Some individuals possessed traits that seemed to produce better organizational outcomes

What is the benefit of effective communication?

Team members who communicate effectively with each other and feel that their voices are heard are likely to provide safe high-quality care, be active team members, and stay with the organization for a period of time

Why is the ability to manage important? Where is this especially true?

The ability to manage is an important aspect of organizational functioning, because management requires determining routines and practices that offer structure and stability to others. This is especially true in certain positions of influence within a clinical setting, such as a nurse manager, clinical nurse specialist, or clinical nurse leader, all of whom share responsibility for creating effective structures that support clinical and organizational outcomes.

What do emotionally intelligent demonstrate when coupled with performing clinical tasks tied to critical thinking and action?

The capacity to be a high-performing professional

What must a successful leader possess?

The capacity to monitor multiple projects while keeping an eye to the future

What should be appreciated by nurses?

The complexity of the work situation and be prepared to assume different roles and to do so in a fluid manner rather than in only a defined time, role, or situation

What are values?

The connecting thoughts and inner driving forces that give purpose, direction, and precedence to life priorities An organization, through its members, shares collective values that are expressed through its mission, philosophy, and practices

What does a process of care specify?

The desired sequence of steps to achieve clinical standardization, safety, and outcomes

What is the application of complexity science reflected in?

The elements of evidence-based nursing practice, which includes patient preferences, along with assessment data, research findings, and clinical expertise

What are employees tuned into?

The emotional intelligence of managers and leaders. The synergy associated with a leader's credibility and capability fuse for success. Without self-reflective skills, growth in emotional intelligence is stymied, work becomes routine, and asynchrony with others results.

What may require nurses to change roles?

The fluidity of a situation

Co-creation

The idea that a change doesn't belong to one person or group, it is critical to moving quality of care and innovation forward.

What does the Literature Project illustrate?

The importance of emotional intelligence

According to Gardner, what considerations must leaders never forget?

The key for renewal is the release of human energy and talent This requires focused energy and personal well-being.

What must a leader address?

The needs of the diverse community. Language variations, cultural barriers, and overused electronic communication create opportunities for misunderstanding that could contribute to errors. Followers and leaders of different generations and values can educate each other on the best ways to communicate.

What variables come into play in regards to a leader's success in one discipline, and not another? What would be an example?

The situation at hand and the work environment itself Another variable studied was activities being performed, an example of this would be a charismatic leader less effective when tasks are repetitive and reproducible

What is within each of us?

The synchrony of leading, managing, and following

What fuses for success?

The synergy associated with a leader's credibility and capability

What is the purpose of motivation theory?

Theories of motivation identify and describe the forces that motivate people

What are the principles of systems thinking theory?

Thinking of the "Big Picture": The nurse who looks past an individual assignment and comprehends the needs of all units of the hospital, or who can focus on the needs of all the residents in a long-term care facility, or who can think through the complications of urban emergency department overcrowding is seeing the big picture. Such nurses have the ability to envision the context of their work beyond the immediate tasks. Balancing Short-Term and Long-Term Objectives: The nurse who recognizes the long-term consequences of actions on the organization or patient, such as the decision of a patient to terminate clinical treatment, can guide thinking about how to balance decision making for quality outcomes. Recognizing the Dynamic, Complex, and Interdependent Nature of Systems: All things are connected. Patients are connected to families and friends. Together, they are connected to communities and cultures. Communities and cultures make up the fabric of society. The cost of health care is linked to local economies, and local businesses are connected to global industries. Identifying and understanding these relationships helps solve problems with full recognition that small decisions can have a large impact. Using Measurable versus Nonmeasurable Data Systems: This thinking triggers a "tendency to 'see' only what we measure." If we focus our measuring on morale, working relationships, and teamwork, we might miss the important signals that only objective statistics can show us. On the other hand, if we consider only numbers (e.g., number of patients seen), we might miss a perspective such as lack of engagement in the workplace.

What is meant by Delmatoff and Lazarus when they use the phrase "emotionally and behaviorally intelligent style of leadership"

This means that the leader not only possesses emotional intelligence but behaves in an emotionally intelligent manner

More than being present symbolically, how can leaders represent a group?

Through active participation

How do other individuals use values?

To achieve their goals, which are then manifested through behavior. The word value connotes something of worth; intentional actions reflect our values. A leader continuously clarifies and acknowledges the values that draw attention to a problem and develops the resources in human and material terms to solve the problem. Values are powerful forces that promote acceptance of change and drive achievement toward a goal.

What is the purpose of achieving a workable unity?

To avoid, diminish, or resolve conflict so that vision can be achieved

Why do clinical procedures have to be adapted?

To be tailored to a patient's physical and emotional challenges Require stepping into the unknown, using principles, showing a commanding presence, and taking risks

What is a hallmark task of leadership?

To behave with consistency so that others believe in and can count on the leader's intentions and direction

What abilities are needed in a professional nurse?

To both lead and manage Nurses are on the front line when dealing with new and unknown health experiences, which require leadership, and implementing care routines, which must be managed

What theory originated from early research in leadership?

