Change Management in Nursing

A health care setting institution with advanced health technology and high calibers doesn’t mean quality nursing care can be offered, unless accompanying with effective clinical leadership. This essay has a strong focus on all aspects of clinical leadership. A case will be used to find out how should effective leadership skill be. Both internal and external factors should be analysed. The latter factors can be found out by PESTEL. Change management is helpful to develop strategies for handling the issue. In recommendations, teamwork, power, communication and presentation skills, conflict management, emotional intelligence and autocratic leadership style all are crucial to solve the issue and a clinician should equip with them. Before concluding all the discussion, training myself as a reflective practitioner is helpful to develop my future practice.

Clinical leadership- What is this?

It has various definitions. Harper (1995, p.81) defines a clinical leader as “one who possesses clinical expertise in specialty practice area and who uses interpersonal skills to enable nurses and other healthcare providers to deliver quality patient care.” More elaborately, it also involves an environment where nurses are empowered and where there is a vision for the future. Clinical leadership requires leadership skills for team building, confidence and respect of others, as well as vision and empowerment. Equally important, clinical leaders must also be good communicators. Meanwhile, Stanley (2006) suggests not only the abovementioned elements clinical leaders have to demonstrate, but also the followings- approachable and role model. Approachable means a clinical leader should be friendly and openness rather than controlling and dictatorial (Stanley, 2006). Role model means clinical leader who serves as an example, whose behaviour is emulated by other nurses (Stanley, 2006). To summarise the above elements, clinical leadership is effective if clinical leaders are expert in their field, and because they are approachable, effective communicators and empowered, are able to become a role model, motivating other nurses by matching their values and beliefs about nursing and care to their practice (Stanley, 2006).

Leadership is important in healthcare today. In Hong Kong, Hospital Authority emphasises any potential or experienced leaders should be educated and trained. Enhancing professional competencies and building up effective leadership is the top priority. In action, providing simulation skill-based training for nurses; developing new in-house specialty training programs for nurses; offering corporate scholarship for overseas training; creating full-time executive development positions; organising senior executive development program and other leadership development all are beneficial to nurture competent clinical leaders (Hospital Authority annual plan, 2010).

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Case scenario

This short paragraph is going to describe a case I experienced at my area of practice. Having been a senior nurse at my workplace, I am mainly responsible for nursing administration, such as arranging vacation leave for my colleagues. One day, one of my subordinates requested annual leave during the Chinese Lunar New Year as she hasn’t been a long vacation leave during the festival for a few years. Her request was simply rejected because of compelling reason- inadequate manpower. I think it was reasonable to reject her request. However, the colleague had seemed disappointed my decision and complained this incident to my senior. It is time for me to contemplate which aspect, for example, communication and interpersonal skills or poor decision making, which I was doing wrong in this leadership issue. In short, there might be conflict issues between the subordinate and senior.

Analysis

There are many external factors which affecting the leadership issue. It is important to reveal them so as to maximize the opportunities and minimize the threats to my work environment. PESTEL is an analytical tool to help decision-maker to consider what external factors are important. Political, economic, social, technological, ethical and legal factors or PESTEL factors in short should be discovered. The following grid shows the analysis:

Any inequality legislation committed due to subordinate’s request being rejected

A lot of alternative nursing employment may contribute staff submitted resignation

Staff social life may be affected due to imbalance work and social time

Outdated IT equipments impede work flow and efficiency

Unfair to the subordinate or not, lack of respect as her wish is rejected

Take precaution of any changes in employees holidays policy/protocol

Having listed the key factor in each PESTEL area, elaboration will be given regarding to individual area. Political factor can be interpreted as what is happening politically in the environment in which a decision-maker operates (Mennen, 2007). A decision-maker should pay attention that any inequality ordinance may be committed, for subordinate’s request for holidays during public holidays is refused. Economic factor can be interpreted as what is happening within the economy (Mennen, 2007). A decision-maker should take notice on every decision. Careless decision may incur angry healthcare staff submitted resignation, for there are a lot of nursing vacancies offered by other clinics, hospitals and old age homes. Social factor can be interpreted as what is occurring socially in an environment in which a decision-maker operates (Mennen, 2007). Having vacation leave during special festival is a reasonable desire for all shift-based healthcare staff. A decision-maker may be in dilemma whose staff can have vacation leave as manpower is so tight. Technological factor can be interpreted as what is happening in technology which can impact what a decision-maker does (Mennen, 2007). In this regard, outdated healthcare technology can affect the leadership issue also. Inefficacy may be caused by the outdated equipment results time-consuming in a simple procedure, such as preparing a roster for frontline staff. Ethical factor can be interpreted as what is right or wrong philosophically (Mennen, 2007). A decision-maker should underscore any decided judgment should be morally acceptable, such as frontline staff’s request should be fairly arranged. Prejudice and bias should be avoided. Legal factor can be interpreted as what is happening with changes to legislation (Mennen, 2007). A decision-maker should update his/her understanding in any staff vacation leave protocol or policy in order to maintain the staff maximum benefit. To make a brief summary, PESTEL can enable an organization to anticipate future threats and take action to escape from their impact.

