Leadership & Management in Hospitals & Healthcare Agencies

1. Leadership & Management in Hospitals & Healthcare Agencies Martha Highfield, PhD, RN, AOCN Associate Professor Nursing California State University, Northridge, USA

2. Presented at the invitation of the Guangzhou Municipal Health Bureau Guangzhou, China August 2001

3. Driving Forces • Professional scope & standards of nursing practice • Legal requirements • JCAHO • Fiscal solvency • Ideals of compassionate care & valuing the individual

4. NURSE EXECUTIVE 1. Leading 2. Collaborating & integrating nursing in interdisciplinary environment 3. Facilitating effective, efficient, compassionate care. 4. Evaluating MANAGER 1. Report to executive 2. Defined area 3. Allocate resources for compassionate care 4. Upward & downward communication ANA Administration Standards

5. Leaders Informal or formal More roles Focus on group process Emphasize relationships Direct willing followers Goals Managers Assigned formal position Delegated authority Specific functions, duties, responsibilities Emphasize control, decision-making, analysis & results Manipulate resources Direct willing & unwilling followers Differences: Leader & Manager

6. Both Executives & Managers... 1. Promote vertical & horizontal communication 2. Inspire critical thinking for proper decision-making 3. Efficient & effective: highest possible individualized care at the lowest possible cost

7. Standards • Standards: “Statements that describe a level of care or nursing performance by which the quality of nursing practice can be judged.” (p. 38-9)

8. Standards of Nursing Administration 1. Standards of Care = statement of a competent level of clinical nursing practice, such as identifying problems and planning & taking action to correct them 2. Standards of Performance = statement of competent role activities, such as collaboration & quality of care

9. Standards of Care Standard 1: Assessment Standard 2: Diagnosis Standard 3: Identification of Outcomes Standard 4: Planning Standard 5: Implementation Standard 6: Evaluation

10. Standards of Care 1. Assessment: Develops, maintains, & evaluates patient/client and staff data collection systems and processes to support the practice of nursing and delivery of patient care. 2. Diagnosis: Develops, maintains, & evaluates an environment that supports the professional nurse in analysis of assessment data and in decisions to determine relevant diagnoses

11. Standards of Care (cont.) 3. Identification of Outcomes: Develops, maintains, & evaluates information processes that promote desired client-centered outcomes 4. Planning: Develops, maintains, & evaluates organizational planning systems to facilitate the delivery of nursing

12. Standards of Care (cont.) 5. Implementation: Develops, maintains, & evaluates organizational systems that support implementation of the plan 6. Evaluation: Evaluates the plan and its progress in relation to the attainment of outcomes.

13. Standards of Professional Performance • Standard 1: Quality of care • Standard 2: Performance appraisal • Standard 3: Education • Standard 4: Collegiality • Standard 5: Collaboration • Standard 6: Research • Standard 7: Resource utilization

14. Standards of Performance 1. Quality of Care & Administrative Practice: Systematically evaluates the quality and effectiveness of nursing practice & nursing services administration 2. Performance Appraisal: Evaluates own performance based on professional practice standards, relevant statutes & regulations & organization criteria

15. Standards of Performance (cont.) 3. Education: Acquires & maintains current knowledge in administrative practice 4. Collegiality: Fosters professional environment 5. Ethics: Decisions & actions are based on ethical principles

16. Standards of Performance (cont.) 8. Collaboration: Collaborates with nursing staff at all levels, interdisciplinary teams, executive officers, and other stakeholders 9. Research: Supports research & integrates it into the delivery of nursing care & administration 10. Resource Utilization: Evaluates & administers the resources of organized nursing services

17. Standards met incarrying out Decision-Making

18. Decision-Making • Fundamental skill for all aspects • Traditional decision-making starts with identifying problem • Management decision-making starts with writing objectives--fixed end goals

19. List alternatives down the first column on left For each write out Financial effect Political effect Department effect Time Last column write decision about each alternative Decision-Making Grid

20. Standards met incarrying out Planning

21. Roles & Functions: Planning • Mission • Philosophy • Goals & objectives • Strategies to achieve goals & objectives: programs, policies, procedures • Time management • Delegation

22. Overcoming Barriers to Planning • Goals & objectives increase effectiveness • Plan is a guide & must be flexible • Include all stakeholders in planning • Plans should be simple, specific, realistic • Planned change

23. Planning: Managing Change • STAGE 1-UNFREEZING • STAGE 2 - MOVEMENT • STAGE 3 - REFREEZING

24. 1. Equilibrium 2. Denial 3. Anger 4. Bargaining 5. Chaos 6. Depression 7. Resignation 8. Openness 9. Readiness 10. Reemergence Planning: Emotional Stages of Change

