Clinical Leadership in Nursing and Healthcare 3rd Edition

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 xvii Preface xxi Acknowledgements xxv Part I Clinical Leaders: Role Models for Values Based Leadership 1 1 Clinical Leadership Explored 5 David Stanley Introduction 5 Clinical Leadership: What Do We Know? 6 Attributes Less Likely to Be Seen in Clinical Leaders 8 Clinical Leaders Are Not Seen as Controlling 8 Clinical Leaders Are Not Seen as Visionary 8 Clinical Leaders Are Not Seen as 'Shapers' 10 Attributes More Likely to Be Seen in Clinical Leaders 11 Clinical Competence/Clinical Knowledge 11 Approachability 13 Empowered/Motivator or Motivated 13 Supportive 13 Inspires Confidence 14 Integrity/Honesty 14 Role Model 14 Effective Communicator 15 Visible in Practice 15 Copes Well with Change 16 Other Attributes 16 Values: The Glue that Binds 17 Who Are the Clinical Leaders? 18 Clinical Leadership Defined 21 Why Clinical Leadership Now? 21 A New Agenda 22 Changing Care Contexts 22 Change Equates to More Leadership 22 More Emphasis on Quality 23 Summary 25 Mind Press Ups 25 References 26 2 Leadership Theories and Styles 31 David Stanley Introduction: Leadership - What Does It All Mean? 31 Leadership Defined: The Blind Man's Elephant 33 No One Way 36 Leadership Theories and Styles 36 The Great Man Theory: Born to Lead? 36 The Heroic Leader: Great People Lead 37 The Big Bang Theory: From Great Events, Great People Come 37 Trait Theory: The Man, Not the Game 38 Style Theory: It's How You Play the Game 40 Situational or Contingency Theory: It's about Relationships 42 Transformational Theory: Making Change Happen 44 Transactional Theory: Running a Tight Ship 46 Authentic/Breakthrough Leadership: True to Your Values 47 Servant Leadership: A Follower at the Front 48 Other Perspectives 50 Shared Leadership/Collaborative Leadership 50 Compassionate Leadership 50 The Right Leader at the Right Time 51 Summary 54 Mind Press Ups 54 References 55 3 Values Based Leadership: Congruent Leadership 61 David Stanley Introduction: A New Theory 61 Values Based Leadership 62 Values Based Leadership Theories Applied in Healthcare 62 Congruent Leadership: Another View 66 It All Started with Clinical Leadership 66 Congruent Leadership Theory Explored 79 A Solid Foundation 80 The Strengths of Congruent Leadership 82 Grassroots Leaders 83 Foundation for Other Theories 83 Strong Link between Values and Actions 84 Supports Further Understanding of Clinical Leadership 85 Anyone Can Be a Congruent Leader 85 The Limitations of Congruent Leadership 85 New Theory 85 Similar to Other Values Based Leadership Theories 86 Not Driven by a Focus on Change 86 Not Suitable for Leaders with 'Control' as an Objective 86 Congruent Leadership, Change and Innovation 87 Congruent Leadership and Power 88 Congruent Leadership and Quality 91 Summary 96 Mind Press Ups 97 References 97 4 Followership 105 David Stanley Introduction: From behind They Lead 105 Defining Followership 106 Followers' Responsibilities 106 The Good Follower 110 The Not So Good Follower 113 Summary 116 Mind Press Ups 117 References 117 5 Leadership and Management 119 Clare L. Bennett and Alison H. James Introduction: Why Delineate? 119 Who Should Take Centre Stage? 120 Skills 123 The Need for Education 125 Toxic or Misunderstood? 127 The Future 128 A Culture Shift 129 Summary 131 Mind Press Ups 132 References 133 Part II Clinical Leadership Tools: How to Influence Quality, Innovation and Change 137 6 Organisational Culture and Clinical Leadership 139 Sally Carvalho and David Stanley Introduction: Values First 139 What Is Organisational Culture? 