Leadership and strategies in Healthcare Sectors

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Leadership is the process by which a person influences the attitudes, thoughts and behaviors of other people who are under him. Leaders are responsible for setting an example for the others who are under them to follow to achieve a certain objective and goal for the better and growth of their units. They assist other to be focused in their course of work, acts as a source of encouragement and inspiration to others and assist those they are leading to visualize what can be achieved in future. A Leaders help to harmonize the operations in a group set up to prevent arguments and conflicts since different people sees things in different perspectives. Therefore they help to channel all the efforts to one direction to achieve a specific objective in group effort. Leadership is also viewed as the efforts and abilities of the occupant to convince other people follow and do certain things that they could otherwise not done through energizing them to perform a certain task and achieve a set objective (Robert 2002, p. 23).

Good leadership should be accompanied by proper ethic which assists the leaders to distinguish what is right and what is wrong wile executing his responsibilities in a group, department, unit or an organization. Leadership is accompanied by several responsibilities and duties to effect a change and an impact in the place of leadership. Leaders should be visionary of their leading entities, have a commitment both o the entities they serve in and the people they lead, ready to assume responsibilities for the accomplishment of their entities goals and objectives, ready to take risks for the success and failure of their departments.

2.0 Leadership and Management

Management is the process of ensuring that activities and procedures are done and carried out in the stipulated way following a clean record and ensuring rules and regulations are adhered to. Therefore, a manger is the person responsible for ensuring that activities are carried out in an entity according to the laid down rules and regulations and observing the code of conducts and ethics while maintaining a proper record of event occurrence. Therefore, management involves planning and budgeting, organizing entities and staffing them, setting directions in the entity, motivating and inspiring others, problem solving and decision making and ensuring control in an organization (Daniel, Richard & Boyatzis 2004, p. 46).

However, in an organization, leadership and management are virtually important for the success of the organization. Since leadership is more demanding than management, many people tend to be managers than leaders due to the responsibilities and nature of the assignments. While leadership is involved in setting the targets and assisting achieve them, management is involved with the coordination and ensuring that all the activities in the organization is carried out efficiently and effectively. Leadership does not necessarily involve being in a position of authority unlike management which uses authority to ensure that all activities are run effectively. This implies that it is possible to be a boss in an organization without necessarily been a leader. Leadership forms the most important function in the operation of a business even more than management (Oren 2003, p. 87).

Leadership has been viewed as in a broad sense in many aspects especially the traditional approaches used to describe leadership in contextual. Traditional approach to leadership has focused on several aspects and generations of leadership theory in any organization. These traditional approaches are categorized in terms of theories which include among others trait theories, transformational theories, behavioral theories and contingency theories. All these approaches are advantageous in one way in that, there are not in any way mutually exclusive to each other but do borrow widely from one theory to another. There have a coherent flow of ideas from one generation to another with a sequential pattern and forms a foundational kind of an aspect that build on each other (William 2003, p. 36).

It is also very clear that each generation of leadership theory have in one way or another added to the pool of knowledge in the field of leadership to an extent capacity. However these generations of leadership theories do to an extent conflict with each other, some advocating different aspects in life totally from the rest and independently on its own self. On the other hand, modern approach to leadership styles have been regarded as one aspect in the field that have a coherent flow of ideas and qualities that do involve the other field in a mutually inclusive way. These approaches include transactional theory, skill-based leadership, charismatic leadership, transformational leadership and self management leadership. These approaches offer a classical categorization of these leadership styles which allows a mutual corporation between them. They are also relevant to the current situation of leadership qualities in the modern contexts (Peter 2009, p. 48).

2.1 Structure of a good strategy

Source: researcher

3.0 Interview with head of maternity department

The maternity department is considered as one of the most important and vital to the success and achievement of a hospital's objectives and target sets for life saving and preservation. Among all other departments in a hospital or a healthcare facility, maternity is regarded highly sensitive because its deals with tender issues. Young ones do not have the ability to express themselves in case of a need unlike all the other departments in a hospital where the patients assist the concerned nurse or doctor in treatment. The new born can't express themselves in instances of problems, the concerned nurses and doctors have to use their abilities, skills and experience to preserve life which in this context is very sensitive. Therefore, the head in this department is not only supposed to be a leader but a manager as well as an administrator to effectively set an example to the junior staffs and provide motivation, morale and enhance performance (James & Thierry 2005, p. 87).

Therefore an interview was conducted with the head of maternity department concerning perception, approaches, challenges and his achievement as a leaders.

