Leadership in Health and Social Care: LSM Module Report

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LEADERSHIP IN HEALTH AND SOCIAL CARE {LSM}

Table of Contents
Introduction..............................................................................................................................................................3
Task 1.......................................................................................................................................................................3
LO1 and 4: Critical analysis of current challenges and perspectives.......................................................................3
Task 2.......................................................................................................................................................................9
LO2 and 3: Application of authentic leadership to a change process......................................................................9
Conclusion..............................................................................................................................................................14
References..............................................................................................................................................................15
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Introduction
Clinical Nurse Leadership is a new concept that has been developed to produce nurses
possessing high skills. This concept is mainly focused on improving safety and quality
outcomes regarding patient populations. Due to an increase in the number of patients with
long term illness, healthcare sector requires effective leadership in order to assist teams so
that they can provide support and help to these patients. Providing help and support to these
individuals can lead an independent life and can minimise the need for expensive
interventions. Effective leadership is also necessary as it enables engaging healthcare staff in
providing care. This enables patients to get a better experience along with less health-related
errors, a lower rate of infection and mortality rates. Good leadership is important as it ensures
good management of financial issues raises morale of staff and motivates them.
Task 1
LO1 and 4: Critical analysis of current challenges and perspectives
1.1 Leadership styles and transformational issues
Lack of good leadership and poor coordination among the staff has been the main causes of
the scam that occurred in Staffordshire hospital. There are several leadership styles
commonly seen in a health institute. Some of these leadership styles are explained in brief:
Figure: Different Leadership style
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(Source: Cherry and Jacob, 2016)
● Democratic: This form of leadership style in nursing allows participation of
subordinates in decision-making processes of an institute. Although the leader takes
the final decision, yet, the leader collects pieces of information, ideas, and feedback
from all their staff members, and then finalises the decision that needs to be
implemented. The advantage of this form of leadership makes workers feel valued
and more enthusiasm is created (Cherry and Jacob, 2016). The main demerit of this
leadership style is that collecting feedback from every staff is a process that requires a
lot of time.
● Transformational: This form of leadership in nursing is based on encouraging the
employees to provide their best in their work using a common vision and mission.
The main advantage in the transformational form of leadership is that it results in a
productive and engaged clinical team. But its demerit is that order to make this
leadership style successful, an inspiring, as well as an experienced nurse leader, is
essential (Weiss et al. 2019).
● Autocratic: In an autocratic leadership style, the lead nurse decides everything and
little input are accepted from the subordinates. The subordinates need to follow the
task that has been assigned to them. This form of leadership works perfectly for
prison hospitals or military hospitals. The only merit of this kind of leadership is that,
during emergencies or complex situations, this form of leadership can be used
effectively. However, in routine operations, it is not a good idea to use this form of
leadership because it fails to create good communication, teamwork, and trust, and
this is a big demerit of this form of leadership (Grossman and Valiga, 2016).
● Coaching: In this form of leadership, the leaders put efforts and concentrates on the
development of people. The leaders work in order to make their team members
recognise their weakness and strengths, and thereby, helping them to achieve their
goals. If implemented in a proper manner, this form of leadership provides a great
opportunity for grooming employees personally and professionally, thereby, helps to
attain long-term results. However, as stated by Kimble et al. (2016), its disadvantage
is that this form of leadership can be successful if and only if the subordinates are
receptive. Moreover, it requires time to implement this form of leadership,
particularly at the beginning.
● Transactional: In this form of leadership, the subordinates are lured to rewards and
threatened to punishments in order to complete a task. This leadership style mainly
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focuses on the leadership, supervision, and performance of group members. It is
completely dependent on the transactions between subordinates and nurse leader. This
form of leadership is based on the fact that employees can be motivated by both using
rewards and discipline (Tyczkowski et al. 2015). The main disadvantage of this
leadership form is that creativity is not encouraged in this leadership style.