25. Planning: Time Management 1. Prioritizes day-to-day planning to meet short-term & long-term unit goals 2. Schedules time for planning 3. Analyzes others’ use of time 4. Eliminates environmental barriers 5. Handles paperwork promptly & efficiently

26. Time management (cont.) 6. Breaks down large tasks into smaller achievable ones. 7. Uses technology for documentation & communication 8. Discriminates between inadequate staffing & inadequate time

27. Planning: Examples of Specific Strategies • Use last 30-60 minutes of day to plan next & clean desk • Plan what you will do in each 30-60 minute block • Number tasks in order of priority • Start with most difficult priority task & work for set time • Plan communication with staff

28. Standards met incarrying out Organizing

29. Roles & Functions:Organizing Delivery of Nursing Care • Organizational structure • Authority & power in organizations • Nursing systems • Organizing client care • Committees • Nursing informatics

30. Organizing: Management Functions 1. Understand agency’s structure & personal responsibility & authority within it 2. Informs staff of unit organizational chart 3. Maintains & clarifies unity of command as possible 4. Follows subordinate complaints upward 5. Establishes proper span of control

31. Organizing: Management Functions 6. Knowledgeable about agency culture 7. Uses informal organization to meet agency goals 8. Uses committee structure for quality & quantity of work

32. Organizing: Decision-Making • Centralized: Few managers at the top • Decentralized: At the lowest level possible

33. Organizing: Assessing Culture 1. How does the organization view physical environment? 2. What is the organization’s social environment? 3. How supportive is the organization 4. What is the organizational power structure? 5. How does the organization view safety? 6. What is communication environment? 7. What are organization taboos & heroes?

34. Organizing: Span of Control • “The appropriate number depends on the organization, the maturity of the subordinates, and the type of work to be done. An inappropriate span of control can result in inefficiency.” (p. 161, Marquis & Huston, 2000)

35. Organizing: Committees • Groups who want to work on a project • Manager must give parameters--A clear assignment with deadlines • Written agendas & chairperson • Large enough to do task; small enough to talk • Discourage “group think”

36. Organizing: Patient Care

37. Organizing: Patient Care

38. Organizing: Patient Care

39. Organizing: Patient Care • Primary Nursing • 1 RN plans & manages care for the patient in collaboration with Associate RNs • Interfaces with MD, Charge RN, & resources • Case Management • All RNs use resources to expedite health; OR • A special nurses monitors & facilitates use of resources in the agency for many patients in collaboration with their nurses

40. Organizing: Informatics • Data recording & retrieval used to • Manage care • Monitor care • Computer/technology • RNs must be educated

41. Standards met incarrying out Staffing

42. Roles & Functions: Staffing 1. Personnel 2. Fiscal planning/budgeting 3. Staffing & scheduling 4. Staff Development

43. Staffing: Management Functions 1. Ensures adequate, skilled workforce to meet agency goals 2. Shares recruitment responsibility 3. Interviews with proper techniques 4. Develops selection criteria 5. Places based on agency needs & employee strengths 6. Interprets employee handbook 7. Participates in employee orientation.

44. Staffing: Personnel • Recruiting: Actively seeking out and hiring those who can best do job • Interviewing: • Based on specific job criteria • Best predictor of future performance is past performance • Give person clear information about job • Try to contradict your first impressions • More than 1 interviewer is ideal

45. Staffing: Structured Interview • Motivation • Physical • Education • Work experience • Present work • Previous work • Personal characteristics & goals • Anticipated contributions to this agency

46. Staffing: Orientation & Socialization • Orientation --> Competence --> Quality • Socialization • Introduce to others & their roles • Coach as take on role responsibilities • “Carrot & stick” • Recognize current skills & knowledge & build on these

47. Staffing: Scheduling • Scheduling should • Meet agency need • Be fair to all • Policies should include, for example • Lateness, absence, illness, emergencies • Vacations & regular time off; Special requests • Expectations for working in other areas of the agency

48. Staffing: Scheduling & Budgeting NCH/PPD = Nursing hours in 24 hour period Patient census • Acuity of patients calculated to adjust RNs • Cost controlled

49. Staffing: Staff Development • Interface with educators • Own role in orientation & motivation • Preceptor program • Identification of clinical & teaching expertise • Education of preceptor • Adjustment in assignments of preceptor & new staff • Competence checklists

50. Standards met incarrying out Directing