Leadership Quiz 1
Review IOM study findings and what results and initiatives followed as a result.
-IOM called attention to eroding quality of care provided in hospitals and said that evidence of best practice must be supported by evidence Institute of Medicine/National Academy of Medicine (NAM) provides national and international advice on issues relating to health, medicine, health policy, and biomedical science, aims to provide unbiased, evidence-based, and authoritative information and advice concerning health and science polity to policymakers, professionals, leaders in every sector of society, and the public at large. To Err Is Human: Building a Safer Health System (2000)--began the patient safety movement, identifying medical errors as the leading cause of injury in the US. Crossing the Quality Chasm: A New Health System for the 21st Century (2001)--outlined six aims for healthcare improvement: that health care should be safe, effective, patient-centered, timely, efficient, and equitable. Health Professions Education: A Bridge to Quality (2003)--identified five core competencies for all health-care professions
authentic leadership
-Is evidenced by a strong commitment to truth-telling, decreasing ambiguity in the system and increasing efficiency and productivity •Embraces self-awareness and self-regulation to enhance moral leadership •Includes five distinguishing characteristics: purpose, heart, self-discipline, relationships, and values
5.) informatics
-communicate, manage knowledge, mitigate error, and support decision making using technology (improves pt safety) §Information management—collecting, analyzing, monitoring, summarizing, and communicating necessary to implement evidence-based practice §Documentation—communicating all interactions with patients, including assessments, interventions, evaluations, and outcomes of care, in the patient's health record
components of the affordable care act
-enacted 2010 (obamacare) -goal was to reduce the number of uninsured persons by expanding medicaid and implementing health-care changes The law addresses health insurance coverage, health care costs, and preventive care. The law was enacted in two parts: The Patient Protection and Affordable Care Act and was amended by the Health Care and Education Reconciliation Act. Prevents insurance companies from denying coverage due to pre-existing conditions and requires plans to cover a list of essential health benefits.
democratic
-expects team members to contribute to the decision-making process -encourages team input -analyzes and makes final decisions -increases participation in projects and creative solutions -brings about higher production and satisfaction GOOD
6.) SAFETY
-freedom from accidental injury -linked with all of the previous 5, especially effective communication and use of EBP -avoid human errors and factors §Standardized protocols and practice—following standard protocols to decrease preventable adverse events and medical errors -safety culture -human factors engineering: science that studies human capabilities and limitations; applying that knowledge of the design of safe, effective processes with the goal of achieving effective, efficient, safe care delivery -reliability sciencce: ability of an operation to be a failure or defect free over time; employs deliberate strategies that make it difficult for nurses to do the wrong thing -high-reliability organizations: creating processes, systems, and a culture that radically reduces system failures and/or effectively responds when failures do occur using the following 5 characteristics (sensitivity to operations, reluctance to simplify, preoccupation with failure, deference of expertise, resilience)
4.) Quality Improvement
-identify errors and hazards in care -understands and implement basic safety design, continually understand quality of care, change processes when needed §Structure or care environment—focusing on where nursing care is provided, including the physical environment, equipment, staffing, policies and procedures, the organizational culture, and management of the organization §Care process—focusing on how nursing care is provided, including models of care delivery, critical pathways, standardized clinical guidelines, and actual physical care of patients, including assessment, intervention, patient education, timeliness of care, counseling, and leadership and management activities §Outcomes of care—focusing on the results of the nursing care provided and reflecting on the effectiveness of nursing activities -7 pillars of quality: efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, equity
autocratic
-makes decisions without input from the team -does not consider valuable suggestions from team members' input -potentially demoralizes team members BAD
3.) Evidence Based Practice
-promotes best practice, clinical expertise, pt's values and circumstances -best current evidence + clinical expertise + pt/family preferences and values = optimal health delivery §Nursing research—answering questions or solving problems by generating, testing, or evaluating knowledge and developing reliable evidence §Relationship with quality improvement—monitoring and evaluating workflow and work processes using benchmarks to measure practice against established standards §Clinical practice guidelines—following and/or developing guidelines that gather, appraise, and combine evidence to address relevant issues while balancing risk and benefits §Evidence-based management—developing management strategies informed by rigorous research based on empirical evidence systematic reviews and metaanalysis of randomized control studies is the highest form of evidenced based practice (lowest is opinions of authorities or expert committees)
2.) Interdisciplinary teams
-results in enhanced quality of care, improved pt outcomes, maximized resources -requires teamwork and collaboration which leads to communication, respect, and shared decision making -interdisciplinary = relating to or involving two or more distinct fields -multidisciplinary = team in which members function indecently and then share information with each other -interprofessional (those with specific training) §Care coordination—organizing the components of the plan of care, coordinating the implementation of the plan of care, advocating for the delivery of dignified human care, and documenting the coordination of care §Communication—communicating verbally and nonverbally with patients, families, and other health-care professionals in an effective manner
· Know what is involved in QSEN competencies. What specific areas do they cover?
