Navigating the Healthcare Leadership Landscape

Introduction

The critical commentary is explanation of the importance of team-working, effective management and leadership and delegation skills that are learned during the execution of the module. Thereafter, the commentary would provide reflection of the areas in which progress is made in Year 1. In this purpose, the plan is to initially inform the context of leadership and management in healthcare along with its importance for the nurses. Thereafter, the importance of leadership is to be briefly described by incorporating recent events in healthcare. The exploration of Trait theory and Transformation leadership theory is to be executed and they are to be compared to inform the way they relate to practice. The role of leadership in quality improvement and key theoretical context regarding multi-disciplinary team working is to be discussed. The delegation in leadership for supporting multi-disciplinary working and digital information use in healthcare is to be explained. The gap experienced in current nursing and way to improve it is to be discussed. A reflection of the performance in care in Year 1 is to be reflected in the context to task delegation and teamwork.

The critical commentary regarding leadership and management in healthcare is to be presented because they are important parts of the care that ensures good health services are provided to patients. This is because effective leadership helps to create well-directed vision regarding what is to be achieved for improved care and way it is to be achieved. The presence of leadership in healthcare is also indicated the way strategies for improvement in care are to be communicated and way strategies are to be evolved for meeting the vision (Kantanen et al., 2017). The presence of effective management motivates people and helps employees negotiate to work together in making health improvements and delivering innovative quality care (Murray, 2017). Thus, discussion regarding them would help to develop overview of the way they work and develop in-depth understanding of the way leader and management in healthcare is to be established for good quality care to be delivered.

Context

According to NHS and nursing, leadership is referred to the ability of individual to motivate, influence and inspire healthcare professionals while they work together in achieving goals and objectives of care on the organization (Kline, 2019). In contrast, Management is referred to the performance of the leadership functions regarding decision-making and governance within the healthcare organization that are employing nurses in care. It involves supporting planning, organising, staffing, controlling and directing actions at work (Ham, 2018). The NHS mentions that teamwork in nursing is the involvement of two or more people who interact independently for achieving a common purpose, allows sharing of information and ideas and ensures collaborative working for enhancing care efficiency and patient safety (Woodhead, 2019). In contrast, delegation in nursing is transfer of responsibility of one nurse to another for performing a task while retaining the responsibility of being accountable for the outcome by the original nurse (Labourne, 2017).

In healthcare, the importance of leadership and management is that it helps in improving patient outcome, lower medical and clinical errors and enhanced staff retention which benefits the workplace of healthcare (Kantanen et al., 2017). This is because enhanced leadership and management makes the healthcare workers and professionals access enhanced support and resources when in need to efficiently care for the patients which enhanced the care satisfaction and quality of delivery. Moreover, they help in resolving professional problems at work and ensures better working environment as well as opportunity for the nurses which assist in their retention and enhanced working zeal (Weiss et al., 2019). In the UK, for leading and managing nursing quality adult nursing care, effective examination of the working environment and hospital outcomes for patients are current being evaluated. This is because it helps in determining the gaps in resources and additional support to be managed along with nature of leadership change required to promote quality working environment for the nurses. It is to make the nurses work peacefully to deliver quality care with efficiency and maintain patient safety without facing lack of resources or support (Brown, 2018).

Discussion

A.

According to House of Commons Public Administration and Constitutional Affairs Committee (2017), in healthcare, the importance of good leadership is empowering healthcare staff to speak with Duty of Candour and enable difficult communication to be established along with uncomfortable truths to be listened and shared so that problems and concerns in the organisation can be effectively addressed (committees.parliament.uk, 2017). It is evident from the Francis Report (2013) where it is mentioned that poor leadership in the organisation led to unnecessary cost-cutting and allowed hindered communication between the managers and subordinates that led the problems faced to remain undiscussed to be resolved (NMC, 2015).

The importance of good leadership in healthcare is that it promotes positive working relationship because effective leaders support development of informal and formal interaction between the healthcare workers. The encouragement of communication makes the workers interact with one another to gradually know and trust them at work which in turn promote collaborative working (Hargett et al., 2017). It is evident from the incidence of Morecambe Bay Investigation where it was mentioned that poor leadership is present in the organisation which led the workers form extremely poor relations at work. Moreover, leaders promoted favouritism and discrimination which worsening the employee relation and affected hindered quality delivery of care by the workers (assets.publishing.service.gov.uk, 2015).

