Application Of Servant Leadership In A Health Care Essay Paper

Application Of Servant Leadership In A Health Care Essay Paper

Application Of Servant Leadership In A Health Care Essay Paper

According to McConell (2012), the difference in a leader and a follower determines the success of a person regarding leadership. This chapter helps explain the content of qualities and proficiency for healthcare managers to be effective. Once again, effective management skills or certain qualifications enhance a healthcare organization environment. Healthcare managers and supervisors must have the capacity to handle challenges while the organization objectives and regulations may change over a period of time. Effective healthcare management governs the success of a healthcare organization. There are many different skill sets and leadership styles to be effective as a manager. People are interested in knowing what strategies are effective…show more content…
Brailer (2005) acknowledges that a sizeable number of citizens receive treatment from multiple providers at a time. Interoperability is a gateway for many business ventures in healthcare to accommodate for patients being admitted in multiple provider organizations. All healthcare professionals, especially managers, must communicate effectively. A good example of interoperability is transformation of electronic medical records, or recruiting physician specialists to operate on a specific procedure (Hellberg & Gronlund, 2013). It is expected that complications must be accounted for while building a strong relationship between healthcare managers and staff. Problems are expected to occur. This is the reason why proper planning is important to healthcare organizations. Healthcare leaders might be concerned with cultural differences that exist in their organization. The problem might be caused by a manager not being involved with the immediate department or working environment. Another reason might be inequality issues that boost poor morale, downgrade associations, and devalue legal rights for healthcare systems operations.Application Of Servant Leadership In A Health Care Essay Paper


One of the philosophies that defies a common understanding of leadership is a model known as servant leadership. The paradox is that this model is characterized, inherently, by the desire to serve others through seeking the well-being of followers and providing them with the necessary support to achieve goals. Servant leadership is a mindset that is counter-intuitive to the common understanding that leadership requires the pursuit of power, authority or self-promotion to advance an agenda. As a result, many situations and work environments find that this prescriptive style embodies the core values targeted by healthcare entities.Application Of Servant Leadership In A Health Care Essay Paper

Leadership Styles

In the leadership world where a continuum of models that include authoritarian, transactional and transformational styles, servant leadership takes its place as an important consideration for situational decision-making throughout all aspects of broad disciplines. Many immediately link servant leadership to faith bases as this philosophy characterizes the model embraced by Jesus Christ, Nelson Mandela, Gandhi and St Mother Teresa.

Leadership self-awareness and emotional intelligence (popularized by George and Goleman respectively) are fundamentals taught in leadership and management classes throughout the world. As core values define healthcare entities, so too does the mindset and elements of servant leadership in a profession rooted in caring and empathetic values.As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone’s leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations.Application Of Servant Leadership In A Health Care Essay Paper

Each leader must dig deep using objective tools such as the Myers-Briggs Personality Profile, DISC, and Gallup’s Strength Finders to characterize the personal self. When coupled with the academic works of leadership experts and management theorists a personal philosophy of leadership is established that define our personal self and approach to this chosen life-path.

Model Proposed

In 1977, Robert Greenleaf coined the term in his essay “Servant leadership: A journey into the nature of legitimate power and greatness.” The following excerpt from this essay offers a general description of this construct for application in both secular and faith-based organizations:Application Of Servant Leadership In A Health Care Essay Paper

The servant leader is servant first. It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. That person is sharply different from one who is leader first, perhaps because of the need to assuage and unusual power drive to acquire material professions…The leader first and the seventy-first are two extreme types.

Spiritual and Self Transcendence

Abraham Maslow said, “Healthcare is a vocation, a calling, and a profession that draws people who seek to become self- actualized in the management hierarchy defined and popularized by an atheist.”

A little-known fact is that self-actualization is not the final rung of his globally accepted pyramid for defining the complete self. Spiritual or self-transcendence are actually used to characterize his realization late in life that there is more to self-fulfillment, a higher purpose defines an ability to become whole and complete. This would be consistent with the calling felt by those who seek out the helping healthcare profession as a chosen career.Application Of Servant Leadership In A Health Care Essay Paper

Situation and Culture Sensitive

Servant leadership has its place among cultures along the continuum of choices for leaders. A situational template is prudent to frame the healthcare context. Servant leadership may not always be a practical model to embrace. Authoritarian model characteristics must be practically applied in operating and procedure rooms where the physician is the captain of the ship by authority and must command how processes unfold.

Similarly, guidance must be provided for task-completion in business operations— some transactional styles (characterized by quid pro quo/tradeoff expectations) or transformational styles (participative with others’ needs first but falling short of the Servant philosophy).Application Of Servant Leadership In A Health Care Essay Paper

The reality is that with razor-thin profit margins in an environment of free-fall change and diminished return on investment (ROI), there is often not the luxury of mistake-making or employee associates finding their true selves in day -to-day experiences.

Rather, servant leadership can be viewed as a marathon in the race of life –crafted, developed and molded through an individual’s collective education, background and experiences.

