Leadership Exam 1

Autocratic Leader

"I am in charge" -makes all the staff decision, does not get any staff input -use authority of the their position to accomplish the goals -Communication is downward

Democratic leadership

"What's your opinion" -desires participation. Relationship and person orientation style. Staff members are encouraged to participate in the decision making. Involve staff in planning -Communication goes up or down -emphasis on we rather than I -Criticism is constructive -Take a long time to make decisions -Not good for emergency

Laissez-faire

"You're are your own" -Complete freedom. Manager embraces a noninterference. No guidance or direction. Could be unable or unwilling. No feedback. Very permissive. Typically communicate by emails or memos.

exchange

"scratching each other's back" if you do this for me, I will do this for you

Things in a Strategic plan

- goals for 2-5 years -how the hospital allocate it's resources, which departments will receive funding -assign who is responsible for each component of the plan -identify the time frame that the goals need to be met by

Staff

-You have a responsibility to follow the polices, follow the procedures, follow protocols, to ensure that you are providing safe pt care. Need to promote evidence based standards. Incumbent on you to report to the manager if you identify quality issues or safety issues on the unit. You have a responsibility to remain current (Read appropriate literature for your specialty, stay informed, listen to webinars) actively participate in quality improvements on the unit

Components of a Strategic plan

-create a strategic mission and vision -assess the internal and external environment -set goals and objectives -develop strategies to achieve goals and objectives -plan an implementation strategy -evaluate the plan

Factors that impede culture of safety

1) Tendency for blame to be put on a person (Ex. staff views errors as failure or that they will get blamed for something, then they will not bring errors in the forefront 2) organizations that focus on how the nurse was trained or on rules rather than knowledge 3) organizations where employees are punished rather than looking at improving the system= more errors 4) employees may assume that because there are no errors or a "near miss" (doesnt have to be reported but not true)

3 key factors for Contingent Theory or situational theory

1) have to have the trust and respect for the leaders and followers 2) a task that is based on the goals and complexity of the problem 3) the position power of the leader, whether or not they can award or influence

National Patient Safety Goals

1) identifies patients correctly 2) improve staff communication 3)use medicines safely 4) uses alarms safely 5) prevent infection 6) identify patient safety risks 7) prevent mistakes in surgery

Goals for STEEP

1) improve the health of the population 2)enhance the experience and outcome of patients experience (this is where HCAHPS came from ) 3) reduce the per capita cost of care for the benefit of the community In short: improve the health of the population, improve pt outcomes and pt experience, reduce cost

STEEP

1) provide Safety care and prevent injuries to patients 2) provide Timely care reducing waits and harmful delays 3) provide Effective care based on scientific knowledge 4) provide Efficient care reducing waste 5) Provide equitable care that does not vary in quality due to gender, ethnicity, socioeconomic status 6)Provide Patient centered care based on preferences needs and values

Deeming Authority

CMS or the government has given the permission to other organizations to say that the hospitals have met the conditions and participation

Regulatory organizations

Center for Medicare and Medicaid services (CMS) The Joint Commission (TJC) Det Norske Veritas Healthcare INC (DNVHC) Healthcare Facilities Accredidation Program (HFAP) Center for Improvement in Healthcare Policy (CIHQ)

8 root causes for medical errors

Communication problems, inadequate information flow, human problems, patient-relateed issues (hospitals are dinged if patient returns less than 30 days--> HF related), organizational transfer of knowledge, staffing patterns and workflow, technical issues, inadequate policies

Expert

Knowledge and skill (Mrs. Smith has the skill and knowledge. She is the go to person for skills)

Quality Improvement

Looking at the work process while also focusing on what the customer wants and needs

Sanctions-Threats

Manager can say if you don't do this, this will happen

Core Measures (Hospital Quality Measures)

National Standards of quality and treatment for processes that are common conditions. Hospitals can choose not to participate in core measures but if they do choose that, they automatically get 2% reduction in what Medicare is going to pay them Increases collaboration across the continuum of care and enhances quality

example of formal leadership

PCC, CNO, Admin Director, Charge Nurse

Patient Safety and Risk Management

Right thing for the patient. Hospital is paid based on safety events

What they do?

They do not tell you what policy and procedures you have to have, but they do monitor and hold the hospital accountable for the policy and procedures they have. Also hold a hospital responsible for quality and safety things like that

Chaos Theory

a degree or older can be obtained by viewing complicated behaviors and situations as predictable. Variation is normal part of managing a healthcare system.