● Laissez-Faire: In a laissez-faire leadership, the lead nurse only provides minimum
guidance to their subordinates and then they are given the freedom to work in a way
they please. A negligible amount of additional guidance or supervision is provided by
nurse leaders. As stated by Williams et al. (2019), this form of leadership proves to be
successful if and only if the medical staff members are experienced, motivated,
educated and highly skilled. The disadvantage is that this form of leadership cannot be
used whenever there are inexperienced or less skilled employees in a team.
● Visionary: This form of leadership is almost similar to transformational leadership
style; however, the leaders in this form of leadership are concerned with the future
and long-term success of the organisation. The leaders encourage their teammates to
remain focused on the goals of the future and provide stepwise procedures to achieve
such goals (Regan et al. 2016). This form of leadership is effective in those clinical
organisations that are new and require directions to expand in the healthcare field.
However, a shortcoming of this leadership style is that leaders often get confused with
varieties of ideas and with unrealistic optimism.
● Servant: Servant leadership is style is often by lead nurses in order to achieve success
of their medical organisation. The lead nurse looks after their staff members serving
the patients and works hard in order to achieve positive results. This style helps to
develop a healthy environment of working to the junior medical staff. This is a caring
leadership style and is effective in building trust between the employees. The main
con of this leadership style is that this form of leadership takes a long time to make
any decisions (Roche et al. 2015).
The Trust board of Staffordshire hospital neither listened to the complaint of the patients nor
it ensured mitigation of deficiencies that were brought to the attention of the Trust. Moreover,
it also failed to tackle the negative culture that involved tolerating poor health and hygiene
standards. Also, there was disengagement from leadership as well as from managerial
responsibilities (The Telegraph, 2009).
1.2 Need for Transformational Leadership
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Effective clinical leadership is essential in order to ensure a healthcare system of high quality
so that it provides efficient and safe care. The lack of proper leadership aspects in
Staffordshire Hospital has led to the development of the negative organisational outcome.
There were several issues that the existing leaders avoided to eliminate. The concerns were
affirmed by the leaders; however, they abstained from taking any action. Moreover, the
leaders provided statements that were contradictory to the situation. Hence, it is essential to
implement transformational leadership in Staffordshire Hospital (Spencer et al. 2017).
Moreover, the time when Mrs. Bailey was admitted to the hospital, her daughter claimed that
she was astonished of her experience in Staffordshire Hospital (The Telegraph, 2009). She
observed that the health care assistants were poorly trained and abstained from assisting the
patients in taking their food. Moreover, several elderly men were found wandering the ward
in a state of confusion and vulnerable patients were left dirty, hungry and in pain. There was
also a lack of drinking water and several patients were seen drinking water from flower vases.
The hospital also lacked funds and hence, there was a lack of trained medical staff. Hence,
the hospital authorities forced to cut 150 jobs in order to maintain their budget. Hence at the
managerial level as well as at the staff level, it is essential to implement a transformational
leadership style. It is very important to improve the current situation and image of the
hospital. The nurses working in the hospital lacked in skills and were not clear about their
task (The Telegraph, 2009). In order to get rid of such situation, it is essential that
transformational leadership is implemented within the organisational structure of the hospital.
The system of NHS consisted of many balances and checks that could have prevented this
failure. It was the lack of leadership abilities in existing higher authorities that led to such
failure. For several years the patients did not receive acceptable care standards. In the
investigation, it was found that patients were left without adequate care and were left at high
risk.
Hence, it can be said that effective transformational leadership was important and this could
have averted the scandal that occurred in the hospital. Transformational leadership is also
essential in Staffordshire Hospital because it shall help to develop an institutional culture that
would provide more weight on positive pieces of information regarding services. In any
medical institute, poor standards of healthcare that enhance the risk of patients are
unacceptable. Transformational leadership shall also help to foster a common organisational
culture and hence focus shall be made on putting patients first (Johnson et al. 2018). This
shall also enable the hospital authorities to develop certain fundamental standards that are
understood and accepted easily by the patients.
