The Essay Explores Leadership Skills And Collaboration In Healthcare.

The assignment requires you to:

• You are expected to provide general information about leadership and management to include nursing, in addition identify relevant leadership and management theories and/or models. But, most importantly discuss the styles that are applicable to your case study and why / why not they were/are appropriate in the context. You are required to support your discussions with current policies, literature, and practice experience which is related to your formative case study.
  

• You are required to identify collaboration, MDT and interprofessional working; and discuss the impact of these to your formative case study and to patient-centred care.
  

• Discuss relational leadership and its effectiveness to create positive and/or negative relationships- e.g. inclusiveness, empowerment and how this links to theory, patient-centred care and your case study.
  

You are required to demonstrate self-awareness- within the essay. Apply your discussions to ‘self’- as a qualified nurse, what do your findings/conclusions mean for your future practice.

Leadership and Effective Collaboration in Health Care

Leadership and effective collaboration in health care is the key to strengthen quality and promote integration of care in health setting. High quality care is crucial for promoting productivity and increasing the likelihood of achieving the expected health outcomes for patient. Positive association between leadership style and interdisciplinary team work is found to be associated with quality of care and successful patient outcomes (Sfantou et al. 2017). This essay seeks to demonstrate the role of leadership skills on patient outcomes by looking at a case scenario of patient and care provided. It will critique the leadership style seen in the scenario and analyse the collaborative work practices that helped to minimize risk of clinical deterioration in patient. The negative or positive relationship between patient and relational leadership will be interpreted and it will also look at the role of self in problem solving and effective decision making process. The case study use for the essay is attached in the appendix and the case study information will be used to develop the argument. To maintain patient’s right to privacy and confidentiality, the name of the client will be kept anonymous (NMC 2018).

Leadership is one of the crucial factors that shapes organizational culture and the role of effective leaders are to direct, align and commit to the needs of the team and the health care institution. Being clear about direction is an attempt to achieve objectives that are consistent with vision and values of the organization. In addition, alignment refers to the method taken to promote effective integration of the work (West et al., 2015). As modern health care is confronted by various challenges, past research studies have explored different leadership styles and theories and its influence on nursing practice. Researchers have tried to link and correlate different leadership styles with patient outcomes. Six leadership styles that has been most commonly seen in health care setting includes transformational, autocratic, transactional, laissez faire, task oriented and relationship oriented leadership style (Sfantou et al. 2017).

The transformational leadership theory is the most common and influential theory guiding clinical practice. It is a theory that aims to create positive changes in followers with the ultimate motive of developing them into leaders. This approach redefines perceptions and values and modifies the expectation of employees. It can be defined as an exemplar of leadership styles that work towards the benefits of the team. Such leadership styles foster relationships and motivates team members (Dartey-Baah 2015). In contrast, the transactional leadership theory is an approach that values law and order and promotes compliance to laws by means of rewards and punishments. Leaders using transactional leadership either provides positive rewards to patient during fulfilment of care goals or they may use negative rewards such as warnings or threats if the tasks do not meet the current expectation (Xu 2017). The application of this leadership theory differs in different circumstances and each can be successful if it is applied in appropriate situations. For example, autocratic leadership style is found to be more commonly used in emergency situations where the leaders take all the decisions without taking any feedback from others. This behaviour might be due to the urgency of the situation (Crombie and Garland 2016).

Different Leadership Styles and Their Impact on Patient Care

While referring to the case study, it has been found that in response to the deterioration in the vital signs of patient, the senior nurse or the nurse leadership instructed the RN to wait for the physician to arrive instead of reviewing the emergency of the situation. Hence, it can be said that this approach is very similar to the transactional leadership style as the nurse leader followed usual norms and laws to deal with patient care. However, the transactional leadership style was not adequately applied to the case scenario because the patient’s breathing rate was abnormally high and the physician did not instructed the junior nurse regarding taking any safety steps before the physician arrived. According to Hershkovich et al. (2016), transactional and directive leadership style is needed during actual acute events and to demonstrate effective team work during this time, leaders must understand mileu of their team and work continuously to strengthen their commitment to the quality care goal. However, leadership seen in the scenario did not revealed any endeavour to motivate the followers. Instead, graduate RN alone took the call to identify critical actions needed at that time. Hence, team cohesion was missing in the initial phase which increased the mental burden of the graduate RN.

Transformational leadership style is another approach that could have been used in the scenario. It is a process to influence satisfaction and commitment of the followers to the organization. It is based on four components of motivation, influencing other personal considerations and intellectually simulating others. The first strategy for leaders adapting transformational leadership style is to build a connection of trust with their followers and then use effective communication style to achieve ultimate goals (Fischer 2016). However, to achieve this, the senior nursing leader in the scenario had to spend much time to talk with the nurse to build connection. However, spending so much time was not feasible as the patient’s vital parameters were fluctuating rapidly. Therefore, transformational leadership style is not applicable in the case too.

