Leadership in Health Care
Healthcare delivery systems strive to achieve improved patient outcomes through the various administrative and clinical approaches. However, it is a difficult task to realize a new model of leadership by merging the leadership and clinical approaches in the healthcare systems. Over the past several years, caregivers and stakeholders have tried to resolve errors in patient care that lead to deaths that can be avoided (Agrawal, 2009), but little has been achieved concerning the same so far. To solve patient safety, sustainability of finances, capacity, and evidence-based practice, healthcare institutional leaders have to collaborate with clinical leaders. However, this has been difficult to achieve around the world because of the tensions that exist between the groups. Healthcare organizations around the world are based on entities that are bureaucratic and arranged in hierarchies of administration (Yuter, 2011). Nevertheless, the organization is usually faulty since it neglects important issues such as collaboration, interdisciplinary engagement, and promotion of trust. As such, it is a challenge to all healthcare systems around the world regardless of the type of system that can be socialized, centralized systems, or free market public and private systems (Hartley et al., 2008).
Several reports have been generated so far recommending the placement of the patients at the center of care, emphasizing the importance of quality and safety of care by making it a central concern, and promoting clinically guided care at the bedside. Because of the increase of new demands in the healthcare entity, the bodies are trying to develop ways of combining the client management capabilities of caregivers with the financial needs of today’s healthcare delivery systems around the world. As such, it is recommended that shared governance models are implemented, frontline clinical empowerment is promoted to help in making changes, and clinical leadership is advanced.
Present Methods of Integrating Clinical and Administrative Leadership
Shared governance is one of the action plans used today to combine the administrative and clinical leadership. Shared governance is a leadership approach that gives healthcare professional the power to influence their work and extends the same control into central sections that were highly influenced by managers in the past (Myers et al., 2013). The various forms of governance have different influences as determined by the setting that they are applied. In most cases, the various forums supervise practice guidelines, protocols, and policies. In many cases, the entities that exercise governance serve as recommending bodies instead of having the power to execute changes because they work outside the line management context. The shared governance has positive influences since it leads to increased empowerment as well as job satisfaction (Santos, 2013).The other approach used to integrate clinically, and administrative leadership is the frontline staff empowerment and has since been given credibility over time. Many nurses have been able to come up with ideas that can improve the safety and increase patient-centered care delivery. This is after the funding and development of literature that gives nurse tips and guidelines for improving care. The empowerment also led to the development of rapid response teams that play essential roles in reducing hospital acquired infections while at the same time improving the surgical outcomes (Regan & Rodriguez, 2011). The frontline nurses need to be given training, authority, and resources to improve safety and patient care within the hospitals. Besides, the willing participation of the stuff in the frontline nursing empowerment leads to greater achievements in the healthcare system. The power to implement change is critical, and this is the essential element that dictates the effectiveness of the frontline teams (Sherman et al., 2011).
In cases where there is no authority to apply the various changes, it is important that recommendations are given through the bureaucracy while awaiting the decisions. Although the nurses are educated to embrace evidence-based practice, they rarely use this knowledge because of the restriction they have in providing care. In normal circumstances, nurses are expected to analyze the evidence and make decisions according to their understanding after thinking critically and intelligently. However, they are not allowed to this in their job (Baumann, 2010). Besides, they usually lack adequate time and resources that they can utilize to work according to the principles of evidence-based practices because of the patient needs and staff limitations. Stakeholders around the world are trying to address the imbalance between clinical and administrative leadership by focusing on the increase of competence of the clinical leaders as well as their number. The effort targets the development of leadership of both the physician and nurse. However, many frontline staff has been disillusioned around the world because of the increase in managerialism and centralism. As such some countries have devised ways to counter the reality. For instance, in the United Kingdom, physician leaders are being recruited under the enhancing engagement in medical leadership project (Kabir et al., 2008). On the other hand, several programs in the United States are developed to encourage the competency of the physicians in the healthcare environment. The various programs are driven by the need to improve outcomes and reduce costs as well. Besides, the development of physician leaders aims at supporting the participation of doctors at a faster rate. However, the programs face some challenges in some cases since some doctors are not ready to share their thoughts toward the leadership roles in hospitals since they are accustomed to freedom of action in their practice.