Faced with uneven quality, lapses in patient safety, pressure to curtail costs, rapidly aging populations, and rising technology expenses, health care organizations are seeking ways to improve quality and efficiency while reducing costs.1,2 Health care leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean, a management philosophy that focuses on improving processes and eliminating waste to add value for customers. Lean calls for a holistic change in management style and organizational culture, requiring leaders to develop new skills and attitudes and adopt new behaviors.Application Of Servant Leadership In A Health Care Essay Paper

Effective Lean implementation requires leadership at all levels of the organization to systematically align Lean philosophy and tools with the organization’s strategic goals, vision, and values. Health care organizations that have implemented Lean comprehensively and systematically have seen improvements in quality, patient safety, and employee satisfaction.1,3,4 Yet few health care organizations have achieved sustainable, long-term implementation of Lean. All too often, health care and other organizations attempt to implement Lean via piecemeal application of methods and tools, rather than creating holistic cultural change that promotes involvement of employees in daily improvement and behavioral changes.57

The centrality of leadership to Lean initiatives has been widely acknowledged.710 For instance, Mann7 observed that 80% of Lean implementation depends on senior management’s creation of an environment that fosters success. Several authors have described the specific leadership characteristics and behaviors that are associated with successful and sustainable Lean transitions in health care.7 Characteristics of successful Lean leaders that have been described include empowerment, trust, modesty, openness, and respect for people Application Of Servant Leadership In A Health Care Essay Paper

Existing findings suggest that successful Lean leaders use a coaching leadership style6,7that shares underlying principles with servant leadership. However, despite the apparent synchronicity of the two approaches, specific similarities and differences between Lean and servant leaderships have not been described. We address that gap by performing a comparative analysis of Lean and servant leaderships in health care. To our knowledge, this is the first study to systematically examine and organize the current body of research literature that either quantitatively or qualitatively explores servant leadership and Lean leadership in health care organizations.

Leadership has been defined as “a process by which one person sets the purpose or direction for one or more persons and helps them to proceed competently and with full commitment”.11 A broad body of work on leadership suggests that there are many appropriate ways to lead and that there are many styles of leadership.12 Some studies examine leadership as a process;13 however, most theories and studies describe traits, qualities, and behaviors of the person who is considered the leader.12 A broader view of leaders as cultural change agents has emerged since the 1980s.14 According to this view, effective leaders clearly identify and address issues related to organizational culture, adapting to change as the environment shifts and develops. Researchers have also identified the following two types of leadership: “transactional” in which leaders motivate employees through consequences and rewards and “transformational” in which leaders motivate followers by satisfying higher order needs and more fully engaging them in the process of the work.12,15,16 Both Lean and servant leaderships are understood as types of transformational leadership.Application Of Servant Leadership In A Health Care Essay Paper

Lean leadership

Lean thinking is based on creating maximum value for the client by minimizing waste and assuring value that is added at every step of all processes.11Goodridge et al17 described the following five key principles of Lean: 1) identify customers and specify value, 2) identify and map the value stream, 3) create flow by eliminating waste, 4) respond to customer pull, and 5) pursue perfection. Employee participation and knowledge are considered central to the Lean organization.5 Lean leaders are coaches who create the strategy, build the team, and help employees develop their skills. Dombrowski and Mielke5 described the following five basic principles of Lean leadership:

  1. Improvement culture: strive for perfection but view failure as an opportunity for improvement.

  2. Self-development: act as role models for others in the organization.Application Of Servant Leadership In A Health Care Essay Paper

  3. Qualification: commit to long-term development of employees and continuous learning.

  4. “Gemba”: commit to managing from the shop floor and making decisions based on firsthand knowledge.

  5. “Hoshin kanri”: work to align goals on all levels, always retaining focus on the customer.

Servant leadership

Greenleaf’s theory of servant leadership is based on the idea that leaders should serve their followers.1820 In contrast to leadership theories that focus on the leader’s actions, servant leadership defines leaders by their character and their commitment to serving others.21 Servant leaders seek to develop a sustainable organization, bring out the best in employees, and serve the community.21 Laub22investigated servant leadership in organizations, defining it as a philosophy in which “the good of those led over the self-interest of the leader”. He identified the following six key areas of an effective servant-minded organization:Application Of Servant Leadership In A Health Care Essay Paper

  1. Values people: believing, serving, and nonjudgmentally listening to others;

  2. Develops people: providing learning, growth, encouragement and affirmation;

  3. Builds community: developing strong collaborative and personal relationships;

  4. Displays authenticity: being open, accountable, and willing to learn from others;

  5. Provides leadership: foreseeing the future, taking initiative, and establishing goals; and

  6. Shares leadership: facilitating and sharing power.

In their practical model of servant leadership, Russell and Stone23 identified functional and accompanying attributes of servant leadership (Figure 1). They defined functional attributes of servant leadership, such as vision, honesty, integrity, trust, service, modeling, pioneering, appreciation of others, and empowerment. The model shows the relationship between the leader’s attributes and the manifestation of servant leadership. Servant leadership is considered as a controllable independent variable that affects the dependent variable of organizational performance. However, several mediating variables, such as organizational culture, social context, and the broader culture, may influence the effectiveness of both Lean and servant leaderships and affect the organizational performance. The model includes all important aspects of leadership in an organization and demonstrates its complexity. We substituted Lean leadership in Russell and Stone’s model and then compared servant leadership with Lean leadership.Application Of Servant Leadership In A Health Care Essay Paper

Healthcare is well suited to servant leadership. The alignment between the values fostered in healthcare and the principles of servant leadership combine to achieve compatibility of this model. Caring for others is among the ethical and professional values and is a basic tenet of servant leadership. It is possible to embrace and foster the values proposed in this philosophy, as all healthcare entities convey in their mission. One can realistically find a balance and embrace the core values that characterize this model by applying daily to an affected area as prescribed.

