Leadership and professional issues
In this era health care industry is booming out the shell. Most of the organizations focus on providing high quality care to patients by insisting changes according to nouveau. Hence, every organization requires an efficient leader for achieving likely hood of success in the delivery of standard care. The leader should have certain skills and qualities for the productive implementation and management of a change. So this activity discusses the leadership qualities, skills, theories, vision, values, and beliefs that are needed for effective leadership to implement a proposed change of “Introduction of an alcohol based hand rub to reduce nosocomial infections in intensive care unit.
Moreover, this paper discusses the factors that can influence the leadership style and strategies for the implementation and identifies pertinent problems that can occur during the process of change introduction. In addition, the barriers of intended implementation of change, role of partnership working and stakeholders are briefly explained in this coursework folder. Also it reveals the role of leadership to resolve the associated problems during the implementation of proposed change. Democratic leadership style is adopted for the successful implementation of the intended change. Lewin’s three step change management model and SWOT analysis is also chosen in this dissertation for guidance in managing and implementing this radical change.
Leadership and Influencing Practice
In fact, Leadership is the supervision or direction of a group of people towards a meticulous idea and it comprises one leader who led a group by providing information and inspiration. According to the view of Wright (1989), Leadership is the ability to recognize a goal, come up with a strategy for achieving that goal and motivate the team and putting the strategy to action. Meanwhile, Zilembo and Monterosso (2008) illustrated that leadership is discriminated by the interconnections between people, their relationships and influence. Ideally a leader tries to influence his acolytes for achieving the goal of organization. Ellis and Abbott (2010) also stated that leadership is a social process and one individual persuades the behavior of group members without the use of threats or aggression. In other words, leadership is discovering the route forward and stirring others to follow.
A good leader has the ability to manage and to preserve the present while planning the future (Nazarko, 2007). Similarly, a clinical leader is directly involved in clinical care that incessantly improves the care through persuading others (Stanley, 2006). Additionally, it is an ability of supporting the people towards introverted goals and allowing them to take invention to attain that goal. The impact of leadership is to enhance the sense of fortitude, team cohesiveness and competency of individuals for the successful execution of a new change. Koch (2007, p.448) stated that in this contemporary world leadership is a central component which conduce the individuals, groups, organizations, regions, states and even nations to perform in an efficient manner. The main attribute of leadership is to exhort others or incite by words to perpetrate a common task. The process of leadership comprises of various characteristics. The leadership process involves five interwoven aspects: the leader, the follower, the situation, the communication process and the goals (Huber, p.8).
Hospitals are composite organisational systems whose primary intention to deliver clinical care to individual patients (Dijkstra et al. 2006). There are formal as well as informal sub systems, in which here I am choosing intensive care units for the introduction of identified change. The intensive care units provide intensive care to patients in hospitals. In reality, the intensive care units are initiated by Florence Nightingale in 1854 for treating seriously injured soldiers (Neuhauser, 2003). Now, most of the hospitals contain intensive care units for handling serious clients. It also divided in to different departments according to the condition or disease of patient like cardiac, nephrology, neurology, etc. In everywhere, nosocomial infections are the major threat of patients in intensive care unit. Poor hand hygiene and inadequate disinfection methods are the main reasons for transmission of nosocomial infections. So, it is essential to introduce a change in the use of hand rubs for the delivery of quality care.
The need for change
Patient safety is of high utility and is a critical problem that hospitals are facing these days thus, it is imperative to improve quality and safety in health care. A change has been identified in order to diminish the risk of infection in health care domains especially in critical care units. Nosocomial infections are a major risk to patients in intensive care unit. The major reason in the transmission of these organisms is poor hand hygiene. Indeed, hand hygiene is one of the most imperative components in the prevention of nosocomial infection. This change has been elected in order to reduce the jeopardy of infection in health care domains especially in intensive care units. The intended change identified for current practice is introduction of an alcohol based hand rub to reduce nosocomial infections in intensive care unit.
