Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

Aims Clinical Leadership Lecturer: Ms. Comfort Chima • • • • • To discuss what clinical leadership is Explore the importance of clinical leadership Compare leadership and management Review the five core dimensions of leadership Deliberate on the art and science of leadership RCSI DEVELOPING HEALTHCARE LEADERS WHO MAKE A DIFFERENCE WORLDWIDE Introduction • A more modern conceptualisation sees leadership as something to be used by all but at different levels • This model of leadership is often described as shared, or distributed leadership and is especially appropriate where tasks are more complex and highly interdependent – as in healthcare • Clinical leadership can be defined as the expert nurse who leads patients to better health care • The importance of effective clinical leadership is ensuring a high quality health care system that consistently provides safe and efficient care, sustaining improvements to care quality and patient safety Activity Can you identify situations where you have been a leader and when you have been a follower? Clinical Leadership role PEOPLE Outcomes, Activities, Behaviours + RESOURCES KNOWLEDGE SKILLS ABILITIES VARIABLES LEADERSHIP/ MANAGEMENT ACHIEVE VISION Leadership & Management • The terms could be used interchangeably • Difference between them not straightforward • Jot down ideas of the difference between a manager and leader in healthcare Management • • • • • Management & Leadership Management matters without it nothing happens Equated ‘sneeringly’ to bureaucracy ‘men in grey suits’ Management, leadership and administration ‘Front line’ and ‘back office’ “Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.” Stephen Covey Comparing Leadership & Management Leadership • • • • Based on influence and sharing An informal role An achieved position Part of every healthcare professional’s responsibility • Initiative • Independent thinking Management • Based on authority and influence

• A formally designated role • An assigned position • Usually responsible for budgets, hiring and firing people • Improved by the use of effective leadership skills MANAGEMENT LEADERSHIP Produces Order & Consistency Produces Change & Movement Planning & Budgeting • • • Organising & Staffing • • • Provide structure Make job placements Establish rules & procedures Controlling & Problem Solving • • • Establish Direction Establish agendas Set timetables Allocate resources Develop incentives Generate creative solutions Take corrective action • Create a vision • Clarify big picture • Set strategies Vs Aligning People • Communicate goals • Seek Commitment • Build teams & coalitions Motivating & Inspiring • Inspire & energize • Empower subordinates • Satisfy unmet needs Northouse (2007:8) 5 core dimensions of Leadership This is drawn from the MLCF/CLCF: (Medical Leadership Competency Framework)(Clinical Leadership Competency Framework) • There are two additional dimensions – Creating the vision – Delivering the strategy Demonstrating Personal Qualities There are five domains highlighted • Demonstrating Personal Qualities • Working with Others • Managing Services • Improving Services • Setting Direction Demonstrating Personal Qualities Need to demonstrate competency in: • Effective leaders need to draw upon their values, strengths and abilities to deliver high standards of care • Effective leadership requires individuals to draw upon their values, strengths and abilities to deliver high standards of service. To do so, they must demonstrate effectiveness in: • Developing self awareness • Managing yourself • Continuing Personal Development • Acting with Integrity • Developing self awareness by being aware of their own values, principles, and assumptions, and by being able to learn from experiences • Managing yourself by organising and managing themselves while taking account of the needs and priorities of others • Continuing personal development by learning through participating in continuing professional development and from experience and feedback • Acting with integrity by behaving in an open, honest and ethical manner Working with others Needs to demonstrating competence in: • Developing networks • Building and Maintaining Relationships • Encouraging contribution • Working within Teams • Developing networks by working in partnership with patients, carers, service users and their representatives, and colleagues within and across systems to deliver and improve services • Building and maintaining relationships by listening, supporting others, gaining trust and showing understanding • Encouraging contribution by creating an environment where others have the opportunity to contribute • Working within teams to deliver and improve services Managing Services

• Effective leadership requires individuals to focus on the success of the organisation(s) in which they work. To do so, they must be effective in: Working with others • Effective leadership requires individuals to work with others in teams and networks to deliver and improve services. To do so, they must demonstrate effectiveness in: Managing Services Developing competency in: • Planning • Managing resources • Managing people • Managing performance • Planning by actively contributing to plans to achieve service goals • Managing resources by knowing what resources are available and using their influence to ensure that resources are used efficiently and safely, and reflect the diversity of needs • Managing people by providing direction, reviewing performance, motivating others, and promoting equality and diversity • Managing performance by holding themselves and others accountable for service outcomes. Improving Services Demonstrates competence in: • Ensuring Patient Safety • Critically evaluating • Encouraging Improvement and innovation • Facilitating Transformation Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