Globally, health care systems in the developed world continue to struggle with escalating demands for services and escalating costs. Service design inefficiencies, including outmoded models of care contribute to unsustainable funding demands.1 An example is the continuing practice in many settings to look to hospital emergency departments to provide what are essentially, primary health care services. While some progress and reforms have been achieved, numerous experts point to the need for further system change if services are to be affordable and appropriate in the future.2 They note that Application Of Servant Leadership In A Health Care Essay Paper

[…] further change is still needed, despite years of progress in the quality of health care around the world. This transformation will require leadership – and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles. Clinicians not only make frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery.2

Effective clinical leadership has been linked to a wide range of functions. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system.2–4 Though most people are provided with health care within the community setting, hospital care continues to garner the bulk of funding and attract considerable attention in relation to care quality and related concerns. Indeed, hospitals are very costly and diverse environments that vary in size and complexity, determined in part by their overall role and function within the larger health care system. The services provided by individual hospitals are determined and driven by a number of mechanisms, including government policy, population demographics, and the politics and power of service providers  Application Of Servant Leadership In A Health Care Essay Paper

However, regardless of the differences, the clinical areas of the hospital are critical to all health care organizations, given that it is at this level where consumers principally engage with the hospital system. It is at this point where consumers are recipients of hospital care and where they witness and experience how the system functions, observing the strengths and inefficiencies of the health care system and conflict and collegiality between and among groups of health professionals. It is also at this point that clinicians, defined as any frontline health care professionals, have opportunities to fulfill leadership roles. For consumers of health care to achieve optimal health outcomes and experience optimal hospital care, many believe effective clinical leadership is essential.

In this paper, we discuss clinical leadership in contemporary health care, definitional issues in clinical leadership, roles of hospitals in contemporary health care, preparation for clinical leadership roles, and the facilitators and barriers to effective clinical leadership in the hospital sector.

Clinical leadership in contemporary health care Application Of Servant Leadership In A Health Care Essay Paper

The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and various government reports.6–8 Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to improving quality and safety.9 As one Australian example, a key priority nursing recommendation of the Garling Report was that Nurse Unit Manager (NUM) positions be reviewed and significantly redesigned “to enable the NUM to undertake clinical leadership in the supervision of patients […] to ensure that for at least 70% of the NUM’s time is applied to clinical duties.”8 The remaining time could be spent on administrative and management tasks. In the more recent Francis report7 from the UK, a recommendation was made for similarly positioned ward nurse managers to be more involved in clinical leadership in their ward areas. In the United States, clinical leadership has also been identified as a key driver of health service performance, with the Committee on Quality of Healthcare suggesting considerable improvements in quality can only be achieved by actively engaging clinicians and patients in the reform process.10

However, leadership in health care is often very complex, and some authors claim it faces unique contextual challenges. For example, Schyve5 claims aspects of governance are sui generis in health care, noting Application Of Servant Leadership In A Health Care Essay Paper

healthcare organizations also have a rather unique characteristic. That is, the chief executive is not the only part of the organization’s leadership that is directly accountable to the governing body. In healthcare, because of the unique professional and legal role of licensed independent practitioners within the organization, the organized licensed independent practitioners – in hospitals, the medical staff – are also directly accountable to the governing body for the care provided. So the governing body has the overall responsibility for the quality and safety of care, and has an oversight role in integrating the responsibilities and work of its medical staff, chief executive, and other senior managers into a system that that achieves the goals of safe, high-quality care, financial sustainability, community service, and ethical behaviour. This is also the reason that all three leadership groups – the governing body, chief executive and senior managers, and leaders of medical staff – must collaborate if these goals are to be achieved (Schyve 2009:35).5

While nursing is not specifically named in the above quote, we believe nursing to be implicit and integral to leadership in hospitals. There is recognition of the challenges associated with health care governance, evidenced by significant investment internationally in building systems for leadership development in health care.5,11 For example, the UK advanced leadership programs have been instituted and run for clinical leaders since 2001 by the National Health System Leadership Centre,12 and there are some similar innovations in other countries (see, for example, Ferguson et al13). This points to the realization that the cost and consequences of poor clinical leadership greatly outweigh the costs and potential benefits of provision of formal programs to enhance clinical leadership capacity ideally in a multidisciplinary health care team context Application Of Servant Leadership In A Health Care Essay Paper

Indeed, across the health care sector, evidence exists of the need for clinical leadership to optimize care delivery. In addition to challenges associated with resources and demand, episodes of poor patient outcomes, cultures of poor care, and a range of workplace difficulties have been associated with poor clinical leadership,8,9,14 and these concerns have provided the impetus to examine clinical leadership more closely.

