Presentation on theme: "Introduction to Leadership NURS205"— Presentation transcript:
1Introduction to Leadership NURS205 Sheryl Abelew MSN RN
2Welcome Introductions Syllabus Review PowerPoint Ann Marie Rivera Resume Presentation
3Health Care Business Health care is a competitive market Health care is not accessible to everyoneCosts are skyrocketingU. S. spends more money on health care than any other countryUsed 16 percent of the GDP
4Health Care Networks Emerged in the effort to cut costs Focus on primary careDeliver a continuum of careCalled Integrated Health Care Networks. They deliver continuum of care, provide geographical coverage, and accept risks of a fixed payment for providing health care to all persons.
5Demand to Reduce Errors Leapfrog GroupConsortium of public and private purchasersProvide benefits to 37 million AmericansReward positive outcomes based on quality indicatorsQuality managementContinuous attempt to improve outcomes and costsIs a preventive approachInvolves continuous evaluation and improvementIs implemented through patient satisfaction surveysBenchmarkingComparison of organizations based on a specific set of performance indicatorsUses results to address weaknesses and enhance strengths98,000 deaths occur from medical errors each year from preventable mistakes. Mistakes also result in longer hospital stays which make increased costs. 2 million people suffer from hospital acquired diseases.
6Cultural and Generational Differences Cultural diversity is increasing in the U. S. populationMany barriersCostAccessBeliefsThe challenge is to provide access to health care regardless of race, ethnic origin, or socioeconomic statusHealth care policy makers and organizations face challenges of serving a more diverse populationNurses need a transcultural focusCultural diversity:Is reflected among nursesRequires sensitivity and responsiveness to cultural differences among staff
7Cultural and Generational Differences (continued) Multiple generations working together is commonNurse managers encourage mutual respect and teamworkChallenge is for managers to avoid stereotypes based on their generation.
8Aging Patients, Aging Nurses Aging patients increase the demand for health careAs aging nurses retire the nursing shortage will grow worseDemand for nurses will continue to growAvg age of a registered nurse is Belief is that positions for registered nurses will be the second largest occupation through Largest is retail.
9Evidence-Based Practice (EBP) Decision-making process includes:Identifying the clinical questionFinding evidence to answer the questionEvaluating the evidenceApplying the evidenceEvaluating the outcome
10Evidence-Based Practice (continued) Is criticized by opponents for:Absence of theory to guide decision-makingLack of time, expertise, and resources to implementIs expected to continue to be used in the futureHas been implemented successfully by the U.S. Veteran’s Health Administration (VA) and University of California Los Angeles (UCLA)
11Electronic Health Records Includes health information from all medical sourcesCan be accessed by multiple authorized providers at different locationsAllows for collective data analysis, facilitates a common nursing language, and support evidence-based practice when fully integratedBeen slower than expected due to privacy issues.
12Barriers versus Benefits of Computerization Privacy and confidentiality concernsCosts of implementing and operatingBenefitsReduced redundanciesImproved efficiencyDecreased medical errorsLower health care costs
13Personal Health Records Track medicationsRecord medical interventionsUpdate medical information
14Other Emerging Technologies Point-of-care systemsHand-held devicesRobotsRobots can be transporters, and diagnostic. Dr in office, robot at bedside can have stethoscope, etc.
15Disaster PreparationOfficial agencies and health care organizations are not prepared to respond to mass casualtiesHealth care organizations must prepare for massive emergenciesThink of Katrina. How long it took to get help and services and supplies.
