Essay on Leadership Development Is Essential in Promulgating an Organisational Culture in Which Patients’ Needs Come First and the Values of Patient-Centred Care Are Communicated and Understood at All Levels, From the Board to the Ward

Introduction

Leadership is something which is inherent in literature- it is commonly studied among literary scribes and circles and has often been the source of contentious debate in the academic world. With leadership being so prominent in academia, it has inevitably been disseminated in relation to a number of disciplines, including education (teachers are some type of leaders), business (at various levels of an organisation one must demonstrate leadership skills in some capacity) and the world of employment in general. Healthcare is also a domain which has been frequently associated with leadership, which is no surprise given the multitude of roles and professions which are contained within a hospital or healthcare setting and the hierarchy which is in place within such institutions- normally with senior professionals near the apex of the pyramid and juniors and their sub-ordinates emanating somewhere below this. However, with reference to the point made at the start of this introduction, leadership will inevitably have to be demonstrated by each professional at some point in their careers and it is worth considering the various degrees to which this can be demonstrated (which will be expounded upon at a latter juncture of this assignment). Even the most inexperienced of nurses will have to demonstrate some leadership qualities, even if it is merely directing their patients and distributing advice and sage guidance to them. Therefore, it is undoubtedly important to scrutinise this at all levels of the organisation, something which this assignment will proceed to do. For more precision, the qualities of a good leader (generic and with specific reference to healthcare) will be identified, as these will contribute to an understanding of how to facilitate exemplary leadership development. This will also be intertwined with an examination of how leadership development can facilitate an organisational culture which is conducive to embodying and espousing the values of patient-centred care. This is widely feted in literature to be the most reputable standard of care on offer in healthcare and is a standard of care which puts patients at the centre of a model, by considering their needs and preferences on an individual basis). The assignment will be critical throughout, ultimately coming to a conclusion over the validity of the statement encapsulated in the title.

Organisational Culture within Healthcare

As per the conventions of compiling academic assignments, the key terminology will be defined. Needles (2004) defines organisational culture as the values, practices and beliefs which are inherent in an organisation (i.e. what is considered to be the ‘norm’). With reference to a healthcare setting, this could be what type of care is delivered most prominently in the institution (the consensus of healthcare literature would presume it to be patient-centred care) or the values and beliefs which the staff in the hospital adhere to or abide by. With reference to the author of this piece’s personal area of practice (adult nursing) these would be the Nursing and Midwifery Council’s (NMC, 2015) code of conduct, which stipulate the standards that all nurses and midwifes must comply with. If these guidelines are invalidated, staff may face sanctions or punishments, which could culminate in potential dismissal if there is a serious breach of regulations (NMC, 2015). However, this point almost seems to infer that the practice of Healthcare institutions is uniform as there is a standardised, mandatory set of regulations which they must comply with. This may be a flawed perception, as literature which delves into the minutiae of organisational culture seems to contradict this point. It is important to point out that homogeneity does not exist in healthcare institutions, particularly in the context of this assignment, as what affects the organisational culture of each institution may vary depending on an assortment of factors. Schein (1992), being the most eminent of a number of theorists/scholars who are of a similar disposition, feels that organisational culture is a diverse and multi-faceted variable, something which is dependent on the nature of the organisation. Kotter and Heskett (1992) make the useful point that there is not one singular organisational culture which exists in an organisation: often being a wide variety of sub-cultures and undercurrents which also influence the behaviour of those in the organisation. When scrutinising the organisational culture in an organisation it may be advisable to employ the micro-meso-macro frame (level of) analysis, something which is commonly used in studying behaviour of organisations in the social sciences, although it has been used to examine the effect of policies in healthcare (Caldwell, 2012). This provides the rationale for including it in this assignment. By using the micro-meso-macro frame analysis in the context of analysing the levels of practice in one hospital (in reference to adult nursing) assembles a picture such as the one below:

Micro: Practice of Nurses on the ward

Meso: Beliefs/practices of more senior members of staff

Macro: Decisions made by those in the upper echelons of the hospital (i.e. board members)

Arguably, the cohesiveness of how these cultures are pieced together will affect the overall practice and effectiveness of an organisation and constitute the overall organisational culture which is espoused within it. Adding to this discussion, Schein (1992) makes the point that organisational culture tends to be durable and ever-lasting: an entity which is ingrained into an institution and is hard to amend or rectify if the culture becomes anathema or a blockade to the delivery of patient-centred care. Although Schein’s (1992) postulations on organisational culture tended to be made with reference to the business sector of industry, they are commonly transferable to all disciplines, including healthcare (which could be regarded to be a business itself). However, it also wise to note that there are an innumerable range of factors which can contribute to organisational culture- not just the various levels of practice which are on offer within the hospital, but also the policies it is governed by, which may differ by the geographical area it is located in (Caldwell, 2012 eruditely made this point in her paper which she submitted).