-serve as guidelines for curricular development in formal nursing education, transitions to practice, and continuing education programs (prepare future nurses to continuously improve the quality and safety of healthcare) -provide framework for regulatory bodies that set standards for licensure, certification, and accreditation
1.) pt. centered care
-shift from disease-focused paternalistic care to ensuring that patient is source of control -pt and families enter full partnership with nurses and HCP -pt is source of control §Advocacy―representing and/or speaking for patients when they cannot speak for themselves §Empowerment—providing patients with access to information, support, resources, and opportunities that allow them to optimize their health and take part in decision making §Self-management—increasing the skills and confidence of patients in managing their health problems §Health literacy—assisting patients and their families in reading, understanding, and/or acting on health-care information §Cultural competence—providing acceptable cultural care and respecting the differences in patient values, preferences, and expressed needs §Optimal healing environment—creating and maintaining an environment that fosters healing, is safe and clean, guards patient privacy, engages all the human senses, and considers the experience of the body, mind, and spirit Patient centered care as identified by the IOM: -Share power and responsibility with patients and caregivers -Communicate with patients in a shared and fully open manner -Take into account patient's individuality, emotional needs, values, and life issues -Implement strategies for reaching those who do not present care on their own, including care strategies that support the broader community -Enhance prevention and health promotion
how is health care offered and paid for in the country
1.) Private health care is the predominant form of health care for persons in the U.S. -cost of services can be paid directly to the provider or through private or government health insurance -includes companies, for profit and nonprofit, not associated directly with government agencies 2.)Public Health care - is funded by tax dollars; disease prevention and health promotion (i.e.: commissioned Corps of the US public health service, vaccinations, STD clinics) 2.) Government health care -government-provided health insurance, such as Medicare and Medicaid, that is actually provided by the private health-care system (i.e.: veterans hospitals, department of defense, etc) -hospitals and clinics are directly funded by tax dollars and provide care to active and former service member of the armed forces -No national/universal health care in the US (this is health care provided to citizens through the government, usually without the involvement of private health insurers, in Australia, Canada, UK) What USA has: -Affordable Care Act (ACA) enacted into law in 2010, the goal is to reduce the number of uninsured persons in the US by expanding Medicaid and implementing health-care exchanges -Provisions include: elimination of pre-existing conditions as a means of denial for insurance, no annual limits on coverage, mandated coverage by employers with at least 50 full-time employees, extension of coverage to adult children to age 26 with individual and group health policies, inclusion of prevention services without cost sharing -Essential health benefits include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management
ignation framework for decision making
11 steps: Identify the decision to be made or issue to resolve Formulate issue in a proposal ("I will do____ or ____") Pray for openness to God's will and freedom from prejudgement/addiction Gather all info Repeat 3 State reasons for or again Formally evaluate pros and cons Observe direction of your will toward pros and cons Ask God to give feelings of consolation about preferred option Trust in God and make decision even if uncertain Confirm decision (live with it for a while and see if it was a good thing)
behavioral theories / leadership styles
1940-1960 Not innate traits but learned behaviors and styles. Can develop through education, training, and life experience
contingency leadership theories
1950s more complex with many factors / Leadership style, relationship with followers, task to be done...etc Managers will adapt leadership style to different situations (authoritarian (autocratic), democratic (participative), laissez-faire styles (permissive))
situational leadership theories
1950s •Identified new contributing factors to leadership theories (situational theories), including that situational factors contributed to the leadership style and that a leader may be effective in certain situations and less effective in others
Trait Theories