Certainly, hand washing plays an important role in hospital infection control, especially in intensive care unit. Hence, introduction of alcohol based hand rub is very essential to reduce the transmission of infected bacteria and in order to increase the quality of patient care. In intensive care domains, skin irritation from frequent washing, reduced time due to high workload and simply forgetting are the main reasons for poor hand hygiene. According to Brown et al. (2003) alcohol based hand rubs provides excellent rapid killing of virus and bacteria. Moreover, it shows significant increases in compliance with hand hygiene with associated decrease in the rate of nosocomial infection. Mody et al. (2003) also agreed that hand antisepsis is the most effectual and least expensive measure to avert transmission of nosocomial infections. It also seems that alcohol based hand rub is faster, more convenient, and less drying method of hand hygiene. The evidence of Kaier et al. (2009) and Samuel et al. (2005) strongly recommend the disinfection of hands with alcohol based hand rub in intensive care units because of its inarguable role in reducing the prevalence of nosocomial infections.
Indeed, an effective leader makes structure, implement processes for nursing care and facilitate optimistic outcomes. The selection of relevant leadership style also part of characteristics of a good leader. These styles are helpful in providing direction for motivating people to practice the intended change. Fleming (2004, p.10) stated that leadership style is contingent on a combination of three factors, namely, the leaders, the supporters and the circumstances. Leadership style gives direction in executing plans and inspiring the people. There are four characteristics of leadership styles that can be identified such as production centered or task oriented leadership, person oriented or person centered leadership, authoritarian or autocratic leadership and participative or democratic leadership. To implement the proposed change democratic or participative leadership is advantageous because this particular style tends to generate cooperation and collaboration which aids in reducing the interpersonal conflicts. In democratic or participative leadership, the leader shares decision making regarding group activities with subordinates (Fleming, 2004).
In one of the studies Sims (2009) point out that following participative leadership, the followers endorsed input into decision making and problem solving. Vesterinen (2009) pointed out that the democratic leaders permitted the group members to plan and do their work themselves, so they more engaged in their work. Moreover, the leaders believe their employees and discuss their work together. According to Kenmore (2008), one of the additional benefits of democratic style is developing the employee commitment and creating the ideas. On top of it, by following democratic style, the leaders describe the limits of task and what is required however they allow the team members as more responsible to decide how can achieve the task( Ellis and Abbot 2010). But in contrast Greenfield (2007) highlighted that the particular form of style is time consuming and in certain cases the leader has been willing to presume control.
Qualities of an efficient leader
Leadership implies numerous enduring characteristics that are imperative for influencing others and to make considerable contributions in an organization (Girvin,1998).Therefore, by following good leadership the leader must have certain qualities (Sims, 2009). In context to the proposed change leadership qualities play a pivotal role in the successful accomplishment of a task. A high-quality leader should know what they want to achieve, care about the organization or team, and act morally and with modesty (Ellis and Abbott, 2010). According to Rigolosi (2005) the qualities of leadership are: good communication skills, inter personal relationship, reliability, inspiration, recognition of goals, articulating vision and proper knowledge. In addition, he or she should work constantly with honesty, should be able to get team members to share their goals and always focus on the team members. These qualities are crucial for overcoming resistance and for the implementation of a planned change.
There are other characteristics that involves in a good leadership. Since, leadership skills like communication skills, management skills and patient care skills play an important role in a good leadership and it help to manage the situations (Grossman, 2007); a leader should be a good communicator. Good communication will helps to bring eloquence to a situation and they can well communicate with their team members. For the introduction of alcohol based hand rub, leader should be eager to share their knowledge as well as collaborate with team members. As well an effective leader should be able to create a healthy work environment and encourage the nurses to interact with others. Also, leader should have self-awareness and good listening skills and should be flexible and assist followers to develop their practices. Eventually, he has to act as a mentor and identifies their own strength and weakness.
