Clinical Leadership in Nursing and Healthcare

Dr David Stanley, RN, RM, Gerontic Cert, Grad Cert HPE, Dip HE (Nursing), BN, MSc (Health Sciences), TF, NursD. David is a Registered Nurse and Midwife. He began his nursing career in the 1980’s and his interest in clinically focused leadership came about because he was once a Nurse Practitioner. David was formerly an Adjunct Professor at Charles Sturt University and a Research Mentor at Fiji’s National University. He retains his passion for the development of empowered nurse leaders and frontline health professionals with a focus on high quality clinical care. Dr Clare L. Bennett, D.Nurs, SFHEA, PGCE, MSc, BSc (Hons), Dip.N, RGN. Clare is a Registered Nurse with a background in Sexual Health, Immunology, HIV and Infectious Diseases. She is a Doctor of Nursing and is currently a Senior Lecturer at Cardiff University. She has taught Leadership, Quality Improvement and Patient Safety on undergraduate and postgraduate programmes for nurses and allied health professionals for over two decades. Clare is also an honorary lecturer at the University of Freiburg, Germany, where she teaches clinical leadership in the context of advancing clinical practice. Clare is Co-Director of the Wales Centre for Evidence Based Care and teaches and coaches in the field of evidence development and implementation. Dr Alison H. James, DAHP, SFHEA, PGCE, MA, BA (Hons), Dip Critical Care, RGN, BA. Alison is a Registered Nurse and Doctor of Advanced Healthcare Practice with a background in Neurosciences, Critical Care, Osteoporosis and Knowledge Transfer in health and social care. She is a Senior Lecturer at the School of Healthcare Sciences at Cardiff University in Wales, UK. Alison teaches Leadership and Quality Improvement on programmes across the nursing and allied health programmes at undergraduate and postgraduate level and is a coach and mentor for student leadership in the UK. Alison’s research is focused on leadership development in the healthcare workforce and education, how this impacts delivery and quality of patient care and influences cultures within healthcare environments.

• Notes on Contributors xviiPreface xxiAcknowledgements xxvPart I Clinical Leaders: Role Models for Values-Based Leadership 11 Clinical Leadership Explored 5David StanleyIntroduction 5Clinical Leadership: What Do We Know? 6Attributes Less Likely to Be Seen in Clinical Leaders 8Clinical Leaders Are Not Seen as Controlling 8Clinical Leaders Are Not Seen as Visionary 8Clinical Leaders Are Not Seen as ‘Shapers’ 10Attributes More Likely to Be Seen in Clinical Leaders 11Clinical Competence/Clinical Knowledge 11Approachability 13Empowered/Motivator or Motivated 13Supportive 13Inspires Confidence 14Integrity/Honesty 14Role Model 14Effective Communicator 15Visible in Practice 15Copes Well with Change 16Other Attributes 16Values: The Glue that Binds 17Who Are the Clinical Leaders? 18Clinical Leadership Defined 21Why Clinical Leadership Now? 21A New Agenda 22Changing Care Contexts 22Change Equates to More Leadership 22More Emphasis on Quality 23Summary 25Mind Press-Ups 25References 262 Leadership Theories and Styles 31David StanleyIntroduction: Leadership – What Does It All Mean? 31Leadership Defined: The Blind Man’s Elephant 33No One Way 36Leadership Theories and Styles 36The Great Man Theory: Born to Lead? 36The Heroic Leader: Great People Lead 37The Big Bang Theory: From Great Events, Great People Come 37Trait Theory: The Man, Not the Game 38Style Theory: It’s How You Play the Game 40Situational or Contingency Theory: It’s about Relationships 42Transformational Theory: Making Change Happen 44Transactional Theory: Running a Tight Ship 46Authentic/Breakthrough Leadership: True to Your Values 47Servant Leadership: A Follower at the Front 48Other Perspectives 50Shared Leadership/Collaborative Leadership 50Compassionate Leadership 50The Right Leader at the Right Time 51Summary 54Mind Press-Ups 54References 553 Values-Based Leadership: Congruent Leadership 61David StanleyIntroduction: A New Theory 61Values-Based Leadership 62Values-Based Leadership Theories Applied in Healthcare 62Congruent Leadership: Another View 66It All Started with Clinical Leadership 66Congruent Leadership Theory Explored 79A Solid