From the scenario of patient who was in a critical state and suffering from breathing problem, engaging in a structured team discussion to identify best care for patient was not appropriate. The leadership style that was needed at this time was to utilize all clinical knowledge and management skills to instruct the best options to escalate care and instruct the graduate RN regarding making MET calls to prevent the adverse clinical situations. This form of action resonates with the autocratic leadership style where a leader takes all the decision without taking other people’s opinion. In normal case, instructing staffs to just work without any team discussion would have resulted in poor staff motivation for work. Asiri et al. (2016) argues that autocratic leadership is a non-supportive management technique that leads to many barriers in nursing practice and presence of such dominating managers discourage nurse from taking any initiative or  responsibility on their own. However, in the case scenario autocratic leadership style would have worked as the situation demanded taking immediate response to patient deterioration. According to Massey, Chaboyer and Anderson (2017), responding to patient deterioration depends on non-technical skills and access to proper leadership support. Hence, execution of strong leadership abilities and use of medical language would have resulted in a positive response to patient deterioration. In addition, use of reprimand as used in transactional leadership style would not have worked too as this would have further delayed escalation of care for the deteriorating patient.     

Case Scenario Analysis

The use of laissez-faire leadership style is also evident in the case scenario as during the encounter with the deteriorating patient, the leader was not involved in taking decisions and the junior nurse acted without any direct supervision (). This type of action echoes with the laissez-faire leadership style (Sfantou et al., 2017). The graduate RN acted without the senior nurse’s direction and took the decision to conduct vital sign assessment again after an hour. This made her clear that calling the MET team is important for her. The team work skills were seen following the MET call. The negative point of laissez-faire leadership is that it involves total absences of leadership during care delivery. However, the positive aspect of this type of avoidant leadership is that it allows team members to engage in micromanagement. It empowers followers to make decisions on their own.  In the case scenario, the confidence and critical thinking skills of the graduate RN worked. However, all new nursing staff may not be skilled enough to make decision on their own during critical care situations. Lorber, Treven and Mumel (2016) argue that it is the least effective form of leadership behaviour and it is likely to have a negative impact on overall job satisfaction of nurses. It promotes role conflict, role ambiguity in a multi-professional health care team.

Relationship oriented and task-oriented leadership style has been implemented during management of patients too. Task-oriented leadership is desirable when the purpose is to engage in proper collaboration and effective interdisciplinary team work (McCay, Lyles and Larkey 2018). Although in the case scenario, the staffs at the hospital were not involved in effective team work, however this was seen after the MET call, as the nurse recalled her knowledge to provide emergency aid and took the decision to contact other physician after making the MET. The graduate nurse action is relevant with the NMC standards of proficiency for registered nurse which states the need for nurses to assess people at risk of harm and take prompt action to safeguard vulnerable (NMC 2018).  The collaboration between the physician helped in providing emergency care to the patient until the MET team arrived. The MET team had an efficient team leader who gave clear instructions to the MET team and the medical team available to the patient. The strong coordination between the team ensured that the patient came out of risk situation or adverse events. The leadership action seen during this stage of the scenario is reflective of task-oriented leadership style. Bahadori et al. (2016) argues that task-oriented leadership style has better impact on patient satisfaction compared to relationship oriented leadership.

Recommendations for Efficient Patient Care

The above discussion gave an insight into the different leadership theories and styles used in health care and the leadership style that is applicable to the case scenario. The critique revealed how autocratic and task-oriented leadership style was most fit for meeting the safety and care needs of patient instead of other leadership styles. The essay furthers looks to identify and analyses multidisciplinary team work and collaboration process necessary for delivery of high quality care and analyses the impact of this on patient-centred care. Interdisciplinary collaboration is defined as a process during which two or more individual from diverse field come together to achieve common goals. The success of such collaboration process is seen when integration of care takes place and working towards a common goal is the main goal of all team members (Mahdizadeh, Heydari and Moonaghi 2015). Effective interprofessional collaboration was seen in the case study after the MET team arrived as the nurse in charge, the MET team, the physician, the local GP and the physiotherapist was involved in delivering the best possible care to patient. The ultimate goal of all the team members was to effectively respond to clinical deterioration. According to the ACSQHC (2012), a rapid response team should always operate in partnership with the health care team. This may involve identifying the role and responsibilities of each team members and working accordingly. The graduate RN in the scenario remained with the patient and the MET team was involved in providing a structured handover information on clinical condition and future actions needed to the medical team. This is a very crucial finding as it gives the lesson to improve personal role as a future nurse and understand personal role while working with skilful interdisciplinary team.   

Based on review of past research work, interdisciplinary working and multi-professional collaboration has been associated with many positive outcomes. A case report done in resource limiting environment depicted that inter-professional collaboration between physician, nurses and other team members contribute to quality of care and continued improvement in decision making as the constant collaboration and communication process increases the collective awareness of one skills and knowledge (Busari, Molls and Duits 2017). Hence, this helps to utilize the expertise and skills of each team members in an appropriate manner to achieve the common goal. This is another word is said as the use of effective skill mix to deliver high level of care. Nancarrow et al. (2013) defines appropriate skill mix as one of the prominent feature of team work as this is reflective of the fact that team values diversity of team members and understand how their complementary experience promotes recovery of patient. However, an appropriate mix of skills, competencies and personalities are seen when proper staffing takes place (Nancarrow et al. 2013). Similar type of positive effect was seen in the case scenario too as the skill mix of each team members were utilized effectively and in the right team. The graduate RN remained at the bed side of the patient to provide basic care, whereas the MET team worked efficiently to provide emergency intervention in response to respiratory distress. In addition, physiotherapist and GP’s role was also identified in the future management of care and support for patients.