The head of the department considered leadership as an ethical approach towards directing, supervising and coordinating fellow employees towards achieving certain set of objectives and realize the vision of the organization. According to him, ethical leadership involves possession of right and correct values, with a strong upright character that helps a person overcome temptations that are pertinent in the course of duty. These are leaders who set examples and are there to be emulated by others in the way they conduct themselves and execute their responsibilities. He also considered and emphasized that a leaders especially in a hospital should be a person who transform the beliefs, attitudes and motives of follower practitioners towards caring for life as opposed to profit inclination (Ferdinand 1999, p. 67).

In a sensitive area like maternity, lives of innocent young ones should not be compromised at any other cost according to the head of department. He concludes by describing a leader as an individual who considers and views his followers as stakeholders rather than just followers in the achievement of a common goal and purpose in the hospital. The head described an approach of transformational leadership as the best to work in such a department. Since he would not be involved in all cases to facilitate the birth of a child, he considered the empowerment of fellow colleagues to value and appreciates life of young ones more than their returns from work. He describes how this approach was useful and helpful in saving many lives of young ones who could have otherwise died if such kind of care was not available. He recalls how important it was to train the entire staff to be responsible in their work carrying out their responsibilities, duties and roles as if they were the managers in their own capacity. This gave the nurses a sense of maturity and autonomy in their facilitation roles to mothers even when he was not available (Ernest 1965, p. 35).

Equipping nurses, appreciating them, enhancing their morale and cultivating their performances were considered to be the most efficient way to approach leadership environment in a maternity department. Without morale, the leader described how many deaths of young ones were recorded but the time they increased the nurses' morale, the activity level was increased and many lives were saved. In his approach, he related and worked closely with nurses in the maternity department to help each other in their advancement of motivation and morale. Initially as he notes, nurses could not even work extra their locate time, but with the introduction of transformational aspects under his leadership in the department, significant gains have been realized with nurses interacting freely with doctors and the working morale has greatly been improved. The workers in the department never consider profit as their motivating factor but the preservation of life as a fundamental element; thus creating a change in the hospital (Frederick 2007, p. 84).

Besides, these transformed approach to work, employees expectations are also changed, their perceptions and values as well as their inspirations in dealing with fellow employees and more necessary with the expectant mothers. This approach as appraised by the head of the department is not based on give and take unlike other approaches but on the leaders' and workers' personalities, their individual traits and abilities to transform the organization, patients live through achievement of goals and visions. He pointed out four basic elements of transformational type of leadership approach that are applicable to a maternity department. First, the utilization of individualized consideration towards fellow employee forms the basic of this leadership style (James 2002, p. 108).

How well the leader was able to change the minds, perception and attitudes of employees was through his personal and individual constant touch with them. Through this, he was able to attend to their needs, listen to their concerns and acts as a mentor. The second element that he regarded in the transformational approach is the intellectual stimulation involving the change of risk taking approaches, challenging assumptions and how well he gets ideas from the followers. In this approach, he encouraged creativity and innovation involving character trait stimulation to enhance their effectiveness in service deliver both to the mothers and the young ones. Therefore the leaders considered opportunities for nurses to learn as a value addition and any unexpected situation in the maternity considered it as an opportunity for nurses to learn since they had autonomy to execute duties fro preservation of lives both of the mother and the baby independently without the presence of the leader. Thirdly, he considered inspirational motivation as a stride to enact the values, visions and mission of maternity department and articulation of ideas to the nurses (Peter 2002, p. 219).

To this end, he recognizes the importance of setting high standards to be followed by junior employees through optimistic communication of future goals and objectives. The provision of importance and meaning of the tasks facing the department was of vital importance in the achievement of the tasks and responsibilities. The communication aspect of the leaders that is powerful and precise facilitates transmission of visionary plan, ideas and objectives that are embraced by the junior employees for implementation. This causes the nurses and other employees to take their tasks, duties and responsibilities seriously investing their efforts in all the tasks they undertake since they are encouraged and optimistic concerning their future through believing in their abilities. Lastly this approach is enhanced and supported by the idealized influence of the leader. This helps the leader to articulate the organizations visions and its mission in an attractive way instilling a sense of pride, respect, trust and integrity in both employees and the leader (James & Thierry 2005, p. 65).

In terms of leadership and management, the head of maternity department considered a slim distinction between them. He considers leadership as more involving and less like a call rather than training while management as an authoritative process of engaging all stakeholders to effectively and efficiently execute their responsibilities. Management involves a lot of administrative responsibilities according to him while leadership does not necessarily involve been the boss or at the top of the organization to execute leadership skills (Robert 2002, p. 23).