16Disaster Training Must address nurses’ concerns of being abandoned Include computer simulations, video demonstrations, and disaster drillsEnsure that nurses understand the communications system and the incident command centerProvide accessible information, support, and opportunities for debriefing
17Changes Facing NursesMovement from hospital care to less expensive settingsNew technologiesFocus on quality controlAccess to care affecting policy decisions
18Challenges Facing Nurses (continued) Every nurse must be prepared to manageOrganizations must provide management training for all nurses
19Effective Leadership and Management in Nursing Chapter 2Designing Organizations
20Organizational Theories Were unexplored until the Industrial RevolutionInclude the following theories:ClassicalContingencyHumanisticChaosSystemsComplexity
21Classical Theory Is built around four elements: Division and specialization of laborChain of commandOrganizational structureSpan of control*Div and Spec of labor divides the work and reduces tasks each employee has to carry out. **Chain of Command is a hierarchy of authority and responsibility. . One type is line authority which is a linear hierarchy where activity is directed. The other is staff Authority, where its an advisary relationship. ***Organizational structure is an arrangement of work groups. Gives a way to maintain command, reinforce authority, and allow for formal communication. . **** Span of Control looks at the pragmatic concern of how many can be managed
23Humanistic Theory Focuses on social aspects of organizational design Views social relationships, group pressure, and search for personal fulfillment as motivatorsSays formal authority only works with willing participantsLooks how people desire social relationships, respond to peer pressure and search for personal fullfillment. People perform as expected because of special attention. This is known as the Hawthorne effect.
24Systems TheorySystem is interrelated parts arranged in a unified wholeSystems can be open or closedOrganization is a recurrent cycle of input- throughput-outputManager is the catalyst for the processSee productivity as the interplay among structure, people, technology, and environment. Managers are responsible for integrating info and other stimulus from the environment.
26Contingency TheoryPerformance is enhanced by matching the organization’s structure to its environmentEnvironment includes people, objects, and ideas outside the organization that influence itOptimal form of the organization depends on the environment in which it operatesBelief is that org performance can be enhanced by matching the organizations structure to the environment.
27Chaos TheoryOrganizations are living, self-organizing systems that are complex and self-adaptiveCreativity and flexibility are necessary to adapt to changeLeader’s role is to build resilience, maintain balance, and encourage creativityNature does not follow straight lines
28Complexity Theory Random events interfere with expectations No linear cause and effect to explain outcomesThe system interacts and adapts to changeManagers must encourage the flow of information in all directions, not just top to bottom
29Different Types of Health Care Organizations Private or governmentVoluntary (not for profit)Investor owned (for profit)Sectarian or nonsectarian
30Hospitals Most are acute care facilities May be classified as general or special-care facilities (e.g., pediatric)Many are teaching institutions-Role of nurse may differ from teaching to nonteaching hospitalNew groups in hospitals include hospitalists and intensivists
31Long-Term Care Facilities Provide professional nursing care and rehabilitative servicesMay be freestanding or part of hospital.Limit length of stayMay be residential care facilities (nursing homes) where care is supervised by RNs and LPNs
32Ambulatory Care Centers Are increasingly being used to deliver health careInclude physician’s offices, emergency rooms, surgical centers, clinics in pharmacies, and family planning centers
33Home Health AgenciesProvide intermittent, temporary health care in the home by skilled or unskilled providersMay offer services other than nursing such as physical therapy or medical equipmentMay offer hospice care
34Freestanding ClinicsProvide ambulatory care in shopping centers, pharmacies, and discount storesAre staffed by nurse practitioners
35Temporary Service Agencies Provide nurses and other health care workers to hospitalsProvide private duty nurses to patients in the hospital or at home
36Managed Health Care Organizations Deliver services through a formal arrangement with a group of individualsInclude HMOs, PPOs, and POS plansHave declined because of dissatisfaction with limitations and inflexibility
37Interorganizational Relationships Horizontal integration: Organizations in a network provide the same or similar services; e.g., all hospitals provide comparable services
38Interorganizational Relationships (continued) Vertical integration: Dissimilar but related organizations in a network provide a continuum of services
39Interorganizational Relationships (continued) Corporate health care network
40Diversification Organization expands into new arenas Two common types: Concentric diversification and conglomerate diversificationJoint venture: Partnership in which each partner contributes different areas of expertise, resources, or services to create a new product or service
41Traditional Organizational Structures Functional: Employees grouped in departments by specialtyService-line: All functions needed to produce a product or service grouped together in self- contained unitHybrid: Contains both self-contained and functional units
42Traditional Organizational Structures (continued) Matrix: Integrates product and functional structures in one overlapping structureParallel: Unique to health care; involves two lines of authority—the authority of the organization and the authority of its medical staff
47Relationship-Oriented Structure Shared governance supports decision making, quality imperatives, and collaboration among disciplinesHeterarchy structure is based on the concept of connectionsSelf-organizing structures are flexible and able to respond to change
48Strategic Planning Philosophy Values Vision statement Mission Goals ObjectivesPhilosophy is written statement reflecting the organizations values, vision and mission. The values are the beliefs or attitudes. The vision statement is the goal to which the company aspires to be. The mission is the broad general statement of the reason for existence. The goals are statements of the outcomes to be achieved. The objectives are specific goals to a specific unit.