According to PHSO report, effective leadership in healthcare is important to support acknowledging mistakes and service failure at the earliest so that enhanced actions can be taken immediately in resolving them for promoting better outcome for the patient (committees.parliament.uk, 2017). It is evident from Winterbourne View Hospital where it was mentioned that poor leadership lead the pattern of serious abuse against the patients remain unrevealed within time which caused serious health consequences for many patients instead of promotion of their health and well-being (assets.publishing.service.gov.uk, 2015).

B.

In healthcare, two of the key leadership theories followed include Trait Leadership theory and Process Leadership theory. According to trait leadership theory, successful leaders are mentioned to born with leadership skill as they have different ability, personality traits and interest apart from the individuals who are going to be low effective leaders (Wyatt and Silvester, 2018). In contrast, Process leadership theory mentions that leadership is regarded as an event that depends on communication between follower and the leader. Process theory makes leadership available to all rather than restricting the action to people who have special qualities (Xu, 2017). Thus, the process theory contradicts the trait theory by mentioning leadership is learned, observed and developed through training and not due to presence of any inborn traits in people.

The trait theory of leadership mentions that core traits of leadership are achievement drive, motivation, presence of honesty and integrity, self-confidence, enhanced cognitive ability, emotional maturity and carving for knowledge (Wyatt and Silvester, 2018). It related to nursing and multi-disciplinary working by mentioning individual who have ability to show increased effort in making or directing change, support inspiring others, has reliability and is open, knolwdege wider things in the industry and has well-control emotional self are able to act as leaders. The process theory of leadership mentions it is developed through interaction between leaders and followers (Xu, 2017). In this context, the leadership in nursing and multidisciplinary team is developed when leaders interact with followers in supporting delivery of care. It is evident as leaders on interacting with followers in the team identify potential ideas to be followed in directing the management of care by the followers for reaching the determined care objectives.

C.

In quality improvement in adult nursing, the role of the leaders acts as backbone for the formation of the improvement strategy as they provide unified purpose to the followers and establish the direction of work to be followed for improving quality of care in the organisation (Evangelou et al., 2021). As argued by Stanley and Stanley (2018), lack of effective focussed purpose and hindered direct leads the nurses in adult care confused about the way they are to execute their work so that improvement in the care quality can be established. This is because in such condition the lack of unified purpose makes the nurses act differently and without effective direction from good leaders at work they get lost from the pathway for improvement. The role of the leaders in quality improvement in adult nursing is to determine the fluctuations in care needs and demands among adult patients. This is because it would make the leaders understand the varied needs and demands of care to be fulfilled through improvement and would make them to accordingly develop the strategies and vision for quality improvement to be followed by the subordinates in making the improvement (Pesut and Thompson, 2018). In contrast, the study by Miles and Scott (2019) mentions that in quality improvement within adult nursing, the role of the leaders is to equip followers with needed resources in making the improvement and provide them freedom to act with accountability. This is because it would help the followers free to perform their duty without facing resources-related obstacles in making the change and avoid experiencing continuous resistance from leaders towards acting to make improvement which makes them lose their focus.

D.

The key theoretical concept regarding team working within MDTs is that effective trusting relationships between the team members are to be built so that they support each other in executing the care (Saint-Pierre et al., 2018). It is argued by Shojaei et al. (2017), lack of trusting relationships between team members in MDT results to create unnecessary conflict and quarrelling with one another. It leads the team members of MDTs fail to work collaboratively which is required for enhanced care of the adult patient. The other theoretical aspect of team working within MDTs is shared vision regarding integrated care is to be created along with clarified care goals are to be communicated to each team members. This is because it leads the members of MDTs to know the key care prospect to be reached for the patients and identify they respective role as well as responsibility in meeting the care needs of the patients with the nurses to ensure patient’s well-being (Rosell et al., 2018). As argued by Devik et al., (2018), lack of shared vision in MDTs leads the team members work inconsistently and perform practices beyond care protocols. It leads the patients to receive hindered care and support which may not be needed for their health leading to disrupted care nature.

