Leadership In Health Care Management Management Essay

Good leaders are made not born. If you have the desire and willpower, you can become an effective leader. Good leaders develop through a never ending process of self-study, education, training, and experience. To inspire your workers into higher levels of teamwork, there are certain things you must be, know, and do. These do not come naturally, but are acquired through continual work and study. Good leaders are continually working and studying to improve their leadership skills.

The term leadership means different things to different people. Northouse’s (2007) define leadership is a process whereby an individual influences a group of individuals to achieve a common goal. This definition is supported by Faugier and Woolnough (2002) that they also define leadership is a process, involves influence, usually occurs in a group setting, involves the attainment of a goal, and leadership exist at all levels. Bryman (1992) states that most definition of leadership emphasizes three main element that relates with leadership which are groups, influence, and goal.

Leadership in today’s Health Care

In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problems causing such behavior. Possibilities include stress, lack of clear roles, responsibilities, and standard operating procedures, and finally, lack of training on important leadership/management skills. As a result of these core problems, several potential solutions are possible, all with potential obstacles to implementation. Additional education around communication and team interaction was felt to be a priority. In summary, clinical leaders probably have a great deal to gain from augmenting their leadership/management skills.

Clinicians today frequently encounter situations in which they are ill prepared for the leadership and management challenges that they will face. In the critical care environment, resource limitations, increasing complexity of care, and diversity of personnel involved make a poorly prepared leader vulnerable. Moreover, the current complex and stressful work environment results in a greater need for strategies to manage stress and conflict. Clinicians who are solely schooled in patient care but assume leadership roles are therefore at a great disadvantage.

In health care institutions, leadership skills are recognized as important across all diciplines. The quality of a leader are important to support the managerial function in all organization and not be forgotten in health care environment. So that, in order to get leadership skills, there are several aspect that leader needs in order to improve their skills. Neccessary skills include effective communication among team members and subordinates also among customer ( in this situation, patient is the customer). Conflict can be resolved when there have understanding of one’s own communication style as well as that of others and having the skills to resolve the arrived conflicts among team members and also management. Leadership training should be available for every team members in reducing error among team members or any miscommunication problem that arise.

Style of Leadership

As a matter of fact, there are three style of leadership which are aotocratic, bureaucratic and laissez faire. Autocratic ledership style is often considered the classical approach. In this style, manager is the only one retains as much power and decision making authority as possible. As Faugier and Woolnough (2002) agreed that autocratic leaders set an end goal without allowing others to participate in the decision making process. The manager does not consult employee, nor are they allowed to give any input. Employees are expected to obey orders from employer without receiving any explainations. The motivation environment is produced by creating a structured set of rewards and punishments. Some expert point out the disadvantage of autocratic leadership style but autocratic leadership is not all bad. Sometimes it is the most effective style to use. These situations can include; the effective supervision that can be provided only through detailed orders and instructions; new, untrained employees who do not know which tasks to perform or which procedures to follow; employees do not respond to any other leadership style and so on. Need to highlight that the autocratic leadership style should not be used when employees become tense, fearful, or resentful; employees expect to have their opinions heard; employees begin depending on their manager to make all their decisions; there is low employee morale, high turnover and absenteeism and work stoppage and so on.

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Meanwhile, bureaucratic leadership is where the manager manages “by the book” which means that everything must be done according to procedure or policy. If it isn’t covered by the book, the manager refers to the next level above him or her. This manager is really more of a police officer than a leader. This statement supported by Faugier and Woolnough (2002) where they said that bureaucratic leadership occurs when a leader strictly adheres to upon the policies, rules and regulations. Bureaucratic leadership style can be effective when employees are performing routine tasks over and over; employees need to understand certain standards or procedures; employees are working with dangerous or delicate equipment that requires a definite set of procedures to operate and so on. However, this leadership style is ineffective when work habits forms that are hard to break, especially if they are no longer useful; employees lose their interest in their jobs and in their fellow workers; employees do only what is expected of them and no more and so on.

Difference with the autocratic style, laissez faire leadership leaves employees to their own devices in meeting goals, and is a highly risky form of a leadership where the leader switches between the above styles depending upon the situation at hand and upon the competence of the followers. This style of leadership effective to use when employees are highly skilled, experienced, and educated; employees have pride in their work and the drive to do it successfully on their own and when outside experts, such as staff specialist or consultants are being used. But, this style should not be used when it makes employees feel insecure at the unavailability of a manager.

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Leadership style in Clinical Management

Leadership styles within the health care profession can be evaluated by understanding the relationship between management and planning, change operations and organization structure. In clinical management, the mainly pattern of leadership that have been practices are transactional and the transformational styles.