Change management

The term-change management is coined by Lewin (1951).Change management model is known as unfreeze, change and refreeze (Mind Tools Ltd, 2010). Change is unavoidable of something is needed to be amended. This paragraph is going to explore how the change management model can be applied in the clinical issue. Before application, force field analysis should be performed. The analysis starts from the premise that any situation is held in a stable position by a series of equal and opposite forces. Change occurs about when the forces become out of balance. The analysis is useful when a decision-maker knows where he/she wants to go but is stuck. The following shows the analysis:

Restraining forces forces

Pushing forces

Maintaining adequate manpower is the top priority

Staff discontents the holiday during the Chinese New Year

Poor mood and low work efficiency due to no holidays during the special festival

Power and discipline are paramount to uphold better patient services/benefit

Involved staff politicizes the issue (i.e. complaint the issue to management level)

Frontline staff is an important asset in caring-demand work environment

To execute change, pushing forces must be greater than restricting forces and the need for change has been recognized. In application of the Lewin (1951) model, the first step should prepare the organization to accept that change is necessary, which involves break down the existing status quo before building up a new way for the next stage (Paton & McCalman, 2008). In practical step, ensuring there is strong support from management team. Compelling message should be disseminated vacation leave during special festival is possible if manpower is enough. Maintaining stable manpower is essential to provide quality nursing care. At the same time, managerial staff should remain open to subordinates concerns and address in terms of the need to change.

The second stage is where people begin to resolve their uncertainty and look for new ways to do things. People start to believe and act in ways that support the new direction (Paton & McCalman, 2008). In practical step, effective communication and empowerment are significant. More clearly, managerial staff should prepare every staff for what is happening if staff requests annual leave during special festival. Also, explanations exactly by the managerial staff how the changes will affect every staff.

The third stage is when the change (i.e. no one is approval for vacation leave during special festival unless manpower is allowed) is taking shape and subordinates have embraced the new ways of protocol, the organization is ready to refreeze (Paton & McCalman, 2008). In practical step, the organisation should anchor the changes into the culture. Establishing feedback system is helpful to sustain the change. Having vacation leave immediately after special festival is encouraged.

Recommendations

There are six recommendations to solve the leadership issue. The concept of teamwork should be imparted into the ward practice. Nursing care is teamwork-based. The importance of teamwork should not be ignored. Teamwork in health care can be defined as a dynamic process involving two or more health care professionals with complementary backgrounds and skills, sharing common health goals and exercising collaborated physical and mental effort in assessing, planning, or evaluating client care (Agich, 1982). I have to explain her that the importance of teamwork. All colleagues need to understand how important it is for them to work smoothly together if they want to provide quality care. All colleagues must be dedicated to the whole nursing team and be willing to act unselfishly. In other words, sacrifice, in a certain extent, is necessary. To build up teamwork culture, making sure that the team goals are completely clear and understood and accepted by each frontline staff. In addition, I have to be careful with interpersonal issues. Early recognising them and dealing with them in full are highly recommended.

Power

There is a famous proverb-nothing can be done without power (Power, 1999). The appropriate use of power is important for clinical leadership, for a healthcare setting environment depends on social relationship based on power. Power (1999) defines power in terms of control or influence over the behaviour of other with or without their consent. Power can be classified as physical, position, resources, expert and intuitive. Position rather than other power should be used in the issue. Position power equals legitimate power. It means occupancy of a role entitles one to the rights of that role in the organization (Power, 1999). As a decision-maker, I have considerable right to determine something. Not approving staff with vacant leave during the special festival during the Chinese New Year is a logical and reasonable decision. Both parties’ interest (i.e. patient and ward) can be preserved.

