Leadership 1
Steps in Auditing Quality Control
1. Establish control criteria 2. Identify the information relevant to the criteria 3. Determine way to collect the information 4. Collect and analyze the information 5. Compare collected info with the established criteria 6. make a judgment about quality 7. provide information and, if necessary. take corrective action regarding findings 8. reevaluate
10 Fatal Leadership Flaws
1. Lack of energy/enthusiasm 2. Acceptance of own mediocre performance 3. Lack of clear vision/direction 4. Poor judgment 5. Not collaborating 6. Resisting new ideas 7. Not learning from mistakes 8. Lack of interpersonal skills 9. Failing to develop others 10. Not walking the talk
Bran's 12 habits to master time management
1. Strive to be authentic 2. favor trusting relationships 3. maintain lifestyle that gives you max energy 4. organize day by your biorhythms 5. Set very few priorities and stick to them 6. Turn down things inconsistent with your priorities 7. Set aside time for focused effort 8. Always look for ways of doing things better and faster 9. Build solid processes 10. Spot trouble ahead and solve problems immediately 11. Break goals into small units of work and think only about one unit at a time 12. Finish what is important and stop doing what is no longer worthwhile.
3 basic steps in time management
1. allow time for planning and establishing priorities 2. complete the highest priority task whenever possible, try to finish one task before beginning another 3, reprioritize based on remaining tasks and new information that may have been received
the smart approach to studying
1. set specific, clear goals to be accomplished 2. record your progress as measurable progress maintains your interest 3. identify the steps needed to accomplish your goals 4. be realistic about your time constraints and set goals that can be accomplished within these constraints 5. set a time frame and plan for this
Hallmarks of effective quality control programs
1. support from top level administration 2. commitment by the organization in terms of fiscal and human resources 3. quality goals reflect search for excellence rather than minimums 4. process is ongoing/continuous.
2 common mistakes in planning
1. underestimate a daily plan 2. not allowing adequate time for planning
Total Quality Management
Also known as continuous quality improvement (CQI). E. Deming Based on the premise that the individual is the focal element on which production and service depend Focus is on doing the right things, the right way the first time and problem prevention, not reactive problem solving.
Chapter 7 objectives
Analyze he 4 planning modes used by organizations and planners (reactive, in-activism, pre-activism, and proactive as well as forecasting) Apply strategic planning tools such as SWOT and Balanced Scorecard Understand roles and management functions associated with operational and strategic planning Summarize the evaluation step in the strategic planning process
Leadership Styles
Authoritative, Democratic and Laissez-faire Slide 9
Medication Errors
Big problem! Strategies to Prevent Medication Errors: Better reporting of the errors that do occur The Leapfrog initiatives (computerized physician-provider order entry, evidence based hospital referral, ICU physician staffing, the use of leapfrog safe practices scores) REFORM of the medical liability system Bar coding Smart IV pumps Medication reconciliation Distraction free zones
Attempting change
Change should never be attempted unless the change agent can make a commitment to be available until the change is complete
Lewin's rules for implementing change
Change should only be implemented for good reason Change should always be gradual All change should be planned and not sporadic/sudden All individuals who may be affected by the change should be involved in planning for the change
Proactive/Interactive
Consider past, present, future. Attempt to plan the future rather than react to it. Dynamic Key requirement is adaptability since the environment changes so frequently
Analysis
Critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome doesn't recur.
Decision making tools
Decision grid: allows one to visually examine the alternatives and compare each against the same criteria. Helpful b it's a visual. Helpful when looking at interventions and multiple options. pg. 20-21 PERT: examines the timing of decisions. Provides number of weeks to complete tasks in best to worst case Decision tree: often tied to the outcome of other events. Shows schematic of how things could progress and provides alternatives. pg 22 (more of a timeline) Consequence table: demonstrates how the various alternatives can create different consequences. table 1.3
Critical elements in decision making
Define objectives clearly Gather data carefully (facts can be misleading if taken out of context) Use an evidence based approach Generate many alternatives (brainstorming) Think logically (weigh the factors) Choose and act decisively (no action is a decision)
Managerial decision making model
Determine the desired outcome/objectives research/ID options Compare and contract the consequences of the options (the big difference bw traditional and managerial) make a decision/choose a solution implement an action plan evaluate
Chapter 2-3 Objectives
Differentiate bw leadership roles and management functions Explore leadership and management theories in relation to healthcare Identify common leadership styes and describe situations in which the styles would be appropriately used
Chapter 1 Objectives
Differentiate bw problem solving, decision making and critical thinking Identify key components of critical thinking Select appropriate management decision making tools that would be helpful in making specific decisions.
