Management and Leadership Issues in Clinical Practice

This essay evaluates management and leadership issues with reference to recent clinical practice experience. It covers low staff morale and the effectiveness of the staff recognition scheme in the workplace.

This essay evaluates management and leadership issues with reference to
recent clinical practice experience. It covers low staff morale and the
effectiveness of the staff recognition scheme in the workplace.
Leadership and management is considering as most crucial part of an
organisation which contribute toward motivating and directing employees toward the
accomplishment of particular goals and objectives. The current report is based on
clinical practice experiences where main focus is put over the management and
leadership issues present within the mental health organisation (Ortega and et. al.,
2014).
This essay is essentially based on the experience of the author, a third-year mental
health nursing student. The study was prepared by the author while he was on
clinical experienced situations involving low morale amongst staff, limited interaction
poor staff attendance, lack of co-operation, and little collaboration. It would be easy
to formulate an argument that working within a mental health unit may be stressful
for its staff. On the contrary, the author eventually worked with mental health patients
for eight years in the custodial field and acknowledged that both management and
leadership play a significant role in ensuring that staff members are instilled with a
positive mental attitude. This in turn, has led to excellent staff attendance records.
Moreover, Her Majesty's Prison Service (HMPS) (2012) has pointed out in their study
that staff recognition schemes aim to reward those organisations wherein flexible
relationships exist among the employers and the employees. Such schemes involve
employment-based conditions that depend extensively on staff suggestions,
exceptional performance, length of service and records of staff attendance.
Furthermore, rewards, cash-based incentives, and vouchers are offered so that good
attendance of staff can be encouraged (Oxford University Hospital, 2012. p.3).
The issues that are presented by authors directly affect the quality of services staff
provide to their patients. Hence, this put emphasis over the major issues within a
mental health organisation in order to present the importance of leadership and
management for such organisation as it crucial for current national policies and
legislation that are formulated for the mental health nursing practitioners which
includes evidence-based practice, eradication of outdated traditional practice and
continuous staff improvement are the major part of professional codes. These codes
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are crucial to be followed by each institute or organisation dealing in providing
mental health related services. Hence, these professional codes can only be
maintained by getting regular guidance from management and direction to
implement by the leaders.
Sullivan and Decker (2009) stated that leaders and managers possess varied
capabilities, which they demonstrate, as well as implement, in the workplace. A
dated romanticised quote that has been provided by Bennis and Nanus (1985), and
which in turn, has been cited by Swanwick and McKimm (2011) is that ‘Leadership is
like the abominable snowman whose footprints are everywhere but who is nowhere
to be seen’ (p. 23). This quote is emotive and identifies the value of leaders as great
role models. It also sums up the fact that a team’s empowerment is equally essential,
along with enabling managers the power to supervise the whole. Furthermore,
Norman and Ryrie (2009) stated that good leadership presents a positive and
professional attitude towards all workers so that they can achieve coherence and
cohesion. This in turn, encourages ownership by staff and helps in the promotion of
the values of good practice. Corresponding views have been shared by Ellis and
Bach (2015), wherein a leader is depicted as someone who solely tends to
encourage team members to achieve all assigned goals by enhancing their skills. On
the other hand, Huber (2014) opined that managers are hired by an organisation so
that they can organise, coordinate, supervise, and represent the company. Sullivan
and Decker (2009) asserted that managers also have a need for excellent
interpersonal skills, but that their primary roles are in planning, controlling,
accountability, authority, organising, responsibility, leading, and controlling.
Swanwick and Mckimm (2011) differentiated the spheres of leadership and manager,
wherein the former set a definite direction for people to follow, while managers set
out to transform. Ellis and Bach (2015) suggested that leadership is one of the roles
played by managers, but it is not necessary for effective leaders to be managers.