19th century •Known as "The Great Man Theory," focused on the traits of a leader and noted that certain men were born leaders •Leaders are born not made •Leaders will arise when a great need arises •Scholars attempted to identify the characteristics that made up a great leader ‒Class ‒Physical characteristics ‒Personality type ‒age
characteristics of leaders
5 C's and an E -Character—keeps true to personal values and incorporates moral accountability while never losing sight of human dignity, humility, and caring -Commitment—makes, keeps, and carries through with promises -Connectedness—builds strong connections -Compassion—demonstrates compassion for patients and team members -Confidence—exhibits self-assurance without arrogance -Emotional intelligence—includes five components:self-awareness, self-regulation, motivation, empathy, and social skills
barriers to healthcare in the US
Barriers to health services include: High cost of care Inadequate or no insurance coverage Lack of availability of services Lack of culturally competent care inability to access the system lack of providers and services insured with limited income quality of care provided These barriers to accessing health services lead to: Unmet health needs Delays in receiving appropriate care Inability to get preventive services Financial burdens Preventable hospitalizations Access to care often varies based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location
Know and define barriers to patient centered care.
COST, ACCESSIBILITY, QUALITY OF CARE 1.) -Access: uninsured=those without healthcare insurance coverage; underinsured: those who have insurance coverage but lack adequate income to facilitate access to care because of high deductibles and copayments)-->patients tend to go to ER=can be labelled as "non compliant"=affects how they are treated in the ER 2.) -Cost: insurers do not cover provider costs. Medicare pays approximately 65% as well as private insurers. Commonly, people will go to the ER because they can't afford a PCP=ER costs way more! Nurses must be good stewards of available resources in the delivery of safe and quality nursing care. 3.)-quality: "the degree to which health services for in- dividuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". The AHRQ states that "quality health care means doing the right thing at the right time in the right way for the right person and having the best results possible". 4.) Lack of providers and services
what field of study did leadership theories grow from?
Established in fields such as business, psychology, sociology, and anthropology, management theories were developed as a means to enhance productivity in business, with leadership theories growing from the science of management.
how is healthcare funded?
It is paid for by government programs (such as Medicare and Medicaid), private health insurance plans (usually through employers), and the person's own funds (out-of-pocket). In addition, the government directly provides some health care in government hospitals and clinics staffed by government employees.
difference between leaders and managers
Leadership is a process of influencing others through effective relationship skills. (shows a direction; Aligns and influences; Motivates and inspires) (interpersonal skills to influence others to accomplish a specific goal) Management is a formal position with specific functions. (Plans and budgets; Organizes and allocates resources; Controls and solves problems) (employee who is responsible and accountable for efficiently accomplishing the goals of the organization) Leaders: §Achieve consensus within the group about goals §Maintain structure that facilitates accomplishing goals §Supply information that helps provide direction and clarification §Maintain group satisfaction, cohesion, and performance Managers: §Clarify the organizational structure §Choose the means to achieve goals §Assign and coordinate tasks §Evaluate outcomes and provide feedback nurse can be both a leader and a manager
5 components of emotional intelligence
MESSS -Self-awareness: ability to recognize moods, emotions, drives and their impact on others Hallmarks: Self-confidence, realistic self-assessment, self-deprecating sense of humor -Self-regulation: self control, ability to think before acting Hallmarks: trustworthiness, comfort with ambiguity, openness to change -Motivation: passion to work for reasons beyond money or status, energy to pursue goals Hallmarks: strong drive to achieve, optimism, organization and commitment -Empathy: ability to understand emotional makeup of others, treat people with consideration for emotions Hallmarks: expertise in building talent, cross-cultural sensitivity, service to clients -Social Skill: proficient management of relationships and networking, ability to find common ground, good rapport, Hallmarks: Effective leading of change, persuasiveness, expertise in building and leading teams
Differences between insurance types and how it is funded and offered.