Written warning

a document that specifically address behavior, rules or polices that have been violated and tells you potential consequences if the behavior is not corrected. Gives you plan of action that you have to implement

example of informal leadership

a fellow employee who gets the team to work together

transformational-follower

a shared vision, increased self worth, challenging and meaningful work, coaching and mentoring happens, a sense of being valued

benchmark

a standard by which everything is measured

procedure

a step-by-step set of instructions to be carried out by a specific person. Written in detail. Very specific under a defined set of circumstances.

systems theory

a system is a set of interrelated and interdependent parts that together form a whole. Anything that affects one department affects the whole

Reward

ability to grant favors or rewards (for complaining with whatever the person values) example- a day off, allowing someone to work extra hours and go into OT, Assignments)

philosophy

an explanation of the belief system that determines how the mission and vision will be achieved

followership

an interpersonal process of participation by which the follower takes guidance and direction from a leader to accomplish goals. Determines the leader's degree of power.

referent

association with the leader/others (this is when you basically see someone that you perceive to be powerful, and you admire them. Mrs. Smith is a great nurse)

ingratiation

attempt to advance yourself by trying to make another person feel important. Nurse manager may go up to a director and say that they like what they on today; trying to influence that person maybe to get something else you want

Legitimate

based on position (think of nurse manager, CNO, charge nurse)

value

beliefs that guide the organization's activities (values do not change, regardless of what is occuring within the organization)

Example of autocratic leader

can be useful with CNAs, those with little or no formal education. May be appropriate in code situation

Fishbone diagram

cause and effect. List potential causes arranged by categories to show their potential effect on their problem

Example of complexity theory

change in abnormal BPs overtime is much more significant than one abnormal BP.

Transactional leadership

comfortable with the status quo, reward staff for desired outcome, monitor work performance and correct when needed, wait until problems occur to take action to correct the problem

Blocking

deliberately keeping others from getting their way. Threatening to stop working, not being friendly, etc. Nurse leaves out something important that you need to know to take care of a pt.

vision

describes future goals and aims of the organization

mission statement

describes the purpose of the organization and the reason why it exist

ORYX

doesnt mean anything. Is a part of the conditions of participation that a Joint Commission certified hopsital have to collect certain performance measures and report it as part of their accreditation process. The joint commission uses this measure to help improve pt safety and quality. Data looks at organizational performance and outcomes. Looks at whole organization and the outcomes.

termination

employee is permanently released from employment. Last resort.

controlling

ensure that employees accomplish the goals, that have been set while maintaining high quality work performance.

Conditions of participation

established to make sure the hospitals were providing quality care and protecting health/safety of their beneficiaries

Culture of Safety Achieved

every single person in the organization has to embrace the principle -every single discipline that believes and embraces the concept that we have to keep a patient safe

Informal Leadership

exercised by a person who has no official appointed authority but is able to persuade or influence people.

assertiveness

expressing your opinion to somebody else without inhibiting their rights. It is an influence behavior. you may stand up for a patient rights but not hurt others feelings doing it

coercive

fear and punishment (threat of negative consequences, I will tell someone if you dont do this, I will make you work 5 extra shifts. Punishment- not giving the weekend off)

examples of procedures

foley catheter, central line, dressing change, inserting NG tube, trach care, putting in an IV

transactional followers

fulfills the contract or gets punished, does the work to get paid, errors are corrected in a reactive manner

directing

function at establishing direction and influencing people to follow the directions. Involves making assignments and giving instructions. During this phase, the manager might use coaching, motivate, and supervision. This is where the work climate is established. Manager needs to give feedback.

Leniency

giving all the team members the same rating

upward appeal

going to a higher authority to arbitrate something. You may have a situation where 2 CNAs do not want something. Both get manager to make decision

Organizational chart

governing board--> president--> CEO visual picture of the lines of authority and lines of communication

Coalitions

group of people get together to speak or negotiate with the same voice. All nurses go to nurse manager about why they don't need to do the accuchecks. More effective if everyone goes then one person goes

examples of policies

handwashing, mask wearing, DNR policy, pt bill of rights, pt privacy, staff attendance policy

Transformational leadership

identify and clearly communicate vision and direction, empowers the work group to accomplish goals and achieve vision, imparts meaning and challenge to work, are admired and emulated, provide mentoring to staff, charismatic and inspiring, causes the followers to rise above their own needs

planning

identify the goals and objectives. Identify the resources needed which includes the people, the supplies, the equipment. What actions you are taking.

phases of planning

identify the mission/goal, assess the environment, analyze the situation, and see what is going on, establish goals, identify the strategy to reach the goal, set objectives, assign responsibilities and timeline, document the plan, celebrate the success.

Good catch program

if a employee found a safety issue, submit it on a form then committee, once a month they recognize them, promoted the idea that safety was important to everybody.