Clinical leader roles and leadership education have to be encouraged around to the world to be parallel to the focus in the physician leadership education. For instance, there is the Clinical Nurse Leader (CNL) developed in the United Sates. The role of the CNL is to help monitor healthcare results accountability for a particular group within the hospital. It also sets a design, application, and follow of patient care plans in a research-based information approach. Clinical leadership is regarded as the link to quality improvement in the United Kingdom and Australia (Ferguson, 2007). Such moves aim at giving nurses the ability to make decisions concerning service delivery and patient care and facilitate processes such as quality improvement at the bedside. However, it is important to note that nursing leadership has been prevented by the past medical subordination, lack of readiness to embrace clinical leaders, and feminized professional roots despite the formalization of training and role development in the healthcare system. It is important that improved patient outcomes, safety culture, and clinician driven change are put as the primary objectives of the systems to achieve success in the healthcare organization. As such, many accrediting organizations tend to include the various needs in their programs. The various measures add value and possibility of improving clinical leadership. However, they only address small process changes since the structural and organizational pressures disempower them leading to a competition between the financial sustainability and patient-centered care in the healthcare system. Besides, the physicians are used to autonomy, and this makes them view participation in team efforts with other clinicians and working towards organizational priorities as less important (Hamilton et al., 2008).
Leadership Challenges in Healthcare Organizations
Although the various stakeholders such as the government and regulatory bodies push for improved patient outcomes, the healthcare system lacks a comprehensive remodel of the leadership processes and systems. In many cases, leadership is compared to industry and such viewed as a role instead of a process that can be implemented through other ways art from the administrative hierarchy approaches. Therefore, it is hard to make necessary changes in healthcare by ignoring the healthcare context while demanding for leadership from the clinicians (McDonald, 2014). Leadership is one of the essential areas for development, and this makes, it necessary to develop conditions that can support and improve new leadership models. It is equally important that the nursing profession is disempowered to support the implementation of governance and leadership. In many instances, nursing as a profession is not respected as other professions are respected. Therefore, it is not possible to achieve improved care delivery outcomes by using the clinical leader without the nursing discipline gaining respect like other disciplines and transforming the organizational culture of the working places of the nurses (Katrinli et al., 2008).
The professional background of an individual determines the attitudes they have towards healthcare systems. In most cases, the nurse clinician, general managers, and nurse managers support the standardization of clinical systems and teamwork to achieve improved safety and outcomes (Zwanenberg, 2017). However, some medical constituents who do not support collaboration have rejected the systemizations of clinical initiatives. Besides, it is common to find conflicts over goals and decision-making in cases where physician leaders work with managers instead of improving the various relationships. It is not easy to achieve change because of the complications that arise from the autonomy of doctors that paralyzes safety and quality improvement processes. However, it is possible to reach such when the administrative leadership supports clinical leadership.
Another great challenge faced by the healthcare organization system is financial problems. Financial problems have been the highly ranked concern around the world (Saarnio, 2016). In most cases, the financial interest is followed by patient outcome quality and safety. The role of the healthcare managers is to monitor the measures of safety and quality achievement as often as it is done to support the financial concerns, therefore, it essential that the managers have to be members of the quality team that can focus on the critical processes. For instance, they can concentrate on reducing time wasting and improving effort instead of focusing on staff and supplies as the only key areas that can help address the need to cut costs. Healthcare systems around the world have a need for improved service, increased innovation and integration. However, the processes solution for these requirements does not have empirical evidence of success. All that has been done so far is an attempt to reformat the strategies for decision-making without proper acknowledgment of the administrative structure and processes that limit the transformation. However, it is hard to transition from a top-down leadership style to a leadership that embraces both the non-clinical executives and business values together with the clinical value systems to have a leadership as a process shared between business and clinical areas (Jones, 2007). To achieve effective change, the various players including clinicians, boards, seniors, patient, and finance officers collaborate to face the different issues within the system. In addition to the proposed structural changes, it is important to address other issues such as the adoption of new leadership methods that promote actions that combine the various stakeholders and key players.