Leadership skills and competencies are also obliging in bridging the gap between the visions and reality. Sylvie et al. (2007, p.30) concluded that leadership skills are essential in executing the plans into realities and the fundamental skills required in leadership are: communication and listening skills, coaching, empowerment, decisiveness, delegation, assertiveness, problem solving, conflict management, goal settings and negotiation skills. These qualities and skills of leadership consist of high values that can help to sort out the issues that may arise while executing a change of alcohol hand rub introduction.
Theories and traits of Leadership
According to Sims (2009) there are several theories includes in leadership such as trait theory, behavior theory, task oriented, relationship oriented, transactional, transformational, afflictive and coaching. To bring resilience and to provide direction throughout the change process “The Kurt Lewin change theory model” will be used. According to Beverland and Lindgreen (2007) this model characterises change as a condition of disparity among driving forces (insists for change) and restraining forces (insists against change). A force-field analysis is to be done to assess the driving and restraining forces. Kassean and Jagoo (2005) described that Lewin’s model comprises of three phases namely: unfreezing, movement and refreezing.
Implementation of change
In unfreezing stage people are motivated to bring alcohol hand rub in the current practice, by assisting them in identifying the requirement for change. In this phase the team members can be motivated to accept the anticipated change by making enhancing awareness about the strengths of the proposed change and the weaknesses of the current practice. During the movement stage new alternative approaches are used by substituting to the older attitudes, values and behaviours. Where as in moving stage the change is plan in detail and then instigate. This stage includes health educational classes, demonstration of hand washing methods, training programs and wide consultations from multi disciplinary team involves internal and external stake holders. Moreover, each stakeholder plays an important role in planning of a new change. Before the implementation of change it is necessary to scrutinize the availability of resources, cost for new disinfectant (alcohol based hand rub). A complete plan of introduction of new hand rub measures for health care givers can be discussed with the chosen external stakeholders.
Whilst, in the final phase of this model that is refreezing phase the incumbent attitudes, values and behaviours are ascertained as a latest status quo. In refreezing the change is stabilized at the new level within the organization. In this phase the nurses are given the opportunity to thrive and take advantage of the alterations made. As well the leader assists with preservation and evaluation because functions stabilize and the change is included into the systems. In this final phase the traditional practice of poor hand washing will completely remove from the intensive care unit and the change of hand rubbing with alcohol based solution begins to practice. Overall, these phases of the Lewin’s model provide guidance about influencing other people and how to make the implemented change as a standard change.
Certain logistical impediments might arise while working towards the accomplishment of the proposed change. To avoid the adversities in the implementation of a sustained change it is essential to identify the probable hindering factors by using various leadership skills juxtaposed with leadership strategies. Subsequently, the recognized factors must be discussed with the other group members. To formulate strategies accordingly SWOT analysis will be performed. Houben et al. (1999) evaluated that the recognition of SWOT (strengths, weakness, opportunities and threats) is beneficial to focus on strategies for change. The relevant interlocking issues which seem to hamper the attainment of this change are inertia of preceding practice, lack of interest, lack of decentralization of information and cost of alcohol hand rubs. To subdue these obstructing factors it is important to establish a sense of importance, make vision, coalition to direct the change, conquer resistance to change and then the work must be initiated for the successful accomplishment of a task.
Factors influencing leadership
In general, there are some factors, which influence the leadership style such as earlier superiors, values, information, collaboration and education (Vesterinen, 2009). The earlier superiors persuade the leadership in two ways. Some leaders may follow the superior’s behavior as a stimulating example, where as others avoid some habits of their earlier superiors. Furthermore, values of the organization can affect the leadership styles for the introduction of new hand rub methods. Communication problems also have the negative outcome on change implementation in intensive care units. Other factors will be collaboration and co-operation with colleagues. Additionally, education also will affect the leader’s thoughts and opinions regarding the introduction of innovation. It supports the leaders by offering tools to assess their own leadership from diverse point of views.
