The leadership is an important concept in an organization that enables the individual to motivate, organize, inspire and accomplish the goal very effectively. As a matter of fact, leadership is the process of social influence in which the person can enrol to aid and support of others in accomplishing a common task. According to Davidson et al. (2006) leadership is defined as a multifaceted process to identify a goal or target, motivating other people to act and provide support to achieve mutually the negotiated goals. Nevertheless, the leaders have the power and the responsibilities to bring the team members together to create a positive communication among the group members, by adopting skills and qualities to achieve the goal for the betterment of humanity. Dierckx et al. (2008) illustrated that leadership is an interactive relationship of sense making and sense giving in which individuals and group are influenced and motivate by others to adapt and enact common values and purposes. This leads in pursuing shared goals in response to the change and conflict. A best leader has the qualities of vision, passion and good communication skills and always ensures that the information which they give to the staff is understandable and they are able to take their roles responsibly (Garber et al.2009). Leadership skills can be taught or learnt and exercised not only by mangers but also by any member of the team that requires some effort on the part of the individuals with a variety of styles in different situations, having a charismatic power to influence others. However, in order to achieve the organisational goals, a leader should have the qualities of communication skills, motivation skills, decision making skills and problem solving skills (Huber,2006). These essential qualities enable the leader to tackle the barriers during implementation of a particular change in to practice.
There is lack of co-ordination and support of health team members in hospital organization because of certain issues and problems that arise. These problems hinders in the successful attainment of properly delivered health care system. Routine health meetings and seminars that are arranged weekly or monthly basis resolves these issues by addressing them in the health team meeting. This helps to identify the sources and maintain improvement strategies for the quality of health care in hospital atmosphere. The intended change identified for the current practice is: "Introducing an effective documentation system of patient care in medical ward". An effective documentation system has the potentiality to improve patient safety outcomes and can help in the guidelines of effective implementation and contribute effectively within the organisation. By these documentations the drawbacks can be identified and issues contributing to the failure can be properly analysed by the useful planning of strategies. It is supported by Edith and Ragnhild (2010) that nurses documentation in the patient record has different purpose ranging from making nursing actions noticeable to fulfilment of legal and professional demands which represents the improvement of patient and better quality of treatment. Moreover, it facilitates to enhance planning, development, implementation, delivery and evaluation of the nursing action done in the organisation. There for the rationale to propose the intended change in the medical record is the primary mechanism to provide continuity, safe and effective patient care which can guarantee that the right patient information is delivered to the clinicians caring for that patient at the right time Ram et al.2009). The effective document in the hospital are the innovative developments of medical fields that support and aid in the organisational development (Vainiomaki et al. 2008). Hence, these documentations are an indispensable part of the hospital health care delivery system in order to promote the effective co-ordination of a health organisation and thereby it will advance the quality of patient care.
Leadership skills have been recognised as a key ingredient universally. It is essential to have certain component skills and strategies in order to be effective an area of leadership. Hendel et al. (2005) stated that the clinical leadership is the voluntary participation of the nurses and it is recommended that the practice nurse should involve in search for the opportunities to develop leadership skills. Time management is another important factor in leadership skills which influence the group members to implement the change successfully. However, these leadership skills help to implement the plan to achieve the organisational goals effectively. It is stressed that to conduct researches and training programme to update knowledge in leadership in order to deal with the issues that may arise during the implementation of a change. Adair (2007) supposes the idea about the fundamental skills require in leadership are planning, briefing, organising, motivating, controlling and evaluating. These are essential skills for overcoming the difficulties to implement the changes in a well organised manner. To practice these leadership skills there should be an ongoing training and study in order to achieve updated knowledge and skills. Therefore Daniels (2004) explained that there are seven types of leadership styles such as autocratic, bureaucratic, charismatic, democratic, transactional, transformational and situational. Autocratic involve centralised authority, power based on position, possible use of coercion and controlled rewards. Bureaucratic implies methodical, rational and systemic method of working where rules are given with enormous importance. Charismatic defines about the leader's vision, ability to inspire and empower others to achieve the organisational goal. Democratic is a delegated authority depending completely on team members for active participation, knowledge and skills. Transactional exemplifies in the relationship between the leader and the follower based on the system of exchange. Transformational depends upon the values of the leader, who inspires the followers to work towards the goal and help others to adapt to the change. Situational is the ability and confidence of the followers which eventually changes the leadership behaviour.
