Sunday, September 16, 2012

Leadership Strategies

Leadership Strategies In the hospital setting many interdisciplinary teams exist to improve patient care. As a member of an interdisciplinary team the nurse is able to provide valuable insight from the nursing perspective and may lead the team to achieve goals. One leadership strategy the nurse may employ is to be a visionary presenting a plan. Enlisting the support of the team to implement a plan through motivation is one example of leadership. A leader must have excellent communication skills to engage the unit staff cooperation in initiating the plan. The unofficial leader builds on abilities to inspire, creates enthusiasm and provides support to the care team members as the plan is implemented. The role of team leader does not have to be by a person in a formal leadership position. Often it is best filled by a front line staff nurse who is able to effectively gather support from her team members on the nursing unit. The leadership strategies exhibited by the nurse are being a visionary, a motivator, a communicator, an inspiration, mentor and even a cheerleader by creating enthusiasm to plan, initiate, implement and evaluate the plan of an interdisciplinary team.
Active Involvement Active involvement of a nurse in the interdisciplinary team allows a well round view of processes that closely impact patient care. By having the nurse represent the nursing unit, much information can be learned about the core patient care area and current processes. If frequent “work arounds” are occurring to either expedite or achieve desired results the nurse is able to explain how and why this maybe occurring. Most processes that need adjusted involve multiple departments, all must have representation by an individual that is will to speak truthfully and openly on behalf of their department. This individual does not need to be the manager but one who portrays the characteristics of a leader and has the respect of the front line staff.
Contributing Position Several ways a nurse can take an active, contributing position within an interdisciplinary team to address sharps injuries are to provide a complete view of processes from the frontline, providing education to frontline staff on team recommendations and helping to evaluate the effectiveness of the plan in action. As an example; if a team is assembled to reduce needle sticks, representatives from materials management, nursing, pharmacy, safety and workers’ compensation may all be members. All members bring a unique expertise to the group. The nurse can provide valuable information about the actual workflow and use of sharp devices on the unit. With everyone’s information a root cause analysis is possible and an effective plan to implement change to protect the staff becomes more realistic. The information may reveal more training is needed, different sharps containers or safety devices are required, or even different staffing patterns may be necessary. The nurse is able to help create a plan that is feasible to the actual workload on the unit, educate unit staff about the team’s plan and is able to provide valuable feedback on measures implemented on the unit to the team for evaluation. Her contribution in this scenario is communication, education, and valuable recommendations based on actual frontline evaluations of devices. Interdisciplinary teams’ success is based on good communication, education of those that will be implementing the recommendation of the team, and the evaluation of the plan for any revisions necessary. (Farrell, Schmitt, & Heinemann, 2001)
Culture of Safety Four characteristics of a culture of safety are explained in the Institute for Healthcare Improvement (IHI) on-line learning course Patient Safety Module, PS 106: An Introduction to the Culture of Safety. Psychological Safety allows people to feel at ease voicing their concerns. They are confident that they will not be belittled or their concerns trivialized. Active leadership provides an atmosphere of camaraderie and trust. Transparency of the organizational leaders builds the level of confidence in the staff necessary to promote a culture of safety. It validates that their concerns or issues reported are addressed and solutions are actively sought. Fairness guarantees that staff will not be blamed for errors as a result of a faulty process. (Frankel & Lonard, 2011) In the healthcare setting staff must be able to feel safe to express their concern. A life may depend on it. A good idea for communication is the SBAR, situation, background, assessment, and recommendation. Active leaders can teach this to their staff so that even a member of the health community not regularly present can be drawn in to actively participate in the culture of safety. This may help build the psychological safety component of this culture. Debriefings can help understand what went wrong or how to improve a situation. Without being quick to assign blame and truly look at a system improvement is possible. A great example is medication delivery. If the medication delivery system is cumbersome or malfunctioning frequently “work-arounds” are employed resulting in medication errors. This is not the fault of one person and will occur again. The system needs to be evaluated so that improvement can occur. In a culture of safety nurses are not afraid to speak up and honestly report the problems and not so safe habits that resulted in the error. In an ideal situation the nurse would have reported the problem and it would have been addressed prior to an event happening without fearing punishment. Not all errors are the result of ineffective systems however; some are due to individual unsafe behaviors. Staff should feel comfortable making leadership aware of those individuals as well.
References Frankel, A., & Lonard, M. (2011). Ps 106: Introduction to the culture of safety. In Institute for Healthcare Improvement Retrieved from Farrell, M., Schmitt, M., & Heinemann, G. (2001). Informal roles and the stages of interdisciplinary team development. Journal of Interprofessional Care, 15(3), 281-295.

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