The importance of role modelling in leadership is that role models acts as examples to be followed by individuals to become leaders. Moreover, the role models also inspire individuals to perform actions through zeal and create individual personalities required for effective leadership (Cope and Murray, 2017). The lack of role model in leadership makes the individuals trying to be leaders lack idea regarding the actions to be performed to become effective leaders (Quinn, 2017). In team working, effective networking skills is important as it helps the team members connect with one another in the same field with various expertise to access additional assistance and skills needed for improved care of the patient (Cope and Murray, 2017).

E.

In healthcare leadership and management, delegation is linked because as a leader or manager, the individual cannot always perform every role and responsibility on their own. This is because of the wide requirement of skills and values that are not always collectively present in single individual to be showcased at the same time (Chen, 2018). Thus, leaders and managers in healthcare share few roles to be performed by capable followers to lead and manage working activities. In nursing, effective delegation is performed by leaders and managers through initially knowing and analysing the skills and knowledge of the followers. This is because it helps in determining the quality and efficiency of each of the followers as well as decide which of them are capable in performing the delegated role most effectively without making any error (Lega et al., 2017). As argued by Gassas et al. (2017), effective delegation in nursing is not reached when the leader or manager show confusion regarding which role or task to be delegated. This is because the confusion makes the leader perform improper delegation of any task that are not within the scope of the individuals to whom it is delegated to be performed due to authoritative restrictions. Thus, effective delegation in nursing is reached when the leaders delegate task by knowing what is to be delegated and has clear idea regarding the range of delegation of the task to be made for others. One of the challenges faced with delegation is inability of the subordinates to work effectively in meeting the delegated task or role due to their lack of confidence and skills (Akinola et al., 2018). The other challenged faced is delegation in nursing is lack of effective control from the leaders and managers which makes the individuals performing the delegated task work inappropriately leading to lack of fulfilment of the delegated task (Lega et al., 2017).

F.

In healthcare, digital data is referred to the information which is presented in a form of a string of discrete symbols among which each symbol indicate finite values or some form of alphabet (Vest et al., 2019). The information technology in healthcare is referred to building interactive network for the organisation in safeguarding information and data, making communication, building security and others (Lapão, 2020). In order to delivery quality care, the leaders interact with help of information technology to gather data that is to be followed as evidence in developing quality working practice (Karp et al., 2019). The information technology and digital data sharing is executed for effective multi-disciplinary team (MDT) working by the leaders as it helps the leaders to share the response of care and current health condition of the patients with the members of the MDT without wasting any time (Lapão, 2020). It is argued by Bauer et al. (2020), digital data and information technology use in healthcare makes the leaders improve patient safety with the help of MDT. This is because the information technology use makes the leaders provide effective reach of guidance regarding care to the MDT which makes them perform less clinical error and reduce adverse care reactions toward the patients leading them to deliver safe care. The digital information use by the leaders makes them to effectively aware MDT regarding the way to systematically perform risk assessment of patients and way to resolve them which in turn improves patient safety (Vest et al., 2019).

G.

One of the recent gaps in the UK healthcare system is lack of effective policies and protocols to fight against sexual harassment of nurses in the care environment from colleagues or patients which needs to be improved. This is because it is causing creating of negative working environment and making nurses feel abused and unsafe. This is impacting nurses to develop lack of concentration as well as efficiency at work out of feeling of vulnerability due to abuse (britsafe.org, 2021). The steps to be taken in Year 2 for the innovation project regarding reducing sexual harassment of nurses at the workplace include initially determining the policy factors and their way of implementation leading to the problem. Thereafter, individual responsible for making the harassment and the rate of nurses who have faced harassment are to be determined for identifying the level of the problem. The next action is to develop strategies related to policy implication and vision for managing and reducing sexual harassment of nurses at the workplace. It would follow determining use of change model to implement the improvement and evaluation process to be used to determine the success of the innovative actions taken in controlling the gap.

Reflection

A.