Moreover, he considered leadership as involvement of influence to direct people towards achieving a certain goal while management mostly involved control and checking of how responsibilities are carried out. Leadership is involved with target setting, goal setting and policy formulations while management involves the control, coordination and implementation of the ideas, goals and organizational objectives. He concludes by stating that while leadership mostly involved influence towards achievement of set goals and objectives, management relied heavily on the laid down procedures of implementing certain duties and responsibilities. Therefore while leadership encouraged innovation, creativity and independence, management did not have any provisions rather than what is stipulated in the organizations memorandum therefore limiting initiative development which enhances service delivery (Frederick 2007, p. 37).

As he pointed out in the interview, leadership is a challenging task in any organization and one needs to be fully prepared for the task at hand. Despite these challenges, the head of maternity department had some vital and crucial success that he shared with us. First his commitment in the development of relationship management within the maternity wing completes his joy. Those leaders who effectively build their relationship management find it easier to improve on the organization's growth, employees' satisfaction, enhanced team work, profitability in the department and the whole organization, and inculcate the vision in all the employees. He pointed out that, this relationship management has been of great output in terms of employees input to the health facility. In order to effectively achieve this relationship management, several competencies are of paramount importance as they were highlighted by the maternity leadership (Daniel, Richard & Boyatzis 2004, p. 50).

First they enhanced that all the employees are equipped and equip each other in return through self development in the department to achieve organizational targets. The leader ensured that he formulated an inspirational leadership styles and manuals which inspired the employees to work towards a compelling vision eminent in their hard and dedicated work. When workers had a driving force, the leader noted that the rate of service delivery in the maternity was exceedingly good beyond his and organization's expectations. The leaders categorically noted that his proper utilization of persuasion skills went along way to influence the employees who worked tirelessly even beyond their normal course of duty to preserve lives and ensure that all the patients got the best serves more than they desire. This led to a good reputation of maternity department in the public and government domain a fact he records was his greatest achievement. Another achievement that he highlighted was his ability to resolve conflict peacefully and in a democratic way among both employees and employees and patients (Oren 2003, p. 37).

Maternity been a sensitive department in a hospital is prone and vulnerable to worker's and patients conflict due to the nature of its work, therefore several are the conflicts that arises, the head of department therefore becomes the center for conflict and disagreement resolutions although it's a hard and a difficult task, he manages to solve nearly all of them a point he considers as a success in his career. Finally his skills and ability to unite the employees to work as a team, has helped him to foster a favorable working environment where every employee feels satisfied, appreciated and secure (Robert 2002, p. 87).

Through team work and close collaborations between employees, the department has been able to achieve the necessary objectives and targets, through this it has been ranked among the best performing departments within the hospital. All these constituted the leaders success within the course of his duty and career live. In conclusion the leaders noted that through these combined efforts, the hospital has been able to achieve highest level of life preservation through well coordinated and safe deliveries of the expectant mothers, health babies were delivered and reduced the number of post delivery complication to the mothers. Mothers were also discharged three to four days after delivery an improvement were initially there were detained for more than a month due to several challenges as a result of both employees negligence and ignorance. The preservation of many lives led the list of the successes shared by the head of maternity department (James & Thierry 2005, p. 98).

Despite the numerous challenges shared by the maternity head, he however highlighted several obstacles that were of great concern to his execution of duties. Every leader desires to make a difference in whatever capacity they are as leaders and bring out the stipulated objectives better than expected. The maternity head noted that leadership challenges are just the best opportunity for one to achieve this objective. Leadership challenge involves how leaders are well able or not to mobilize their juniors towards achieving extra ordinary results. They involve leaders' action to transform the company's values into practical actions, obstacles to innovations and creativity, visions to realities through practicality, diverse view and separateness to solidarity and unity, and risks inherent in an organization into rewards (Oren 2003, p. 96).

It represents challenging environment where people use the chances to transform then into successful remarks. He therefore pointed out that due to complexity and nature of his work; he was not very successful to orient everyone towards achieving the desired goals and objectives of the department which consequently resulted to poor performance of the organization. The diverse experiences that were held in the department also provided an obstacle to achieving the desired results which he was not much successful in consolidating them into a common strategy to achieve remarkable successes (Daniel, Richard & Boyatzis 2004, p. 98).

