Leadership in Healthcare

Editor’s note: This text-based course is an edited transcript of the webinar, Leadership in Healthcare, presented by Claire Aloan, MS, RRT-NPS, FAARC 
 
Learning OutcomesAfter this course, participants will be able to:
Define leadership and its importance to healthcareDiscuss different leadership stylesExplain methods for developing leadership skillsWhy Leadership Is ImportantWhy is leadership important? In most businesses, including healthcare, we find over-management occurs. Over-management refers to doing a lot of management tasks rather than leadership tasks. We are over-managed and under-led. Tasks need to be managed, and people need to be led.
Leadership is a learned skill. We think of people as 'born leaders', but that is not true. Leadership is a learned skill and research shows that it is directly connected to outcomes. Good leadership leads to good outcomes. Bad leadership leads to suboptimal outcomes. It's important for us to focus on leadership. 
Management v. LeadershipManager is a job description. Management is something you do. A manager is someone who supervises or directs others; that could be a line supervisor or even a corporate president. Everyone from lowest level supervisor to highest level president is a manager. Management includes tasks like planning and setting objectives. We refer to 'managing your resources, ' which could be human resources or financial resources. We manage things to achieve objectives and we measure our results. Management is a process.
Leadership is a little different, because a leader is someone who is there to guide and inspire others. It could be guiding their actions. It could be guiding and inspiring their opinions. It's someone who takes the lead in an enterprise or a movement. Leaders have followers and leader is a role as opposed to a job description.
Peter Drucker describes leadership as lifting people's vision to a higher level, raising performance to a higher standard, and building personality beyond its normal limitations. In this definition, leadership is an event as opposed to a task or a job description. Another way of looking at it is that management is "Who is going to do what and when are they going to do it"? Leadership is, "How are we going to do it and why are we doing it?" You can see from these definitions that leadership and management have different connotations. Figure 1 includes a summary of these differences. To be successful, you need to develop both management and leadership.

Figure 1. Management v. leadership summary. 
Traditional Leadership Roles in Healthcare In traditional healthcare leadership roles, we have executive leaders. These may be referred to as the C-suite; the chief executive officer, the chief operating officer, and the chief financial officer. Executive leaders may also include vice presidents, assistant vice presidents, and there may be other layers depending on the size of the organization. Executive leadership may also include directors and managers. Examples may be a director of cardiopulmonary services, or a manager of a department.
 Clinical leadership roles in healthcare include doctors, nurses, therapists, multidisciplinary teams, and others. Ideally, both executive leaders and clinical leaders are important. It would be hard to imagine an organization that could function with strong executive leadership, but a lack of leadership on the clinical side.  And vice versa, an organization does not succeed if you have excellent clinical leaders who don't have support at the executive level. Both types of leadership are crucial in healthcare.
Leadership: Why Do We Need It?Most organizations do routine employee satisfaction surveys annually or every other year. Happy employees make happy customers and, in our case, that would be happy patients. It is important that our employees are satisfied. Issues impacting employee satisfaction may be salary, benefits, and schedules, which are all management issues.
Most companies or hospitals or departments, however, find that the major issues affecting employee satisfaction are leadership-related failures. Leadership-related failures include things like employees not knowing or understanding the company's vision; poor communication from senior management; and, when employees are not involved in planning and decision-making. These leadership-related failures can all be fixed with effective leadership and it doesn't cost a cent to do that.
Communication Strategies Communication is important and employees value transparency. Transparency includes the what, where and how of work.
Three Keys to Transparency: Asynchronous, Scheduled, MultimodalThere are three keys to keep in mind with transparent communication: make it asynchronous, scheduled, and multimodal.
Asynchronous means avoiding communication that only happens at a specific date and time, so it can be accessed anytime. Scheduled refers to the fact that communication is not haphazard; it occurs regularly. Multimodal communication is critical because people learn things in different ways and people receive information in different ways. We want to give employees information in different ways to align with learning needs and preferences. For example, some people might like audible information. They might like you to record something that they can listen to. Some people prefer the visual modality, so they like to read information or watch a video. For effective communication, the message should be available in different formats.
Preplan, Strategize, and PinpointIn addition, it's important to plan, strategize and pinpoint what we will communicate on a consistent basis. The frequency may be daily or weekly. I recently worked for an organization that included five hospitals in the system and multiple other organizations, and we instituted a daily huddle at the beginning of each shift. We worked 12-hour shifts so there was a 7:00 AM and a 7:00 PM huddle for the people starting their shifts.
Multiple FormatsDeliver the same information in multiple formats at the same time. At my previous organization, in addition to delivering information in the huddle, we would deliver those messages in other ways. We'd send an email. We would post it on the board. We did not do a lot of audio-visual communication, but maybe we should have.
Frequent FeedbackFeedback is important in communication. If you have a training, for example, you need to get feedback.  After the training, you give feedback on who completed it, who needs to complete it, and how it is going.
If you are instituting something new on a particular patient care unit, ask for feedback and give feedback frequently.
Employee Retention and SatisfactionEmployee retention and satisfaction is an important part of leadership and management. We know that there's a lot of turnover in healthcare, and that it has increased recently.  Eighty-two percent of hospitals report their nursing turnover rate is 15 to 20% annually. That means if you have 100 nurses on January 1st, by December 31st, only 80 of them will still be there. That's considered a fairly high turnover rate and in many institutions, the turnover rate is even higher. A standard to aim for is turnover of 10% or less.
 As managers, we need to evaluate turnover to see who left and why they left. Turnover may mean employees are not happy. A good organization will make sure that they get that information from employees when they leave. Sometimes employees may tell us that they didn't have effective leadership and communication and that's why they're leaving. They don't want to work in an organization where they do not feel like they know what is happening. Sometimes there are good reasons for turnover. For example, a small department may have a large number of retirements happening in the same year, which may push the turnover number up. 
How Does Effective Leadership Affect Quality in Healthcare?Leadership is linked to quality. Leadership affects the quality of patient care and that includes safety. The personality and behavior of leaders may contribute towards quality through the effects they have on the culture of the department.
How does a leader's personality affect safety in high stress environments? Some of this research comes from the airline industry. Research with airline crews found error levels were lowest where the leaders were considered to be warm and friendly and self-confident. There are other studies that have shown that teams produce less errors if they consider their leaders to be intelligent, self-confident, determined, honest, and social.
We have some studies in health service leadership where staff and leaders were asked what makes a good leader. The responses included: 
More "servant leadership"Less "promotional leadership"Fostering teamwork and creativitySome people responded that "more servant leadership" was the quality of a good leader. Servant leadership comes out of the Christian faith model that we exist to serve our followers. Servant leadership is not limited to the Christian faith, and this leadership model is used in healthcare and other industries. It's fairly similar to transformational leadership. Others indicated "less promotional leadership". Promotional leadership means we promote someone into a "leader position" not because they have exhibited great leadership skills, but because they've been with the organization for a certain amount of time and then they are automatically promoted to the next level. Promotional leadership doesn't work very well and employees know that. Lastly, fostering teamwork and creativity is something that makes people think you're a good leader. Fostering teamwork and creativity are examples of actions we can take as leaders to reduce stress, enhance satisfaction, and improve quality, within our organizations. 
Errors in Healthcare Healthcare is a stressful environment and we want to give the best possible care in the safest possible manner. We're human and we make mistakes, regardless of the industry we're in. However, in healthcare mistakes can be deadly. What affects quality and safety? When it comes to errors, consider: How errors are reported; when errors are reported; what is the outcome; and, what is the...