CLINICAL LEADERSHIP WITHIN THE CONTEXT OF IMPROVING SAFE AND PERSON-CENTRED CARE

 

Author’s Name:

 

Tutor:

Course/Class:

Institutional Affiliation

Department

City/State:

 

Date:

 

 

 

 

 

 

Table of Contents

Clinical Leadership within the Context of Improving Safe Effective and Person-Centered Care. 2

Introduction. 2

The Case for Clinical Leadership. 3

Defining Clinical Leadership. 4

The Role of Leadership in Contemporary Healthcare. 4

Advanced Nurse Practitioners. 6

Advance Nurse Practitioners and Clinical Leadership. 6

Leadership Styles in the Scotland NHS. 6

Policy Issues Relating to Barriers and Facilitators of Leadership. 8

Barriers. 8

Facilitators. 9

Conclusion. 10

Bibliography. 10

 

 

 

 

 

 

 

 

Introduction

Throughout the world, contemporary hospital care has continued to struggle with numerous challenges amidst rising demand, changing consumer expectation and then need to ensure patient-centred care. Clinical leadership has become apparent in the provision of quality and safe care. Healthcare systems have continued to change. While some progress and change have been achieved so far, many experts expound on the need for further changes in the healthcare system in order for more people and more individuals to access quality and affordable care into the future (Daly et al. 2014 p.75). Many stakeholders in the healthcare sector agree that leadership must be experienced from the doctors and other clinicians, in their informal or informal capacities.

The urge for leadership in the clinical context has not always been existent. However, nurses and other clinician have continued to offer leadership and managerial service. The need for more engagement into leadership has, however, been fuelled by many developments in a few decades ago. In the last few decades, healthcare systems globally have been the subject to regulation and accountability aimed at driving change and exercising control over clinical activities. Despite the increase in regulation and control, there have been specific imbalances between clinical power and financial power. Anderson (2018 p.14) writes that clinical power entails the authority and mandate that is held by clinicians in decision making. On the other hand, the financial power entails the power of the government has the sole provider of public health, hence mandated with the provision of resources required in the clinical setting.

The influence of financial power over clinical power has seen to be ineffective. Top-down approaches to management have since been ignored, for several reasons. Doctors and other caregivers occupy a special position in relation to the care receivers and the general public. Doctors always tend to have an important position to play in the implementation of policies and other changes that have rather been developed by non-experts in the clinical setting. However, over the years, the role of doctors and clinicians in policy implementation has been incremental. In that, nurse and other experts are now seen as important in the coordination of care that is system-wide and focused on the needs and expectations of the care receivers (Joseph & Huber, 2015).

Due to the economic burden of care, there has been an absolute need to engage caregivers.  Indeed, the provision of healthcare has become expensive, and the need to improve the quality of care is challenged with the provision of limited resources. Caregivers have shown the capability to provide workers with a limited resource through patient advocacy. Equally, patients have shown the desire to engage clinicians in the rationalisation and allocation of resources. Doctors and other caregivers today have been provided with an incentive to engage in leadership directly. Clinical leadership has become an important and integral part of the nursing practice.

Defining Clinical Leadership

Just like leadership, the concept of clinical leadership can be described in varying ways.  There lacks a standard definition of leadership. Literature review on clinical leadership tends to focus on what may be the difference between effective clinical leadership and ineffective clinical leadership, relative to offering optimal care and overcoming care barriers in the clinical environment. Lamb et al. (2018) explored some of the forms of ineffective leadership through secondary research. Three forms of ineffective leadership were identified. They include the placating avoidance, in which a leader shows concerns but fails to act; equivocal avoidance, in which leader are docile in response and hostile avoidance; where the leaders tend to become hostile towards the subject.

Contemporary healthcare is built around hospitals. In Scotland, hospital and other care facilities have continued to experience increased strain and scrutiny. Anderson (2017 .31) notes that increased demand and fiscal requirement have continued to pressure hospitals. Hospitals have been required to increase their accountability, scrutiny and visibility relative to care. One of the inquiries from the Francis (2013) report was gross incompetency in NHS leadership.

In the contemporary healthcare sector, the roles and responsibilities place on leaders have become more and more complex; thus, the need for different forms of leadership has become an apparent urgency. To ensure that cost efficiency is achieved, and to improve productivity, immense changes in the reorganisation of leadership style has been experiencing. Joseph & Huber (2015 p.56) notes that coupled with related financial goals is growing attention towards improving safety and quality. Hence some of the common assumptions of leadership have been ignored as they are not well suited in delivering the changes expected in point of care. Accordingly, there have been calls for a transition into a new approach of hospital leadership as a major transformational shift in the conceptualisation of leadership. This shift has been in part in response to the growing recognition that having designated leaders that assume a position of leaders is fundamental feature of clinical practice and ensuring that demand-driven change in enacted.