• Ensuring patient safety by assessing and managing risk to patients associated with service developments, balancing economic consideration with the need for patient safety • Critically evaluating by being able to think analytically, conceptually and to identify where services can be improved, working individually or as part of a team • Encouraging improvement and innovation by creating a climate of continuous service improvement • Facilitating transformation by actively contributing to change processes that lead to improving healthcare Setting Direction Effective leadership requires individuals to contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. To do so, they must demonstrate effective in: Improving Services • Effective leadership requires individuals to make a real difference to people’s health by delivering high quality services and by developing improvements to services. To do so, they must demonstrate effective in: Setting Direction Demonstrate competence in: • Identifying the context for change • Applying Knowledge and evidence • Making decisions • Evaluating impact • Identifying the contexts for change by being aware of the range of factors to be taken into account • Applying knowledge and evidence by gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvements • Making decisions using their values, and the evidence, to make good decisions • Evaluating impact by measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions. The art & science of leadership Is clinical leadership an art or science ??? Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

• Florence Nightingale (1920-1910) once said: ‘Nursing is an Art’ • So any nurse who leads in any capacity, is an artist and fosters a passion for creativity and innovation Leadership is both an art and a science – An art as many of the skills and qualities cannot be learned – Science as there is growing body of knowledge that that describes the leadership process Daft 2017 Good to Great, Level 5 Leaders •Future •Engage •Deliver Help people see the future, create a future that is compelling, makes best use of their skills. Move from the present. Engage with people: open & honest conversations. Feedback Maintain a healthy emotional bank account. Listen and hear. Be present. Autonomy. Cross sectors/ boundaries Mobilise the team’s drive for improvement, provide a sense of purpose, hold people to account, drive for results and celebrate success so people feel they have done something important . Make things happen • Many people have the potential to be level five leaders • Most level five leaders come from within their companies • Level five leaders, get the right people on the bus… and the wrong people off the bus, and then figured out where to drive it • When in doubt…..don’t hire – keep looking • All good to great companies had level Five leaders • Level 5 = personal humility and professionalism • Modest and safe effacing, motivated to produce sustainable results, plough horses • Look out the window to attribute success, in the mirror when things go wrong • When you need to make people change – act • Put your best people on your biggest opportunities, not your problems Create a climate.. • Lead with questions…not answers • Engage in dialog and debate not coercion • Conduct investigations without blame • Build red flag mechanisms to identify essential information that cannot be ignored ………and a question for you What actions do you need to take to become the leader you aspire to be? Poor Leadership Poor leadership has a cost, Francis – what he identified: • preventable deaths • insufficient attention to professional standards • a weak professional voice in management decisions • acceptance of poor standards of conduct • low staff morale – demoralised • a lack of any systematic approach to coordinating care • very poor communication Reference • • • • • • Any Question ? Barr J. & Dowding L. (2019) Leadership in Health Care (4th edn) Sage Publication. UK. Daft R (2017) The Leadership Experience (6th edn). Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

India: Centage. Ennis G., Happell, B., & Reid-Searl, K. (2016). Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing. Issues In Mental Health Nursing, 37(5), 353-359. Mannix J., Wilkes, L., & Daly, J. (2015). ‘Watching an artist at work’: aesthetic leadership in clinical nursing workplaces. Journal of Clinical Nursing, 24(23/24), 3511-3518. Mannix J., Wilkes, L., & Daly, J. (2015). ‘ Good ethics and moral standing’: a qualitative study of aesthetic leadership in clinical nursing practice. Journal of Clinical Nursing, 24(11/12), 1603-1610. McNamara M. S., Fealy, G. M., Casey, M., Geraghty, R., Johnson, M., Halligan, P., & Butler, M. (2011). Boundary matters: clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care. Journal of Clinical Nursing, 20(23/24), 3502-3512. Clinical Leadership Lecturer: Ms. Comfort Chima RCSI DEVELOPING HEALTHCARE LEADERS WHO MAKE A DIFFERENCE WORLDWIDE Aims • • • • • To discuss what clinical leadership is Explore the importance of clinical leadership Compare leadership and management Review the five core dimensions of leadership Deliberate on the art and science of leadership Introduction • A more modern conceptualisation sees leadership as something to be used by all but at different levels • This model of leadership is often described as shared, or distributed leadership and is especially appropriate where tasks are more complex and highly interdependent – as in healthcare Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