Role of partnership working
In addition, partnership working is very important in implementation of proposed change to attain a successful implemented change. The implementation of alcohol hand rub can include stakeholders like hospital management, physicians, and consultants, other paramedical staff and external stakeholders. Carroll and Edmondson (2002) concluded that executives have to eloquent a convincing vision of a learning culture that assisted stakeholders to perceive savings as supportive common goals. Lammon et al. (2010) affirmed that effective partnership engrosses shared responsibility for improving patient outcomes. So the leader must joint involve to the partnership through shared knowledge, property, assets, activities and meetings. According to Stanley (2007) generating an effective partnership between organizations should make a new or diverse way of working together..
Besides, each stakeholder plays important role in anticipated change into practice and continuing this practice. The leader can engage the both internal and external stakeholders (health care agencies) to achieve a successful change. For internal stakeholders the leader can arrange educational programs and enhance the members to take inventiveness in attending educational sessions. Also leaders can monitor for practice the change for achievement. Likewise leaders can arrange the training session for external stakeholders to investigate the benefits of change
Evaluation has a pivotal role in motivating and planning change (Petro-Nustas, 1996). A comprehensive evaluation is required to generate options and solutions. It not only gives guidance for institutional problem solving but also provides a foundation for judging whether decisions either to terminate or institutionalize special projects were made on justifiable grounds. According to Senior and Fleming (2006, p.108) the evaluation phase of the change process allows choices in a decision area. Execution of a new change has substantial effects on the practice patterns of the health care providers. Hence, there is always a requirement to audit the current state for converting the change into best practice.
Cummings and Worley (2006, p. 663) defined that evaluation feedback is the information about the overall effects of a change program. Feedback is considerable for evaluation since information will be gathered from health care personals and patients by conducting interviews and group deliberations using questionnaires. Factual data collected from patients and nurses’ feedback will help in appraising the effectiveness of the proposed change. Panel and group discussions will also aid in reviewing the identified change. Moreover, clinical assessments can be performed by observing clinical practice in action to find out whether the educational curriculums assisted in improving the quality of care. The use of all these evaluation strategies can be helpful in predicting the success rate of the identified change.
To sum up, nosocomial infections are the major risk of patients in intensive care unit introduction of alcohol based hand rub reduces the nosocomial infection and improves the quality of care of the critically ill patients in the intensive care unit. Moreover, appropriate leadership styles, theories, qualities, values, beliefs and vision are help to achieve an effective leadership. On top of it, partnership working that includes role of internal and external stake holders plays an imperative role in the implementation of an identified change to attain a successful implemented change. However, there are some barriers and factors can affect the implementation of proposed change. Lewin’s theory helps to overcome these barriers and factors before the implementation of an intended change. Further evaluation can be done with clinical visit or analyzing feedback reports regarding the experience with alcohol hand rub and its effects in reducing nosocomial infection. By running through all these steps health care professionals will be able to gain specialized knowledge and the change would be implemented prosperously.
Brown , S.M., Lubimova, A.V., Khrustalyeva, N.M., Shulaeva, S.V., Tekhova, I., Zueva,L.P., Goldmann, D., O’Rourke, E.J. (2003) Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control Hospital Epidemiology, 24 (3), p. 172 -179. Uchicago [Online]. Available at: http://www.journals.uchicago.edu/doi/pdf/10.1086/502186 [Accessed on: 24 April 2011].
Carroll, J. S. and Edmondson, A.C.(2002) Leading organizational learning in health care, Quality and Safety Health Care, 11(10), p. 51-56.Science direct [Online].Available at: http://ejournals.ebsco.com/Direct.asp?AccessToken=9I5IXI58X9EZK55EPKZXEJXM5PJ48QI1M1&Show=Object [Accessed on: 24 April 2011].
