LIH Oral Presentation

The speaker discusses the differences between management and leadership in healthcare and how they are often used interchangeably. Effective leadership and management are essential for healthcare organizations to improve patient outcomes and address challenges. The concept of global health has become important in coordinating efforts to address global health challenges. Organizational culture plays a significant role in healthcare, impacting staff satisfaction and patient care. Inadequate organizational culture can lead to failures in healthcare delivery. The speaker mentions the Francis Report and the importance of leadership in creating a positive organizational culture. There have been other inquiries into healthcare failings, highlighting the need for safe and effective staffing and the importance of nursing voices being heard. My name's Laura Goodwin, and my banner number is B00418721. Introduction. During this presentation, I will discuss the differences between management and leadership from an international, national, and local perspective. I will then look at how an organizational culture can impact on the quality of care patients receive who have a variety of health care needs, followed by a discussion on the impact public health inquiries have had on the nursing profession. Finally, I will analyze the support and supervision of others who deliver care to promote a positive organizational culture. Section 1. The debate on whether leadership and management are the same is interesting. The terms leadership and management are so frequently interchangeable when discussing the health service that any distinction between the two roles is often lost. There are many different definitions of both leadership and management. Michael West, the head of leadership at King's Fund, believes that management is supporting, resourcing, and facilitating day-to-day work, whereas leadership creates direction, alignment, and commitment. He believes the two are intertwined, and to separate them out would be deceiving. In contrast, Lisa Gordon, a researcher from Dundee University, believes that management is about processes. It's about the day-to-day running of processes, whereas leadership is more about change. It's about continuously reviewing and exploring possibilities for improvement and change. Lim, 2016. Moreover, Wajdi, 2017, believes that while the two are distinct functions, leadership and management must go hand-in-hand. While they're not the same, they are necessarily linked and complement one another. Any effort to separate the two is likely to cause more problems than it solves. Strong leadership and management is essential for productivity, capacity, and meeting new challenges. Within a healthcare organisation, staff's job satisfaction, retention, turnover, and quality of care are all correlated with effective nursing leadership. In addition, it is necessary that effective healthcare leaders can rethink, innovate, and create new models that provide accessible, efficient, and high-quality care. Lee, Doherty, and Hamelin, 2019. Al-Sadrani et al., 2013, states that nursing leadership plays a crucial role in facilitating and enhancing nurse performance, which is necessary for delivering high-quality care and guaranteeing patient safety. Leaders and managers in healthcare are currently facing many challenges. Part of this is due to complex health systems and continuous change across a variety of contexts at health service level. A recent review by Fugora et al., 2019, found that leaders and managers in healthcare don't have the capacity required to respond to current issues as they're not well understood. The main issues emerging for leaders in the global healthcare workforce are efficiency saving, change, and human resource management. Effective leadership and management in healthcare are essential for driving innovation, improving patient outcomes, enhancing healthcare delivery, and addressing the complex challenges facing healthcare systems at global, national, and local level. The idea of global health was almost non-existent even 20 years ago. However, it now embraces a sophisticated concept that many countries engage with. Koch, 2017. As Savage and White, 2020, explain, global health is now becoming a major policy subject for an increasing number of nations and organizations. Global health is essential for coordinating efforts among nations to address global health challenges, such as pandemics, infectious diseases, and health crises. Global leaders guide international collaboration, set priorities, allocate resources, and establish policies to improve health outcomes. Since the COVID-19 pandemic, it's been established that responding to future global infectious disease threats and other health emergencies will require the creation of stronger mechanisms for multilateral collaboration before they arise again. Gyp, et al., 2021. According to the World Health Organization Leadership and Governance, 2023A, in the event of a disaster, national and international health partners will collaborate to collectively address the health requirements of the impacted population as WHO Europe works closely with local health authorities to manage the humanitarian health response and the health cluster. Leadership is also required at national level to navigate challenges, such as healthcare reforms, population health management, and healthcare financing. World Health Organization Leadership and Governance, 2023B, explains that at national level, countries should provide a health sector-specified program as well as effective coordination structures, partnerships, and advocacy. Relevant up-to-date information for decision-making, public information strategies, and monitoring and evaluation are also needed. At a local level, leadership is also important. Healthcare organizations rely on skilled leaders and managers to optimize resource allocation, streamline operations, and deliver a high quality of care to patients. Rustavio et al., 2022. Section 2. There are several theories of