Finkelman (2006) identified leaders as visionaries who use influence in maintaining
peace within the workplace so that trust and achievement can be ensured amongst
employees. Naidoo and Wills (2001) asserted that managerial authority is largely
dependent on rank, while effective leaders have inherent personal qualities that
permit them to influence others. Both leadership and managerial authority are
equally needed to maintain proper balance in a specific unit. Similarly, a mental
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health unit can be easily sustained when managerial skills, along with leadership
capabilities, are implemented properly. Bennis and Goldsmith (1997) as cited by Ellis
and Bach (2015) define a set of twelve distinguishing points which explore
comparisons between the differing roles of leaders and managers:
1. Managers administer; leaders innovate.
2. Managers maintain; leaders develop.
3. Managers rely on control; leaders inspire trust.
4. The manager is a copy; the leader is an original.
5. Manager’s focus on systems and structure; leaders focus on people.
6. Managers have a short-range view; leaders have long-range
perspectives.
7. Managers have their eye always on the bottom line; the leader’s eye is
on the horizon.
8. Managers accept the status quo; leaders challenge it.
9. Managers ask how and when; leaders ask what and why.
10. Managers imitate; leaders originate.
11. Managers are the classic good soldiers; leaders are their own person.
12. Managers do things right; leaders do the right thing
As is discovered in these comparisons both leaders and managers have equally
important roles to play within an organisation, especially when these two roles are
delivered juxtaposed with each other by skilled staff. Currently, in health care,
evidence-based practice, continuous staff improvement and eradication of outdated
traditional practice are at the fore, and form part of the professional code of conduct
for all nurses NMC (2018). This is because the major issue found by author while
practising as a health nursing student within the clinic that majority of employees are
experiencing low morale while working within the organisation. The main reason
behind this lowering down of morale among employees of mental health organisation
is that working within the unit always remain stressful for the staff members as it
remains very difficult for them to manage and take care of patients that are mentally
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disturb (Daly and et. al., 2014). The major reasons because of which the morale of
employees are dropping out is due to limited interaction with the staff members as a
result of which employees not be able to share the issues they are facing at
workplace. In addition to this there is lack of collaboration as well as co-operation
present at the workplace which creates pressure over the staff members which
results into low morale and it further leads to increase in absenteeism. Hence, it has
been identified that the leadership and management practices within the mental
healthcare clinics plays a crucial role by ensuring that the staff members must get
instilled with a positive mental attitude so that appropriate care can be delivered to
the patients.
A harmonious working environment can be achieved, and as broached by Finkelman
(2006), one of the main goals of leadership is the importance of continuous lifelong
learning plus quality and practice improvement so that staff can strive to achieve
their best. As described by Finkelman (2006) there are many leadership styles and
theories over the years that have affected the management and delivery of care in
healthcare organisations. Huber (2014) points out that leadership theories used to be
grouped as distinguishing characteristic traits of the individual, these included:
ambition, self-confidence, tolerance, intelligence, flexibility and sensitivity, but as
Huber (2014) explains, it has been found that it is not possible to predict leadership
from clusters of traits. Trappen (1995) describes trait theory as an ability which is
born within you and is not crafted from training unlike managerial skills which can be
learnt by anyone in the classroom, she goes on to say that the most important
attribute for leadership is the desire to lead. Swanwick and Mckimm (2011) convey
that the UK’s National Health Service, have chosen to favour the Transformational
leadership theory, they continue to suggest that this theory has proven to be an
enduring model which the NHS have incorporated in many of their frameworks. As
described by Ellis and Bach (2015) transformational leadership relates to the vision
the leader has and the ability to communicate this effectively to others. Ellis and
Bach (2015) continue by saying that this type of leadership relies entirely on the
relationship and trust built up from the leader and their followers, they emphasise
that if there is not mutual respect and trust, this type of leadership style would not
work. Huber (2014) describes the transformational leadership theory to provide a
sense of direction and a change of perception in the hope of motivating followers
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over time to perform to their full potential and thus achieving performances beyond
expectations and altered institutional culture. Al-Sawai (2013) explains that
transformational leadership is used to motivate performance beyond expectations by
the ability to influence and positively change attitudes. Transformational leadership
must not be confused with the similar sounding Transactional leadership, as
expressed by Ellis and Bach (2015) is a type of leadership at its most basic and
involves staff doing their job and being paid for doing it, by a way of a transaction.