Ultimately, the arguments contained above certainly reference the importance of leadership, as it is arguably a leader’s responsibility to ensure a culture where the practice of a healthcare setting is cohesive and consistent (Marriner-Tomey, 2009). Now that the precise tenets of what constitutes organisational culture has been affirmed, this assignment will now progress to identifying the qualities of a good leader (in a generic manner but mainly with reference to healthcare) and how they can be developed to promulgate an organisational culture which facilitates patient-centred care.

Qualities of a Leader/Manager within healthcare

As alluded to in the introductory section of this assignment, leadership has been incessantly examined in the literature from multiple perspectives. In terms of leadership development, it has long been debated whether leadership is an innate quality or something which can be developed and cultivated through time and experience (Chase, 2010). Such a debate could briefly verge into field of education, with similar relevance to the discussion over whether intelligence is influenced by biological or environmental influences (known informally as the ‘Nurture vs. Nature’ debate). It is important to establish whether leadership is indeed learned or something which is predominantly influenced by genetic influences, to establish the efficacy of leadership development programmes (although it is unwise to cast aspersions on the delivery of such programmes prior to their delivery). The consensus among literature seems to be that being a leader can be taught to a certain extent (Northouse, 2009), although there may be some people who are more pre-disposed to be leaders than others (Chase, 2010).

Gopee and Galloway (2014), who are widely respected authors in the field of nursing, project that the qualities that distinguish a leader in a healthcare industry are different from those in other industries, but there is a commonality between the characteristics they exhibit and those leaders in other disciplines exhibit. Expounding on their arguments, Gopee and Galloway (2014) postulate that leaders in any industry are defined by the power that they hold over a set of individuals or people, and it is their responsibility to use this in a sensible manner and not abuse or misappropriate it in any manner. Specifically to healthcare, they cite the work of Cook (2001) who proffers the point that characteristics of clinical nursing leaders can tend to have an interpersonal element to them. Reinforcing this viewpoint, Goleman (1996) thought that emotional factors were more important than pure academic intelligence in determining success in life, a sentiment which he also extended to leaders.

Cook (2001) defined the afore-mentioned traits as ‘facilitative factors’: including a willingness to learn from others, operate within legal and ethical boundaries (Diamond, 2011) and collaborate with patients and other professionals/multi-disciplinary agencies, demonstrate sound interpersonal skills (something which is commensurate with the NMC code of conduct) and also have the creativity to plan ahead and account for any changes which may occur in their environment (a useful characteristic given the frenetic and volatile environment which nurses sometimes have to operate within). Bach and Grant (2011) converse particularly about the importance of interpersonal skills for nurses, given the variety of patients that they will interact with; they also make link between possessing such interpersonal skills and displaying exemplary leadership: no matter what level it may be at, from a nurse instructing a patient to a nurse practitioner leader commanding a team of sub-ordinate nurses and relaying instructions and directions to them.

Leadership development and how to achieve a culture of patient-centred care

Evidently, interpersonal skills are an asset to a leader, no matter what field of leadership they operate in. Another generic characteristic of a good leader (although one which is particularly applicable to healthcare) is the ability to inspire change, even in difficult and challenging circumstances (Gopee and Galloway, 2014). This is what is known in the academic vernacular as transformational leadership (Bass and Riggio, 2005). Bass and Riggio (2005) progress to state that a transformational leader is capable of inspiring change through the construction of a shared vision (hence transformational leaders often been known as ‘visionaries’ or ‘pioneers’) with their sub-ordinates. Gopee and Galloway (2014) also embrace the assets of a transformational leadership style, verbalising its assets of changing rigid practices in nursing and creating a harmonious working environment. In the context of this assignment, it could be particularly useful to change an organisational culture in a nursing/healthcare setting which is not attuned to provide patient-centred care. The possible inference could be made here that any leadership development programmes in nursing should have a transformational component, or at least inspire the recipients to embody or adopt characteristics of a transformational leader.