Presentation and communication skills

Oral communication skills consistently rank near the top of competencies valued by clinical leaders. As a clinical leader, promoting positive workplace relations through conservation is highly recommended (Burnard, 1997).. In the leadership issue, I have to offer constructive criticism pertinent to the issue rather than directly rejecting her request. Think currently about what I want to say is the first step. Next, be specific in conveying core message during face-to-face communication. Clear rather than vague assertion is preferred. I do wish there is enough manpower during the special festival so you can have holiday us better than your request is banned due to inadequate manpower. On the one hand, I have to offer help and empathy her. More clearly, holiday after the special festival should be arranged immediately and understanding that the mood of no holiday during the festival.

Conflict management

Since different staff will have different viewpoints, ideas and desire, conflict is unavoidable in any group. The sources of conflict are disagreement on how things should be done, personal interest as well as tension and stress (Shortell & Kaluzny, 1997). The outcomes of conflict include polarization, low morale and regrettable behaviours produced. Therefore, conflict should be well encouraged In this regard, understanding how conflicts arise is important. Obviously, the above mentioned conflict can be categorized as personal interest (i.e. requesting on holidays during the special festival). To handle the conflict due to personal interest, compromise or negotiation is effective to settle down the incident. I have to talk with her gently as manpower is too tense, your compromise is critical. At the same time, I have to manage the issue intelligently, banning her request straightforwardly seems provoking her emotion. Rather, I have to refuse her request euphemistically. For example, your request must be approved if manpower is enough.

Emotional intelligence

Emotional intelligence is recognition of our own feelings and those of others (,). A clinical leader who accurately perceives other’s emotions can handle change better and build stronger social networks. To achieve so, three emotional intelligence skills a clinical leader should possess. The skills include social skills, motivation and self-awareness. Social skills are the ability to influence or persuade others (Pahl, 2008). Good communication skill is a typical example. Motivation is able to enjoy challenges and be passionate about work and initiate optimism (Pahl, 2008). Motivating all frontline staff to work at the special festival is a big challenge task. Self awareness is a deep understanding of one’s emotions or self-assessment in short (Pahl, 2008). Understanding my own strengths and weaknesses is helpful to deal with emotional event.

Authoritarian

Autocratic rather than laissez-faire and democratic styles should be considered. Autocratic style is an autocratic leader who is directive and makes decisions for a group. Being autocratic does not mean the leader is a dictator. Instead, the leader usually provides direction and makes decisions (Northhouse, 2010). Meanwhile, laisser-faire style is noninterference in the affairs of others and democratic style is subordinates have an equal say in the decision-making process (Northhouse, 2010). In the leadership issue, if a lot of subordinates’ requests annual leave during the special festival, inadequate manpower is guaranteed. Therefore, laissez-faire and democratic styles mustn’t be adopted because it is impossible for subordinates to freely choose the period of vacation leave. To prevent any chaos in holiday arrangement, autocratic style is the best style to be adopted.

Development of future practice

This experience should be in my heart because the experience I engaged is helpful to my future practice. Reflective practice is highly recommended. It is associated with learning from past experience, and is regarded as an important strategy for health professionals who embrace lifelong learning (Johns, 2009). Due to the ever changing context of healthcare, there is a high level of demand on healthcare professional’s expertise. Healthcare professionals could benefit from reflective practice, since the act of reflection is seen as a way of promoting the development of autonomous and qualified professionals. Engaging in reflective practice is associated with the improvement of the quality of care and stimulating professional growth. In practical step, there are several frameworks for reflection, for instance, Gibbs reflective cycle. Gibbs (1998) developed the reflective cycle in order to provide structure for reflecting on a nursing situation. The cycle involves six phases. The first phase is to describe what happen (i.e. the case scenario). The second phase is to think and feel about the scenario (i.e. unwisely to handle the issue). The third phase is to evaluate what was good and bad about the experience (i.e. adequate manpower can be maintained but the involved subordinate become angry). The fourth phase is to analyse what sense can I make of the issue (i.e. managing conflict of personal interest intelligently). The fifth phase is to think what else could I have done (i.e. managing conflict tactically). The final phase is to prepare contingency plan (i.e. if it arose again, what would I do).

Conclusion

So far, all aspects of clinical leadership have been covered. To solve the issue due to personal interest, negotiation with involved staff, wisely-used conflict management skills, fully utilizing position power and compelling presentation skills all are constructive to the issue. Before settling down the issue, both PESTEL analysis and change management should be engaged. The strengths of the above are to discover any threats as soon as possible and implement related changes immediately. Successful settling down the issue doesn’t mean a clinical leader demonstrates effective clinical leadership. As clinical leadership is a persistent phenomena performed by a clinical leader, reflective skill a clinical leader should have so as to enhance clinical leadership in an advanced level. (Words: 2711)