Huber (2014) explains transactional leaders are more common in health care and
their core values are exchanging one thing for another in the form of payment for
employment. Al-Sawai (2013) suggest transactional leaders focus on supervision,
organization and group performance not unlike the managerial role. The author feels
this type of leadership theory does not encourage empowerment, autonomy,
creativity and unity within a team.
As suggested by Finkelman (2006) the key skills in the leadership role are having an
in-depth knowledge of the topic or function and to be a people person as it is
imperative that leaders have the ability to achieve the best out of their staff by
creating an environment where staff feel comfortable to share information and that
their opinions matter. Huber (2014) advocates the importance of being a strategist
and to plan for the future, as well as being open minded and when required take on
the role of change agent if they feel it will improve the organisation; and finally to
have the role of administrator, ensuring all policies, procedures, guidelines, values
and other necessary rules are improved, maintained and adhered to encourage
efficiency. Al-Sawai (2013) has suggested that most theories of leadership
improvement were not developed to be used within the healthcare setting, but for a
business setting and then applied to healthcare which at times can cause difficulties,
this is echoed by Hartley (2008) who suggest leaders in healthcare face the biggest
challenge due to the continual changing pace of organizational and system change,
she continues to emphasise the importance of nurturing future nursing leaders and
the ability to change, innovate and improve.
As described by Andersen (2012) leaders can be both born and made and that
natural born leaders do have a head start in achieving success, but what makes the
best leaders is self-awareness and reflection, she continues to mention that listening
is the foundation to success as is the ability to invite feedback, as well as the
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importance to being a fair witness, meaning to be transparent and to express your
experiences as accurately as possible, which might involve mentally taking a step
back and imagining you are another person observing yourself, or see yourself in
your staff and patients eyes.
Barr and Dowling (2016) outline that leadership is important as it builds loyalty
commitment and ownership by using the organisations mission and vision which in
turn sets out the platform from which effective running of the organisation can be
achieved. Storey and Holti (2013) writing for the NHS Leadership Academy suggest
leaders are required to provide and justify a clear sense of purpose and continuation
with the goal of focusing on performance improvement, whilst constantly motivating
individuals to work effectively, responsibly and with accountability which encourages
autonomy.
Leadership is considering to be most crucial aspect for each organisation as it
support in directing the employees in a particular direction toward the
accomplishment of particular goals or objectives. Within a mental health unit there
are number of unpredictable issue get arrived which can be only deal with the help of
effective leadership practices. A mental health unit can easily get sustained when the
managerial skills along with the leadership capabilities are being implemented
appropriately (Spano-Szekely and et. al., 2016). It is suggested by NHS that being a
nurse it is crucial to get inherently step within the leadership role from the very
beginning of the career as they have substantial responsibilities of managing the
ward as well as patients. In addition to this there is a direct link between the high
quality care and the compassionate culture with the leadership practices performed
by the nurses.
As per the current practice issue of low morale due to lack of leadership and
management and management practices it has been found that transformation
leadership is more appropriate. This is because transformation leadership relies
mainly over maintaining the relationship and building up the stronger trust among the
leaders as well as their followers. As the transformation leadership suggest that if
there is not any sort of mutual respect and trust among the employees toward the
leaders that operations can't be able to perform over the direction of leaders (Gopee
and Galloway, 2017). This leadership approach will be fruitful to this situation as by
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maintain the positive relationship with the follower it become easier to develop a
friendly environment at clinic so that staff members feel free to share information or
new ideas. In addition to this it also supports the leaders in directing the work of its
employees as the professional codes of conduct such as evidence-based practices,
continuous improvement etc. Despite of this it also helps the leaders in implementing
the National Quality Assurance strategies which are crucial to be consider while
performing nursing practices as it help in ensuring the quality of work performed by
the nurses toward taking care of patients.