Foundation 80The Strengths of Congruent Leadership 82Grassroots Leaders 83Foundation for Other Theories 83Strong Link between Values and Actions 84Supports Further Understanding of Clinical Leadership 85Anyone Can Be a Congruent Leader 85The Limitations of Congruent Leadership 85New Theory 85Similar to Other Values-Based Leadership Theories 86Not Driven by a Focus on Change 86Not Suitable for Leaders with ‘Control’ as an Objective 86Congruent Leadership, Change and Innovation 87Congruent Leadership and Power 88Congruent Leadership and Quality 91Summary 96Mind Press-Ups 97References 974 Followership 105David StanleyIntroduction: From behind They Lead 105Defining Followership 106Followers’ Responsibilities 106The Good Follower 110The Not-So-Good Follower 113Summary 116Mind Press-Ups 117References 1175 Leadership and Management 119Clare L. Bennett and Alison H. JamesIntroduction: Why Delineate? 119Who Should Take Centre Stage? 120Skills 123The Need for Education 125Toxic or Misunderstood? 127The Future 128A Culture Shift 129Summary 131Mind Press-Ups 132References 133Part II Clinical Leadership Tools: How to Influence Quality, Innovation and Change 1376 Organisational Culture and Clinical Leadership 139Sally Carvalho and David StanleyIntroduction: Values First 139What Is Organisational Culture? 139A Culture of Care and Compassion 142Culture and Leadership 144How Congruent Leaders Shape Culture 146Clinical Leadership, Education and Training 150Summary 152Mind Press-Ups 153References 1537 Leading Change 157Clare L. Bennett and Alison H. JamesIntroduction: Tools for Change 157All Change 158Transformational Change 159Approaches to Change 160SWOT Analysis 161Stakeholder Analysis 162Pettigrew’s Model 163The Change Management Iceberg 164PEST or STEP 165Kotter’s Eight-Stage Change Process 166Nominal Group Technique 166Process Re-Engineering 167Force-Field Analysis 168Restraining Forces 169Driving or Facilitating Forces 169How Do You Find Either Restraining or Facilitating Forces? 170Initiating, Envisioning, Playing, Sustaining: A Theoretical Synthesis for Change 171Beckhard and Harris’s Change Equation 172People-Mover Change Model: Effectively Transforming an Organisation 172Instituting Organisational Change: An Examination of Environmental Influences 172Change Is Never Simple, Even with a Model 172Resistance to Change 173Self-Interest and Conflicting Agendas 173Increased Stress 173Uncertainty 174Diverging Points of View 174Ownership 174Recognising the Drivers 175Some People Just Do Not Like Change 175Recognising Denial and Allowing Time for Reflection 175Successfully Dealing with Change 176Summary 179Mind Press-Ups 180References 1808 Patient Safety and Clinical Decision Making 183Clare L. Bennett and Alison H. JamesIntroduction: A Choice 183Patient Harm 183What Is Patient Safety? 184Leadership and Patient Safety 185Clinical Decision Making and Patient Safety 186Terminology 188Decision-Making Approaches 188Theories of Clinical Decision Making 190Knowledge and Information 191Intuitive-Humanistic Model 191Systematic-Positivist, Hypothetico-Deductive and Technical Rational Models 192Integrated Patient-Centred Model 192IDEALS Model 193Managerial Decision-Making Process 193Clinical Leadership and Decisions 194Why Decisions Go Wrong 195Not Using the Decision-Making Framework 195Flawed Data 195Bias 195Seeking to Avoid Conflict or Change 196Ignorance 196Hindsight Bias 196Availability Heuristics 196Over-Confidence in Knowledge 196Haste 196How about Emotion? 197Group Decision Making 197Advantages of Group Decisions 198Disadvantages of Group Decisions 198Challenges 198Summary 200Mind Press-Ups 201References 2019 Creativity 205David StanleyIntroduction: A New Way Forward 205What Is Creativity? 