Medicaid: Medicaid is the federal-and-state-funded health insurance program for low-income, needy Americans and their families. States jointly fund and run their programs, so Medicaid eligibility varies, depending on where you live. Medicaid eligibility requirements are broadly based on income, age, disability, pregnancy, household size and the applicant's household role. if you make less than 100% to 200% of the federal poverty level (FPL) and are pregnant, elderly, disabled, a parent/caretaker or a child then you could qualify. Medicare: it's offered by insurance companies and other private companies approved by Medicare - federal health insurance program that pays for a variety of health care expenses. It's administered by the Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries are typically senior citizens aged 65 and older. Medicare is an entitlement program. Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. The types of Medicare programs are often referred to as Part A,B,C & D.
· Review in depth Fr. Cavanaugh's materials on his Prudence lecture. Be able to define terms as outlined in his lecture content.
Prudence= charioteer of virtues / guides all other virtues Correct knowledge of things to be done "Well ordered reason applied to action" -Obstacles: rashness, procrastination...etc -3 Aspects of Prudence: 1 Good Counsel and deliberation (defects are impulse, passion and stubborness) 2 Wise Judgement 3 Decisive action Discernment = virtue to know best course of action + understand true vs false Virtue: governs actions / orders passions / guides conduct Dev. of good inclinations into habits (habit = firm + predictable way of acting)
· Review Ch. 17 on Murray text covering transition to professional role and Ms. Ronevich's material (ex. what goes into resume construction?)
The NCSBN developed an EB TTP program to ensure successful transition from the academic to practice setting - the model integrates education, practice, and regulations from classroom to professional life and beyond. Current research indicates that residency programs can reduce turnover rates in the first year of practice and promote growth in clinical decision making. -nurse manager is responsible for leadership competencies that support the transition of the newly licensed nurse -customized to individual -support programs to aid retention of newly licensed nurse
QSEN competencies
adapted the 5 competencies outlined in Health Professions Education and added 6th competency (safety) - provide patient centered care -work in interdisciplinary teams - employ EBP -apply quality improvement - utilize informatics -safety
styles of management
autocratic, democratic, laissez-faire
what do both medicare and medicaid do?
both benefit ppl with disabilites, both offer prescription drug coverage, both may offer outpatient and inpatient hospital coverage
how are nursing leadership theories distinguished from industrial models / how have they developed over time
change from historic (industrial) theories to contemporary theories by moving toward a comprehensive view, incorporating flexibility, and adding broader perspectives now more multidimensional leaders must be influenced by environment, relationships
· What is a culture of competence? What goes into it? Examples of how can it be practiced or implemented?
culture of competence is the attitude, knowledge, and skills necessary for providing quality care to diverse populations -can do this through interdisciplinary/ inter professional teams -Also being a lifetime learner, how your licensing renewal requires you to have certain hours of continuing education, etc.