organizational culture which make the concept a complex phenomenon to explore. For example, Sheen's 2010 model suggests organizational culture has three levels, artifacts and symbols, espoused values, and basic underlying assumptions. The theory highlights the importance of digging beneath the surface to understand the deeper layers of culture. In contrast, Handy, 2007, believes that organizations are a part of everyday life, whether in schools, hospitals, playstations, or commercial companies. He states that the key to successful organizations lie in a better understanding of the needs and motivations of the people within them. More recently, Simpson et al., 2019, explains that organizational culture represents the values, views, and practices held by employees within an organization. It has an impact on the history, clinical governance, goals and objectives of management, as well as the political, economic, technological, and legal aspects of healthcare. A strong organizational culture can contribute to staff satisfaction and overall organizational effectiveness. Moreover, staff values can also have a significant impact on the quality and safety of the healthcare that is delivered to patients, Francis, 2013. Within the NHS, organizational culture is not a new concept. Due to the changing dynamics within the NHS, there has been a shift away from what the organization stands for, which is frequently tied to its history and rituals, to who the NHS serves, including how medical professionals, like nurses, can shape and lead the organizational culture. Nightingale, 2018. There is a consensus that positive organizational culture is related to positive patient outcomes. Braithwaite et al., 2017. However, for the culture to be effective, a whole system approach is necessary where people are motivated to collaborate and work together to create, carry out, and achieve the goals of the organization. This in turn develops the foundations for a positive organizational culture that transcends through all levels of the organization, from chief executive to frontline healthcare staff. Nonetheless, evidence of inadequate care within the National Health Service has demonstrated how an ineffective organizational culture can have a major impact on patient care. Nightingale, 2018. Healthcare organizational culture has been a major contributing factor in serious failings in the healthcare delivery. Culture, as a term, has become synonymous with patient experience, satisfaction, mortality, and morbidity. Simpson et al., 2019b. In 2013, the Francis Report found that Ms. Staffordshire NHS Foundation Trust experienced catastrophic care failures. Francis conducted an independent public inquiry into these failures, which revealed that healthcare organizational culture was a significant contributing cause to the Trust's persistent inability to satisfy patient requirements. Francis, 2013. The learnings from this report found that in order for the organization to learn, it must make sure that leaders uphold the shared values of a culture of zero tolerance for subpar care. It must also endeavor to empower employees to report instances of poor performance and acknowledge their contributions to providing good care by fostering a culture of collective leadership and integrating the six Cs. Mulls et al., 2015. Moreover, the King Fund, 2021, believes leadership and organizational culture are inextricably linked, suggesting that leadership is a primary factor in developing a positive organizational culture. Since the Francis Report in 2013, there have been reports and subsequent inquiries into other failings. For example, in 2019, organizational culture was again in the spotlight in the serious case review into the failings at Gosport War Memorial Hospital, UK. The study discovered an institutionalized culture of practice that approves of prescribing and using opioids without a valid medical reason in order to shorten life. Gosport War Memorial Hospital, the report of the Gosport Independent Panel, 2018. The aftermath of these inquiries and the consequences for nursing is a story of evidence, campaigning, journalism, and missed opportunities. There is a growing body of evidence around safe and effective staffing and how it was blatantly ignored by policy makers, employers, and workforce planners. Some would say the professional voice of nursing is still too weak and has only recently been heard in the wake of industrial action. Rafferty and Leary, 2013. 11 years on from the Francis Report, Robert Francis has recently stated that nursing is still not given the respect it deserves. One of the problems in the Mid Staffordshire Report was that nurses' voices were not heard and he believes going forward, it is absolutely vital that there is a professional voice of nursing which is listened to in relation to standards, which is distinct from the trade union. He believes the chief nursing officer does not have the status she deserves and furthermore acknowledges there's a general pressure on national leaders to toe a line rather than expressing an independent voice. Linterin, 2023. Nurses within the NHS still have ongoing difficulties with problems of culture and behavior, including the malign influence of individuals whose unacceptable behavior and conduct create toxic working environments. Martin, Stamford and Dixon-Woods, 2023. A healthy organizational culture is believed to be related to positive patient outcomes such as reduced mortality and length of stay in hospital, increased quality of life and decreased pain level. Hezelbank et al., 2013. Simlish-Lack et al., 2021, found that hospitals with higher nurse burnout had worse patient outcomes in terms of patient mortality, failure to rescue and days of stay. Positive work environments were also found to reduce the negative relationship between nurse burnout and patient outcomes. To promote positive patient outcomes within an organization, it's important that patient safety and quality of patient care is focused on. Work conditions and policies within the organization must continually be improved to eradicate institutional and managerial factors that contribute to, for example, medical errors. Safety improvement efforts, such as medication, management, quality circles and cross-disciplinary teamwork should be invested in medical institutions worldwide. Linnather et al., 2020. Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. A framework that is used worldwide in healthcare settings is the Safety Attitude Questionnaire. This framework is used to measure safety attitudes among healthcare providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement intervention leading to reductions in errors. Bondivic et al., 2019. Section three. Change is inevitable in healthcare. However, a significant problem specific to healthcare is that almost two thirds of all change projects fail for many reasons, such as poor planning, unmotivated staff, deficient communication or excessively frequent change. Nelson, Brantley and Ford, 2017. Change management theories are often used to help implement change within complex healthcare systems. These theories are valued for providing guiding principles for change that are well suited to enable the theories to be applied in complicated healthcare environments as well as being used in implementation and improvement procedures. Two commonly applied theories within healthcare are the Kotter's model and Lewin's model. Harrison et al., 2021. The Kotter model is an easy step-by-step model that focus on preparing and accepting change. John Kotter considered what steps are required to transform organizations and summarized it in an eight-step change model. These steps include developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up and making it stick, Aziz, 2017. In contrast, Lewin's change management theory suggests that successful change involves three stages. These stages include unfreezing the current state, implementing change and then rephrasing the new state to make it stick, Barrow, Tony, Butler and Maragiu, 2022. Moreover, Harrison et al., 2021b highlighted the potential opportunities to integrate these models for change management with other models commonly applied for improvement implementation to support positive changes in organizational culture. Leadership has been found to be one of the key factors affecting change and change management. There are four main themes of leadership change. These include the role of the leaders and followers, authority and influence, power and empowerment and building relationships. Successful change management was said to depend on a leader's ability to influence the team, empower the team and foster ties with other hospital services as well as with the team itself. Leadership interactions that foster positive emotions motivate staff to implement change. Participants identified that clear communications and providing education associated with the change process was important leadership activities. Ratna Planning, 2019. Similarly, a study by Nelson et al., 2020, discussed the importance of leaders in management communicating the motives for change to staff. They consistently find that organizational change has a greater chance of succeeding as employees consider them to be well thought out and respect the managers responsible for the changes whereas resistance to change is more likely if employees consider the changes to have little or no value for themselves. It is simply not possible for change to happen without skilled leadership. Leaders need to individually plan for change, clearly articulate their vision for change and remove obstacles to build a culture that not only welcomes change but also encourages it. This is known as the change infrastructure. Weber and Joshi, 2000. In order to promote a positive organizational culture, there are several ways leaders can do this. Transformational leadership can motivate staff by encouraging a shared vision, providing support and promoting a positive work environment which in turn leads to greater employee satisfaction. Kim and Cruz, 2022. Employee engagement is also important. By involving staff in decision-making processes, providing opportunities for professional development and recognizing their contributions, this can lead to higher job satisfaction. Brenna and Darko, 2017. Open and transparent communication is also essential for building trust and producing a positive environment. Communication is especially important in healthcare settings as it leads to improved patient safety and all-over organization effectiveness. Encouraging collaboration and teamwork among care team members can promote a positive, promote a sense of belonging and shared purpose. Interprofessional collaboration in healthcare can lead to enhanced patient care and outcomes. Bosch and Mansfield, 2015. Continuous quality improvement encourages a commitment to excellence and innovation and improves overall organizational performance. Lastly, recognizing and rewarding employees for their contributions will reinforce positive behaviors and cultivate a culture of appreciation. Employee recognition is important in healthcare as it promotes job satisfaction and reduces staff turnover. Lativa, Alhene, et al., 2013. While the principles of leadership and management, sorry, conclusion. While the principles of leadership and management remain consistent at global, national and local level, the priorities change depending on the unique challenges and opportunities that arise at each level. A well-managed organizational culture requires strong leadership. This helps to create an environment where high-quality patient care is delivered, fostering a culture of excellence and prioritizing patients' wellbeing throughout their journey. However, as proven in recent inquiries, such as the Francis report in 2017, organizational culture can also lead to toxic environments due to poor leadership, fear, target-driven priorities and a disregard for patient safety. Leaders and managers are needed to promote positive organizational culture and to supervise and enable change when required.