Practice Greta Cummings RN PhD FCAHS Professor, Faculty of - PowerPoint PPT Presentation

Translating Knowledge into Leadership Practice Greta Cummings RN PhD FCAHS Professor, Faculty of Nursing, University of Alberta CLEAR Outcomes ( Connecting Leadership Education & Research ) AHFMR Population Health Investigator President, International Society of Nurses in Cancer Care August 29, 2012 1

64% of employees report being depressed, anxious and wish they worked elsewhere Gallup Polls, 2006

59% of workers are disengaged ¡and ¡can’t ¡wait ¡ to go home 14% actively disengaged (total 73 % - disengaged) Gallup Polls, 2006

87% of workers believe their work lacks any meaning beyond getting paid Gallup Polls, 2006

Healthcare Restructuring • Closure of hospitals, facilities, beds and programs • Aggregation of patients needing similar resources • (De)centralization of decision-making and resources • Process change to increase efficiency • Flattening/delayering structures • Regionalization of health authorities • Skill mix changes • “Rightsizing” ¡of ¡the ¡healthcare ¡workforce 5

Current Healthcare Issues 30%-40% of patients do not receive care based on current evidence 20%-25% of care provided is not needed or potentially harmful (Grol & Grimshaw, 2003) 10,000-20,000 annual preventable deaths from adverse events in Canadian healthcare (Baker et al., 2004)

Simple Complicated Complex Following a Recipe Sending a Rocket to the Raising a Child Moon The recipe is essential Formulae are critical and Formulae have a limited necessary application Tested to assure easy Sending one rocket Raising one child replication increases assurance provides experience, but that the next will be OK no assurance of success with the next No particular expertise is High levels of expertise Expertise can contribute required. Cooking in a variety of fields are but is neither necessary expertise increases necessary for success nor sufficient to assure success rate success Recipes produce Rockets are similar in Every child is unique and standardized products critical ways must be understood as an individual The best recipes give There is a high degree of Uncertainty of outcome good results every time certainty of outcome remains (Glouberman & Zimmerman, 2004) 7

Leadership …is ¡being ¡able ¡to …see ¡the ¡present ¡for ¡what ¡it ¡ really is, …see ¡the ¡future ¡for ¡what ¡it ¡ could be, and ¡then, ¡…take ¡ action to close the gap.

Leadership is action, not position 10

PARiHS Framework for Research Implementation Evidence-based practice Leadership Context Culture Evidence Facilitation Evaluation (Kitson, et al., 1998, QSHC)

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Leadership Distinctions • Management is doing things right; leadership is doing the right things. Peter Drucker • Management is about reducing risk; keeping things the same, standardized. • Leadership is about taking calculated and planned risk, in order to achieve a preferred future. Cummings 13

Leadership Styles • How you accomplish leadership. • Reflects your approach to accomplishing the goal • Arises from your self-awareness • Frames your relationships with others • Can lead to good or bad results 14

Emotional Intelligence Self Others • Self-Awareness • Socio-political awareness • Managing • Self Management relationships with others 15

Emotional Intelligent Leadership Styles Resonant Dissonant • Visionary • Pacesetting • Coaching • Commanding • Affiliative • Democratic Goleman, Boyatzis & McKee, 2002

PARiHS Framework for Research Implementation Evidence-based practice Leadership Context Culture Evidence Facilitation Evaluation (Kitson, et al., 1998, QSHC)

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011)

Nurses relationships to their work 19

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al, 2010; Schalk et al., 2011)

Work Environment 21

Interventions to Improve the Healthcare Work Environment 11 controlled intervention studies • primary nursing (two studies) • educational toolbox (one study) • individualized care and clinical supervision (one study) • violence prevention intervention (one study)

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al, 2010; Schalk et al., 2011) 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)

Autonomy (1) (4) (2) Working Relationships Leadership (5) Performance Behaviors & Motivation Practices (8) Resources (3) (7) Individual Nurse Char. factors

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al, 2010; Schalk et al., 2011) 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011) 4. For improving patient outcomes (Cummings et al., 2010)

Relationships between Leadership Practices and Patient Outcomes • Systematic review through 2007 • 7 studies Transformational leadership is related to - significantly fewer patient adverse events (3 studies) - significantly fewer complications (2 studies) - significantly higher patient satisfaction (2 studies) - significantly lower mortality (1 study)

Influence of Leadership Styles after Adjustment Odds Ratios and 95% confidence interval † Unadjusted Leadership Style P-values Adjusted model P-values model High Dissonant 0.51 (0.34-0.76) 0.001 0.74 (0.49-1.12) 0.151 Moderate Dissonant 1.09 (0.96-1.24) 0.155 1.08 (0.95-1.22) 0.323 Moderate Resonant 0.90 (0.79-1.03) 0.115 0.92 (0.79-1.06) 0.236 High Resonant 0.62 (0.49-0.78) 0.001 0.69 (0.54-0.89) 0.004 Relative contribution * 22.77% 6.18%

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al. 2010; Schalk et al., 2011) 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011) 4. For improving patient outcomes (Cummings et al., 2011) 5. For supporting staff to collaborate on care decisions (Cummings et al 2005, 2007)

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al, 2010; Schalk et al., 2011) 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011) 4. For improving patient outcomes (Cummings et al., 2011) 5. For supporting staff to collaborate on care decisions (Cummings et al 2005, 2007) 6. For empowering managers to do their best work (Lee & Cummings 2008)

When ¡Senior ¡Healthcare ¡Leaders ¡…. Managers’ ¡report ¡ significantly increased Inspire a shared vision • autonomy • recognition Empower managers • community • perceived fairness Recognize others • Job satisfaction contributions and accomplishments • Intentions to stay Lee & Cummings 2008. Journal of Leadership Studies 30

Evidence 1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011) 2. For improving work environments (Cummings et al, 2010; Schalk et al., 2011) 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011) 4. For improving patient outcomes (Cummings et al., 2011) 5. For supporting staff to collaborate on care decisions (Cummings et al 2005, 2007) 6. For empowering managers to do their best work (Lee & Cummings 2008) 7. For empowering clinical staff to make patient care decisions (Laschinger et al, 2008, 2009, 2010, 2011).

PARiHS Framework for Research Implementation Evidence-based practice Leadership Context Culture Evidence Facilitation Evaluation (Kitson, et al., 1998, QSHC)

Leadership is unlocking people's potential to become better

Translating Knowledge into Leadership Practice Mary M. Gullatte, PhD, RN, AOCN, FAAN President Oncology Nursing Society Pittsburgh, Pennsylvania, USA Vice President of Patient Services and Chief Nursing Officer Emory University Hospital Midtown Atlanta, Georgia, USA 34

Learner ¡Objective… • Explore ways nurse leaders can use evidence based knowledge to inform the development of policies, procedures and practice. • Develop quality improvement measures. • Strategies for implementation and embedding in practice. 35

Leadership Empowerment and Quality Clinical Outcomes 36

Why Evidence-Based Practice? • Information overload – Knowledge explosion – Consumer awareness • Professional responsibility – Evidence-based medicine – Nursing Research (American Nurses Foundation [ANF], National Institute for Nursing Research [NINR]) • Regulation and Accreditation – Tie process to outcomes 37

Role of the Oncology Nurse Leader In Advancing Practice through Evidence. • Lead the transformation • Educate to the critique, synthesis, and application of the evidence • Navigate for staff nurses to be able to know how to apply the evidence • Form teams and workgroups to implement the evidence through – Policies – Procedures 38