With regards of how to achieve the desired change in nursing/healthcare settings (whether it is to create more transformational leaders or else achieve a transition to a patient-centred modality of care), Gopee and Galloway (2009) have devised the RAPSIES framework for managing change effectively (with the application of it towards achieving a patient centred model of care denoted in parentheses after each letter of the model):

Recognition (recognising that there needs to be a change towards patient-centred care)

Analysis (consider how to make the transition towards patient-centred care and how this may differ from current practice)

Preparation (devising strategies towards achieving it)

Strategies (such as training and education)

Implementation (training employees and telling them of the movement towards patient-centred care)

Evaluation (assessing the effectiveness of the change)

Sustaining (continual assessment of effectiveness of the change and maintaining it on a longitudinal basis)

It seems apt to outline the difference between a leader and a manager in sustaining this change. Gopee and Galloway (2014) argue that an effective clinical nurse leader should be both: exhibiting qualities of transformational leadership (in being able to envisage and project the desired change), but also in being able to manage it (which normally requires sound interpersonal skills). Relating this to theory, this arguably seems to indicate that a leader should not only be transformational, they should also display situational leadership. This is the ability to tailor leadership as is required to suit the situation and depends on the competency of employees as to the amount of autonomy/free reign that they are allowed (Bass and Bass, 2009). In a healthcare context, it also relates to the managerial responsibilities which a nurse practitioner must assume such as the correct allocation of resources and personnel as well as being able to understand the feelings and emotions of the Nurses that they deploy (Bach and Ellis, 2011). Synthesising business and healthcare perspectives, the conjecture could be made that the situational leadership which managers/leaders espouse in the healthcare profession is akin to the clinical reasoning which nurses use to assess their patients and provide them with the right treatment (Higgs, 2008), which is arguably synonymous with patient-centred care.

Conclusion

Ultimately, for a culture of patient-centred care (where patients’ needs are respected and fulfilled) to be possible, leadership needs to be developed at all levels of a healthcare organisation: from nurse leaders/managers co-ordinating the nurses under their tutelage and resources at their disposal to nurses displaying clinical reasoning in directing the treatment of their patients.

References

Bach, S. and Grant, A. (2011) Interpersonal skills for Nursing. Exeter: Learning Matters.

Bach, S. and Ellis, P. (2011) Leadership, Management and Team Working in Nursing. Exeter: Learning Matters.

Bass, B. and Riggio, E. R. (2006) Transformational Leadership. New York: Psychology Press.

Bass, M. B. and Bass, R. (2009) The Bass handbook of leadership: Theory, Research and Managerial applications. New York: Simon and Schuster.

Caldwell, S. E. M. (2012) ‘Studying policy implementation using a macro, meso and micro frame analysis’, Health Research Policy and Systems, 10: 32.

Chase, A. M. (2010) ‘Should Coaches Believe in Innate Ability? The Importance of Leadership Mindset?’, Quest, 2010, 62: 296-307.

Dimond, B. (2011) Legal aspects of nursing. London: Pearson Education.

Dweck, C. (2009) Mindset: The Psychology of Success. New York: Robinson Books.

Gopee, N. and Galloway, J. (2009) Leadership and management in Healthcare. London: Sage.

Gopee, N. and Galloway, J. (2014) Leadership and management in Healthcare. 2^nd edn. London: Sage.

Goleman, D. (1996) Emotional Intelligence: Why it can matter more than IQ. New York: Bloomsbury Publishing.

Kotter, J. P. and Heskett, J. L. (1992) Corporate Culture and Performance. New York: The Free Press.

Higgs, J. (2008) Clinical reasoning in the Health professions. Boston: Elsevier Health Services.

Marriner-Tomey, A. (2009) Guide to Nursing management and Leadership. New York: Mosby.

NICE (2011) Patient-Centred Care. London: NICE.

Northouse, P. (2009) Leadership: Theory and Practice. London: Sage.

Nursing and Midwifery Council (2015) The Code for Nurses and midwives. [Online]. Available at: http://www.nmc.org.uk/standards/code/ (Accessed: 12 May 2015).

Needle, D. (2004) Business in Context: An Introduction to Business and Its Environment. New York: Cengage Learning.

Schein, E. (1992) Organizational Culture and Leadership: A Dynamic View. San Francisco, CA: Jossey-Bass.