139 A Culture of Care and Compassion 142 Culture and Leadership 144 How Congruent Leaders Shape Culture 146 Clinical Leadership, Education and Training 150 Summary 152 Mind Press Ups 153 References 153 7 Leading Change 157 Clare L. Bennett and Alison H. James Introduction: Tools for Change 157 All Change 158 Transformational Change 159 Approaches to Change 160 SWOT Analysis 161 Stakeholder Analysis 162 Pettigrew's Model 163 The Change Management Iceberg 164 PEST or STEP 165 Kotter's Eight Stage Change Process 166 Nominal Group Technique 166 Process Re Engineering 167 Force Field Analysis 168 Restraining Forces 169 Driving or Facilitating Forces 169 How Do You Find Either Restraining or Facilitating Forces? 170 Initiating, Envisioning, Playing, Sustaining: A Theoretical Synthesis for Change 171 Beckhard and Harris's Change Equation 172 People Mover Change Model: Effectively Transforming an Organisation 172 Instituting Organisational Change: An Examination of Environmental Influences 172 Change Is Never Simple, Even with a Model 172 Resistance to Change 173 Self Interest and Conflicting Agendas 173 Increased Stress 173 Uncertainty 174 Diverging Points of View 174 Ownership 174 Recognising the Drivers 175 Some People Just Do Not Like Change 175 Recognising Denial and Allowing Time for Reflection 175 Successfully Dealing with Change 176 Summary 179 Mind Press Ups 180 References 180 8 Patient Safety and Clinical Decision Making 183 Clare L. Bennett and Alison H. James Introduction: A Choice 183 Patient Harm 183 What Is Patient Safety? 184 Leadership and Patient Safety 185 Clinical Decision Making and Patient Safety 186 Terminology 188 Decision Making Approaches 188 Theories of Clinical Decision Making 190 Knowledge and Information 191 Intuitive Humanistic Model 191 Systematic Positivist, Hypothetico Deductive and Technical Rational Models 192 Integrated Patient Centred Model 192 IDEALS Model 193 Managerial Decision Making Process 193 Clinical Leadership and Decisions 194 Why Decisions Go Wrong 195 Not Using the Decision Making Framework 195 Flawed Data 195 Bias 195 Seeking to Avoid Conflict or Change 196 Ignorance 196 Hindsight Bias 196 Availability Heuristics 196 Over Confidence in Knowledge 196 Haste 196 How about Emotion? 197 Group Decision Making 197 Advantages of Group Decisions 198 Disadvantages of Group Decisions 198 Challenges 198 Summary 200 Mind Press Ups 201 References 201 9 Creativity 205 David Stanley Introduction: A New Way Forward 205 What Is Creativity? 206 Building Creative Capacity 209 Techniques for Developing Creativity 210 Relax 211 Keep a Notebook or Journal 211 Journaling 211 Record Your Ideas 211 Do or Learn Something New Each Day 211 Learn to Draw 211 Become a Cartoonist 212 Learn to Map Your Mind 212 Try Associational Thinking 212 Go for a Walk 212 Adopt a Genius 212 Open a Dictionary 213 Study Books about Creative Thinking 213 Flood Yourself with Information 213 Attend Courses 213 Listen to Baroque Music 213 Face a New Fear Every Day 213 Develop Your Imagination 213 Leave Things Alone for a While 214 Find a Creative Space 214 Develop Your Sense of Humour 214 Define Your Problem 215 Know Yourself Well 215 Use Guided Reflection 215 Be Mindful 215 Focus 215 Do Not Be Afraid to Fail 215 Develop Some Techniques for Creative Thinking 215 Barriers to Creativity 216 Organisational Barriers 217 Competition 217 Organisational Structure 217 Being Too Busy to Address a Problem 217 Too Hectic an Environment 217 A Sterile Environment 217 Poor or Harsh Feedback 218 Rules 218 Unrealistic Production Demands 218 The Boss Is Always Right 218 Poor Communication 218 Personal Barriers 219 Fear of Criticism/Fear of Failure 219 Our Belief that We Are Not Creative 219 Fear of Change 219 Ego 219 Beliefs and Values 219 Lack of Confidence 219 Stress 220 Previous Negative Experiences with Risk 220 Negative Self Talk 220 Routines 220 Other Barriers 220 Daily Distractions 220 Not Having a Place to Go or Time to Get There 220 Drugs 220 Leadership and Creativity 221 Summary 224 Mind Press Ups 224 References 225 10 Leading Teams 227 Alison H. James and Clare L. Bennett Introduction: Identifying Dynamics and Self Role within Teams 227 Do We Really Need Teams? 