While confronted with his most remarkable success as a leader in the maternity department. He was very quick to point out that his ability to foster teamwork was his greatest achievement that he was proud of. This not only contributed to the success of the organization in terms of profitability, but also improvement in service delivery to the patients where there was an increase of the young ones who were born with no complications and it took less time to discharge a patient than it was the situation before. He counts the improved service delivery in the maternity department as one of the most precious achievement that he is proud of. This is so since he values life more than wealth and could not deny services since there were no finances.

Leadership always involves development of other potential leaders to a higher level that will improve on service delivery of an organization. Leaders are supposed to be people of integrity who can be trusted and assigned responsibilities to train and equip other with similar and better skills to continue performing responsibilities effectively than their predecessors. The virtue of self esteem is the value that this head so dearly up held and engaging all the stakeholders in the process of decision making (Frederick 2007, p. 108).

This made them own up the department and could have done everything to perform their duties even without expecting any reward. He developed and managed the human capital of not only the maternity department but also the entire health facility as a whole to equip them with the necessary skills that will enable them perform responsibilities even without depending on the leadership team. Therefore, the head of department considers his personality not only as that of molding leaders and inculcating leadership skills ion others but also providing with a platform to exercise their leadership talents, abilities and responsibilities (Oren 2003, p. 39).

Leadership style involves the use of a certain agreed upon model of performance in an organization which everyone is expected to follow to achieve the desired results. According to the head of department in the maternity department, the leadership style that is adopted in the hospital involves transforming the employees and in compliance them to the focus of achieving the desired results and objectives. With this consideration, the leader informed us that transformational leadership style is preferred, practiced and adopted in the hospital where everyone is given an opportunity to develop a leader. Employees' skills, thoughts and values are transformed by the leadership class to conform to the organization's objectives to achieve the necessary results. The views of where leadership style is set, the head was quick to point that for a successful leadership style, should be set, formulated and implemented by all the employees or their representatives. The vital role the top leadership should engage in is through supervision of the formulated leadership style to ensure that it conforms to the organizations vision and objectives to realize the optimum goal. For a leader to be successful, they must be people of great values admirable by the junior employees. The head stated that; no leaders can perform well without upholding values necessary to foster unite and teamwork for his leadership style to succeed (James & Thierry 2005, p. 201).

There are many leadership approaches in the corporate world and it depends with the nature, objectives, vision and mission of an organization to adopt that which conforms to the organizational activities best. The maternity department adopted transformational style of leadership. The nature of maternity provision services, require a trusted and a person of integrity, therefore, the department choose to implement transformational approach of leadership to ensure that employees performs their responsibilities with minimal or no supervision at all. This type of leadership approach becomes very useful when employees are faced with challenging tasks and other difficulties in the course of duty in absence the department head. Since the approach trained them to be leaders in their capacity, they were able to tackle these challenges and enhance better service provision. The skills and abilities provided by this leadership approach ensured that all the employees can perform responsibilities to satisfactorily levels (Robert 2002, p. 102).

3.1 SWOT analysis of the organizational strategy

The strengths of transformational type of strategy adopted are numerous and allowed the hospital to offer the best services. The strategy is usually transparent allowing free suggestions on better ways to improve service delivery. Comments on better ways of improving the health facility are encouraged with the current strategy. It also enhanced that service delivery was client oriented and favored the needs of the patient. The patient's satisfaction was the key in achievement of the objectives. Despite the strong and well formulated strategy, the clients can not air their views to the administration in case of complains. The strategy does not also offer the penalties for misconduct of employees (Daniel, Richard & Boyatzis 2004, p. 83).

In addition, there is no ways for future expansion provided in the current strategy. However there is still room for improvement on the current strategy since it has not explored on means under which employees can be evaluated in the process of service delivery. In terms of threats, the emergence of other health facilities ensuring patient's satisfaction is the key priority is threatening the steady growth and performance of the hospital.

Internal

SWOT analysis diagram

S

W

T

O

External

Source: Researcher

PESTLE analysis of the organization

This is a tool that plays a vital role in the strategic making process of an organization through thorough understanding of the external environment where the organization operates besides its future trends.

