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PubMed2001

Maternal and child health nutrition training builds leadership skills.

For more than 30 years, the Maternal and Child Health Bureau (MCHB) has funded specialized professional training in nutrition with an emphasis on the development of leadership skills. A survey was conducted of individuals who received Maternal and Child Health nutrition training at the Center for Human Development and Disability (CHDD) at the University of Washington. Those surveyed were asked to reflect on the impact of the training on their career pathway and to report on their leadership activities. Of the 91 respondents, 83 (92%) indicated that the training supported a career pathway that emphasized maternal and child health or children with special healthcare needs. Eighty-five former trainees (93% of respondents) reported leadership activities at the local level, 61 (67%) reported leadership activities at the state level, and 46 (51%) reported leadership activities at the national level. The results of the survey indicate that specialized, intensive training in the field of nutrition develops and supports leadership skills.

Adult↗
PubMed2002

The evaluation of a clinical development unit leadership preparation program by focus group interviews - part 2: negative aspects.

In Western Sydney, Australia, in 1996, the Area Health Service and the University of Western Sydney entered a strategic alliance to develop a nursing research culture in the health services. One of the strategies implemented to achieve this was the establishment of a network of research-receptive environments known as Clinical Development Units (CDUs). In terms of research receptivity, evidence at the time suggested that it could only be developed in units where the leadership style is democratic and participatory. In terms of CDUs, evidence suggested that their successful development depended critically on the effective management of CDU leadership stressors. In light of this, it was agreed to conduct a CDU leadership preparation program in Western Sydney. The program aimed to furnish CDU leaders with the participatory leadership skills required to develop and manage their units. It was expected that the acquisition of such leadership skills would serve to minimize the leadership stessors they could expect to experience. This is the second of two papers which report course evaluation data. The first focused on the more positive evaluation data; this paper focuses on the negative evaluation data and outlines how the current program has been modified in light of these data. In addition, it discusses two themes which emerged during data analysis. These were nurses' apparent mutual lack of trust and their pressing needs to be recognized as valuable and merit-worthy.

Anecdotes as Topic↗
PubMedDate not supplied

Nurse practitioners: leadership behaviors and organizational climate.

The purpose of this article is to examine the relationships of individual nurse practitioners' perceptions of the leadership climate in their organizations and self-reported formal and informal leadership behaviors. The nine climate dimensions (Structure, Responsibility, Reward, Perceived Support of Risk Taking, Warmth, Support, Standard Setting, Conflict, and Identity) identified by Litwin and Stringer in 1968 were used to predict five leadership dimensions (Meeting Organizational Needs, Managing Resources, Leadership Competence, Task Accomplishment, and Communications). Demographic variables of age, educational level, and percent of time spent performing administrative functions were forced as a first step in each multiple regression analysis and used to explain a significant amount of variance in all but one analysis. All leadership dimensions were predicted by at least one organizational climate dimension: (1) Meeting Organizational Needs by Risk and Reward; (2) Managing Resources by Risk and Structure; (3) Leadership Competence by Risk and Standards; (4) Task Accomplishment by Structure, Risk, and Standards; and (5) Communication by Rewards.

Adult↗
PubMedDate not supplied

Principles of disaster management. Lesson 7: Management leadership styles and methods.

This lesson explores the use of different management leadership styles and methods that are applied to disaster management situations. Leadership and command are differentiated. Mechanisms that can be used to influence others developed include: 1) coercion; 2) reward; 3) position; 4) knowledge; and 5) admiration. Factors that affect leadership include: 1) individual characteristics; 2) competence; 3) experience; 4) self-confidence; 5) judgment; 6) decision-making; and 8) style. Experience and understanding the task are important factors for leadership. Four styles of leadership are developed: 1) directive; 2) supportive; 3) participative; and 4) achievement oriented. Application of each of these styles is discussed. The styles are discussed further as they relate to the various stages of a disaster. The effects of interpersonal relationships and the effects of the environment are stressed. Lastly, leadership does not just happen because a person is appointed as a manager--it must be earned.

Disaster Planning↗
PubMed2002

Transformational leadership and the mental health team.

Bass's (1990) multifactor model contrasts transformational and transactional styles of leadership with an essentially ineffective style: laissez-faire leadership. This study examines the relationship between these leadership styles and measures of organizational culture and staff burnout in mental health services teams. There were 236 leaders and 620 subordinates from 54 mental health teams who provided their perceptions of leadership style, organizational culture, and burnout in their program. Results show transformational leadership to be positively associated with a cohesive organizational culture and negatively associated with burnout. Moreover, leaders and subordinates differ in their ratings of transformational leadership-leaders viewed themselves more positively. These findings are helpful for understanding the central role of leaders in the organizational structure of teams.

Burnout, Professional↗
PubMed2007

Trait-based perspectives of leadership.

