NURS09232B00415717

In this oral presentation, the speaker discusses the differences between management and leadership in healthcare. They explore various theories and challenges related to leadership and change management. The importance of leadership in promoting service improvement, effective change management, and creating a positive work culture is emphasized. The speaker also highlights the impact of organizational culture on patient care and staff performance. They mention the need to measure and uncover organizational culture in healthcare and the role of public inquiries in addressing concerns and promoting change. Different leadership styles, such as authentic and transformational leadership, are discussed, emphasizing their positive impact on nursing outcomes and staff well-being. Overall, effective leadership is crucial in healthcare to ensure high standards of education, research, and clinical practice. My name is Rebecca Armstrong, Banner Number B00415717. In this oral presentation, I am going to critically discuss the differences between management and leadership, explore some of the leadership and change management theories and the challenges these can bring when implemented. I will be discussing how the need for change comes about in healthcare and the role of public inquiries when they are failing through organisational culture. The Nursing and Midwifery Council, the NMC, 2018, set out the standards of proficiency for nursing and midwifery professionals. This identifies key roles in management and leadership in platforms 1, being an accountable professional, 5, leading and managing nursing care and working in teams, and 7, coordinating care. Alimo Metcalfe, 1999, states that management places more emphasis on organising, planning, fixing problems that may emerge and monitoring progression of desire and predicted outcomes. They describe leadership as the ability to create new scenarios and visions, initiating new approaches and having the creative and emotional drive to go beyond the ordinary to deliver the exceptional. Wood, 2021, adds that leaders cope with new challenges and can transform organisations. All nurses are expected to play a role in leadership. Will managers maintain functional operations using resources effectively? Azad et al., 2017, states that leadership is who you are, management is how you make use of resources and there is an overlap of optimism, decisiveness, integrity and open communication. Degail et al., 2020, adds that management and leadership are equally important in accomplishing organisational goals and acknowledges the differences between management, which produces consistency and order, while leadership produces movement and change. Specia et al., 2021, acknowledges the impact that leadership styles and different approaches in management have on staff, performances and healthcare system performance matrix. They define leadership as the art of influencing others to achieve their maximum potential to accomplish any task, objective or project. Knight and Gale, 2020, states that effective leadership is essential in healthcare and states that there is a link between ineffective leadership and compromised patient safety. Hughes, 2018, found some of the main barriers to leadership development in nursing to be time restraints, limited organisational leadership opportunities and a lack of leadership training and development funding. Yoder, Wise and Sportsman, 2023, defines leadership as the use of individual traits and abilities in relationships with others, influencing, inspiring and enabling through advice and counselling. Leadership is important in healthcare as it is at the centre of workplace culture. De Gell, 2020, puts that poor management means goals cannot be achieved and if the leadership is poor then there is no clear goals or visions to work towards. Good leadership is needed to manage change and maintain stability. Klein, 2019, adds that leadership in the NHS influences quality of care and the performance of hospitals. They add that the treatment of staff significantly influences the organisational performance and staff should feel cared for, valued, supported, respected and feel that they are encouraged to contribute to the effectiveness of their workforce. West et al, 2015, states the importance of leadership at a national level to embody development to ensure that overarching national organisations exemplify models of collective leadership, encourage positive cultures and have compassion towards the entire health service. The direction from leaders ensures pride within the organisation and what it is aiming to achieve, setting out consistency with the vision, values and strategies. Klein, 2019, states that cultures within national and local bodies, such as networks, commissioners, regulators and providers that make up the NHS, deeply influence priorities and behaviours at a local level in leadership. As mentioned earlier, Massa Natal 2021 recognises the impacts of workplace culture and the environments created on patient care. A positive environment can reduce the rate of hospital-acquired infections, hospital mortality rates, adverse events and readmissions. They also acknowledge the connection between good working culture and the retention and recruitment of health professionals. That is crucial to battle the staff and shortages seen at present. Marzara, 2016, adds to that with significant research into the impact that the workplace culture has on employee engagement, satisfaction and staff turnover. Mulls et al, 2015, backs Massa Natal with their findings from the research, with evidence to suggest that organisational culture plays a part in healthcare performance. A definition of culture shared by Marzara, 2016, said by Robbie Katango, is that culture is how we do things. Odeakos, 2018, defines organisational culture as an informal, shared way of looking at an organisation and membership in the organisation that binds members together and influences what they think about themselves and their workplace. Building on that, Aberdebade, 2021, defines organisational culture as the pattern of shared values and beliefs that help individuals to understand organisational functioning and thus provide them with the norms for behaviour in the organisation. A toxic culture in healthcare is cause for many concerns. Malloch et al, 2020, links poor organisational culture as a major contributing factor to serious failings in healthcare delivery. Through unprofessional behaviour and unsafe attitudes, they acknowledge the challenges in uncovering the factors that can have an impact on poor organisational culture to implement change. Odeakos, 2018, defines a strong organisational culture as one where every member agrees and follows the agreed pattern of behaviour. That has proven beneficial to the whole organisation and a weak organisational culture as one that refers to beliefs and values that are not strongly or widely shared within the organisation. Van Buitjoten and Foster, 2018, put that a strong organisational culture has beliefs and values held by a large number of staff that can lead to improvement in behavioural uniformity and performance. On the other side, it can have a negative influence on staff performance when bad practice becomes the norm. That can cause cultural entrapment A strong culture exists when every member of the organisation agrees to follow the agreed pattern of behaviour that has proven to be beneficial, both in content and context, to the whole organisation. According to Ashupoli, 