Some of the issues that have led to shifts in leadership approaches include overwhelming evidence that nurses and other clinicians may experience dissatisfaction within their working environments (Shariff, 2014 p.10). The strained relationship between the administration and clinical practices are well evidenced in the NHS, writes (Shariff, 2014). In the last few decades, different forms and layers of leadership have been developed to overcome such disparities, with consensus towards the need to enact leadership that will meet the needs and expectations of clinicians rather than meeting the traditional managerial function. These include the advancement of leadership within the area of Advanced Nurse Practitioners.

The role of the Advanced Nurse Practitioner has been in existence, as early as the 1960s in the United States. In the United Kingdom, the need to create a clear career progression led to the development of the ANP. To this day, the function and role of the ANP and its definition varies from one country to another. In Scotland, the 2015 report of Pulling Together; Transforming Urgent Care for the People of Scotland as reported in RCN (2012) highlighted the need to adopt a consistent definition of ANPs relative to the description of their roles, competencies, education needs and compensation (Scottish School of Primary Care, 2019). Hence ANPs were defined as highly experienced, educated registered nurses who are engaged in the management of complete clinical care of patients and not focusing on any sole factor.  ANPs are additionally described by their the advanced –level-capability in four major domains clinical practice facilitating learning leadership and evidence, research and development. On qualification, ANP’s are expected to have attained education at Master Degree Level; be non-medical prescribers and demonstrate competence in their level of practice following assessment. One of the key competencies of an ANP is leadership. The other three include clinical practice, facilitating learning, evidence, research and development (Anderson 2018). The ANP works at this experienced level of practice characterised by a degree of autonomy and complex decision making higher than usually expected, (Chief Nursing Officer Directorate, Scottish Government (CNOD) 2017). The role focuses on preventative care, health promotion and disease prevention as well as the management of patients with acute and chronic health issues.

Leadership Styles in the Scotland NHS

Before the advent of advanced nurse practitioner, various leadership styles have shown to the prevalent in the NHS.  Joseph & Huber (2015, p.59) notes that these forms of leadership are rigid and do not meet the dynamic needs of healthcare today. One such kind of leadership is the heroic leadership. Transactional leadership is the most heroic form of leadership, explains Lamb, et al. (2018) It is a leadership style in which the leader leads without forming any form of leadership and expected others to follow. Transactional leadership has been criticised for various limitations, especially when applied in the clinical setting. One is that it fails to take into consideration the role of culture. Secondly, this form of leadership is more poised towards attaining results more of managerial rather than leadership.

Transformational leadership is one style of leadership that is based on vision. Transformational leadership is described as a partnership between the leader and the subjects towards attaining an intended change. Transformational leadership is based on evidence-based practice theory that is used as a strategy and deployed as a style for realising change within the complexity of care and the use of interdisciplinary teams. The relational nature of transformational leadership style has been deemed a vital management practice for clinical leadership education and development (Lamb et al. 2018).

The healthcare context is always complex, and thus, certain leadership styles may not serve the intended purpose of patient-centred care. Hence a number (hence and a number are used repetitively) of other strategies have been used to complement leadership approaches in the provision of safe and effective care. One such approach is multi-disciplinary or inter-professional working (RCN, 2012). Royal college of nursing should be written in the full first time. This entails persons from different backgrounds like nurses, physicians and doctors working together in a manner that brings about collaboration. This style has, however, been challenged, since different professional tend to manifest values within their profession as opposed to working collaboratively. On the other hand, inter-professional approaches have been deemed vital in environments that require the input of various discipline. Multi-professional teamwork has been deemed as a means towards rendering teams more effective and meeting the care need of individual and communities within a single framework. When applied within the concept of community care, multi-disciplinary approaches have shown exemplary success. Where is the evidence of this – needs reference?

Frontline leadership is another form of leadership that has been adopted in the Scotland NHS to resolve several issues (RCN, 2012). Several issues promoted the adoption of the frontline leadership style. One was to ensure that competencies and skills of frontline nurse and midwives are supported to assume a central role in the promotion of healthcare. Another important aspect was to identify the potential and benefits for nurses and midwives. A report filed by the RCN (2012) outlined that the public was not aware of the role of the ANP, especially those that had not received any care before.  The public perception of the nurse as just caregivers had been shown to undermine their role as leaders, a major barrier facing ANP nurses.