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However, before implementing transformational leadership within Staffordshire Hospital,
certain barriers should be taken care of. The clinical staffs of most healthcare organisations
have a lack of awareness regarding transformational leadership style. There is also a
significant lack of accessible leadership training and education. Since the staffs of
Staffordshire Hospital are not highly skilled, it is not possible to develop effective
transformational leadership among the existing staff (Cleeter et al. 2016).
In order to implement the vast changes within NHS, a transformational form of leadership
need to be implemented. This would encourage creativity, flexibility among the staff.
However, according to the Francis report (2013), it was highlighted that the senior nurses
were not efficient enough in safely managing the clinical areas. In this context, it can be
effectively said that a transformational form of leadership cannot rectify such situation alone
and a mixture of transformational as well as transactional leadership styles needs to be
implemented (Boamah et al. 2018).
1.3 Presentation of Key Issues:
There were several key issues within the organisational management of Staffordshire
Hospital. These key issues were mainly overlooked by the authorities of the hospital. The
hospital authorities were too tolerating of the poor healthcare standards delivered to the
patients. There was an autocratic form of leadership among the nursing staff and they did not
bother taking care of the patients or provide relief to them. There also existed a lack of
effective communication among staff as well as healthcare agencies in sharing their
concerned knowledge. There was an immense failure in building a culture of positive
environment, not only among the nursing staff but also within other medical professionals.
The performances of the cleaning staff regarding the cleanliness of the hospital were strictly
below expectations. The responsibility of keeping a healthcare premise clean is not only that
of the cleaning staff but it is the responsibility of every medical staff (The Telegraph, 2009).
A high mortality rate of the patients was also a serious issue of Staffordshire Hospital. Along
with the absence of high cleanliness degree within the hospital, it was also noted that there
existed healthcare staff lacking in skills and experience with an acute shortage of highly
skilled nurses and other medical staff (The Telegraph, 2009). Due to a shortage of medical
staff, several patients, suffering from critical illness were left dirty and in pain. Lack of
proper drinking water forced patients to drink water from flower vests that were present in
the ward. The floors of lavatories had stinks of urine. This showed that lavatories were
unhealthy and were the source of infections to the patients.
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It was also found that several disposable surgical equipments like clamps and clips were used
more than once. The hospital also had untrained receptionists and these receptionists were
given the task of triage and were forced to assess patients for treatment priority. This task
should have been done only by a well trained medical staff and not anyone else. There was
also mismanagement of the Trust along with lack of efficient leadership approaches of
clinicians within the Trust. Several other issues that existed within the hospital were
inadequate equipment, lack of support from the management, and poor management of
operation theatres (Francis, 2013).
However, even after knowing the issues, the Trust did not take adequate measures to address
those concerns. As a result, the problems kept on mounting. The problems finally came to
light in 2009, when there was an investigation regarding abnormal rates of high mortality.
The work culture of the Hospital was such that higher authorities discouraged the staff
members having concerns regarding failures and the staffs were discouraged from speaking
about the failures (Leuning et al. 2016).
It can be inferred from the case study that the behaviour of the clinical staff was too rude and
such kind of behaviour is not expected from clinical staff. The hospital authorities also failed
to respond and accept legitimate complaints (The Telegraph, 2013). The hospital had a lack
of funds and immediate amendment in their financial budget was necessary so that more
trained and skilled staff could be employed in Staffordshire Hospital.
Task 2
LO2 and 3: Application of authentic leadership to a change process
2.1 key authentic leadership and its importance during process changes
Authentic leadership works on a principle suggesting leaders can prove legitimacy to their
work through maintaining sincere relationship with subordinates and offering more
significance to their input. In a health care environment like Staffordshire NHS Hospital
authentic nursing leaders must encourage their co-workers and subordinates to become more
open. Nursing leaders should promote both team and individual performances. Another great
hallmark regarding authentic leaders is consistency. As per (Curtis and Sheerin 2019),
nursing professionals who show leadership qualities generally possess patience and less
fickle in nature. They prefer to be stick to principles and guidelines of Staffordshire Hospital
in every situation. In case of process changes that occurred in case of Staffordshire Hospital,
nursing leaders must maintain their consistency. These types of chaotic situation generally
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draw a lot of media attention. Authentic professional leaders must remain transparent and
mediate open communication combined with empathy and directness. Lack of this
transparency can be detrimental to this hospital. The reason is that, people name it as scam
when they get partial and moulded information about any situation. Nursing leaders should
not hide their weakness as well as strength in this situation.