In addition to various leadership theories transformational theory is used for the successful implementation of change and is focused on the co-operation and collaboration with in the team members that enables a friendly relationship between them. The literature by Kaleinman (2004) stated that the transactional leadership increases the feeling of stress whereas transformational leadership intend to cope with the stress. According to Taylor (2007) a transformation leader is able to do more than they were expected to do, by motivating the members of the team. Moreover, a transformational leader raises the level of awareness and consciousness of the team members about the significant and value of expected outcome. As a result, transformational leader can persuade the team members to leave their self interest for the sake of team and organisation. This style also improves the co-operation, collaboration and co-ordination among the team members and aids in building effective relationship among the different personals of the health team by the documentation that enhances the quality of patient's care and safety of the patients in the medical wards. Hence, transformation style helps to adapt the valuable implemented change by the team members, by the outstanding of their enormous motivation. Nielsen et al.(2008) illustrates that transformational leaders are charismatic leader and are characterised by energy, determination, self confidence, verbal skills, intellect and strong ego ideals. These characteristics organise the knowledge about the value of goal and helps to implement them in a better way. Therefore, transformation theory is one of the best and most suitable applications for the proposed change to be successful.
The awareness of an organisational culture has a vital role in the implementation of the change process and it supports in the growth of the organisations. According to Manley et al.(2008), organisational culture in the primary part is in the advent of change process that is shared, implicit assumptions which determines the perceptions, thinking and reactions to the various environments. Appropriate understanding of the organisational culture and commitment to the organisation influences the entire structure and enhances its standard to build a strong leadership. Caside and Pinto-Zipp (2008) illustrate in a literature that the aim of the organisation culture is to complete the objectives of the shared values, beliefs and norms within the organisation that are needed to sustain the change, with the alignment and strategy. However, organisational culture is of vital importance among health professionals in a hospital to achieve these shared goals with the team members and sort out the ways to discuss and solve certain difficult tasks. Nevertheless, organisational culture stresses more of interpersonal relationship that is capable of affecting and altering the changes in an organisation and gives less importance to the personal motives which enables the team members to achieve the target with the joint effort.
Successful leadership strategies are indispensible in discovering the solutions for the various problems that crawls behind the change. According to Armstrong(2008), a leader should accomplish three basic strategies such as defining the task, completing the task and preserving an effective relationship prior to the implementation of the new change. Schickedanz et al. (2008) portrays that the leader should use other policies like motivation and communication in order to resolve the problems. By the use of this motivation strategy the leader should inspire the team members by providing the reward for the good work and should be able to change their views in the practice. In addition, with the help of communication strategy, a leader can influence the group members and reduce the gap among them by bringing them together. As a result, it leads to create a sense of urgency in the team members about the necessity of the change which prevails over the barriers. The leadership style can build the togetherness of the team members in the organisation who have enough power to influence and guide the change process (Burns, 2009). It is necessary to have sincere commitment and determination for the effective implementation. Thus, the powerful leadership strategy leads in developing and articulating the influential notion that helps to the change process to the pinnacle.
The experience during the implementation of the proposed change helps to eradicate the challenges by a joint effort. The implementation of a new change is a difficult task because of certain difficulties that may hinder the entire process. Whittaker et al. (2009) stated that the barriers that arise during the implementation of changes are lack of guidance, inadequate system diagnosis and the possibility of inefficiency to address the problems. The presumed issue related to the implementation of the documentations are excessive cost, failure of authority to perceive the benefits and lack of co-operation among the team members. Another factor that hinders the implementation of documentation is the absence of training sessions that affects the practical skills and knowledge of the team members. Draft (2008) illustrates that the most important barrier to research based care is the lack of perseverance of the authority to introduce a change in patient care. In order to overcome these difficulties of the authorities and employees, it is needed to have proper education and appropriate knowledge about the positive aspects of the change. Henderson and Winch (2008) point out that effective communication and orientation are necessary among the team members to improve the interpersonal relationship to have an effective patient care. It helps to develop co-operation, co-ordination and collaboration between the team members that aids in the interpersonal relationship of the health team. Thus it enhances the quality of patient care and safety of the patients in medical ward by the effective documentation system.