Personal characteristics of time wasting
Doesn't understand time planning Cannot distinguish what is important from what is not Underestimates time and effort needed to accomplish tasks Makes too many rules/procedures/approvals Anxiety about planning robs energy Doesn't look at the standard of work necessary
Lewin's driving and restraining forces
Driving (facilitators): forces that push the system toward change Restraining (barriers): forces that pull the system away from change The drive must outweighs the restraining
Quality control
Fifth and final step of management process Activities that are used to evaluate, monitor or regulate services Performance is measured against predetermined standards Action is taken to correct discrepancies between these standards and actual performance
Chaos Theory
Finding the underlying order in apparently random data. Determining this underlying order is challenging and the order is constantly changing.
Transformational Leadership
Focus on vision and empowerment; proactive. Collaborative and welcomes input and consensus. Leads followers to higher levels of morality (do the right thing for the right reasons) Treat people with care and compassion, inspire others and encourage creativity and innovation.
The Time Inventory
Helps the individual determine how much time he/she spends a particular task and what time of day he/she is most productive Important to maintain the time inventory for several days-weeks and to repeat it annually to see if long term changes have been made
Traditional problem solving process
Id the problem gather data to analyze explore alternatives evaluate alternatives select appropriate solution implement the solution evaluate
Critical thinking/reflective thinking
It is a mental process where the nurse actively and skillfully applies, analyzes, synthesizes and evaluates information to reach an answer or a conclusion. It is manifested when nurses ask WHY, HOW and WHAT
5 Practices of exemplary leadership
Kouzes and Posner 1. Model the way: titles are granted but behaviors earn respect, lead from what you believe. Words and deeds are consistent. 2. Inspire a vision: desire to make something happen; cannot be commanded. 3. Challenge the process: pioneers and early adopter, involves risk. 4. Enable others to act: foster collaboration and build trust, empower others 5. Encourage the heart: genuine acts of caring, encourage others.
Leadership vs Management
Leaders empower others Leadership w/o management=chaos and failure.
Interactional Leadership
Leadership behavior is determined by the relationship bw the leader's personality and the specific situation Success is dependent on diagnosing the situation and selecting appropriate strategies Leaders and followers have roles outside of the leadership situation and both my be influenced by events occurring in the other roles. Assumptions: people are complex and variable. Dynamic process/change. The situation affects performance.
Making lists
Lists are planning tools and must be flexible Re-exmine items that remain on the list day after day. May not need to be done or may need to be broken down into smaller tasks Only put as many items on the daily list as can reasonably be done in a day.
Integrating Leadership and Management Functions in Planned Change
Manager: mechanic who implements the planned change Leader: inventor or creator of the planned change
Standardizing Nursing languages and measures
NANDA international (NANDA I) Nursing Interventions Classification (NIC) Nursing Outcomes Classification (NOC) Clinical Care Classification System (CCC) Omaha system Preoperative Nursing Data Set (PNDS) International Classification for Nursing Practice (ICNP) Systemized nomenclature of medicine clinical terms (SNOMED CT) Logical Observation Identifiers Names and Codes (LOINC) Nursing Minimum Data Sets (NMDS) Nursing Management Minimum Data Sets (NMMDS) ABC Codes
Contingency/Situational Leadership
No one style is ideal for every situation. Interrelationship bw leader and group members are influenced by leaders ability Adaptive to situation TRUST AND CLARITY OF GOALS IS CRUCIAL.
Principle Agent Theory
Not all followers/agents are inherently motivated to act in the best interest of the principle/leader The principal must identify and motivate agents to act in the organization's best interest by providing incentives (ex. OT and health benefits)
Organizational Aging
Organizations progress through developmental stages. As organizations age, structure increases to provide greater control and coordination The young organization is characterized by high energy, movement, and virtually constant change and adaptation Aged organization have established "turf boundaries," function in an orderly and predictable fashion, and are focused on rules and regulations.