Role of nurses in cleanliness: Expectations regarding cleaners’ performance and duties are
not reliable in every situation. Instead of cleaners, the responsibility relies on every health
care professional to keep environment of hospital tidy and clean. In order to avoid
contaminations and spreading of infections, nurses must sterilise laboratory equipments
before applying it to patients of Staffordshire Hospital. Disposable gloves should be used and
disposed because it is not meant for long term usages. Contamination through clothes can be
prevented by wearing disposable aprons at the time of cleaning. Nursing leaders need to plan
specifically to train their subordinate nursing staffs as well as other healthcare professionals
about cleanliness and safety of patients. In reference to opinion of (Martin et al. 2015),
frequency of cleaning operations should also be noted by authentic nursing professional
leaders. It is mandatory to keep people involved in cleaning operations at regular interval to
ensure proper and consistent cleanliness.
Nursing leaders’ role in improving care:
Currently in Staffordshire Hospital, some realistic and critical issues persist along with
process changes. The change in organisational process seems to be no longer effective for
patients care. There are some burning issues regarding neglect and suboptimal care in
healthcare settings. One solution that can be implemented in this situation is that
establishment of leadership skills and styles in front line nurses (Smith et al. 2018).
Responsibility of matrons, ward managers and nurses are optimal in providing holistic and
patient centred care to patients. In case of irregularities, nursing leaders should arrange for
respective training opportunities for existing and new subordinates.
2.2 Importance of authentic leadership models
Administration of authentic nursing leadership may impacts not only upon nursing
workforce but also society and delivery system as a whole. Nursing leaders must possess
certain leadership qualities that are beneficial to their workplace (Smith et al. 2018). Nurses
must look for providing certain health care that supports patient centred and holistic care to
patients. In addition to that, hygiene of a health care unit must be regulated wisely so that
patients do not get infected due to unhealthy environment. As per comments by (Lusiani et
al. 2016), an authentic nursing leaders must be self-aware of their taken decisions and
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actions. In a critical situation within Staffordshire NHS Hospital, nursing leaders should put
their effort so that they can overcome their fears. In addition to that, they can apply their
strength to an ultimate. Authentic leaders are those who can lead their subordinate teams with
empathy and encouragement. Temporary setbacks within organisational context should be
given less importance. The reason is that authentic nursing leaders always look for long term
goals rather than stellar outcomes. They should be diligent and patient in taking rightful
decisions while in a critical situations. Integrity is another great feature in nursing leaders
which makers the team a good one. They must be full of vision and purpose. As per
(Baldacchino, 2015), in a chaotic situation like Staffordshire NHS Hospital authentic leaders
should keep their calm and listen to others when they contradict in a particular point of
matter.
Great man leadership theory: This theory of great man suggests that some individuals have
been born with adequate attributes and characteristics that make them different from other
individuals. Assuming positions of authority and power are given to those nursing leaders for
those specific traits. As per concepts of this theory, leaders are a person who achieves goals
against all differences for followers (Coyte and McKeever 2016). This theory also entails that
this types of traits become stable over across group and time. Great leaders generally share
these traits irrespective of their activities and time of execution.
Contingency or situational theory: This theory of contingency opines that efficacy and
potentiality of nursing leaders is contingent with situational leadership styles. Leaders must
identify particular situation and its importance before application of any types of leadership
styles. Fiedler’s Contingency Model suggests that none of the leadership styles can be
considered as best leadership styles (Smith, 2018). It also entails that any leadership style
become effective when it become fit with that particular situation.