206Building Creative Capacity 209Techniques for Developing Creativity 210Relax 211Keep a Notebook or Journal 211Journaling 211Record Your Ideas 211Do or Learn Something New Each Day 211Learn to Draw 211Become a Cartoonist 212Learn to Map Your Mind 212Try Associational Thinking 212Go for a Walk 212Adopt a Genius 212Open a Dictionary 213Study Books about Creative Thinking 213Flood Yourself with Information 213Attend Courses 213Listen to Baroque Music 213Face a New Fear Every Day 213Develop Your Imagination 213Leave Things Alone for a While 214Find a Creative Space 214Develop Your Sense of Humour 214Define Your Problem 215Know Yourself Well 215Use Guided Reflection 215Be Mindful 215Focus 215Do Not Be Afraid to Fail 215Develop Some Techniques for Creative Thinking 215Barriers to Creativity 216Organisational Barriers 217Competition 217Organisational Structure 217Being Too Busy to Address a Problem 217Too Hectic an Environment 217A Sterile Environment 217Poor or Harsh Feedback 218Rules 218Unrealistic Production Demands 218The Boss Is Always Right 218Poor Communication 218Personal Barriers 219Fear of Criticism/Fear of Failure 219Our Belief that We Are Not Creative 219Fear of Change 219Ego 219Beliefs and Values 219Lack of Confidence 219Stress 220Previous Negative Experiences with Risk 220Negative Self-Talk 220Routines 220Other Barriers 220Daily Distractions 220Not Having a Place to Go or Time to Get There 220Drugs 220Leadership and Creativity 221Summary 224Mind Press-Ups 224References 22510 Leading Teams 227Alison H. James and Clare L. BennettIntroduction: Identifying Dynamics and Self-Role within Teams 227Do We Really Need Teams? 228Are We a Team or a Group? 229Established Teams 230High-Performance Teams 230OK or Functional Teams 232Struggling Teams 232‘Teaming’ for Healthcare 233Creating Powerful and Positive Teams 234Psychological Safety 236Team Building 236Team Roles 237Leadership and Teams 239Summary 241Mind Press-Ups 241References 24211 Networking and Delegation 245Tracey CoventryIntroduction: Strength in Numbers 245Networking 245The Skills of Networking 246Get Yourself Known 247Volunteer 247Join a Professional Organisation 247Look Beyond Your Own Organisation 247Be Professionally Committed and Have Clear Messages 247Join Professional Discussion Groups 248Use Social Networks 248Engage with Professional Development 248Go to Conferences 248Mentor Others or Be Mentored 249Travel (for Professional Reasons) 249Develop a Clinical Supervision Process 249Expand Your Informal ‘Coffee’ Network 249Publish 250Other Ideas 250Networking Through Social Media 250Networking Tips 251Delegation 252Effective Delegation 253Common Mistakes in Delegation 255Under-Delegation 255Over-Delegation 255Inappropriate Delegation 255Failing to Provide Sufficient Supervision 256Resistance to Delegation 256Delegation and Clinical Leadership 256Summary 258Mind Press-Ups 259References 26012 Dealing with Conflict 261Kylie RussellIntroduction: Collaboration or Clash 261Past Conflict 262Influencing Factors 262Conflict Styles 263Conflict at Work 266Conflict Resolution 267Responding to Conflict 268Conflict Management and Clinical Leaders 270Building Bridges: Negotiation and Mediation 271Pre-Negotiation Phase 271Negotiation Phase 271Post-Negotiation Phase 272Non-Productive Behaviour 273Negativity 273Being Talkative 273Attention Seeking 273Arrogance 273Arguing 274Withdrawing 274Aggression 274Complaining 274Active Listening 275Self-Talk 276I-Messages 277Communication Styles 278Mindful Communication 279Assertive Communication 279Communication Tools 279Cus/s 280Cus 280Pace 280Benefits of Conflict Management 280Summary 282Mind Press-Ups 283References 28413 Motivation and Inspiration 287David StanleyIntroduction: Inspiring Others 287What Is Motivation? 288Models and Theories of Motivation 288Maslow’s Hierarchy of Needs 288Expectancy Theory 290Job Characteristics Model 290How to Motivate Others 290Signs that People Are Demotivated 293The Motivational Power of Failure 294Inspiration 296Summary 298Mind Press-Ups 299References 30014 Creating a Spirit of Enquiry (Enhancing Research) 303Judith Anderson, Sarah Dineen-Griffin and David StanleyIntroduction: Is the Spirit with You? 303Two Keys 303Evidence-Based Practice 304How to Create a Spirit of Enquiry 306Being Involved in Research 306Role Modelling Use of EBP 306Mentorship 307Understanding the Value of a Nexus 307Encouraging Quality Improvement Initiatives 307Fostering Innovation 307Rewards 308Professional Development Opportunities 308Collaboration 308Journal Clubs 309Making It Relevant to Practice 309Benefits of Evidence-Based Practice and a Spirit of Enquiry for Health Professionals 309Barriers to the Development of a Spirit of Enquiry and the Use of Evidence-Based Practice 310Applying Evidence-Based Practice 311Strategies for Breaching the Evidence/Practice Nexus 312Diffusion: A Simple Form of Nexus Development 314Dissemination: More Involved with Wider Nexus Results 314Implementation: Key Nexus Activity Integration 314What Can Clinical Leaders Do to Promote Evidence-Based Practice and a Spirit of Enquiry? 