medicare =
disabled and 65+ Provides health insurance for disabled persons and persons over the age of 65 (discussions on amending this threshold ongoing). To be eligible without a disability, must have worked a minimum of 10 years and paid into the Medicare Trust Fund. -federally funded with nationwide consistency -participants pay deductible and part of coverage costs
connective leadership
focus is caring! -incorporates diversity and identifies strengths and includes them in process of change must consider not only home they are guiding but where they may be leading them •Incorporates the needs of diverse stakeholders within the health-care environment
medicaid =
low income people; CHIP = children -federally and state funded -coverage varies state to state -mostly benefits pregnant women, non disabled adults, and ppl with low income -participants pay little or nothing for coverage
transactional leaderhisp
most common style in healthcare Based on principles of social exchange theory: Individuals engage in social interactions expecting to give and receive social, political, and psychological benefits or rewards. Exchange between leaders and followers viewed as essentially economic. Nature of these transactions is determined by the participating parties' assessment of what is in their best interest. Ex: employee responds favorably to manager's request to work overtime in exchange for granting special requests for time off focus on goals of organization with a directive style of expectations for team members and motivating by rewards / No shared vision b/w leader and team member but both gain - quid pro quo)
transformational leadership
motivate one another to achieve levels of success. all members contribute and all are actively involved in decision making •Viewed as an effective type of leadership for nurses to lead the change necessary to meet the demands of the current healthcare system.
shared leadership
not one person is amazing, everyone is a leader empowerment with principles of participative and transformational leading (uses relationships, dialogues, partnerships, and understanding boundaries) made up of many leaders / unrealistic to have only 1 leader assumes that work-force is dedicated, well educated, and professional
different parts of medicare
part A: premium free (hospital services / inpatient) part B: $104 and then deductible (medical insurance / outpatient) part C: cost varies by plan part D: tiered drug plan with premiums based on income and IRS
attribution leadership theories
the cornerstone! §Considers the characteristics or attributes of the leader as the cornerstone within leadership relationships §Takes into consideration either the context or the inter-relational aspects authentic leadership, servant leadership, and apealing to nursing
Laissez-faire
wishy washy -provides advice, support, and timelines with low-level involvement -lacks focus or time management, resulting in high job satisfaction with risk of low productivity -risks the potential of team members not having the knowledge to execute the tasks -may find intra team disagreements common, which may produce `disharmony
servant leadership
§- based on the premise that that leadership originates from a desire to serve and that in the course of serving, one may be called to lead. •Embody empathy, awareness, and persuasion.
relational leadership theories
§Focus primarily on the relationship that occurs between the leader and the team member. §Put more emphasis on the leader's relations with others, and less emphasis on leader traits, the situation or context, or the result. §Include, for example, quantum leadership, transactional leadership, and transformational leadership.
Be a leader and a follower (followership)
•"Doing following"—act as positive role models who potentially could be groomed for leadership •"Standing by"—participate in the group but respond best with detailed guidance •"Resisting following"—bring negative energy to the group dynamic and potentially distract from the performance of the team (dont want to do this) §A good follower •Does not undermine the goals of a leader •Contributes to the success of the organization •Has the ability to interpret overt and subtle objectives and adjust his or her work behavior §Types of followers include •Effective or exemplary •Alienated •Conformist •Passive
contemporary leadership theories (20th + century)
•Concepts developed in earlier research are utilized but have expanded to include a multidimensional approach. •For leaders to be effective, the values and beliefs of the environment needed to be considered. •Relationships within the organization need to be cultivated in order to promote a productive and healthy environment. INCLUDE RELATIONAL THEORIES
quantum leadership
•Focuses on holistic and relational perspectives (not linear) •Looks at the system, the processes, and the relationships between workers and tasks to determine efficiency and job performance •Offers nursing a framework in which to develop leadership skills to assist in advancing the goals of their organizations Promote flexibility and adaptility
5 principles for creating and maintaining a safety culture
•Providing leadership - make pt. safety a priority and everyone's objective •Respecting human limits in the design process •Promoting effective team functioning •Anticipating the unexpected - be proactive, identify threats before an accident can occur •Creating a learning environment - use of simulation when feasible, transparency, report of errors without reprisals -nurses at all levels are leaders in the patient safety movement