Conclusion

To work efficiently as a multi-disciplinary health care team, it is necessary to display respect to other team members. However, team conflict and poor coordination takes place when there is lack of appropriate leader in the team to promote role clarity and develop a common vision based on which the team should work. This also leads to poor collaboration process, discontinuity in care and risk of adverse events (St Pierre, Hofinger and Simon 2016). However, when a multidisciplinary team values and understand each other’s contribution to patient care, it helps to effectively manage conflict and promote cooperation process. The desirable behaviour and attitude needed to engage in collaborative practice in health care includes coordination, cooperation, shared decision making and partnership. Partnership during team work involves building open and respectful relationship with team members and engaging in shared decision making process relying on mutual trust, communication, negotiation and respectful power balance (Morley and Cashell 2017).

The potential benefit of such collaborative practice within a health care team is that it is associated with improved health outcomes, improved symptoms and standardized care (Morley and Cashell 2017). Rosen et al. (2018) revealed that effective collaboration is associated with reduction in medical errors and maintaining patient safety. Use of appropriate skill mix and proper negotiation between the MET team and the health care team in the case study was associated with improvement of symptoms in the patient too. As all the team members worked and coordinated as per the instructions of the MET team, it was associated with stability of condition of patient. It saved the patient from an adverse event and a negative patient safety event was avoided through this process. Another potential benefit of an effective health care team is that it has a positive impact on patient-centred care as collaborative practice leads to effective sharing of information related to patient (Fox and Reeves 2015). In the case scenario, the graduate RNs regular update and information about patient helped the MET to understand previous health state and extent of risk for patient. Similarly, effective exchange of information by the MET team related to the care to be provided during ICU and after returning to the ward helped to avoid adverse event for the patients and maintain the continuity of care.    The immediate need of patient was met.

The analysis of the case study shows the potential role of timely communication and communication related competencies in engaging in problem solving process too. The graduate RN was able to save the life of patient as she realised the emergency of the situation and escalated the care at the right time. She first took the decision to inform about change in patient condition to the senior nurse leader. In addition, her communication with the MET team also ensured that the patient received proper care. The review of past events of clinical deterioration in emergency departments shows that one of the crucial patient safety issues is that rapid response systems such as MET calls are very rarely utilized. The positive aspect of the case scenario was that the nurse was able to recognize the symptoms of clinical deterioration and activated the MET call at the right time. Hence, the review of poor MET calls in emergency departments gives many important implications to future nursing practice too. The issue identified highlights the need to improve knowledge of nursing students regarding the criteria during the MET calling is necessary. Such understanding and knowledge can significantly improve safety of patient (Hosking, Considine and Sands 2014).

Another form of leadership most commonly seen in health care setting is relational leadership which is associated with practices such mentoring other and building relationship to achieve common purpose. This form of leadership is essential for improving the performance of the health systems and collaborative practice is the main element of this leadership that focus on fostering values and relationship. Relational leadership is strongly linked with empowerment as by engaging team members, they are empowered to contribute to the quality of care (Cleary et al. 2018). If leaders in hospitals aim to fulfil holistic care needs of patient, then they must use this leadership style to achieve self-actualisation, empowerment and well-being. As policy makers and administrators are now showing great interest in person-centred care, future nursing leaders must have the attributes of self-awareness, openness, reflexivity and openness (Cardiff, McCormack and McCance 2018). In the case scenario, relational leadership was seen as the MET team did not individually took the responsibility for care of patient. Instead the graduate RN and other members of the medical team were involved too. Openness was seen in the leader of the MET team as all good exchange of information related to patient care took place. The above discussion on leadership and its impact of patient outcome and quality of care gives the implication to nursing students to engage in continuous training to develop their leadership attribute and fulfil the new demands of the health care team.

To summarize, the essay looked at the case scenario of a patient with respiratory distress and the role of nurse and the multidisciplinary health care team in improving patient outcome and providing quality care. The essay discussed about different leadership styles and theories and considered the application of different leadership styles on the case study. Based on the leadership demonstrated by the senior nurse in the case study, it was found that the senior nurse used transactional leadership style as usual normal was followed. However, no team cohesion and critical thinking was applied by the leader to understand the graveness of the situation. Transformational leadership style was also found to be inappropriate for the case study as the situation demanded immediate action from the team and transformation leadership aims to motivate and develop followers, which is time consuming. Task-oriented leadership can be appropriate for the scenario too as the team work and collaborative practice recognized the task at hand and plan work accordingly. The element needed for effective interdisciplinary team work and collaboration was discussed too and its impact with patient-centred care was identified. The overall lesson obtained from the critical analysis of leadership style and interprofessional collaboration gives the implication that future nurse must be prepared to lead the team and they must develop their skills to engage in effective leadership for the betterment of the team.

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