CMS: Setting Standards and Measuring Quality in healthcare
Pay for performance/quality based pricing hospital consumer assessment of healthcare providers and systems (HCAHPS survey) national committee for QA (NCQA) Maryland Hospital Association QI Project (QI project) Multistate nursing home case mix and quality demonstration Report cards
Centers for Medicare and Medicaid Services
Play an active role in setting standards for and measuring quality and healthcare. Medicare QI (MQI)/Hospital QI (HQI) targeted health outcomes as data source As part of HQI, easy to understand data on health care quality from nursing homes, home health agencies, hospitals and dialysis facilities are made available to all consumers via a variety of media
Standard
Predetermined baseline condition or level of excellence that constitutes a model to be followed/practiced Each organization/profession must set standards and objectives to guide individual practitioners in performing safe and effective care
Setting priorities
Priority setting is the most critical skill in good time mgmt bc all actions we take have some type of relative importance
Decision making and problem solving
Problem solving is a part of decision making and is a systematic process It focuses on analyzing a difficult situation It always includes a decision making step Decision making is the last step of a problem solving process. It can occur without full analysis or a decision can be made to not problem solve
Clinical practice guidelines
Provide diagnosis based step by step intervention for providers to follow in an effort to promote quality care Also called standardized clinical guidelines Should reflect EBP/be based on cutting edge research and best practices
Mission and planning hierarchy
Purpose of the organization It is the highest level of the planning hierarchy Mission Vision Philosophy Goals Objective policies Procedures Rules
Quality Improvement Models
Quality Assurance (QA) targets currently existing quality with quality improvement (QI) targets ongoing and continually improving quality and ongoing . QI-total quality management and toyota production system (customer focused QI model; focused on the pursuit of the most efficient production method possible)
Classic Change Strategies
Rational-empirical strategies: used when there is little anticipated resistance to the change or when the shane i.e. perceived as reasonable Normative: re-educative strategies-use group norms and per pressure to socialize and influence people so that change will occur Power-coercive strategies: feature the application of power by legitimate authority, economic sanctions or political clout of the change agent.
5 components of EI
Self awareness: know yourself, your triggers and reactions Self-regulation: control impulses/choose yourself, values impact choices Motivation: passion and commitment, intrinsic Empathy Social skills: relationship, give yourself Display 3.2 g 55
Six Sigma Approach
Sigma is a statistical measurement that reflects how well a product/process is performing *Higher sigma values indicate better performance The healthcare industry used to strive for 3 sigma processes Organizations should aim for less errors by carefully applying the 6 sigma methodology to every aspect of QI
Manageable tasks
Some projects aren't done because they aren't broken down into manageable tasks
Stages of change model
Stage 1: Precontemplation-no current intention to change Stage 2: Contemplation-individual considers making a change Stage 3: Preparation-there is intent to make a change in the near future Stage 4: Action-Individual modifies his/her behavior Stage 5: Maintenance-change is maintained and relapse is avoided
Audits frequently used in quality control
Structure-monitor the structor/setting in which pt care occurs Process-measure the process of care or how the care was carried out Outcome-determine what results, if any, followed from specific nursing interventions for pts
Complex Adaptive Systems Change Theory
Suggests that the relationship bw elements an agents within any system is nonlinear and that these elements are the key players in changing settings or outcomes. Self-organizing nature of human interactions in a complicit organization leads to surprising effects
Transactional Leadership
Table 2.2 pt 44 Traditional; more authoritative and managerial. Concerned with day to day operations, tasks and getting the work done. Superior makes decisions with little to no input. 3 methods: reward for desired work, correct problems as they arise, deal with problems retrospectively.
Management
The act of handling or controlling something successfully. A process of directing through manipulation of resources. Providing structure and direction.
3 steps of the quality control process
The criterion or standard is determined information is collected to determine whether the standard has been met educational or corrective action is taken if the criterion has not been met
Resistance
The natural and expected response to change. Individuals' resistance typically depends on 4 things: their flexibility to change their evaluation of the immediate situation the anticipated consequences of the change their perceptions of what they have to lose and gain Perhaps the greatest factor contributing to the resistance encountered with change is a lack of trust bw the employee and the manager or the employee and the organization.
Benchmarking
The process of measuring products, practices, or services against best-performing organizations Organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement.
Kurt Lewin's Change Theory
Unfreezing: the change agent convinces members of the group to change or guilt, anxiety or concern are elicited (convince people to change) Movement: the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces Refreezing: the change agent assists in stabilizing the system change so that it becomes integrated into the status q
Involvement in change
Whenever possible, all those who may be affected by a change should be involved in planning for that change When information and decision making are shared, subordinates feel that they have played a valuable role in the change.
Decision making
a complex, cognitive process, the nurse chooses a particular course of action Although usually triggered by a problem, it is often handled in a manner that doesn't focus on eliminating the underlying problem A leadership activity and the core of management
Good planning principles
all plans must flow from other plans. Short range plans must be congruent with long range plans. Be sure objectives are clear. Planning in all areas of the organization must follow the mission, philosophy and goals of the organization Planning involves the same process regardless of the period involved. Don't bypass levels of people. Interpersonal relationships are important. The length of the plan is determined by what actions are necessary to make the plan successful. Keep target dates realistic. All plans must include a regular review process (evaluation)
Quality control
an effort to monitor the quality services provided
Leadership roles
assessment and forecasting vision influence and inspire values clarification active listening and feedback communication encouragement receptive to new ideas role model/model the way
Decision making styles
autocratic democratic/participative laissez faire
Inactivists
consider the status quo as the stable environment and they spend a great deal of energy preventing change and maintaining conformity
Three primary requisites for successful management
decision making problem solving critical thinking
3 categories of prioritization
don't do do later do now
Quality measurement as an organizational mandate
external impacts on quality control professional standards review organizations the joint commission (ORYX, Core measures and National pt safety goals)
Creating a time efficient work environment
gather all supplies before starting group activities that are in same location use time estimates document nursing interventions as soon as possible always strive to end the work day on time
Individual variations in decision making
gender, values, life experience, individual preference, brain hemisphere dominance and thinking styles
Key components of critical thinking
insight, intuition, empathy, willingness to take action (important for leaders to have the willingness to take action!) Nurses need to be able to think critically to prioritize care.