49Organizational Environment System-wide conditions that contribute to a positive or negative work settingA positive environment directly affects better patient outcomesThe nurse manager plays a key role in maintaining a positive environment
50Organizational Culture Encompasses basic assumptions and values held by members of the organizationVaries among institutions, subcultures, and counterculturesConsonance occurs when the subculture’s norms and traditions agree with the organization’sDissonance occurs when they are not in agreement
51Magnet Recognition Program ANCC designates organizations that provide nursing excellenceMagnet hospitals successfully recruit and retain nurses despite the nursing shortage
52Magnet HospitalsPromote quality in a setting that promotes professional practiceIdentify excellence in the delivery of nursing servicesDisseminate best practices in nursing services
53Effective Leadership and Management in Nursing Chapter 3Delivering Nursing Care
54Nursing Care Delivery Systems Provide structure for delivering careAssess care needsFormulate plan of careImplement planEvaluate patient’s responses
55Challenges of Delivery Systems EffectivenessCost efficiencyQualityNeeds of consumers and practitioners
56Functional Nursing RNs, LPNs, and UAPs are assigned different tasks RNs assess patientsOther staff give baths, make beds, take vital signs, administer treatments
57Team NursingTeam of nursing personnel provides total care to a group of patientsRN leads team that may include other RNs, LPNs, and UAPsTeam leaders must be skilled in delegating, communicating, problem solvingAll members of effective teams are good communicators
58Differentiated Practice Structure of roles and functions differentiated by nurses’ education, experience, and competenceRoles, responsibilities, and tasks defined for professional nurses, licensed practical nurses, and unlicensed assistive personnel
59Patient-Centered Care Nurse coordinates team of multifunctional, unit-based caregiversAll patient care services are unit basedFocus is decentralization, promotion of efficiency and quality, and cost control
60Functional Nursing Advantages: Disadvantages: Staff become efficient at performing assigned tasksDisadvantages:Uneven continuityLack of holistic understanding of patientProblems with follow-up
61Team Nursing Advantages: LPNs and UAPs perform tasks that don’t require RN’s expertiseCare is more easily coordinatedSaves steps and time
62Team Nursing (continued) Disadvantages:Time needed for communicating, supervising, and coordinating team membersAffect of changes in team leaders, members, and assignments on continuity of careTotal patient not considered by any one personRole confusion and resentmentLess control for nurses over assignmentsPossibility of unequal assignments
64Total Patient Care Advantages: Disadvantages: Continuous, holistic, expert nursing careTotal accountabilityContinuity of communicationDisadvantages:RNs perform tasks that could be done more cost- effectively by less skilled persons
65Total Patient CareRN is responsible for all aspects of care for one or more patients
66Primary Nursing Advantages: Knowledge-based practice model Decentralization of decisions, authority, and responsibility24-hour accountabilityImproved continuity and coordination of careIncreased nurse, patient, and physician satisfaction
67Primary Nursing (continued) Disadvantages:Excellent communication requiredAccountability of associate nursesPatient transfers disrupt continuity of careCompensation and legal responsibility for staff nursesUnwillingness of associates to take direction
68Primary NursingRN designs, implements, and is responsible for nursing care for duration of the patient’s stay on the unit
69Practice Partnerships Advantages:Improved continuity of care and accountability for careDisadvantages:Decreased ratio of RNs to nonprofessional staffPotential for junior team members to assume too much responsibility
70Practice Partnerships RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients
71Case ManagementCase manager supervises care provided by licensed and unlicensed nursing personnelCritical pathways provide direction for managing care of specific patients
72Clinical Microsystems Small unit of care that maintains itselfDynamic, interactive, self-aware, and interdependentProven to improve teamwork, communication, and continuity of care
73Other Innovative Systems of Care Segmenting hospital into smaller unitsPrimary Care Team modelCollaborative Patient Care Team modelTransitional Care modelHospital at Home model