Definitional issues in clinical leadership

Within the health care system, it has been acknowledged that clinical leadership is not the exclusive domain of any particular professional group.15 Rather, all members of the health care team are identified as potential leaders.16 Like “leadership,” the concept of clinical leadership can be defined in a range of ways; and while a standard definition of clinical leadership providing absolute agreement on meaning is not crucial to progress and is likely to prove difficult,17 it is useful to consider the various ways clinical leadership is conceptualized and presented in the literature. While effective clinical leadership has been offered up as a way of ensuring optimal care and overcoming the problems of the clinical workplace, a standard definition of what defines effective clinical leadership remains elusive.15,18 Indeed, in some ways it is easier to consider what constitutes poor or ineffective clinical leadership.Application Of Servant Leadership In A Health Care Essay Paper

A secondary analysis of studies exploring organizational wrongdoing in hospitals highlighted the nature of ineffectual leadership in the clinical environment. The focus of the analysis was on clinical nurse leader responses to nurses raising concerns. Three forms of avoidant leadership were identified:

placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant.14

These forms of leadership failure were all associated with negative organizational outcomes. Similarly, McKee et al employed interviews, surveys, and ethnographic case studies to assess the state of quality practice in the National Health Service (NHS); they report that one of the most important insurances against failures such as those seen in the Mid-Staffordshire NHS Trust Foundation is active and engaged leaders at all levels in the system Application Of Servant Leadership In A Health Care Essay Paper

Despite the definitional uncertainty, a number of writers have sought to describe the characteristics, qualities, or attributes required to be an effective clinical leader. Synthesis of the literature suggests clinical leadership may be framed variously – as situational, as skill driven, as value driven, as vision driven, as collective, co-produced, involving exchange relationships, and as boundary spanning (see Table 1). Effective clinical leaders have been characterized as having advocacy skills and the ability to affect change.20,21 As well, effective clinical leaders have been linked to facilitating and maintaining healthier workplaces,22,23 by driving cultural change among all health professionals in the workplace.24 To achieve these positive outcomes, clinical leaders need to be seen as credible – that is, be recognized by colleagues as having clinical competence18,25–27 and have the skills and capacity to effectively support and communicate with members of multidisciplinary clinical teams.18,25 Taking an individual perspective, effective clinical leaders require personal qualities that reflect positive attitudes toward their own profession, have the courage and capacity to challenge the status quo, effectively address care quality issues, and engage in reflective practice.18,14 Pepin et al found that clinical competence, the capacity to lead a team, and being prepared to challenge the status quo were necessary skills for clinical leaders in one Canadian study.28 In an Australian study, findings indicated that student nurses want clinical leadership attributes from their clinical preceptors to include being supportive, approachable, and motivating, while being effective communicators.29 Table 1 summarizes the characteristics of clinical leadership and the attributes of clinical leaders distilled from the literature.Application Of Servant Leadership In A Health Care Essay Paper

Nurses can serve as agents of change in the drive towards better working practice. A model for change to evidence-based practice, systemically asks a clinical question, searches the relevant literature, critically evaluates the evidence, and applies the results to the practice setting was described (Rosswurm & Larrabee, 1999). Many times communication appears to be a simple concept within health care. A lack of quality communication limits the quality of service that can be provided to the patient. Some of these issues are rooted within health care system design, while others are the result of inappropriate services provided to patients (Wanzer, Booth-Butterfiled, & Gruber, 2004; Strawderman & Koubek, 2006). Communication limitations often make the patients’ visits frustrating and unpleasant but since the products of health care systems are services, measuring health care quality must extend beyond clinical measures to also incorporate patient perceptions and experiences (Wanzer, Booth-Butterfiled, & Gruber, 2004; Strawderman & Koubek, 2006).Application Of Servant Leadership In A Health Care Essay Paper

Patient safety is dependent on practicing nurses, nurse educators, leaders, researchers, and other healthcare professionals to contributions to the health of patients, nursing education and practice, by discovering and evaluating new strategies for improving healthcare quality for patients and communities can find great value in the new insights and innovations. Knowledge of how to develop, implements, and continuously improve patient safety is currently limited and not accessible to most health care organizations. Health care organizational strategies for electronic health records safety which either affects patient safety directly or indirectly are; care-process transformation (thoroughgoing redesign of health care processes to achieve significant improvements in clinical outcomes, service levels, and costs), patient safety (consistent, organization-wide efforts to improve care quality and patient outcomes), human-factors engineering (fitting technologies to organizational, team, and individual needs), project management (the application of explicit management practices to a project to maximize benefits and minimize costs, including risks) software safety (the application of systems engineering methods to reducing the risks associated with software design and use), continuous improvement (unceasing, systematic efforts to improve processes and outcomes (Brown et al., 2007; Carayon, 2007; Ebright, 2010; Kohn et al., 1999; Walker, 2005). Leadership models can offer increasing knowledge for stability that may be ideal for health organizations to focus control and management of resources, manpower and assets, efficiently. However, a hierarchical form of leadership is not congruent with our current knowledge era marked by the need to build intellectual capital and facilitate knowledge flows, adaptability and learning.Application Of Servant Leadership In A Health Care Essay Paper

Nurses who understand the emerging science of complexity will be better prepared to creatively face these issues and improve health in broad and lasting new ways for improved safe patient care, from the start of nursing education programs providing advanced leadership theory content in academic curricula or respective organizational/system leader development programs, and then applying these areas learnt to practice. A survey revealed that healthcare leaders intuitively support principles of complexity science, because, leaders that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes (Burns, 2001). Leadership functions will be need to thrive in complexity, the challenge facing organizations by identifying new ideas, interacting with others to generate novel solutions, and building relationships and networks. Policy-making initiatives will be vital for these successes, and for providing seamless, affordable, quality care that is accessible to all, with improved health outcomes. The impacts and organizational/ national changes that can occur from policy creation can become extremely beneficial for the healthcare population. As leaders, nurses can work with all groups, agencies, organizations and communities to foster and develop the transformation that is necessary for the 21st century.Application Of Servant Leadership In A Health Care Essay Paper

Nurses are often asked to think about leadership, particularly in times of rapid change in healthcare, and where questions have been raised about whether leaders and managers have adequate insight into the requirements of care. This article discusses several leadership styles relevant to contemporary healthcare and nursing practice. Nurses who are aware of leadership styles may find this knowledge useful in maintaining a cohesive working environment. Leadership knowledge and skills can be improved through training, where, rather than having to undertake formal leadership roles without adequate preparation, nurses are able to learn, nurture, model and develop effective leadership behaviours, ultimately improving nursing staff retention and enhancing the delivery of safe and effective care.