Management functions
knowledge of legal, political, economic and social factors affecting planning provide opportunities for stakeholder participation coordinates nit level planning develops and articulate a unit philosophy develops and articulates unit level policies and procedures develops and articulates unit goals reviews unit philosophy, goals, policies, and procedures and revises as needed actively participates in the organizational strategic planning, defining and operationalizing such strategic plans at the unit level
What planning takes place in healthcare?
organizational planning-short range strategic planning-long range strategic plan is a tool to organize the present based on future projections Like a roadmap/blueprint
Management Functions
p. 36 H. Fayol: planning, organizing, command, coordination and control Planning-determining philosophy, goals, objectives, policies, procedures, rules... Organization-establishing the structure to carry out plans, determine most appropriate type of delivery and group activities to meet goals. Staffing/Command-recruiting, interviewing, hiring and orienting staff, scheduling, staff development, employee socialization Directing-Staging functions, human resource management responsibilities like motivating, managing conflict, delegating, communicating.. Controlling-performance appraisals, fiscal accountability, quality control, legal and ethical control
Scientific Management
p.35, F. Taylor. Establishing one best way to accomplish a task to increase productivity. 4 principles of scientific management: 1. Traditional rule of thumb means of organizing work must be replaced with scientific methods-using time and motion studies and experience of workers then work could be designed to promote greatest efficiency of time/energy. 2. A scientific personnel system is needed so workers can be hired/trained/promoted based on competence/abilities; match them to appropriate job. 3. Workers should be able to see how they fit into an organization and how they can contribute to productivity (ex. financial incentives) 4. The relationship bw managers and workers should be cooperative, interdependent and shared equally. Managers are functional foremen and they plan/prepare/supervise while workers work.
Management controlling functions
periodic evaluation of unit philosophy, mission, goals and objectives measurement of individual and group performance against pre-established standards auditing of pt goals and outcomes
Planning
pg 37 Planning is deciding, in advance what to do who will do it how it will be done when it will be done where it will be done Planning is a proactive, deliberate process required of all managers. It involves choice-choosing from among alternatives. It is a guide to reach a goal so it must be flexible and allow for readjustment as unexpected events occur. It is critically important to and takes precedence over all over mgmt functions. Without adequate planning, the mgmt process fails and organizational needs/objectives can't be met.
Emotional intelligences
pg 59 The understanding and recognition of oneself and another's abilities, perceptions and attitudes. The capacity to recognize our own feelings and empathize with those of others.
Planning tools
pg. 144-145 Balanced Scorecard: organizational, used to develop metrics (performance indicators), collect data, analyze the data from organizational perspective, improves overall performance by measuring what matters and aligns strategy wit the work people do day to day SWOT analysis: identifies Strengths, Weaknesses, Opportunities and Threats
Quantum leadership
pg. 63 Builds on quantum physics and transformational leadership;suggests that the environment/context in which people work is complex and dynamic and this has a direct impact on organizational productivity. A quantum leader must address the gap bw the present and the future, resolve conflict and create a better healing environment for providers and consumers.
Reactivists
plan AFTER a problem exists past oriented
Primary planning modes
reactive planning in activism pre activism proactive planning
Quality assurance
seeks to ensure that quality currently exists
Strategic planning and management
should include... clear statement of the organization's mission identification of external stakeholders (patients, families, community) and determination of their assessment of the agency's purpose and operations delineation of the agency's strategic goals and objectives development of strategies to meet these goals
Internal time wasters
technology socializing paperwork overload a poor filing system interruptions
Factors influencing planning in healthcare
technology, cost mgmt, aging population, electronic access, alternative meds, healthcare team
Leadership
the art of motivating a group of people to act towards achieving a common goal. Uses personal traits and power to constructively influence. Table 2.1
Quality gap
the difference in performance bw top performing health care organizations and the national average
Preactive
utilize technology to accelerate change and are future oriented. There is an attempt to predict the future and react to that prediction
Qualities of Change Agents
visionary, risk taker, flexile, excellent communicator, creative, sensitive, current