Barriers

The role of the ANP has always remained controversial, in most times leaving them exposed to the criticism of their actual roles. Existing policies have contributed towards the role and function of the ANP has a leader. The ANP is viewed to offer sets of function patient-centred leadership and organisational leader. As noted earlier, the ANP role has been developed around the role of a clinical practitioner. The ANPs attachment to their nursing identity has indeed become a major barrier. For instance, when working in a multi-disciplinary team, their leadership competencies are often overlooked (Cardiff et al., 2018 p.20).  Due to the nature of their professional focusing on clinical care, ANPs are often assumed to lack competence in managerial aspects integral to leadership like finance and healthcare policy, note McGuirre et al. (2016)

Existing policies surrounding the hierarchy of power between ANP nurse and doctors have resulted in collaborative issues, hence undermining their function as leaders (Anderson, 2018). A follower can only be supportive of the course of the leader if he or she is subordinate (Joseph & Huber, 2015).  In those cases, rather than serving as subordinates to ANPs, doctors are more likely to look down on the ANPs as mere clinician notes Shariff (2014). Such hierarchical issues remain unresolved even as the NHS seeks to mainstream the leadership function of ANPs.  Studies have shown that doctors will tend to achieve full authority while ANPs are struggling to remain relevant to the hybrid roles.

Facilitators

The Scottish government, just like other governments, have sought to resolve some of the issues surrounding the role of ANP as leaders. Some of the policy changes have been realised. These include the adoption of the ANP definition that recognises leadership as their function and an area that they ought to achieve competence prior to placement. The defined scope is also in line with the level of education and skills that nurse leaders are accorded (Scottish School of Primary Care, 2019). The development of tools like The Healthcare and Leadership Model, (National Health Service (NHS) 2013), is one example of a self-directed tool designed to highlight areas requiring further development. It is a user-friendly and evidenced-based program that suggests nine dimensions of leadership behaviour and expectations that accentuates the importance of personal qualities and personal awareness.

It is debatable that nine dimensions are enough as many external factors can affect the outcome such as locality, finance and isolation.  It is, however, a useful tool in that it is clear on ‘what it is,’ and ‘what it is not.’ (NHS 2013). The intention, as with any leadership tool, is to assist nurse leaders in developing an understanding of their strengths and weaknesses, through self -awareness, critical reflection and role modelling, (NHS 2013). Nurse leaders are prepared to take charge of disciplinary and multi-professional team function. Equally, they have been actively involved in developing strategies and policies for health care. The current educational provisions of ANPs have been developed to reflect the complex leadership needs (Shariff, 2014 p.14). The development of the doctoral nurse program (DNP) is one of the attempts to ensure that they are well equipped and prepared in the leadership and mange of organisation as a business within the practice of healthcare. NHS Scotland has created frameworks that outline leadership requirements that nurse leaders should fulfil, discusses Anderson (2017). Additionally, the fulfilment of leadership resource needs is dependent of the patient-centred care approach has been deemed vital in promoting the function of ANPs in their leadership and clinical role (Scottish School of Primary Care, 2019)

Due to the ongoing changes in the clinical setting, the need for clinical leadership has become an integral part of the provision of care. The literature review shows the ongoing changes, issues, challenges and opportunities facing ANP nurse leaders. ANP nurse leadership has been aimed at bridging leadership gaps that have been existing in healthcare. Despite the advancement of the specialised role of ANPs, their leadership function is still not well fitted.  ANPs ought to function as both clinical nurse and leaders. The increased scope of practice in clinical and leadership roles also dawns with complexities. The role of the ANP leader still overlaps other leadership position in the healthcare setting. This undermines approaches like multi-disciplinary practices that should promote patient-centeredness. Primarily this and several other barriers have been identified, and policies changes have been enacted to promote the function of leadership.

Anderson, C., 2017. Leadership experiences of London-based Advanced Nurse Practitioners: A Case Study, s.l.: University College London.

Anderson, C., 2018. Exploring the role of advanced nurse practitioners in leadership. Nursing Standards, 33(2), pp. 29-33.

Cardiff, McCormack & McCance, 2018. Person-centred leadership: A relational approach to leadership derived through action research. Journal of Clinical Nursing, 1(2), pp. 15-26.

Daly et al., 2014. The importance of clinical leadership in the hospital setting. Journal of Healthcare and Leadership, 1(3), pp. 75-83.

Joseph, L. & Huber, D. L., 2015. Clinical leadership development and education for nurses: prospects and opportunities. Journal of Healthcare Leadership, p. 55–64.

Lamb, A., Martin‐Misener, R., Bryant‐Lukosius, D. & Latimer, M., 2018. Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. NursingOpen, 1(4), pp. 1-9.

McGuire, Russel & Matthews, 2016. Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study. Journal of Nursing Management, 2(4), p. 366–375.

RCN, 2012. Frontline First; Congress 2012 Update, s.l.: Royal College of Nursing.

Scottish School of Primary Care, 2019. Advanced Nurse Practitioner Case Study, s.l.: Scottish School of Primary Care.

Shariff, N., 2014. Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC Nursing, 1(2), pp. 1-20.