• Clinical leadership can be defined as the expert nurse who leads patients to better health care • The importance of effective clinical leadership is ensuring a high quality health care system that consistently provides safe and efficient care, sustaining improvements to care quality and patient safety Activity Can you identify situations where you have been a leader and when you have been a follower? Clinical Leadership role PEOPLE Outcomes, Activities, Behaviours + RESOURCES KNOWLEDGE SKILLS ABILITIES VARIABLES LEADERSHIP/ MANAGEMENT ACHIEVE VISION Leadership & Management • The terms could be used interchangeably • Difference between them not straightforward • Jot down ideas of the difference between a manager and leader in healthcare Management • • • • • Management matters without it nothing happens Equated ‘sneeringly’ to bureaucracy ‘men in grey suits’ Management, leadership and administration ‘Front line’ and ‘back office’ Management & Leadership “Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.” Stephen Covey Comparing Leadership & Management Leadership • • • • Based on influence and sharing An informal role An achieved position Part of every healthcare professional’s responsibility • Initiative • Independent thinking Management • Based on authority and influence • A formally designated role • An assigned position • Usually responsible for budgets, hiring and firing people • Improved by the use of effective leadership skills MANAGEMENT LEADERSHIP Produces Order & Consistency Produces Change & Movement Planning & Budgeting • • • Establish agendas Set timetables Allocate resources Organising & Staffing • • • Provide structure Make job placements Establish rules & procedures Controlling & Problem Solving • • • Establish Direction Develop incentives Generate creative solutions Take corrective action • • • Vs Create a vision Clarify big picture Set strategies Aligning People • • • Communicate goals Seek Commitment Build teams & coalitions Motivating & Inspiring • • • Inspire & energize Empower subordinates Satisfy unmet needs Northouse (2007:8) 5 core dimensions of Leadership This is drawn from the MLCF/CLCF: (Medical Leadership Competency Framework)(Clinical Leadership Competency Framework) • There are two additional dimensions – Creating the vision – Delivering the strategy There are five domains highlighted • Demonstrating Personal Qualities • Working with Others • Managing Services • Improving Services • Setting Direction Demonstrating Personal Qualities • Effective leaders need to draw upon their values, strengths and abilities to deliver high standards of care Demonstrating Personal Qualities Need to demonstrate competency in: • Developing self awareness • Managing yourself • Continuing Personal Development • Acting with Integrity • Effective leadership requires individuals to draw upon their values, strengths and abilities to deliver high standards of service. To do so, they must demonstrate effectiveness in: • Developing self awareness by being aware of their own values, principles, and assumptions, and by being able to learn from experiences • Managing yourself by organising and managing themselves while taking account of the needs and priorities of others • Continuing personal development by learning through participating in continuing professional development and from experience and feedback • Acting with integrity by behaving in an open, honest and ethical manner Working with others Needs to demonstrating competence in: Nursing Leadership at all Levels Basing on The Covid 19 Pandemic

• Developing networks • Building and Maintaining Relationships • Encouraging contribution • Working within Teams Working with others • Effective leadership requires individuals to work with others in teams and networks to deliver and improve services. To do so, they must demonstrate effectiveness in: • Developing networks by working in partnership with patients, carers, service users and their representatives, and colleagues within and across systems to deliver and improve services • Building and maintaining relationships by listening, supporting others, gaining trust and showing understanding • Encouraging contribution by creating an environment where others have the opportunity to contribute • Working within teams to deliver and improve services Managing Services Developing competency in: • Planning • Managing resources • Managing people • Managing performance Managing Services • Effective leadership requires individuals to focus on the success of the organisation(s) in which they work. To do so, they must be effective in: • Planning by actively contributing to plans to achieve service goals • Managing resources by knowing what resources are available and using their influence to ensure that resources are used efficiently and safely, and reflect the diversity of needs • Managing people by providing direction, reviewing performance, motivating others, and promoting equality and diversity • Managing performance by holding themselves and others accountable for service outcomes. Improving Services Demonstrates competence in: • Ensuring Patient Safety • Critically evaluating • Encouraging Improvement and innovation • Facilitating Transformation Improving Services • Effective leadership requires individuals to make a real difference to people’s health by delivering high quality services and by developing improvements to services. To do so, they must demonstrate effective in: • Ensuring patient safety by assessing and managing risk to patients associated with service developments, balancing economic consideration with the need for patient safety • Critically evaluating by being able to think analytically, conceptually and to identify where services can be improved, working individually or as part of a team • Encouraging improvement and innovation by creating a climate of continuous service improvement • Facilitating transformation by actively contributing to change processes that lead to improving healthcare Setting Direction Demonstrate competence in: • Identifying the context for change • Applying Knowledge and evidence • Making decisions • Evaluating impact Setting Direction Effective leadership requires individuals to contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. To do so, they must demonstrate effective in: • Identifying the contexts for change by being aware of the range of factors to be taken into account • Applying knowledge and evidence by gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvements • Making decisions using their values, and the evidence, to make good decisions • Evaluating impact by measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions. The art & science of leadership Is clinical leadership an art or science ??? • Florence Nightingale (1920-1910) once said:

‘Nursing is an Art’ • So any nurse who leads in any capacity, is an artist and fosters a passion for creativity and innovation Leadership is both an art and a science – An art as many of the skills and qualities cannot be learned – Science as there is growing body of knowledge that that describes the leadership process Daft 2017 •Future •Engage •Deliver Help people see the future, create a future that is compelling, makes best use of their skills. Move from the present. Engage with people: open & honest conversations. Feedback Maintain a healthy emotional bank account. Listen and hear. Be present. Autonomy. Cross sector … Nursing Leadership at all Levels Basing on The Covid 19 Pandemic