As health care issues and the technology being designed to solve them become more complex, the ability to adapt to change is becoming an increasingly important trait for clinical nurse leaders. The transformational leadership style compels nurse leaders to teach their employees how to become leaders in their workplace by participating in the development of realistic solutions to logistical issues in their respective departments. Nurse leaders must consult with patients, colleagues and administrators to identify which areas of practice should be overhauled in order to improve the quality of care offered by the organization. To advance this effort, transformational nurse leaders must encourage their employees to become invested in care outcomes. In doing so, they may better engage individual employees in actively participating in the process of improving care.Application Of Servant Leadership In A Health Care Essay Paper

In practice, talented transformational leaders employ effective communication and interpersonal relationship techniques to motivate and inspire their teams, gradually building up a reputation for trustworthiness upon which their employees can grow to depend. Such interpersonal communication skills are represented by a leader’s ability to elicit teamwork in groups by facilitating a working environment that encourages respectful sharing of ideas. This could be done subtly—not explicitly asking for employee input, but welcoming it in an open fashion. Or it may be more appropriate to solicit feedback through designated meetings or other forms of communication, like an online message board. Regardless of how they are sourced—as these ideas are expressed, the team works together to evaluate them through their own personal insights and group feedback in order to structure a comprehensive plan to solve performance problems. In these regards, transformational nurse leaders help health care organizations adapt to industry-driven changes by leveraging information to identify problems in their organization, encouraging their subordinates to contribute to the process of making positive changes, visualizing a solution to said problems, and building a foundation of collaboration between stakeholders to implement solutions successfully.Application Of Servant Leadership In A Health Care Essay Paper

Through a democratic leadership style, nurse leaders include other nurses in the decision-making process during procedural changes. Clinical nurse leaders collect the ideas and opinions of their staff, then distill them in hopes of finding practical ways to improve the quality of care that they are delivering. In order to maximize the effectiveness of democratic leadership, clinical nurse leaders should advise their staff to develop both professional and casual partnerships with one another, allowing open expression of disagreement regarding patient goals, progress and health outcomes. Rather than designating select members of the team to solve problems on their own, each available nurse should be offered an opportunity to participate by contributing their own individual expertise to clinical processes. But unlike transformational leadership, the democratic leadership style generally leaves final decisions up to the leader, restricting how extensively the group can impact decisions. This allows nurse leaders to maintain control over the decision-making process while still offering employees the chance to have their feedback acknowledged by their leaders.Application Of Servant Leadership In A Health Care Essay Paper

Nurse leaders should note that a democratically led organization may generate a workplace environment that is founded upon the ideals of a select group of highly vocal individuals. This could lead to the timid nurses feeling less valued than their more vocal colleagues, leaving them unmotivated to express their opinions. This could be especially harmful to an organization if the nurses with reserved personalities have critical insights to offer, but instead choose to remain quiet to avoid conflict. Regardless of the slight flaws in this leadership style, an educated and experienced democratic leader can be highly effective at harnessing the power of employee thoughts, opinions, and ideas to coordinate successful policies and programs. To remedy this, clinical nurse leaders must actively solicit input from every employee who may be impacted by the decision being made. For example, if an acute care department is proposing changes to the patient release procedures, the nurse leader should solicit every nurse who is involved with that process, as they will likely want to contribute their own thoughts on how to optimize that area of the department.Application Of Servant Leadership In A Health Care Essay Paper

Autocratic Leadership

Concentrating decision-making power at the top of the chain of command can be an effective method for completing simple tasks; rather than getting bogged down by conflicting opinions, autocratic leaders can ensure that quality care is delivered safely and efficiently, with minimal time wasted on deliberation. Autocratic leaders are adept in their ability to make critical decisions in time-sensitive circumstances where fielding employee input may only serve to complicate matters and therefore, pose a risk to the patient. As such, autocratic clinical nurse leaders must be clear, concise and direct when organizing employees, and ensure that they comply with their respective facilities’ standard procedures.Application Of Servant Leadership In A Health Care Essay Paper

While it may seem daunting to lead in this manner, autocratic leadership is highly effective in health care settings that follow strict routines, such as jails, prisons and military hospitals; it can also be effective within standard medical facilities faced with critical volumes of patients. Such facilities thrive when an autocratic leader provides them with orders broken down into basic steps, as an imbalanced ratio of patients to health care providers limits how many resources can be committed to the decision-making process. For instance, some autocratic leaders may set protocols that define when to admit/discharge patients based on time or other factors related to their condition, so the clinical nurse won’t need to make this decision based strictly upon their own judgement.Application Of Servant Leadership In A Health Care Essay Paper