74Using the System Effectively Communication skillsAbility to delegateProblem-solving skills
75Effective Leadership and Management in Nursing Chapter 4Leading, Managing, Following
76All Nurses Are Managers Direct work of professionals and nonprofessionals to achieve desired outcomesCan use leadership skills to be effective and successful
77Leaders and ManagersLeader: Anyone who uses interpersonal skills to influence others to accomplish a specific goalManager: An employee who is responsible and accountable for efficiently accomplishing the goals of the organization
78Functions of Leaders Achieve consensus within the group about goals Maintain structure that facilitates accomplishing goalsSupply information that helps provide direction and clarificationMaintain group satisfaction, cohesion, and performance
79Functions of Managers Clarify the organizational structure Choose the means to achieve goalsAssign and coordinate tasksEvaluate outcomes and provide feedback
80Formal and Informal Leadership Formal: Practiced by a nurse with legitimate authority described in a job descriptionInformal: Exercised by a staff member who does not have a specified management role
81Leadership Theories Trait theories Behavioral theories Inborn traits of successful leadersBehavioral theoriesLeaders made through education, training, and life experienceLeadership stylesDimensions of behavioral styleSystem 4 managementManagerial gridContinuum of leadership behaviorTrait theories have 3 categories: intelligence, personality, and abilities.
82Leadership Theories (continued) Contingency theoriesLeaders adapt style to situationFiedler’s contingency theorySituational leadership theoryVroom-Yetton expectancy modelHouse-Mitchell path-goal theoryExpectancy theory of motivation
84Leadership Theories (continued) Contemporary theoriesQuantum leadershipCharismatic leadershipTransactional leadershipTransformational leadershipRelational leadershipShared leadershipServant leadershipQuantum based on concepts of chaos theory. Constantly changing and shifting. Charismatic is based on charm, personality, persuasiveness, etc. Transactional is based on social exchange theories, where individuals engage in social interactions. Transformational emphasizes importance of interpersonal relationships. Relational leadership looks at how we are all connected. Shared leadership is based on empowerment principles of participation and transformation. Servant leadership is that the leader is there to serve, and in that lead.
85Leadership Approaches are Adaptable SituationsTasksIndividualsFuture expectations
86Leadership Styles Autocratic Democratic Laissez-faire Bureaucratic Individuals are motivated by external forces i.e. power, authority, and a need for approvalDemocraticIndividuals are motivated by internal drives and impulses, and want active participation in decisionsLaissez-faireIndividuals motivated by internal drives and need to be left alone to make decisions.BureaucraticAssumes employees are motivated by external forcesAutocratic leader makes all decisions with coercion and punishment. Democratic, uses majority rules. Laissez Faire. Leader provides no direction or facilitation. Bureaucratic leader trusts no one for decisions and relies on organizational policies and rules to ID goals and direct work processes.
87Functions of Nurse Managers PlanningOrganizingProcess of coordinating the work to be doneDirectingProcess of getting the organization’s work doneControllingEstablishing standards of performanceMeasuring performanceEvaluating performanceProviding feedbackContingency planning manager id’s and manages problems that interfere with getting work done. May be reactive or in response to a problem. Have a back up plan. Strategic plan is a continual assessment and planning and eval to guide the future.
88Mintzberg’s Behavioral Description Interpersonal rolesInformational rolesDecisional roles3 roles that reflect the formal authority to a manager. The figurehead, the leader and the liason. 3 informational roles Monitor, dissseminator, and the spokesperson. The decisional roles has 4; enterpreneur, disturbance handler, resource allocators, and negotiator,
89Contemporary Model of Managerial Work Information, people, actionCommunication and control at the information levelLeading and linking at the people levelDoing at the action level
90AONE Areas of Competency for All Nurse Managers Communication and relationship managementKnowledge of the health care environmentLeadershipProfessionalismBusiness skills