228 Are We a Team or a Group? 229 Established Teams 230 High Performance Teams 230 OK or Functional Teams 232 Struggling Teams 232 'Teaming' for Healthcare 233 Creating Powerful and Positive Teams 234 Psychological Safety 236 Team Building 236 Team Roles 237 Leadership and Teams 239 Summary 241 Mind Press Ups 241 References 242 11 Networking and Delegation 245 Tracey Coventry Introduction: Strength in Numbers 245 Networking 245 The Skills of Networking 246 Get Yourself Known 247 Volunteer 247 Join a Professional Organisation 247 Look Beyond Your Own Organisation 247 Be Professionally Committed and Have Clear Messages 247 Join Professional Discussion Groups 248 Use Social Networks 248 Engage with Professional Development 248 Go to Conferences 248 Mentor Others or Be Mentored 249 Travel (for Professional Reasons) 249 Develop a Clinical Supervision Process 249 Expand Your Informal 'Coffee' Network 249 Publish 250 Other Ideas 250 Networking Through Social Media 250 Networking Tips 251 Delegation 252 Effective Delegation 253 Common Mistakes in Delegation 255 Under Delegation 255 Over Delegation 255 Inappropriate Delegation 255 Failing to Provide Sufficient Supervision 256 Resistance to Delegation 256 Delegation and Clinical Leadership 256 Summary 258 Mind Press Ups 259 References 260 12 Dealing with Conflict 261 Kylie Russell Introduction: Collaboration or Clash 261 Past Conflict 262 Influencing Factors 262 Conflict Styles 263 Conflict at Work 266 Conflict Resolution 267 Responding to Conflict 268 Conflict Management and Clinical Leaders 270 Building Bridges: Negotiation and Mediation 271 Pre Negotiation Phase 271 Negotiation Phase 271 Post Negotiation Phase 272 Non Productive Behaviour 273 Negativity 273 Being Talkative 273 Attention Seeking 273 Arrogance 273 Arguing 274 Withdrawing 274 Aggression 274 Complaining 274 Active Listening 275 Self Talk 276 I Messages 277 Communication Styles 278 Mindful Communication 279 Assertive Communication 279 Communication Tools 279 CUS/S 280 CUS 280 PACE 280 Benefits of Conflict Management 280 Summary 282 Mind Press Ups 283 References 284 13 Motivation and Inspiration 287 David Stanley Introduction: Inspiring Others 287 What Is Motivation? 288 Models and Theories of Motivation 288 Maslow's Hierarchy of Needs 288 Expectancy Theory 290 Job Characteristics Model 290 How to Motivate Others 290 Signs that People Are Demotivated 293 The Motivational Power of Failure 294 Inspiration 296 Summary 298 Mind Press Ups 299 References 300 14 Creating a Spirit of Enquiry (Enhancing Research) 303 Judith Anderson, Sarah Dineen Griffin and David Stanley Introduction: Is the Spirit with You? 303 Two Keys 303 Evidence Based Practice 304 How to Create a Spirit of Enquiry 306 Being Involved in Research 306 Role Modelling Use of EBP 306 Mentorship 307 Understanding the Value of a Nexus 307 Encouraging Quality Improvement Initiatives 307 Fostering Innovation 307 Rewards 308 Professional Development Opportunities 308 Collaboration 308 Journal Clubs 309 Making It Relevant to Practice 309 Benefits of Evidence Based Practice and a Spirit of Enquiry for Health Professionals 309 Barriers to the Development of a Spirit of Enquiry and the Use of Evidence Based Practice 310 Applying Evidence Based Practice 311 Strategies for Breaching the Evidence/Practice Nexus 312 Diffusion: A Simple Form of Nexus Development 314 Dissemination: More Involved with Wider Nexus Results 314 Implementation: Key Nexus Activity Integration 314 What Can Clinical Leaders Do to Promote Evidence Based Practice and a Spirit of Enquiry? 315 Summary 318 Mind Press Ups 318 References 319 15 Reflection and Emotional Intelligence 323 David Stanley Introduction: The Noblest Way to Wisdom 323 What Is Reflection? 