Bureaucratic Leadership

In nursing, rules are designed to ensure patient health and safety first and foremost; therefore, clinical nurses who adopt a bureaucratic leadership style are responsible for upholding protocol and ensuring that subordinate nurses adhere to the rules. This requires training employees to follow rules, and communicating with the institution’s administrators when policy changes may be necessary. Due to the invariable nature of bureaucracy, strict protocol normalizes treatment routines for patients in emergency situations, as well as high-volume and acute care facilities—similar to autocratic leadership. However, autocratic leadership is inherently more flexible, as the rules are less rigid; accountability starts and ends with senior nurse leaders instead of a fixed system of standards and practices.Application Of Servant Leadership In A Health Care Essay Paper

Bureaucratic leadership approaches often create a tight web of rules that can potentially obstruct clinical nurse leaders from reaching their goals. These rules and regulations often stall the decision making process by creating unnecessary oversight in situations that would be better addressed through quick and direct actions. With these communication barriers in place, team members may lose motivation to contribute constructive feedback to their workplace, hampering patient outcomes and the organization’s growth. Therefore, an effective bureaucratic leader must regularly review the rules and suggest ways that their superiors can alter them to suit the current needs of patients, nurses, and administrators.Application Of Servant Leadership In A Health Care Essay Paper

In stark contrast to the strictures of autocratic and bureaucratic leadership, laissez-faire leadership prioritizes employee freedom, allowing them to work with oversight, but little interference from personnel or policies. If clinical nurse leaders are to trust their team with minimum supervision, they must first build a team that is skilled and responsible enough to balance freedom with individual duties; this means promoting educational opportunities that improve the staff’s ability to resolve health care problems while providing motivation to continue advancing their expertise to achieve greater patient outcomes. They could do so by providing employees with resources that will help them find classes to take, or hosting those classes within their respective medical institutions.Application Of Servant Leadership In A Health Care Essay Paper

Realistically, a laissez-faire leadership approach is most effective for new clinical nurse leaders who are in charge of a team of well-educated nurses who have extensive experience. While these nurse leaders may not have obtained enough experience to effectively make authoritarian choices, they can develop their leadership expertise by observing talented professionals and providing them with feedback when needed. The leader themselves may provide basic knowledge, but generally the employees are accountable for their own actions. As long as they maintain strong attention to detail and an eye for selecting competent, experienced employees, nurse leaders can utilize the laissez-faire style of leadership to allow more experienced nurses to thrive, improving their institution’s ability to serve patients.Application Of Servant Leadership In A Health Care Essay Paper

Nursing leadership styles all come with relative costs and benefits, with each method impacting patient and staff satisfaction in different ways. When staff members are valued within their health care organizations, allowed to participate in patient care decisions, and given the opportunity to communicate their vision, clinical nurse leaders are better able to guide them toward solving pressing organizational issues that may limit the institution’s ability to provide exceptional care to patients. Although, sometimes a stricter leadership style may be necessary to maintain control and achieve desirable patient outcomes in institutions that are strained by high patient volumes. Through the completion of a Master of Science in Nursing degree program, educated clinical nurses can refine their understanding of fundamental nursing administration practices and develop a style of leadership that will empower their staff to proactively address clinical challenges.Application Of Servant Leadership In A Health Care Essay Paper

Clinical nurse leaders are often responsible for keeping their respective departments organized in their efforts to achieve successful care outcomes. Therefore, they must be equipped with leadership competencies that, when combined with practical nursing skills, allow them to quickly make tough decisions. By incorporating executive leadership styles into their professional strategies, clinical nurse leaders can more effectively coordinate health programs, nurse-led procedures, and administrative activities within their places of employment. For nurse leaders, it is a good idea to adopt a leadership style that best fits their daily routine. But in order to refine their ability to adapt to constantly changing medical environments, it is crucial that nurse leaders understand the different leadership styles and when they are most applicable.Application Of Servant Leadership In A Health Care Essay Paper

Nurses play vital roles in health care organizations. How they are managed by their leaders can drastically affect their performance and influence patient outcomes. It is important to understand the different leadership styles that are often found in the workplace, as well as their effects on the staff and those under their care. To learn more, checkout this infographic created by Bradley University’s Doctor of Nursing Practice program.

The world’s population is aging. This aging population is also living a lot longer. In fact, by 2050 16% of the world’s population will be 65 years of age and older. The number of people aged 85 and over will also increase by 351% while the number of people aged 65 and over will increase by 188%.

Many of the increased elderly will inevitably suffer from chronic diseases. Currently 4 out of 5 elderly people in the United States have multiple chronic medical conditions and 60% of people aged 67 or older have 3 or more chronic illnesses.Application Of Servant Leadership In A Health Care Essay Paper

This aging population, and the increase of chronic illnesses, will increase the need for professional and high quality nurses. This is why 1.12 million nurses are anticipated to be needed for new jobs or replacement between 2012 and 2022. These nurses will need to be highly skilled and able to work in a variety of potential settings.

In the past nurses have typically been viewed as subordinates without a need for leadership skills or capabilities. They were not expected to be leaders in the healthcare field and this lowered the respect and expectations associated with the position.