2014, a weak organisational culture refers to beliefs and values that are not strongly or widely shared within the organisation. How can we uncover or measure organisational cultures in healthcare? Taken from Simpson, et al., 2019, there are no universally accepted ways to do that. In the research paper, they use the Francis inquiry that looks into the failings of one NHS trust hospital as an example. The inquiry found organisational culture as a major contributing factor in repeated failings in meeting patients' needs and impacting on staff wellbeing. Taken from the book, the inquiry, in 2010, Francis made 290 recommendations from the failings, one of which was the need to develop a culture of care barometer to accurately measure organisational culture in practice. We cannot accurately measure organisational culture, but we can ensure that we learn from failings and take appropriate actions to ensure mistakes do not reoccur. Patient and family feedback is commonly used in order to identify and assess areas of concern and lead to change. Public inquiries can be used when there is a level of concern. Norris and Shepard, 2017, highlight in their report on how public inquiries can lead to change the three main questions that inquiries set out to answer. Those are what happened, who is responsible and what we can learn from that. The need to uncover the truth in situations that may occur is important to help restore public confidence and provide the victims and their families with a sense of being heard. The findings can improve institutions, regulations, behaviour, attitudes and provide valuable legislative changes. Leadership in healthcare is important in today's healthcare setting. It is needed to promote service improvement, provide effective change management and create a positive work culture. There are several leadership series adopted by healthcare leaders. Kumar, 2013, defines leadership as a function of knowing yourself, having a vision that is well communicated, building trust among colleagues and taking effective action to realise your own leadership potential. De Gaulle, 2020, adds that leaders have the ability to shape and influence their followers, their followers' values, attitudes and behaviours and are able to gain support to reach a shared goal. Effective leadership is complex and highly valued in healthcare education. It is essential to the delivery of high standards of education, research and clinical practice. Authentic leadership has been shown to build trust and create a healthier work environment. Alay Yianni, 2020, put that it is one of the leadership series shown to have a positive impact on nursing outcomes. It encourages the development of trust, positive interpersonal relationships and has shown to create healthier and more engaging working environments. Lasingar Etal, 2013, defined authentic leadership series as a leader's ability to create an open environment so people feel able to challenge and share their own opinions, can encourage positive changes and ultimately promote nurses' wellbeing. Anselman and Mulder, 2020, write about transformational leadership and how it can be measured using the GTL, global transformational leadership scale, through an answering format with five point scale, rating from one being never to five being very often on questions around communication of a clear and positive vision, support for staff development, encouragement for staff, fostering of truth, involvement and co-operation, encouragement of thinking about problems and behaviours that are respectful and inspiring and congruent to values. Kuliski, 2020, describes the adaptive leadership as the separation of technical solutions from adaptive solutions, addressing adaptive challenges by identifying assumptions that may limit people's motivations to change and identifying and change behaviours influenced by assumptions. This model of leadership can be applied well to the front-line care in advanced person centre care delivery and for this reason it has shown to work well. Diego, 2020, shared that the focus has been shifting towards the term team leadership with the role being everyone's responsibility and shared leadership to lead forward change and organisational shift from one leader to the team. The team leadership should share goals, whilst have personal autonomy, accountability, appropriate recognition and clarity of roles to contribute to great team performance. Organisational culture should be supportive of collaborative work and be able to take a step forward as well as a step back when needed. Diego also added that successful teams thrive on diversity drawn from the strengths of each member of the team. I quote from Wayne Trubb and McKee, 2019, that the process of influencing others to understand and agree about what needs to be done and how to do it and the process of facilitating individual and collective efforts to accomplish shared objectives. Lewin's three-step model of change management theory for organisational change, where most of the change management theories originate from. Burns, 2019, states that Lewin first developed this model as a tool for resolving social conflict such as racism and writes about the three stages. These three stages are unfreezing the present level, moving to the new level and then refreezing group life at the new level securely against change. Chelston and City, 2020, explain how the three-step model of change may be implemented in practice. The first step is to provide the stimulus for the people involved to recognise the need for change and become willing to change. Management should ensure employees have the information and motivation necessary to feel involved and be a part of the drive to change and reach shared goals. The second step is where the change takes place. By taking on new values, attitudes and procedures through open communication and contribution from all involved instead of a one-way flow of orders or advice, it needs to be a two-way process of communication. Step C is where the change is established through the knowledge, skills and behaviours. Management should highlight the goals that were achieved and publicly reward all involved in making the changes happen. Any difficulties that were faced should be addressed in a positive manner. Pollack and Pollack, 2015, write about the steps in the Quarters 8 stage process of managing organisational change. 1. Establishing a sense of urgency. 2. Creating the guiding coalition. 3. Develop a vision and strategy. 4. Communicating the change vision. 5. Empowering broad-based change. 6. Generating short-term wins. 7. Consolidating gains and producing more change. 8. Anchoring new approaches in the culture. Love and Sang, 2017, state that collective leadership can be a powerful way to overcome the barriers and create an effective environment of adaptation of changes by analysing and analysing the Quarters 8 stage process. They also acknowledge some of the barriers that come across when implementing organisational change. Those are fear of change, resistance to change and often are met with anger, anxiety and bargaining. The third most common barrier is found to be a lack of finances and the ability to meet the needs of the community. The fourth most common barrier is found to be a lack of resources and limited resources. Change often requires more time, coaching, facilities and extra costs. The fourth more commonly found barrier in some senior leaders may be that they are not ready for change. 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