323 Reflection and Learning 324 Benefits of Reflection for Clinical Leaders 324 Better Self Knowledge/Increased Self Awareness 325 Identification of Your Values 325 Connection to Caring 325 More Effective Working Relationships/Stronger Teams 325 Empowerment 325 Learning from Mistakes 326 Models to Support Reflection 326 Using Reflective Models 327 Approaches to Reflection 327 What Is Emotional Intelligence? 329 The Five Building Blocks of Emotional Intelligence 329 Reflection on Reflection and Emotional Intelligence 331 Summary 333 Mind Press Ups 333 References 334 16 Quality Improvement 337 Clare L. Bennett and Alison H. James Introduction: What Does Good Quality Healthcare Look Like? 337 Systems Thinking 338 The Quality Cycle - A Quality Management System 340 Quality Initiative Stories 343 Project Management 344 Project Management Explored 345 What Is a Project? 345 What Is Project Management? 345 What Is the Role of a Project Manager? 346 How Is Project Management Structured? 346 Phase 1: The Initial Phase 347 Project Management Team 347 Time, Money and Scope 347 Charter 347 Scope Statement 347 Phase 2: The Intermediate Phase 348 Planning the Project 348 Baseline 348 Progress or Executing the Project 349 Acceptance or Controlling the Project 349 Phase 3: The Final Phase 349 Closure of the Project 349 Key Issues 349 The Components of Project Management 350 Final Project Management Issues 350 Implications for Clinical Leaders 350 Summary 352 Mind Press Ups 352 References 353 Part III Clinical Leadership Issues: The Context of Values Based Leadership 355 17 Gender, Generational Groups and Leadership 357 Julie Reis and Denise Blanchard Introduction: The Impact of Gender and Generations 357 Is There a Difference? 357 The Case for a Difference 358 The Case for No Difference 359 Challenges for Women in Leadership 360 The Causes of Gender Differences in Leadership 362 Personal Differences 362 Professional Differences 363 Potential Barriers that Female Leaders Face 364 Recommendations and Strategies to Address Gender Differences Manage Gender Bias 367 Gender and Congruent Leadership 369 Generational Differences and Leadership 369 Builders 370 Baby Boomers 370 Generation X 370 Generation Y 370 Generation Z 371 Generation Alpha 371 Summary 376 Mind Press Ups 376 References 377 18 Power, Politics and Leadership 385 Alison H. James and Clare L. Bennett Introduction: Power and Politics 385 A Beginning 386 Professional Power 386 Power Base 387 Powerlessness and Abuse 388 Influencing Styles 389 Critical Social Theory 392 Healthcare and Politics 394 Practical Politics 396 Dealing with the Media 396 Becoming Politically Active 397 It's How You Use It! 398 Summary 399 Mind Press Ups 400 References 400 19 From Empowerment to Emancipation - Developing Self Leadership 403 Alison H. James and Clare L. Bennett Introduction: Elevating Your Voice 403 Defining Empowerment 404 The First Perspective: Empowerment as a Tool 405 The Second Perspective: Empower Walking 406 Oppression: Bridging the Power Divide 410 Liberated Leaders or Co Oppressors? 412 How Can Oppressed Groups Liberate Themselves? 414 Summary 416 Mind Press Ups 417 References 418 20 Leading Through a Crisis 421 Alison H. James and Clare L. Bennett Introduction 421 Defining Crisis 422 Flexibility, Innovation and Resilience 424 Lessons Learnt for the Long Term 425 Maintaining Compassion and Empathy in Leadership 426 Considering the Emotions of the Experience 428 Leading for Self Care and Well being 428 Stories of the Crisis 429 Summary 433 Mind Press Ups 433 References 434 21 Clinical (Values Based/Congruent) Leaders 439 David Stanley Introduction: Clinical Heroes 439 Many Marys 440 Values Based or Congruent Leaders beyond the Ward 442 The First Step: Finding Your True Voice 443 Innovation, Change and Quality 444 Two Final Examples of Values Based/Congruent Leaders 445 Mother Teresa 445 Tank Man 446 Conclusion 447 Summary 447 References 448 Index 451