Cummings, G., Lee, H., MacGregor, T., Davey, M., Wong, C., Paul, L and Stafford, E. (2008) Factors contributing to nursing leadership: systematic review. Journal of Health Services Research & Policy, 13 (4), p. 240–248. EBSCOhost [Online]. Available at: http://ejournals.ebsco.com/Direct.asp?AccessToken=9II5MI58X499DX4P1IKUKKMKUUJ18QI1M1&Show=Object [Accessed on: 24 April 2011].
Dijkstra, R., Wensing, M., Thomas, R., Akkermans, R., Braspenning, J., Grimshaw, J. and Grol, R. (2006) The relationship between organizational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis, BMC Health Services Research, 6(53), p.1-10. NCBI [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479332/pdf/1472-6963-6-53.pdfv [Accessed on: 24 April 2011].
Ellis, P. and Abbott, J. (2010) Leadership and management skills in health care. British Journal of Cardiac Nursing, 5 (4), p. 200-203. Internurse [Online]. Available at: https://www.internurse.com/cgibin/go.pl/library/article.cgi?uid=47424;article=cn_5_4_200_203 [Accessed on: 24 April 2011].
Fleming, L. (2004) Excel HSC Business Studies. Singapore: Pascal press Publishers.
Girvin, J. (1998) Leadership and nursing. Great Britain: Macmillan.
Greenfield, D. (2007) The enactment of dynamic leadership. Leadership in Health Services, 20(3), p. 159-168. Emerald [On line]. Available at: http://www.emeraldinsight.com/journals.htm?issn=17511879&volume=20&issue=3&articleid=1617126&show=pdf [Accessed on: 24 April 2011].
Grossman, S. (2007) Assisting Critical Care Nurses in Acquiring Leadership Skills. Dimensions of Critical Care nursing, 26 (2), p. 57-621. EBSCOhost [Online] Available at: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&hid=111&sid=d034cc7b-a673-4ce6-bb22-273b156da1f5%40sessionmgr111 [Accessed on: 24 April 2011].
Houben, G., Lenie, K. and Vanhoof, K. (1999) A knowledge-based SWOT-analysis system as an instrument for strategic planning in small and medium sized enterprises. Journal of decision support systems, 26, p. 125-135. [Online] Available at:http://www.cuaed.unam.mx/puel_cursos/cursos/d_gcfe_m_dos/modulo/modulo_2/m2-10.pdf
Huber, D. (2006) leadership and nursing care management. 3 rd ed. United States of America: Elsevier Health Sciences Publishers.
Kaier, K., Hagist, C., Frank, U., Conrad, A., Meyer, E. (2009) Two Time-Series Analyses of the Impact of Antibiotic Consumption and Alcohol-Based Hand Disinfection on the Incidences of Nosocomial Methicillin-Resistant Staphylococcus aureus Infection and Clostridium difficile Infection. Infection control and hospital epidemiology, 30(4), p. 346-353. Uchicago [Online]. Available at: http://www.journals.uchicago.edu/doi/pdf/10.1086/596605 [Accessed on: 24 April 2011].
Kassean, H. K. and Jagoo, Z. B. (2005) Managing change in the nursing handover from traditional to bedside handover- a case study from Mauritius. Journal of BMC nursing. 4 (1), p.1-6. [Online] Available at: http://www.biomedcentral.com/content/pdf/1472-6955-4-1.pdf [Accessed on: 24 April 2011].
Koch, R. (2007) Public governance and leadership: political and managerial problems in making public governance changes the driver for re-constituting leadership. Germany: DUV Publishers.
Lammon, C. A.B., Stanton, M.P and Blakney, J. L. (2010) Innovative partnerships: the clinical nurse leader role in diverse clinical settings. Journal of Professional Nursing, 26 (5), p. 258-263. ScienceDirect [Online]. Available at: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6WKV512TVRB63&_cdi=6916&_user=7225030&_pii=S8755722310000633&_origin=search&_zone=rslt_list_item&_coverDate=10%2F31%2F2010&_sk=999739994&wchp=dGLbVtzzSkzV&md5=e153850566f3181b8e596ae930b1a39a&ie=/sdarticle.pdf [Accessed on: 24 April 2011].