In the placement, I was responsible to act as a nurse in the gastrointestinal ward where I was allocated to care for one of the patients among other who was suffering from Inflammatory Bowel Disease (IBD). The IBD cannot be cured and the patient was admitted in the hospital to be treated for abscess draining by the Examination Under Anaesthesia (EUA). In the post-operative process, it was my responsibility to deliver him care and I was involved with the multi-disciplinary team consisting of the pharmacist, surgical doctors, dieticians and other to arrange safe care for the patient. During the handover, I was mentioned the patient is to be provided ‘low residue diet’ to avoid blockage in bowel movement. Since I had no idea about the aspect, I connected with the dietician who informed me regarding the nature of food and amount to be arranged for him for keeping his steady health after the surgery and further. The action led me to realise that team working is important as it helps to access knowledge and information that are not known to gain competency in delivering effective care to patients. It is evident I knew nothing regarding diet approved for the IBD patients, but on consultation with the dietician as a team I was able to gain competency in arranging proper diet for the patient. The teamworking also helps in easy flow of connected health-related data of the patients to ensure their safe care (Goh et al., 2020). It is realised because by working as a team with the surgical doctors and nurses who took care of IBD in the operative phase, I was able to develop understanding of the way to effectively care for the patient. The good thing about the situation was that I understand I have effective ability to collaborate with different professionals in delivering care to patient due to my successful interaction with the MDT for the patient. However, the bad thing about the situation is that I felt I lack effective leadership qualities in leading team as I expressed more dependence on actions mentioned by the MDT to be performed rather than leading them to support me in the care for the patient.

B.

In my Year 1, I was delegated to take care of medication administration for a day of a patient who was receiving chemotherapy for oesophageal cancer. The delegation of the task made me felt confident that other nurses in the ward believe regarding my efficiency to take care of individuals who are beyond my regular patients. The delegation was undertaken under my mentor’s supervision where the nurse in-charge for the patient mentioned me the medication for the day and detailed dose along with time to be maintained for the patient as she would be on leave. This led to one of the good things that I was aware of the dose, type and timing of the medication to be delivered to the patient. However, the nurse did not introduce me to the patient during the delegation. It led me to face lack of compliance from the patient when I went to administer her medication as she mentioned to not know me and therefore do not trust to take her medicines. Thus, the thing to be done differently next time is that during the delegation of responsibility regarding patients, I would ask the delegator to introduce to me to the patients so that they trust me and easily execution of the delegated task can be done.

Conclusion

The above discussion mentions that importance of leadership in healthcare is effective regulation of positive working environment, support enhanced communication, encouragement of employees to work with increased zeal and others. The delegation is important part of management and leadership as a single leader cannot execute all the responsibilities due to which few roles to be shared with others to assist them in performing effective leadership. The key theoretical concept of team working with the multi-disciplinary team (MDT) in care are trust and shared vision along with presence of role model. The digital data and information technology help in easier sharing of information and assist leaders to create effective compliance with MDT to delivery quality care.

In the light of the findings and conclusion, one of the recommendations is that effective leadership training is to be provided to nurses at the beginning of their work so that they have presence of required skills to act effectively as leaders. The other recommendation is that delegation steps and process is to be clearly informed to nurses so that they avoid making mistake and unnecessary error which create difficulty for the nurse performing the delegated duty leading to unsatisfactory care delivery to patient.

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Appendix

Appendix 1:

Identified Gap: Lack of effective polices and procedure to protect nurses from sexual harassment in the workplace

Steps to be taken to prepare the project:

To initially determine the factors leading to hindered policy management in workplace for controlling sexual harassment of nurses

To identify factors leading to sexual harassment of nurses at the workplace

To develop strategies related to policy implication and vision for managing and reducing sexual harassment of nurses at the workplace

SMART Goal 1:

To strictly implement whistleblowing policy for reporting sexual harassment at workplace by the nurses

SMART Goal 2:

To establish well-structured policies and procedures in the workplace for tackling sexual harassment of nurses at the workplace

Action Plan:

Self-development Checklist:

Personal Qualities of Leadership to be improved:

Self-awareness

Focus and enhanced vision

Ethical mindedness

Strategic thinking and innovating attitude

Cross-cultural communication

Professional Qualities of Leadership to be improved:

Critical Thinking

Authenticity

Flexibility

Responsibility and Dependability