Luckily times have changed. In today’s world nurses are viewed as important healthcare partners and are increasingly involved in the leadership of dynamic healthcare teams. They are being required to take on new responsibilities, and also remain up to date with the advancements in medical technology and the constantly evolving healthcare trends. They are expected to be extremely competent and participate in a high level of education like the cutting edge programs being offered. Most importantly the next generation of nurses will be expected to take a hands-on role as competent leaders in the healthcare field.Application Of Servant Leadership In A Health Care Essay Paper

Nursing Leadership Styles

Nurses have the unique opportunity to apply leadership styles in a way that can also affect patient outcomes. Here are some of the leadership styles and traits that every nurse should know:

1. Transactional Leadership

Transactional leaders ensure staff compliance through a system of punishments and rewards. Every interaction is based on a transaction. When a person follows instructions and obtains an objective, they receive a reward. When they fail to follow an instruction or meet an objective, they are disciplined.

When practicing this style of leadership there is a high priority on supervision. This can be a very effective style for managing a crisis or ensuring that projects are completed with a high level of detail.

2. Transformational Leadership

Transformational leaders tend to lead by example. When followers see this example, they are inspired to change or do better. Transformational leaders also demonstrate that they truly care about their followers and their best interests. They accomplish this by putting the needs and priorities of the organization above their own.Application Of Servant Leadership In A Health Care Essay Paper

They have a clear vision and they use that vision to motivate their staff members. Innovation is embraced and people are encouraged to generate new ideas. This can be a very effective style for managing teams that need to implement a significant change.

Health care organizations (HCOs), with hospitals at the center, are considered as large and complex contemporary organizations, owing to their advanced procedures and different resources (1). HCOs’ performance depends on knowledge, skills, and personal incentives of human resources (2-4). Given the importance of this resource, a consistent leadership is needed to achieve high performance and enhance employees’ capabilities to improve the quality of care and outcomes (5, 6). Leading quality improvement process requires leaders who manage uncertainty and foster cultural and behavioral changes (7-9).Application Of Servant Leadership In A Health Care Essay Paper

Leadership is a long-term process of influencing people toward accomplishing a mission and particular goals of a group or an organization (10). This process sets goals and strategies, enhances commitment and compliance to objectives and organizational productivity, and promotes the culture of team and dynamicity in organizations (11, 12). It is also a timeless practice of structuring or restructuring the conditions and members’ perceptions and expectations (13, 14). Studies have revealed that most of the problems of health care systems are due to poor communication and leadership (1, 15). Poor leadership in HCOs could increase costs, reduce efficiency and effectiveness, and cause dissatisfaction among staff, ultimately resulting in lower patient satisfaction and society health level (16-19). Appropriate leadership can create an organizational culture that is committed to quality, reducing conflicts, improving efficiency and productivity of teams, enhancing staff’s satisfaction, advancing hospital performance, and finally, meeting personal and organizational goals (20, 21). Most leadership studies have been conducted in developed countries and in the areas outside health care, and only a very few has been done in the realm of health care (22, 23). Given the prominent role of context in the sense that national culture, public laws and socioeconomic status might influence managers’ behavior and their leadership style and considering the shortage of studies in health care, there is an urgent need for similar studies in developing countries (24).Application Of Servant Leadership In A Health Care Essay Paper

Healthcare leadership is a complex multifaceted process, comprising of diverse definitions and qualities. It is highly beneficial for healthcare nurses to be able to identify the leadership styles applicable to their nursing practice. Being proficient in identifying these styles qualifies nurses to advance their expertise to become better leaders and also improves the relationship with other leaders and colleagues. Effective leadership is essential for the safety of the patients and better patient outcomes. This essay explores the connection between leadership and patient safety, different leadership styles and their main features and explains how these leadership styles are applicable in different clinical instances.

Leadership and patient safety

Literature addressed the significant impacts of nursing leadership has on patient safety is extensive and a strong connection exists between patient safety and leadership in health care systems (Wong et al., 2013). Patient safety can be defined as the inhibition of mistakes and adversative effects to the patients allied with the healthcare system. With the advancement of the healthcare system, maintaining patient safety is also becoming more challenging. The main properties of safety emerge from the accurate interactions between components of the healthcare structure, thereby leading the approach to a well-defined emphasis for patient safety, namely system. The objective of patient safety can also be stated as the prevention, evasion, and amelioration of adverse outcomes or harms stemming from the course of care. Thus effective leadership is essential for the patient-centred care and patient safety.Application Of Servant Leadership In A Health Care Essay Paper

The essence of nursing leadership is to motivate, to inspire, to promote ethics, to generate and empower a consistency emphasis on the essentials of the patient being served. By the means of effective leadership, strategies can be implemented to prevent errors, make coordination with the patient and their families, delivery of individualized care to maintain diverse cultural health beliefs of the patients and most importantly maintain patient safety. An emerging body of information now demonstrates a strong association between leadership activities and safety metrics (Wong et al., 2013). A study found that high-performing healthcare organizations with high rank on measures of safety and quality tend to have clinical leaders with more skills in safety and quality issues and devoted more time to discussion of safety and quality with the management bodies. Studies have provided more insight into how leaders can positively influence safety and found that leaders of high-quality hospitals used more effective leadership practices to monitor and improve safety. These practices embrace planned use of data to improve care by allocating detailed eminence objective and frequently observing performance dashboards etc. (Scott & Miles, 2013). Clinical leaderships can address exact safety issues and noticeably illustrate the significance of patient safety as an organizational priority.Application Of Servant Leadership In A Health Care Essay Paper