External factors

External factors affecting the maternity department

Implication of these factors to the department

Political

Interference from other departments in the hospital targeted towards specific individuals

This affects the values of the department from not performing its responsibilities impartially. The affected person do not feel comfortable working in a pressured environment and the productivity greatly declines since they work in uncertainty circumstances

Economic

Limitations and delay of fund submission from the head office of he hospital

These causes the departmental delays in purchases of modern equipments require for proper operations of maternity department with consideration of its sensitive work. Nurses salaries are delayed which is detrimental impact because it reduces their commitment and job morale

Social

Patients aggressiveness and lack of understanding for the department workers

This may result to conflict between patients and the employees which greatly hampers the steady operations of the department. Time wasted in the arguments may have otherwise been used effectively to achieve and attend to other patients. Nurses get demoralized when patients do not understand them and they quarrel then frequently

Technological

Lack of modern equipments for instance in caesarian cases

This results to loss of lives for those patients who could not deliver in the normal way. Other patients are left with permanent complications because the instruments and equipments used were not to standard levels

Legal

Legal suits filed by patients

This wastes much time for the legal proceeding to take place which could otherwise be of much help. The department also wastes a lot of resources to acquire legal services and advices from experts which could have been used to improve on service deliver.

Environment

Pollution from the waste materials generated from the hospital

The hospital incurs huge losses due to fulfillment of environmental compliance requirements regulations. Lack of enough space for expansion also limits the department from provision of better services to the patients.

Stakeholders' analysis

This is a process used to analyze all parties with vested interests in attainment of a project in an organization or its unit. This analysis assists in formulation of a strategic view of institutional and human landscape through identification of existing relationships (WWF 2000, p. 9). The analysis can be carried out in design, implementation and evaluation processes of a project. It also assists in identification of the project's weaknesses especially in gender differences which are detrimental in achievements of the department's goals and objectives. Several approaches may be utilized to carry out stakeholder's analysis which include; interviews, focus groups and workshops. For the sake of this study, interviews were employed (WWF 2000, p. 9).

Several stakeholders were identified in the maternity expansion project and the whole departmental affairs at large. The hospital executive mangers, government through concerned ministry, departmental employees and patients, their influence was found to be paramount in the achievement of the departmental objectives as well as those of the hospital at large. The decision making processes were sole responsibility of the departmental heads although the hospital management demanded to be part of these processes from time to time a fact that delayed crucial implantations in the department.

Though it was the sole responsibility of the hospital officers to learn and manage the department affairs, the government wanted to be included in the board of management through the health government officials. This was both beneficial and disadvantageous to maternity department. Their inclusion meant access to government funding while their exclusion resulted to limited resources and collaborations with other stakeholders in the health department. The patients are mostly important in influential part of the department. The large influential the department has in terms of geographical area, the better for the maximized influence of the department. They are also vital since any expansion or any other activity of the department directly influences the patient's welfare. Their satisfaction with service delivery is paramount to growth and development of the department. To achieve the department's objectives, government and hospital officials should be involved in the decision formulations and making of all matters concerning the department. The employees and the patients should be involved and actively participate in the implementation and evaluation stages concerning achievements and challenges that face the department.

3.2 How to optimize the current strategy

This current and utilized strategy in the hospital can be optimized through a consultative process that should involve all the stakeholders to factor in their views. If this is done in a conference, where all the stakeholders will air their discontentment and recommendations on the way forward, the leadership then formulates a representative strategy for the growth of the organization. This is likely to succeed since it's supported by all the stakeholders who work willingly to implement what they formulated leading to great success of not only the organization, but also the employee development (James & Thierry 2005, p. 23).

3.3 Three lessons that I have learned

For a leader or manager in any organization to be successful or to develop in his management; there is a need to understand the importance of trust and teamwork. This means that the leader must work together with others for the success of the organization to be realized. From this activity, I have learned the following lessons:

Always trust people you assign a certain task and the need for duty delegation

Always work as a team/group

Focusing on early planning in organization is important

4.0 Conclusion

Leadership in an organization is very vital and key to the development, growth and expansion of the organization. Although three important aspects do exist in the running and operations of any organization which includes, administration, management and leadership, leadership forms the most fundamental role for the success of the organization. However it depends with the type of leadership that is in existence to determine the success of the organization since different types of leadership models will thrive differently in separate and different forms of organization. Therefore this paper has identified transformational leadership model as the best adopted by the hospital under study.

The maternity department that was studied demonstrated how successful transformational leadership was both to the quality service delivery and also to the employees' satisfaction in their daily activities at the maternity. The formulation of strategies to be followed in the hospital was also found to be formulated by the employees at the bottom levels unlike other cases where it is done at the top. The advantages associated with formulation at the bottom is that the implementers (employees) owns up the whole process and does a lot with minimal or no supervision at all. It has also been found that, when the leadership appreciates and values the employees who have a direct contact with the clientele of the organization, then the benefits and outcomes are immense and greatly contributes to the growth of the organization. Another key concept that was evident is the utilization of client's feedback to improve on the service delivery of any organization especially.

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