Australian and NZ data Leadership • 10% of NZ and Australian hospitalized patients experienced Managing difficult an adverse event, of which nearly situations half were considered preventable (2014) Anne Evans-Murray www.healtheducation.com.au • Doctor-nurse hierarchy - outdated traditional role. ‘Patients deteriorate for many • Still enforced (although changing) reasons. The problem is • Up until the mid-20 th century, nurses, almost always women, were expected to stand failure to recognise, failure to when a male doctor entered the room. escalate care and failure to • Nurses waiting passively for instructions respond appropriately’ without questioning the physician. • Nursing usually conspicuous by its absence from lists of national leaders. • (Merry, 2015. Learning from adverse events. Heath Safety and Quality Commission NZ 1 July 2014 to 30 June 2015) • Public doesn’t perceive nurse leaders as having power (slowly changing) • Hierarchical culture, physicians are at the top. • Research consistently shows adverse events often the by-product of physician-nurse disagreement • What is the main reason to • Many studies found that poor communication why people leave their jobs? between nurses and doctors was one of the leading causes of preventable deaths in hospitals (Taran, • Poor management 2011) • Common trend - nurses are either reluctant or –but they state other reasons. refuse to call physicians, even with a deteriorating (Selden, 2010) patient • Intimidation, fear of a confrontational situation, fear of retaliation. (O’Daniel 2008)
Examples of why managers fail • Many definitions of a leader. • Communication problems the main cause – Not listening, interrupting others • ‘If you think you are a leader, – Monopolising the conversation and no one is following you, – Too passive /and or too aggressive ....then you’re not a leader.’ • Becoming defensive and cutting off expressions of feelings • Confusion exists: • Gossiping and having ‘favorites’ • Fear of competition from others • Difference between managers – Withholding information and leaders • Moody and untrustworthy Common problem: Leaders do NOT: • Lack of skills in conflict management –Inability to manage destructive •Become defensive patterns or deal with conflict •Give staff the silent –Making judgment without the full facts treatment – passive • Acting on the first story aggressive • Makes a decision before hearing BOTH sides •Avoid conflict Poor management qualities More research • Other problems: • Survey on Leadership 2015 • Poor ineffective communication • Doing too much • Lack of connection to team members –Trying to fix everything, taking • Little appreciation of others on too much and won’t delegate • Micromanaging –Don’t trust others to do the work • Bullying • Narcissism, : (Solomon. 2015)
Micromanagement Continued –examples of poor management • Control and micromanagement is outdated • The "I" syndrome • Most common complaint in nursing management • Its all about them • Excessive, unnecessary control over details – Never admitting they are wrong • Time spent on managing detail, to get others to conform – Feelings of superiority • Become irritated when a subordinate makes decisions without consulting them – Rarely praising others – taking praise to • Even if the decisions are within the subordinate's level of themselves authority. • Emphasis on the 'authority of leadership‘ • Disempowering others leads to demotivation and resentment. – Leading by instilling fear, • Have difficulty keeping good staff – high turnover • Abusing position of power • Calls anyone who challenges a trouble maker Culture Change – leadership role • Extreme cases of Leaders play a crucial role in culture transformation micromanagement closely related • Leaders address disruptive physician to workplace or nurse behaviour bullying and narcissistic behaviour • Flattening the hierarchy within the • May also have underlying mental- organization and fostering respect health condition such among the various disciplines as obsessive–compulsive providing patient care (Shannon,2012) personality disorder Democratic Leader: • Authority delegated to others. •Traits of leaders • Democratic leader has personal relationships with their team consistently • Relies on influence and trust, not control • Uses group process to make decisions, identified in • Willing to share information • Based on openness, fairness, numerous research transparency and as much information sharing as possible
How employees describe their leader Why courageous? • Say they are tough but fair • Dealing with difficult behaviour • Approachable • Dismal statistics effective • Not afraid to ask for help or advice management • May say they are not even sure if they • Majority of bullying cases like them management did nothing • However, they always treat people fairly • Usually side with the bully by their passive stance • They don’t blame their staff • 2% of cases – justice, fair • Motivate and inspire investigation • Courageous Self worth is vital traits of a leader Need for approval • Why would you expect anyone to respect you, follow you if you don’t like yourself, • Aim for respect not for being liked don’t think you are of any value or respect • Respect, is the hallmark of a great leader yourself ? (my quote) • ‘I must have others like me, I must have • Before you can effectively lead others you others approval’ - a problem to the leader: have to understand who you are. • When the acceptance of yourself • Confidence in yourself depends on approval of others • Recognising your strengths • When you are overly concerned – Acknowledge a compliment, but not looking about your popularity for compliments • Not emphasising your weaknesses Develop these habits Successful leaders • Train your team to bring solutions with their •Behave predictable complaints • Staff can get into a habit of always complaining and consistently • Insist and ask them when they complain what is the solution. •Being reliable • Ask: ‘What do you think we should do’ • Philosophy – against gossip – refuse to participate •Honest • Leaders are in a position of trust • Don’t sit by and ignore it when someone is being talked about
Percentage of respondents Credibility selecting each characteristic • Credibility (made up of many Characteristic Percentage components) is the foundation of selecting leadership Honest 85 Forward looking 70 • 30 years research Inspiring 69 • What employees look for in a leader Competent 64 Intelligent 42 • Someone they would willingly follow • Values and personal traits of the (Kouzes and Posner 2010) leaders: Number one requirement Perfectionism: • Honesty is the most admired quality of a • Hypercritical of self leader for over 30 years. • Anxiety • High trust – more cooperation and • Poor self esteem communication • Permission to not know everything, to make mistakes • Trustworthiness is the essential • Competent component of credibility • Don’t be concerned if you don’t feel as • Your word can be trusted competent clinically as your clinical nurse • Admit to mistakes / don’t aim for • You don’t have to do everyone's job perfectionism • You are their leader, be competent in leading. Factors What managers What employees Meetings – assertive leader thought want Appreciation 8 1 • Be firm and assertive in meetings Money – good wages 1 5 • Always start on time Working conditions 4 9 • Don’t allow one or two people to talk too Interesting work 5 6 much Job security 2 4 • Don’t allow others to constantly interrupt Feeling ‘in’ on things 10 2 you Sympathetic help on 9 3 • How do you react when someone personal problems consistently interrupts (Summary from Selden, 2010)
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