Leadership styles

Appropriate leadership styles are crucial for instigating evidence-based interdisciplinary clinical practice. The commonly used leadership styles are autocratic, democratic, transactional, transformational, situational, visionary and Laissez-Faire leadership (Huber, 2013). The manner in which clinical leaders execute leadership over their staff has positive or negative consequences that can give rise to far-reaching effects on the manoeuvres of healthcare organizations (Scott & Miles, 2013). A clinical professional’s individual style of leadership definitely holds a substantial impact on not only patient safety but also on vital health care aspects like employee attrition, teamwork and communication, morale, turnover rate, feedbacks and productivity (Wong et al., 2013).Application Of Servant Leadership In A Health Care Essay Paper

According to Huda (2014), autocratic leadership style characteristically involves leaders or nurse managers who make all relevant decisions, provides working orders and guidelines and also gives instructions to subordinate staffs who must follow under attentive supervision. In this styles, leaders do not consult other staff and the leaders retain as much power and decision-making authority as conceivable. Staffs are expected to follow instructions without receiving any explanation.

The democratic style of leadership enables greater participation from subordinate workers in the decision-making process of the organization. Despite the fact that the democratic leaders have the ultimate decision-making authority, they gather ideas, information, and feedback from employees before concluding the very decision that will affect those employees (Huber, 2013). This is an extremely effective method of leadership since workers are more likely to present exceptional efforts when they feel valued. Employees feel appreciated when their contribution becomes an integral portion of the decision-making process of an organization. Democratic leadership prospers in healthcare context because of the diverse skill sets and educational backgrounds of staff members. This style encourages open communication of clinicians and decision making (McKeown & Carey, 2015).Application Of Servant Leadership In A Health Care Essay Paper

According to Huber (2013), in transformational leadership style, a leader works with followers to detect the desirable changes, fashioning a revelation to direct the modification through encouragement and implementing the transformations in tandem with dedicated associates of the group. This style is most effective when handling lower-skilled employees who need closer observation or at the time of crisis (Clarke, 2013). Transformational leaders assists in motivating, increasing confidence and work performance of staff by means of multiple appliances such as linking the employee’s sense of self to the identity of the institute, being a role model for subordinates, inspiring employees to take bigger possession for their work and understanding the strengths and flaws of employees; it allows the leader to align employees with responsibilities that enrich their performance. (Antonakis & House, 2014).Application Of Servant Leadership In A Health Care Essay Paper

Clinical instances

The assortment of a leadership style is entirely reliant on the clinical circumstances and the requirements of the patients. The application of autocratic or authoritarian leadership can be effective for a nurse in charge of the ward working with an inexperienced junior team. A patient unexpectedly collapses on his bed who shows no responses and the leading nurse suspects that he is having a cardiac arrest. The leading nurse can direct the followers and allocate tasks by applying autocratic leadership for the patient’s safety (McSherry & Warr, 2011). The leader cannot be democratic or transactional in this situation because the team members are inexperienced and expecting effective interventions from them can lead to the loss of valuable time for treatment of the patient.

When prescribing medicines clinical leaders frequently applies democratic leadership to avoid any medication error. It is always better to consult with the experienced team members and not to be an autocratic leader before prescribing a drug (Cunningham et al., 2012).Application Of Servant Leadership In A Health Care Essay Paper

Transformational Leadership has a significant indirect effect on patient falls. Inspiring employees to rigorously assess the safety measurements of the organization, evaluate existing organizational attention to fall, improve supports for fall prevention programs and detect available as well as required resources for fall management can be done effectively by transformational leadership (Higgins, 2015). Autocratic and democratic leadership cannot effectively motivate the followers for patient safety and reduction of fall incidents.

Different leadership styles are suitable according to the ever-changing environment of the healthcare system. Several pieces of evidence demonstrated a noteworthy association between affirmative leadership styles, behavior and practice with amplified patient satisfaction and declined adverse incidents. Autocratic leadership is highly effective in an emergency situation. Hospital administration, from workforces and secretarial divisions to amenities upkeep and insurance billing necessitates autocratic leadership to ensure accountability and uniformity. Simultaneously, physicians work collaboratively under democratic leaders to avoid medication and treatment errors. On the other hand, many results proposed that an emphasis on developing transformational nursing leadership can be an imperative organizational approach to enhance patient safety.Application Of Servant Leadership In A Health Care Essay Paper

Despite the presence of the complex challenges in managing health care organizations in developing countries, not enough studies have been done in these countries (25). Most of the leadership related studies that have been performed in Iran investigated the leadership style and its impact on such issues as efficiency and operational indicators of hospitals, job satisfaction, conflicts management, staffs’ motivation, creativity, and etc. (26-29). Some have further investigated the transformational, ethical, charismatic, spiritual, and other prominent hospital leadership models, while most have been conducted on limited hospital settings (30-35) .

Therefore, there is a gap in integrated studies to investigate and recognize the challenges of leadership in Iranian health care system (IHCS). Qualitative studies, as an effective approach, are expected to provide in-depth and objective views on the real experiences of leaders in this sector. The current study has been conducted to explain the obstacles and challenges of leadership in Iranian HCOs to help identify the problems, and thereby develop the appropriate operational and applicable solutions for effective leadership in HCOs of IHCS. Application Of Servant Leadership In A Health Care Essay Paper


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