Al-Sawai (2013) conveys that effective leadership must cover ethical guidelines,
which focus on good intentions, values and behaviours which cause no harm, and
fully respects the rights of all parties, they urge on the importance effective
leadership can have substantial impact on the working (and at times home) lives of
nursing staff, patient outcome and fate of an organisation. This links in to the ability
to recognise your own limitations and strengths, which is part of the NHS leadership
model which came into fruition after the publication of the Francis report (2013).
The transformation leadership provide a sense of direction and help in
changing the perception with the hope of keeping employees motivated in order to
keep on improving their practices so that risk which may arise can be managed
properly. Hence, transformational leadership is considering to be most appropriate
leadership style for this as it helps the leaders in maintaining better relationship with
staff members which further contribute toward keeping them in engaged with better
practices (West and et. al., 2014). But in order to implement this leadership 6c's are
being consider more crucial such as care, compassion, Competence,
Communication, courage and commitment. These factors are considering as the
foundation for all the nurse’s leaders that strives to work in effective manner while
considering all the professional codes and legislator requirements so that practices
can be performed within more ethical and reliable manner.
Furthermore, university nursing students cover in class the type of leaders that are
required in the NHS and as the chief Nurse for the NHS England Jane Cumming
(2014) suggests Nurses inherently step into leadership roles from the start of their
careers due to the substantial responsibilities for wards and patients and that there is
a link between high quality care, a compassionate culture and strong leadership.
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Jane Cumming (2012) has indicated what she feels are key requirements for a
transformational leader, they have been conceived as the 6C’s and have been cited
by Ellis and Bach (2015) as:
1. Care;
2. Compassion;
3. Competence;
4. Communication;
5. Courage;
6. Commitment.
Cumming (2012) explains that the above 6C’s should be the foundation that all nurse
leaders should strive to work by and she implies that when there is lacklustre
leadership this is when problems can arise, this is echoed by Wedderburn Tate
(2003) in a now dated book which the author feels is still relevant today, as they
describe how poor ineffective leaders do not have the ability to read their
environments, they plod along with a distorted view of reality which prevents them
from acknowledging they have a problem on the unit, they achieve this state of
delusion with the help of a few chosen followers who would like nothing more than
having a nice, stable, familiar unit and feel change would upset the applecart.
From the above mentioned report it can be summarised that the leadership
plays a crucial role within the quality of operations and practices performed by the
nurses. This is because there is a continual changing pace with the system as well
as organisational setting of the healthcare due to changes get anticipated with the
healthcare need and want of patients. Hence leadership plays a crucial role in
healthcare organisations by developing the strategies and guiding the employees in
order to bring changes for innovating and improving the quality of services.
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REFERENCES
Books & Journals
Carlos Pinho, J., Paula Rodrigues, A. and Dibb, S., 2014. The role of corporate culture,
market orientation and organisational commitment in organisational performance:
the case of non-profit organisations. Journal of Management Development, 33(4),
pp.374-398.
Daly, J. and et. al., 2014. The importance of clinical leadership in the hospital
setting. Journal of Healthcare Leadership, 6, pp.75-83.
Gopee, N. and Galloway, J., 2017. Leadership and management in healthcare. Sage.
Ortega, A. and et. al., 2014. The influence of change-oriented leadership and psychological
safety on team learning in healthcare teams. Journal of Business and
Psychology, 29(2), pp.311-321.
Spano-Szekely, L. and et. al., 2016. Emotional intelligence and transformational leadership
in nurse managers. JONA: The Journal of Nursing Administration, 46(2), pp.101-
108.
West, M. A. and et. al., 2014. Developing collective leadership for health care. London:
King's Fund.
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