The trait-based perspective of leadership has a long but checkered history. Trait approaches dominated the initial decades of scientific leadership research. Later, they were disdained for their inability to offer clear distinctions between leaders and nonleaders and for their failure to account for situational variance in leadership behavior. Recently, driven by greater conceptual, methodological, and statistical sophistication, such approaches have again risen to prominence. However, their contributions are likely to remain limited unless leadership researchers who adopt this perspective address several fundamental issues. The author argues that combinations of traits and attributes, integrated in conceptually meaningful ways, are more likely to predict leadership than additive or independent contributions of several single traits. Furthermore, a defining core of these dominant leader trait patterns reflects a stable tendency to lead in different ways across disparate organizational domains. Finally, the author summarizes a multistage model that specifies some leader traits as having more distal influences on leadership processes and performance, whereas others have more proximal effects that are integrated with, and influenced by, situational parameters.

Aptitude↗
PubMed2002

Trust in leadership: meta-analytic findings and implications for research and practice.

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k = 106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs. organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation.

Humans↗
PubMed2003

Interdisciplinary team leadership: a revisionist approach for an old problem?

Understanding of interdisciplinary teamwork is evolving. During health care restructuring, leaders across organizations have challenging responsibilities when work groups must integrate changing organizational values with new modes of service delivery. In this environment, a well-functioning interdisciplinary team in which clinicians work as member-leaders has the potential to further organizational change and foster improvements in patient outcomes. In this paper it is argued that the term interdisciplinary team leadership should be embraced cautiously as it may be a revisionist approach to an old problem, namely a means to modify existing theories of leadership that have been vague and continue to be poorly understood despite considerable effort to explicate knowledge over several decades. Preliminary research suggests that interdisciplinary team leadership is a model of shared leadership that requires more development if it is to become the cornerstone of interdisciplinary team practice in a radically reforming health sector. Stewardship is proposed as a potential philosophy for interdisciplinary team leadership, and a new, shared leadership role of practice leader is suggested.

Attitude of Health Personnel↗
PubMed1997

Hospital leadership for quality: theory and practice: II. Quality performance evaluation.

Hospitals need excellent leadership to be efficient in the use of scarce stakeholder resources and to be effective in the competitive provision of services to multiple customers. This paper is the second report on a study conducted with cooperation of the executive team at a large government-funded hospital in Brisbane, Australia. The overall study focused on linking the leadership concepts and attributes of the members of the executive with an overall evaluation of quality practice in the hospital. The first paper reported the leadership results. This paper reports the quality practice and its links with leadership. The study revealed use of data, understanding of processes and the formation of supplier partnerships as the areas of hospital activity most limiting the ability to improve. Little impact of leadership attributes was found, contrary to studies conducted elsewhere. This may be due to the strong influence of different professional groups within the hospital, since domains of leadership influence largely coincided with these groups.

Attitude of Health Personnel↗
PubMed1999

Leadership behaviors for successful university--community collaborations to change curricula.

PURPOSE: What constitutes effective leadership in a collaborative effort to achieve enduring curricular and student career changes? This question was investigated as part of a larger evaluation of the W. K. Kellogg Foundation's Community Partnership Health Professions Education, a five-year initiative involving projects at seven sites. The goal was to produce more primary care health providers by making enduring curricular change. METHOD: Data were collected from participants with respect to predictors of project success and leaders' use of 16 behaviors via telephone interviews, mailed surveys, and focus groups. Focus groups also gathered project leaders' views of skills and knowledge necessary for effective leadership. RESULTS: Leadership strategies associated with positive outcomes were: consistent leader; use of multiple cognitive frames, especially a human resource frame; use of a broad range of leadership behaviors, particularly participative governance and cultural influence; and a majority of community representatives on the partnership board. The primary leader, compared with a leadership team, is most influential in achieving positive outcomes. CONCLUSION: Effective leaders use a broad array of behaviors, but particularly emphasize the use of participative governance and culture/value-influencing behaviors. In addition, the more frequent use of these behaviors compared with the use of organizational power behaviors is important. It is helpful to perceive the project from a human-relations frame and at least one other frame. Using a leadership team can be helpful, especially in building coalitions, but the importance of the primary leader's behaviors to project outcomes is striking.

Academic Medical Centers↗
PubMed1994

Leadership: a new conception.

The article summarizes the common wisdom regarding leadership that informs our present understanding of leadership. It articulates a new understanding of leadership, referred to as the postindustrial paradigm of leadership; comments on this new paradigm; contrasts it with the industrial paradigm of leadership; and ends with some comments on leadership as an episodic affair.

Commerce↗
PubMed2003

Charge nurse leadership development and evaluation.