Transformational-organizational outcome

increased loyalty, increased commitment, increased job satisfaction, increased morale, increased performance

Influence Behavior

influence is the power to change or affect someone or somebody or something. It turns into power strategy

Verbal warning

informal reprimand or admonishment where a manager calls you in to discuss an issue and suggest ways for you to improve your performance. Goes into permanent record

power

is a vehicle that a leader influences a follower to take take action. It is the ability to motivate people to get things done with or without the legitimate right granted by the organization

formal leadership

is practiced by nurse who is appointed to an approved position and given the authority to act by the organization

Reporting errors

is rewarded. More errors found on units and in organizations where there is poor safety culture

authority

is the legitimate right to direct others and is given by the organization through an authorized position

Strategic plan

is what the hospital uses to forecast the future success of the organization

performance appraisal

it is an evaluation of how well an employee performs a duty of the job based on their job description -Take a minute to read your job description because that's what you will be evaluated on -Designed to help you grow in your role

Transformational leader

keeps the self worth and not resentment. Take a walk with me, walk me through what happened. What would you have done differently?

Excutive team

lead the culture of transformation or culture of quality. They have to provide the resources and remove the barriers. CNO- main responsibility is to remove barriers. Define procedures for immediate response if errors occur

Trait theory

leaders are born with certain leadership characteristics and not made. -This theory assumes you cannot learn the management process -Fails to take into account leadership can be learned through various experiences.

RCA

looks at problems that has already occured (retrospectively) and you are trying to understand the causes of adverse event by looking at flaws that could have occured. Looks at process problems

pareto chart

looks at the frequency of events and how often they occur

Halo effect

manager rates employee based on one event or skill that was positive or negative

staffing

number and type, set up schedules, decide how assignments are made, orient train them, socialize them, on board them, implement staff development programs, look at staff. (one of the most time consuming management functions)

Contingent theory (Situational Theory)

organization behavior is contingent on the situation or environment

Connection

personal relationship (friend says that she knows Terri and she is the CNO, make people think you have an "in" with someone else.I know so and so, I'll see what I can do.

PDSA cycle

plan- plan for the change with activity focused on improvement. Looking at doing something to improve something Do- carry out the change Study- look at what were the results Act- modify the process if it didn't work or if it worked, adopt the change

five functions of management

planning, organizing, staffing, directing, controlling

Standard

predetermined standard of excellence that serves to guide the practice. Nursing has standards that we follow. Rules that apply to key processes. (Sponge count in OR example)

rationality

provide pertinent information, presenting a reasonable and logical layout of an idea in a structured manner. A, B, B1, B2, etc.

Disciplinary processes- progressive discipline

purpose to correct behavior or performance problems with the goal of helping people be successful.

similiar-to-me

rate people more favorably that you believe are like you

Quality

refers to the characteristics of and the pursuit of excellence. Right care, right time, right person, and in the right way it is supposed to be delivered

chain of command

regulatory policy manager--> nursing professional practice--> CNO

suspension

removed from work environment for a few days. Typically 1-3 days. not paid. pending investigation-pay for shifts missed. Tells you when you can come back to work. May tell you write a plan of action. Allows employee time to reflect and think about what happened and modify behavior.

Nurse manager

responsible for quality and safety in their area of responsibility. Responsible for communicating with staff what the priorities are. Need to meet regularly with the staff and let the staff know, what the monitoring process is going to be, and what the progress is. (How are we doing with pt satisfaction? What are the things we need to work on?). Work with staff to develop action plans.

RCA

root cause analysis- done to see if its a person problem or systems issue

Flawed systems

safety issues and the things that happen are not people problems, they are system failures

Example of Chaos theory

say you are a visitor, there is a code called. Watching what is going on. It looks like nobody knows what they are doing. Nurse sees everything as predictable. You know what is going on.

Policy

serves a guide for organization's decision making. It directs or guides any decision making in relation to process and activities

Leadership

the act of guiding or influencing to achieve desired outcomes. Occurs at any time when a person attempts to influence the beliefs, opinions, or behaviors of an individual

Culture of Safety

the attitudes, beliefs, perceptions, and values employees share in relation to safety in the workplace

organizing

the goal: assemble required resources. Materials need to do the job. Formal line of authority is established here

informational

the need for information (person who possess information that is needed by others. I'll tell you if... they know something you want to know)

complexity theory

the world is full of patterns that interact and adapt through relationships. Studies the interrelationships of multiple components. Looks at relationships across units and between units. Looks at patterns of relationship. Behavior over time is complex, the future is unpredictable.

Process improvement tools

understand what they do

Recency

where you are evaluating an employee on very recent events. Manager looks at last 3 months. Or time period in the not very distant past. Not looking at the whole year

Contrast

where you instead of rating employees based on the job description or whatver you are using as your tool, you rate them based on how they are to each other. Comparing employees to each other. Sometimes that can be easy to do when you look at high vs low performers.

A good follower

will question their leader, be comfortable questioning their leader, will use critical thinking and problem solving

Transactional organization

work is supervised and completed according to the rules, deadlines are met, limited job satisfaction, low stable levels of containment

flow chart

you are looking at what is actually occuring vs what is intended to be occuring. To see the flow

RCA 1

you bring all the people who are involved in the situation together and you go through what happened and there are questions the risk manager asks.