Style theory: Style theory of leadership is more concerned about performance or work of
leaders rather than what they are. Principal focus of these leadership styles is on relationship
and task behaviours. There is a thin line between concepts of trait theory and style of theory
of leadership. Instead of looking towards leadership qualities, their born environment or
styles and skills related to leadership, they put stress on their actual work or duty (Gradinger
et al. 2015).
Trait theory: Trait theory provide example both unsuccessful and successful leaders. This
trait theory tries to establish effectiveness of leaders (Kantanen et al. 2017). This theory
entails that failure or success of leaders is positively correlated with their effectiveness.
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Figure: Leadership Models
(Source: Kantanen et al. 2017)
2.3 Key issues of the case and importance of responsible leadership during process
change
Due to the lack of effective leadership within Staffordshire Hospital, there was a lack of
proper job divisions among the staff. Repeated failures within the management existed and
only focus was laid on boosting the financial performance and meeting national standards
figure. Staffordshire Hospital also reduced more than 150 health staff as well as their
expenditure regarding training. This resulted in a severe understaffing in certain critical and
important areas and hence there developed a lack of leadership among the clinical staff
subsequently. The authorities of the hospital were extremely obsessed with meeting certain
national targets such as reduction of waiting time in the A&E department, that the clinical
staff often discarded important clinical protocols and patients were moved out of the A&E
without receiving proper care from qualified doctors (The Telegraph, 2009).
Management of change of processes is a key concern in every healthcare management.
Handling several complexities of process change is the main basis of managing a change. It is
mainly about implementing, planning and evaluating operations, strategies, and tactics, along
with ensuring that changes made are relevant and worthwhile (Johnson et al. 2016).
Management of organisational is a dynamic, challenging and complex process.
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GreatmanLeadershipTheoryStyleTheoryTraitTheoryContingencyorSiituationaltheory

Changes can be brought within Staffordshire Hospital by ensuring that hospital authorities
and staff are prosecuted if patients are not taken good care. Major changes need to be
implemented in recruitment of highly skilled nurses. It is essential to construct a more
transparent and open healthcare system as well as to launch a new national drive in order to
improve the safety of patients at NHS. The organisation should be newly designed in a way
such that each healthcare practitioner working in the hospital develops a responsibility of
putting patients’ well being before every other issue. It must be the responsibility of a
medical practitioner to maintain and ensure that proper healthcare facilities are being
provided to the patients (Curtis and Sheerin, 2019). Each practitioner should take appropriate
and strict action whenever they are alerted of the poor medical standards.
The events that took place in the Staffordshire Hospital could have been avoided and the
investigation reports declared that there existed negligence of staff in their duty. It is very
essential to bring a positive organisational change within the hospital so that GPs maintain a
continuing correlation with patients (Martin et al. 2015).
Effective changes need to be characterised as old unfreezing behaviours and refreezing the
newly introduced behaviours. According to Smith et al. (2018), the changes may be
occasional, sporadic, continuous or rare. Even after a change is approved, employees working
within the organisation often want to understand the reasons behind the changes and how
their working environment shall be affected. Change of processes should be implemented in a
tactical way such that it does not lead to anger, paranoia, insecurities, and confusion among
the employees.
2.4 Critique of the change processes and implementation of the benefits of sustainable
change
Ability to adapt, evolve and change is the only competitive advantage in a sustainable way to
perform better in competition. Failures in organisational changes are mainly due to several
factors that include lack of commitment and proper vision from senior authorities, along with
limited involvement of the senior authorities with processes and system of the organisation
(Lusiani et al. 2016). In order to enjoy success at a greater level, the higher management
authorities should develop a better framework of their thinking regarding bringing the
changes and should have a clear knowledge and understanding of several main issues that are
important for accompanying change management.
However, promoting a sustainable change within any healthcare institution is fatiguing as
well as challenging. It requires the health staff and other higher authorities to challenge the
preceding techniques as well as it require perseverance against already established norms and
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