Leadership’s Role The Power and Perils of Perception Kathleen Bartholomew, RN, MN

"The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking." Albert Einstein

Complexity Science Focuses on the patterns of relationships among parts of the system, rather than the parts by themselves or the structure Order and direction emerge from the grass roots up, not from a single or centralized intelligence.

Failures of group decision making Failure to anticipate a problem before it arrives When the problem does arrive, the group fails to perceive it After perception, failure to solve Try to solve, and don’t succeed (Diamond, J Collapse)

Conclusion: Applying the failure of group decision making to the nursing profession is illuminating and provides a practical framework for addressing the profession’s numerous challenges. As with all societies, Nursing’s greatest problems are primarily self generated and therefore, within our power to solve – if we anticipate, perceive and act to resolve them in time. 3. After perception, a failure to solve Examples: Nursing educator shortage Educator salaries below market value Nursing shortage articulated to government to no avail due to: Lack of financial strength, current culture, and poor public support Workplace injuries and violence Damage caused by poor MD-RN relationships Union’s effect on self esteem/power Work place re-design 4.Try to solve, but don’t succeed Global nursing shortage Articulating the value of Nursing to the greater society as evidenced by absent or incorrect media coverage A conflict of interest among groups – failure to collectively decide on entry level college requirements for licensure Narrative: “After receiving my Master’s Degree I was offered a tenured track college faculty position – for $50,000 less than I was making as a manager” Hypothesis: Being immersed in any culture prevents an accurate assessment of that particular culture What could Nursing gain by applying a broader sociological framework designed to answer the question: Why do some societies thrive and other’s become extinct? According to Jared Diamond, entire civilizations have vanished because of Failures of group decision making: 1.Failure to anticipate a problem 2.Failure to perceive a problem 3.Failure to solve after perception 4.Try to solve, but don’t succeed. Application 1.Failure to anticipate a problem Primarily due to inability to see the origin of a problem – root causes: Human Adaptability Theory: states that changes that are small and incremental are not noticed by human beings Myopic Embedding: intrinsic group values of nursing drive us to focus on the workload Oppression Theory: The characteristics of oppressed behaviour stem from the ability of dominant groups to identify the “right” norms and values; and from their power to enforce them. Unable to direct their power upward, oppressed groups take out their frustrations on each other --- primarily due to low self esteem and the lack of awareness that they are oppressed in the first place. Narratives: “Yesterday I floated to another unit and had to give one patient 35 scheduled medications! I only recognized 18 and desperately tried to look up the other 17.” “Before I even have the zipper up to the neck on the body bag, the charge nurse is standing there giving me report on my next patient.” 2.Failure to perceive a problem Driven by distant managers, landscape amnesia, and creeping normalcy Examples Damage from RN-RN Hostility Objective assessment of workload The emotional work of Nursing Assimilation of the dominant group values Larger cultural context: most trusted and most invisible profession Critical lack of solidarity- political power “Nurse Disempowerment Act” Foundation of Nurse Practice Act based on medical model, decreases autonomy. Poor leadership skills Nursing as an oppressed group Prevalent culture of passive-aggressive communication; poor conflict skills Link between communication style and self esteem Decrease in professionalism and image Lack of long term planning: reactive focus Narratives: “If you are a nurse in the year 2009 then we all have one thing in common: we have all been asked to do more with less.” “I haven’t seen my manager for literally weeks.” Application of the Failures of Group Decision Making to the Nursing Profession Kathleen Bartholomew, RN, MN Seattle, Washington, USA What was the person thinking when he cut down the very last tree on Easter Island?

Failure to perceive Cannot perceive in enough time to intervene because of: Creeping Normalcy Landscape Amnesia Distant Managers

The first accountability of a leader is to know reality. Max Dupree

Human Adaptability Changes that are small and incremental are not noticed

ER Scrubs House Nurse Jackie Grey’s Anatomy

“Voice connects what is on the inside to the outside” E. Robinson, “The Soul of the Nurse ”

Humans in Groups Voice is critical – self silencing Weakened and Strengthened by emotion Don’t see ourselves objectively Risk averse Critical mass tips the scale Group Think Bystander Effect Belonging at all cost

No one no matter how wise or powerful is able to control outcomes in self organizing complex systems On the Edge by Lindberg/Nash

Complexity Science Focuses on the patterns of relationships among parts of the system, rather than the parts by themselves or the structure Order and direction emerge from the grass roots up, not from a single or centralized intelligence.

If you want to create power and synergy focus on: 1. Connections 2. Diversity 3. Information Flow 4. Interactions On the Edge/Lindberg/Nash

Hierarchy “ … fewer physicians and CEO’s saw a major impact on patient safety, early detection of patient complications or time for team collaboration.” Buerhaus, 2007

Leadership ? “Patriarchal system used to create high performance through centralization of power” Side effects Sense of entitlement Employees frozen in their own development Controlling people so they feel good about being controlled

Technical vs. Adaptive Change Technical WHO? Authorities WHAT? Apply current know-how Adaptive WHO? The people with the problem WHAT? Learn new ways

HIERARCHY Staff complain to mgr. or each other Boss solves problems People know their place No feedback sought Secrecy and blame Control as key Different rules for different roles

HIERARCHY Staff complain to mgr or each other Boss solves problems People know their place No feedback sought Secrecy and blame Control as key Different rules for different roles TRIBE Staff take accountability Staff seek resolution People know their value Peer evaluations Just Culture – open sharing Relationships as key 100% of staff held to same standard

OLD Hierarchy Manager as parent “us” and “them” Staff as worker bee Show up, have a job Punish mistakes Silence ‘Training’ as cost Fix the blame NEW Team/Tribe Manager as partner “we” Staff as problem solvers Accountability Learn from mistakes Crucial conversations “Training’ as investment Fix the system (Cox)

“While nursing is on its Odyssic quest to develop the science of nursing practice, the universal humanistic art of nursing lies unattended” Watson, 1981

Patterns of communication are the most important predictor of a team’s success

Teaming Behaviors Speaking up Experimenting Reflecting Listening Integrating

Swarm When individuals in a group are able to respond collectively to changes in circumstances, the group becomes a complex adaptive system - CAP

“Common Healthcare Norms” Non verbal behaviors Hierarchical Fear based Don’t rock the boat Knowledge and skill communication deficit Self silencing Status Quo reigns

300 years of Leadership interventional studies since prior Small impact 63% for interventions Longest 7 days The greatest effect: “The Pygmalion Effect” Raise the positive beliefs of followers to believe they are better at a task than they thought

Authentic Leaders “…act in accordance with deep personal values and convictions, to build credibility and win the respect and trust of followers by encouraging diverse viewpoints and building diverse networks of collaborative relationships with followers…leading in a manner that followers recognize as authentic.” Bruce Avolio et al 2004

Leaders Act according to their values –Builds credibility and –Wins respect and trust by Encouraging diversity and Building diverse collaborative networks Leading in a way people recognize as authentic

“What we need is what the ancient Israelites called hochma …the capacity to see, to feel and then to act as if the future depended on you. Believe me, it does.” Bill Moyer

Thank you! Kathleen Bartholomew