As there are various crisis and challenges can be run throughout the execution of the change, being a single individual it is not possible to uphold the proposed change. To attain the goal of partnership working it is necessary to solve this problem by making the feasible option. According to Douglas (2009), partnership is defined in health care as a close, long team contractual relationship of ownership where there is shared corporate authority which is based on trust and qualitative team work for the health improvement, management, methods of operating and above all performance beyond to the ordinary relationship with individual and community health as ultimate beneficiaries. Georgeson (2009) stated that partnership demands for a greater responsibility not only for sharing information but also for commitment and accountability than just participation and collaboration. It is accomplished by the mutual understanding and consideration by the co-operation of the initiatives. Walshe et al. (2007) illustrated that partnership is a collaborative working of interpersonal relationship and helps the team members and hospital authorities to reach the sufficient knowledge by achieving the goal accurately for the successful implementation of a change. For the successful implementation of change in documentation, it involves approval from the top management, guidance from the doctors and nurses together co-operate in the form of partnership working. Thus, it is necessary to have co-operation, co-ordination and active participation among the team members in the organisation for the successful implementation of the change.
Another significant factor in the implementation of the change is stakeholders. They play an important role in an organisation's health and performance and it is affected by the organisational environment. Stakeholders should involve volunteers, patients or families, board of directors, management staffs, doctors or nurses, equipment planners, general contractors or the communities (Lyons, 2007). Key stakeholders recognised as in the implementation of change are health professional, patients and team members. Lea (2004) illustrates that key stakeholders are a team of people who organise to have a good insight into the stakeholders for the identification of expectations. In this team there should be a person who has the thorough knowledge about the proposed change, who is aware of the internal structure and policies of the organisations and its relationship with the external constituencies and also who is responsible for the heading up for the proposed change. Patients are the most important key stakeholders for the identified change in the improvement of their health and health care professionals focuses on the standard of care given to the patient (Franche et al.2005). The stakeholders ensure the competencies and skills to sustain the flexibility in the process of implementation of change. A leader manages the stakeholders by the application of creativity and good communication skills to tackle the problem and issues in relation with the change. Thus all stakeholders as a team bring out their own role in the implementation of the proposed change.
Lewin's three phase model will be used in this essay for the proper direction that is needed to develop a change in an organisation. According to Cameron and Green (2004), the three phases consist of unfreezing, movement and refreezing. Unfreezing stage directs towards the requirement of the change by the constant motivation of individuals. In this phase, comparison of strengths in the current practice is done as an introduction of change. The second phase that is the movement, there will be a discussion with the stakeholders are held in the planning of strategies for the implementation of proposed change. In this stage the alternative approaches are used in the replacement of old attitudes, values and behaviours (Nilakant and Ramnarayan, 2006). Refreezing which is a third phase, the health professionals make modifications and to comes to know about the problems related to the change (Cummings and Worley, 2005). Thus these three phases of Lewin's model goes deep into the knowledge of influencing others and improves the quality of life.
The process of evaluation is done after the completion of an implementation to know its strength and weakness of the proposed change. Evaluation helps to see as individuals and as a group regarding the growth that has taken place in an organisation by the implementation. Buelow et al.(2010) describes that evaluation is the process of determining the value of things with a worth in a systematic and appropriate way. It is done through the analysis, examination, interviews with the team members, presentation of findings, summary and suggestion for the new change. After the evaluation, the health professionals as a team is able to take the decisions and developments that are needed to sustain the change in an organisation by the daily practice (Allen and Fabri, 2005). In the evaluation it is valuable to take the knowledge from the patients as well as from the health professionals to implement the change. Therefore, in the context of society and work environment, the team is able to understand from the various perspectives the effectiveness of actions that are taken for the change (Cant and Aroni,2009). Thus, evaluation is helpful in assessing the effectiveness of the implemented change in the documentation.
In conclusion, the effective documentation system of patient care in medical ward has the efficient intended change through the transformation of regular practice with the positive attitudes of the health practitioners aids in the leadership skills and strategies as an effective leader. In effective leadership skills and strategies a leader should have the capability in making decisions, motivating and planning of the future and attracting others with the valuable communication. Lewin's three phase model is needed for the successful implementation of the new intended change. Moreover, stakeholders and partners should co-operate and collaborate with the team for the implementation of a change in an organisation. The effective documentation system in patient care is beneficial and creates a positive influence for their safety. This study enabled to persevere in the related concepts, different styles and strategies of leadership and the essential qualities needed for effective implementation of the change. This activity helps to learn and understand about a role of a leader in an organisation to implement a new change. Furthermore, this leadership study module gave further information regarding the utilisation of the skills and strategies by giving equal importance to the organisational culture in the implementation of change.