Trait theory

What are traits of followers?

Traits of followers include acting synergistically with others, being enthusiastic and responsible, speaking and acting with principle and integrity, adding value to the work being accomplished, and questioning decisions and directions that are not congruent with the purpose or values of the group. The effective follower is willing to be led, to share time and talents, to create and innovate solutions, to take direction from the manager and to role model confidence and professionalism.

According to Lencioni _____ is the key component of a team

Trust; Without trust, the team is dysfunctional. Trustworthiness is reflected in both actions and communications

What must a leader understand when representing a group?

Ultimately, leaders must understand the organization's objectives and contribute to its mission and purpose. As an example, nurses who speak on behalf of a group should represent an organizational perspective rather than a personal one.

What do interprofessional educational experiences focus on?

Understanding and communicating with other members of the healthcare team and provide opportunities for the development of leadership skills that can be readily applied in the clinical setting

What is an adaptive leader?

Understands that systems are ecological—they restore themselves—and that change can happen equally from the bottom up or from the top down. Questioning, observing patterns, and generating new patterns through being involved is how change unfolds. Adaptive leaders appreciate that they have influence and can help shape overall outcomes, with no sense that absolute control is either necessary or possible

Attributes of leaders, managers, and followers, including commonalities

Use focused energy and stamina to accomplish a vision. Use critical-thinking skills in decision making. Trust personal intuition and then back up intuition with facts. Accept responsibility willingly and follow up on the consequences of actions taken. Identify the needs of others. Deal with people skillfully: coach, communicate, counsel. Demonstrate ease in standard/boundary setting. Examine multiple options to accomplish the objective at hand flexibly. Be trustworthy and handle information from various sources with respect for the source. Motivate others assertively toward the objective at hand. Demonstrate competence or be capable of rapid learning in the arena in which change is desired.

What do complexity sciences pay keen attention to? How does it relate to nursing?

What naturally occurs as patterns in the universe and how these patterns create adaptive change rather than how people create planned or forced change Nurses care for individual patients who each present a unique challenge. With experience, nurses recognize that patterns of patient behaviors emerge and learn that certain nursing actions lead to effectively managing pain, engaging family members in end-of-life planning discussions, and addressing a host of other issues

How are leaders able to generate energy?

When changes are made based on a shared vision, they can be made with renewed spirit and purpose. Taking time to celebrate individual accomplishments or creating a "Hall of Honor" to post photos, letters, and other forms of positive feedback renews the spirit of workers.

When is trust developed?

When leaders establish clear goals and objectives with associated employee behaviors. Inherent in this concept is the behavior of truth telling

When is leadership required?

When the unknown presents itself, necessitating the use of principles to improvise solutions and help others cope, thrive, and function in the situation

What is motivation?

When values drive our actions, they become a source of motivation. Motivation energizes what we value, personally and professionally, and stimulates growth and movement toward the vision. One task of leadership is communicating organizational values and vision to enhance motivation. Motivators are the reinforcers that keep positive actions alive and sustained, fueling the desire to engage in change.

Are many of the skills related to patient-centered communication are transferrable to those in leadership roles?

Yes

Is the culture in most healthcare organizations more ethnically diverse today?

Yes; Has an expansive educational chasm (from non-high school graduates to doctorally prepared clinicians) Has multiple generations of workers with varying values and expectations of the workplace; involves extensive use of technology to support all aspects of the organization Challenges workers, patients, families, and communities with antibiotic-resistant microorganisms and emerging diseases.

What is the purpose of management in the workplace?

mMneeded to provide structure, a sense of purpose, and safety.

What is managing?

§ the ability to plan, direct, control, and evaluate others in situations where the outcomes are known or preestablished, where one or more ways of performing have been agreed on based on evidence, where feedback and communication is shared to improve clinical processes and outcomes, and where sustained relationships advance consistency of purpose.

What is the role of the nurse in leadership?

"The nurse must lead, manage, and follow within any nursing role, from direct care nurse to chief executive nurse, and do so with fluidity among those roles. In the end, nurses with leadership, management, and followership abilities will make better clinical decisions, consider the organizational and societal context of decisions, act as advocates for individuals receiving care, and influence the impact of these decisions on families, the organization, and the society"

What do leading, managing, and following all represent?

A distinct aspect of nursing role

What do new grads tend to focus on?

Direct patient care

What is a 'healthy" definition of followership?

Each group member contributes optimally in tandem with other group members to achieve clinical or organizational outcomes

What is the role of each person in a process of care?

Each person must respect and act on a prescribed role in a process of care

What do followers require from others to stay on course?

Feedback

What happens without self-respective skills?

Growth in emotional intelligence is stymied, work becomes routine, and asynchrony with others results

How does envisioning goals help a patient?

Helps patients envision their life journey when health outcomes are unknown Might help a patient envision walking again, participating in family events, or changing a lifestyle pattern

What is a care delivery system composed of?

Multiple processes necessary to achieve effective patient care

What is the goal in responding to patient and organizational problems?

To examine a problem through multiple lenses