315Summary 318Mind Press-Ups 318References 31915 Reflection and Emotional Intelligence 323David StanleyIntroduction: The Noblest Way to Wisdom 323What Is Reflection? 323Reflection and Learning 324Benefits of Reflection for Clinical Leaders 324Better Self-Knowledge/Increased Self-Awareness 325Identification of Your Values 325Connection to Caring 325More Effective Working Relationships/Stronger Teams 325Empowerment 325Learning from Mistakes 326Models to Support Reflection 326Using Reflective Models 327Approaches to Reflection 327What Is Emotional Intelligence? 329The Five Building Blocks of Emotional Intelligence 329Reflection on Reflection and Emotional Intelligence 331Summary 333Mind Press-Ups 333References 33416 Quality Improvement 337Clare L. Bennett and Alison H. JamesIntroduction: What Does Good Quality Healthcare Look Like? 337Systems Thinking 338The Quality Cycle – A Quality Management System 340Quality Initiative Stories 343Project Management 344Project Management Explored 345What Is a Project? 345What Is Project Management? 345What Is the Role of a Project Manager? 346How Is Project Management Structured? 346Phase 1: The Initial Phase 347Project Management Team 347Time, Money and Scope 347Charter 347Scope Statement 347Phase 2: The Intermediate Phase 348Planning the Project 348Baseline 348Progress or Executing the Project 349Acceptance or Controlling the Project 349Phase 3: The Final Phase 349Closure of the Project 349Key Issues 349The Components of Project Management 350Final Project Management Issues 350Implications for Clinical Leaders 350Summary 352Mind Press-Ups 352References 353Part III Clinical Leadership Issues: The Context of Values-Based Leadership 35517 Gender, Generational Groups and Leadership 357Julie Reis and Denise BlanchardIntroduction: The Impact of Gender and Generations 357Is There a Difference? 357The Case for a Difference 358The Case for No Difference 359Challenges for Women in Leadership 360The Causes of Gender Differences in Leadership 362Personal Differences 362Professional Differences 363Potential Barriers that Female Leaders Face 364Recommendations and Strategies to Address Gender Differences Manage Gender Bias 367Gender and Congruent Leadership 369Generational Differences and Leadership 369Builders 370Baby Boomers 370Generation X 370Generation Y 370Generation Z 371Generation Alpha 371Summary 376Mind Press-Ups 376References 37718 Power, Politics and Leadership 385Alison H. James and Clare L. BennettIntroduction: Power and Politics 385A Beginning 386Professional Power 386Power Base 387Powerlessness and Abuse 388Influencing Styles 389Critical Social Theory 392Healthcare and Politics 394Practical Politics 396Dealing with the Media 396Becoming Politically Active 397It’s How You Use It! 398Summary 399Mind Press-Ups 400References 40019 From Empowerment to Emancipation – Developing Self-Leadership 403Alison H. James and Clare L. BennettIntroduction: Elevating Your Voice 403Defining Empowerment 404The First Perspective: Empowerment as a Tool 405The Second Perspective: Empower Walking 406Oppression: Bridging the Power Divide 410Liberated Leaders or Co-Oppressors? 412How Can Oppressed Groups Liberate Themselves? 414Summary 416Mind Press-Ups 417References 41820 Leading Through a Crisis 421Alison H. James and Clare L. BennettIntroduction 421Defining Crisis 422Flexibility, Innovation and Resilience 424Lessons Learnt for the Long Term 425Maintaining Compassion and Empathy in Leadership 426Considering the Emotions of the Experience 428Leading for Self-Care and Well-being 428Stories of the Crisis 429Summary 433Mind Press-Ups 433References 43421 Clinical (Values-Based/Congruent) Leaders 439David StanleyIntroduction: Clinical Heroes 439Many Marys 440Values-Based or Congruent Leaders beyond the Ward 442The First Step: Finding Your True Voice 443Innovation, Change and Quality 444Two Final Examples of Values-Based/Congruent Leaders 445Mother Teresa 445Tank Man 446Conclusion 447Summary 447References 448Index 451