Healthcare System Transformation Leadership Framework
To achieve significant improvements such as advanced collaborations, leaving of old models, advanced innovations, and notable transformational change in the healthcare delivery systems it is important to improve the understanding of leadership and implementation of leadership. Some entities are built around principles of stability. However, such policies must be avoided at all costs by healthcare organizations since such systems are not flexible and cannot change (Al-Abri, 2007). As such, the healthcare system has to embrace the shared leadership practice to accommodate the built-to-change system. The practice of shared leadership is helpful because it enables the movement of members in new directions as well as the dispersion of leaders across the country (Al-Sawai, 2013). The shared leadership has several advantages including the spread of information and power in the organization, promotion of quality leadership succession, and easy detection of the needs of the clients because of the closeness of the leaders (Cox, 2016). Today’s leadership requires the use of dispersed unit leaders as opposed to the traditional central centers of command. The new method of dispersing leaders across organizations helps them in improving their knowledge from team members as well as the original participants. The shared leadership can enjoy mutual influence and empowered change among the leaders since it does not depend on orders given by the senior management alone. Therefore, the shared leadership can be said to be an activity that combines the influence from the horizontal and vertical influence.
According to the Center for the Creative Leadership (CCL), leadership is a process that an organization or a community can use to set directions, create alignment, and gain commitment (West et al., 2015). One of the ways of realizing shared leadership is through the promotion of clinical leaders as well as clinical governance. However, this is not the case because physicians cannot be engaged well, administrators and clinical lack trust between themselves, lack of the empowerment of the nursing profession, and the team authority limits weaken the attempts the attempts to initiatives thus requiring new approaches to promote leadership across the organization. The reason for this is that shared leadership needs trust, commitment, and potency. Therefore, the individuals involved in the shared leadership must be knowledgeable and empowered and must have the required authority and resources. The Complexity Leadership Theory (CLT) can be applied to explain well the shared leadership.
According to CLT bureaucratic healthcare systems and complex adaptive systems (CAS) are a network of interacting that are neutral and interdependent but combined with the collective changing common goal and prospect (Uhl-Bien et al., 2007). They are also systems that can change and usually have hierarchies that overlap due to the dynamic network of CAS that is interactive. CLT is useful since it can help in distinguishing management from leadership by considering the context, the organizational patterns, and variations between leaders and leadership. Bureaucracies work in the sense that administrative leadership has to integrate with the unofficial leaders and processes that can be realized the organization applies necessary changes after individuals collaborate with teams to create the various needs (Giltinane, 2013). This is referred to as adaptive leadership and is supported by the Critical Leadership Theory. It helps in developing advanced ideas and changes that can support organizational success. Besides, the type of leadership can be implemented at any level within the organization and individuals and teams in the frontline can organize this kind of leadership. Another kind of leadership supported by the CLT is the enabling leadership form of leadership. Enabling leadership can be regarded as the collaboration between the adaptive and administrative leadership that enhances the use of advanced knowledge and process at work (Boylan, 2016). It also assists in balancing the regulatory ideas and process that have to be supported by the administrative leadership.
Besides, CLT recognizes the lack of harmony between the organizational leadership and adaptive processes and strives to achieve alignment between the two (Uhl-Bien et al., 2007). Healthcare systems need to have strong administrative leadership that can support the adaptive processes that will allow the various individual such as clinicians, engineers, information technology teams to practice the frontline leadership. Besides, healthcare systems must move from the perception of entanglements as problems that need quick solutions rather than opportunities for improvement and discussion. Furthermore, CLT views friction and perspective disparities as an unexploited potential that can be used to support innovation and improvement in healthcare organizations. Furthermore, it helps in defining analysis of leadership from ladder and linear views to a dynamic and non-linear understanding of how individuals, as well as occurrences, affect the changes that were planned earlier (Uhl-Bien et al., 2007). Adaptive and administrative processes have a serious entanglement that must be understood by the leaders in the bureaucratic organizational forms.
Besides, the corporate leaders have to design structures that can allow the adaptive function to operate efficiently. It is also the role of enabling leaders to promote adaptive dynamics and incorporating adaptive outcomes in the formal systems. The reason for this that the enabling leader can operate on the platform between the administrative and adaptive leadership (Bailey et al., 2014). Besides, the adaptive leaders can control adaptive changes by being proficient in identifying rising practical outcomes. Furthermore, it is important that leaders appreciate the fact that leadership is based on contexts and as such, they should learn to interact efficiently with the ever changing and complex environments that they operate in their practice.
The objective of healthcare systems is to achieve improved patient outcomes. As such, many health systems strive to improve their services to realize their goals. One of the ways of achieving the goals is through having leadership that is capable of organizing the various units and individuals in the organizations. However, several challenges are facing the healthcare systems in their attempt to have quality leadership. The problems include lack of comprehensive remodel of leadership processes, professional background attitudes towards leadership, and financial issues among others. However, the various challenges can be addressed by using shared governance, frontline clinical empowerment, and clinical leadership.
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