Mody, L., McNeil, S.A., Sun, R., Bradley, S. F and Kauffman, C. A. (2003) Introduction of a waterless alcohol-based hand rub in a long-term–care facility. Infection control and hospital epidemiology, 24 (3), p. 160-170. Uchicago [Online]. Available at http://www.journals.uchicago.edu/doi/pdf/10.1086/502596 [Accessed on: 24 April 2011].
Nazarko, L. (2007) Developing leadership skills: Managing and leading. Nursing & Residential Care, 9 (1), p. 34-36. Internurse [Online]. Available at: https://www.internurse.com/cgibin/go.pl/library/article.cgi?uid=22579;article=NRC_9_1_34_36 [Accessed on: 24 April 2011].
Neuhause, D. (2003) Florence Nightingale gets no respect: as a statistician that is. Quality and Safety Health Care, 12 (4), p: 317. BMJ [Online]. Available at: http://qualitysafety.bmj.com/content/12/4/317.ful [Accessed on: 24 April 2011].
Petro-Nustas, W. (1996) Evaluation of the process of in traducing a quality development program in a nursing department at a teaching hospital: the role of a change agent. International Journal of Nursing Studies, 33 (6), p. 60-618. SienceDirect [Online]. Available at: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T7T-3W2V3NR31&_cdi=5067&_user=7225030&_pii=S002074899600020X&_origin=search&_zone=rslt_list_item&_coverDate=12%2F31%2F1996&_sk=999669993&wchp=dGLbVzz-zSkzV&md5=06458c75d76f78efb6918dc60b30741a&ie=/sdarticle.pdf [Accessed on: 24 April 2011].
Rigolosi, E.L. (2005) Management and leadership in nursing and health care: an experiential approach. 2nd ed. USA.Springer Publishing Company.
Samuel , R.,Almedom, A.M., Hagos, G. , Albin, S. and Mutungi, A. (2005) Promotion of hand washing as a measure of quality of care and prevention of hospital- acquired infections in Eritrea: the Keren study. African Health Sciences, 5(1), p. 4-13. NCBI [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831903/pdf/AFHS05010004.pdf?tool=pmcentrez[Accessed on: 24 April 2011].
Senior, B. and Fleming, J. (2006) Organizational change. 3rd ed. Harlow: Financial Time Prentice Hall.
Sylvie, G., Wicks, J. L., Hollifield, C. A., Lacy, S. and Sohn, A.B. (2007) Media Management: A Casebook Approach. 4 th ed. United States of America: Taylor and Francis Publishers.
Sims, J.M. (2009) Styles and Qualities of Effective Leaders. Dimensions of critical care nursing, 28(6), p.272-274.NCBI [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19855205 [Accessed on: 24 April 2011].
Stanley, D. (2006) Recognizing and defining clinical nurse leaders. British Journal of Nursing, 15 (2), p. 108-111. Internurse [Online]. Available at: https://www.internurse.com/cgibin/go.pl/library/article.cgi?uid=20373;article=BJN_15_2_108_111 [Accessed on: 24 April 2011].
Vesterinen, S., Isola, A. and Paasivaara, L. (2009) Leadership styles of Finnish nurse managers and factors influencing it. Journal of Nursing Management, 17(5), p. 503-509. EBSCOhost [Online]. Available at: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&hid=111&sid=9ef25987-cd49-41b2-a417-32c14e3dd849%40sessionmgr115 [Accessed on: 24 April 2011].
Wright, S.G. (1989) Changing Nursing Practice. 2nd ed. Arnold.
Zilembo, M. and Monterosso, L. (2008) Nursing students and perceptions of desirable leadership qualities in nurse preceptors: A descriptive survey. Contemporary Nurse, 27(2), p.194-206. EBSCOhost [Online]. Available at: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&hid=110&sid=f709ed50d801-433b-9d53-51876f1f048f%40sessionmgr110 [Accessed on: 24 April 2011].