According to Outhwaite (2003), transactional leadership involves the skills required in the effective day to day running of a team. Meanwhile, transformational leadership involves how an integrated team works together and the innovativeness of their approach to the work. For example, a leader can empower team members by allowing individuals to lead certain aspects of a project based on their areas of expertise.  This will encourage the development of individual leadership skills.  In addition, leaders should explore barriers and identify conflicts when they arise, and then work collaboratively with the team to resolve these.

Cook (2001) discusses that transactional leadership focuses on providing day-to-day care, while transformational leadership is more focused on processes that motivate followers to perform to their full potential by influencing change and providing a sense of direction. Besides, Faugier and Woolnough (2002) said that the ability of a leader to articulate a shared vision is an important aspect of transformational leadership.

Leadership styles also affect performance and not just personality patterns and behaviours. The overall performance of a unit has been critically examined by Bass et al (2003) assessing both transformational and transactional leadership styles. Prenkert and Ehnfors (1997) measured organisational effectiveness in relation to transactional and transformational leadership in nursing management. The relative influences of transactional leadership and transformational leadership styles was measured as the degree of goal attainment and reflected on the quality of nursing care provided.

Knowledge, Attitudes, and Skills of an Effective Nurse Leader

According to Cook (2001), clinical nursing leader is one who is involved in direct patient care and who continuously improves care by influencing others. He also add that leadership is not merely a series of skills or tasks; rather, it is an attitude that informs behavior. Several important functions of a nurse leader are acting as a role model, collaboration to provide optimum care, provision of information and support, providing care based on theory and research, and being an advocate for patients and the health care organization.  In addition, nurse leaders should have knowledge of management, communication, and teamwork skills, as well as some background in health economics, finance, and evidence-based outcomes. Personal qualities desirable in a nurse leader include competence, confidence, courage, collaboration, and creativity.  Nurse leaders should be aware of the changing environment and make changes proactively.  Leaders who show concern for the needs and objectives of staff members and are cognizant of the conditions affecting the work environment will encourage productivity. In doing this, it is important that a philosophy of productivity is established.

According to Jooste (2004), three things that are essential to leadership are authority, power, and influence.  Effective leaders of today should use more influence and less authority and power.  It is more important to be able to motivate, persuade, appreciate, and negotiate than to merely wield power.  The author cites three categories of influence for nurse leaders to use in creating a supportive care environment.  These include modeling by example, building caring relationships, and mentoring by instruction.  In addition, Jooste lists five practices fundamental to good leadership including inspiring a shared vision, enabling others to act, challenging processes, modeling, and encouraging.  For example, a leader may challenge others to act by recognizing contributions and by fostering collaboration.  Recognizing contributions also serves to encourage employees in their work.  Team leadership moves the focus away from the leader towards the team as a whole.

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Applications to the Wider Health and Social Context

Jooste (2004) state that nurse leaders function at all levels of nursing from the ward through top nursing management.  Over time, the function of leadership has changed from one of authority and power to one of being powerful without being overpowering. Boundaries between upper, middle, and lower level leaders are becoming blurred, and responsibilities are becoming less static and more flexible in nature.  He also add there is a trend toward decentralization of responsibility and authority from upper to the lower levels of health care deliver. 

Conclusion

In general most of the expert suggest that transformational leadership is preferred and is the more positive form of leadership as it emphasises on individual power and charisma to change the surroundings and the situation. Transformational leadership is ideal for today’s nursing practice as it seeks to satisfy needs, and involves both the leader and the follower in meeting needs. It is also flexible allowing the leader to adapt in varied situations.  The leader accepts that things will change often, and followers will enjoy this flexibility.  Thus both nurses and patients will benefit.  The avoidance of hierarchy and the ability to work in new ways helps organizations put resources together to create added value for both employees and consumers.  Welford (2002) also suggest in further, the use of transformational leadership allows team nurses to enhance their role as teacher or advocate.  

Recommendations

Following the discussions and evidential research from the expert above, here i suggest several moves for better services and improvement of leadership behaviours in the clinical settings keeping in mind the ethical implications. These can be given as follows:

1. Conducting interviews, using surveys and questionnaires to understand nurse attitudes and perceptions towards leadership styles

2. Performing personality tests to identify traits correlating with the different leadership styles to understand the strengths and weaknesses of the workforce

3. Having transformational and transactional leadership style training, education and analysis to make nursing staff suitable for handling crisis situations especially in mental health units

4. Increasing awareness on leadership styles among and showing the importance or use of each leadership behaviour during crisis in hospitals and psychiatric wards

5. Forming a disaster management team or emergency team that will be well informed of leadership styles and relative characteristics or advantages of each.

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