OBJECTIVE: To describe the development and evaluation of a permanent charge nurse role and report outcomes of this leadership model over 4 years. BACKGROUND: A permanent charge nurse role was developed to improve continuity of care and develop emerging nurse leaders. An evaluation model was constructed to measure program outcomes. Kouzes and Posner's Leadership Model served as the theoretical framework. METHODS: The permanent charge nurse role was developed, training planned, and the evaluation framework established. Measurements included two survey instruments, an investigator-developed End-of-Shift Report, and institutional patient satisfaction data. Survey instruments included Kouzes and Posner's Leadership Practice Inventory (LPI), concurrently measuring self (charge) and other (staff) perceptions of charge leadership. The McClosky Mueller Satisfaction Scale (MMSS) measured charge and staff nurse job satisfaction. Data were collected at baseline, post-implementation, and additional time periods. RESULTS: Charge RNs reported significantly more favorable perceptions of leadership abilities than staff. The Shift Report successfully tracked both system and charge management issues. Patient satisfaction data did not yield data due to vendor changes. Job satisfaction results showed charge nurses reported higher satisfaction with schedule, praise and recognition, control and responsibility, than staff nurses. CONCLUSIONS: Using data to evaluate charge nurse leadership guides continued program improvements.

Attitude of Health Personnel↗
PubMedDate not supplied

Leadership perceptions of nurse practitioners.

Education in leadership principles is included in Master's Degree programs for nurse practitioners (NPs). NPs have an opportunity to be leaders in a variety of roles and to make major decisions within their profession and within the healthcare system. NPs' collaboration with nursing professionals, colleagues, and other healthcare professionals--including clients and families--demonstrate their expanded practice. The purpose of this study was to examine perceptions of leadership by Master's-prepared NPs and determine if they are providing leadership in practice. There has been minimal research to evaluate whether NPs graduating from Master's programs are effectively using leadership skills in their practice. Master's Degree education has a strong focus on leadership and, combined with the need for lower cost of healthcare, NPs have the potential to provide important leadership and cost savings to the healthcare delivery system.

Adult↗
PubMed2000

A qualitative evaluation of shared leadership barriers, drivers and recommendations.

Shared leadership is a management model based on the shared governance philosophy. Assumes those individuals or teams performing tasks are best equipped to provide meaningful improvement. The changing image of the current leadership model is one that resides in relationships rather than with a singular person. The key concepts are accountability, partnership, equity, and ownership. When shared leadership was initiated at St Joseph's Health Care, London, Ontario, in 1998, there was a commitment by management and staff to ensure that it was successfully implemented. In order to determine areas for improvement in the implementation process, continual evaluation is necessary. Reports from various staff members, prior to the project, indicated that the shared leadership implementation plan had not been fully realised. Therefore, a qualitative evaluation project, utilising focus groups and interviews, was completed. The purpose of the study was to identify the drivers, as well as the barriers affecting the implementation process. Several recommendations for improving the process were determined by the participants of the study. The result of the project was a collection of four themes, common to the discussions of barriers, drivers and recommendations. The internalisation of the concepts specific to the shared leadership model was found to be vital. The effectiveness of the council framework, including the council structure, processes and membership was also important. Communication of outcomes arising from the council was crucial. The final theme to be identified included those Humanistic Needs that addressed the relationship aspects of this model. Furthermore, the relationship between these themes was explored in the context of the external forces affecting the shared leadership model.

Data Collection↗
PubMed2005

Clinical leadership in health care: a position statement.

PURPOSE: This paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives. DESIGN/METHODOLOGY/APPROACH: It is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of "local" leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery. FINDINGS: The reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process. PRACTICAL IMPLICATIONS: For leadership initiatives to become truly culturally embedded into the "way we do things around here", they require more than just individual training and development. ORIGINALITY/VALUE: A view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the "organizations" to which they are accountable and between health care professionals and service users.

Delivery of Health Care↗
PubMed2001

How do directors of public health perceive leadership?

This study examines how directors of public health (DsPH) perceive effective leadership. Kelly's repertory grid technique is used. A total of 13 out of a possible 14 DsPH in one NHS region of England were interviewed. Qualitative and quantitative analysis were carried out. The findings show that male DsPH (n = 8) rate their leadership ability more highly than do female DsPH (n = 5). Qualitative analysis produced a number of categories of constructs, some of which are perceived to be indicative of effective leadership, these being "working for others", "personal attributes", "vision and innovation" and "courage and integrity" Some categories appear to be applicable only to the UK (or to public health) and not to the existing dominant US models of leadership. In general, DsPH perceptions of effective leadership converge with current theories; most specifically the UK-based theories. This study therefore refutes any simple extrapolation of US theories of leadership to UK health organisations.

Administrative Personnel↗
PubMed2004

Systemization of leadership for the systemization health care of health care: the unaddressed issue in health care reform.

The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of "improved performance". It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g an orthopaedics unit or birth unit), as the possible "fix" for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located Argues that the "following" that clinical unit managers could command was shaped by the sub-cultures and "regulatory ideals" with which staff of each profession are involved In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings.

Australia↗
PubMed2004

Leadership development in health care: a word of caution.

Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development programmes have been developed to meet this need This paper reviews the evidence concerning leadership development in nursing. The conclusion reached is that leadership is only one element in the changes that need to occur in health care. Too much emphasis on leadership without an equal concern for transforming the organisations nurses and other health personnel work in may result in leadership being added to the list of transient management "fads" which have characterised health care in recent years.

Leadership↗