Changing the leadership of public hospital

Clinical leadership is significant in the clinical practices as it impacts the work environment, safety and quality care and job retention and satisfaction for the healthcare providers. Leadership in clinical settings is responsible for identifying work inefficiencies, motivating other healthcare workers and lead change initiative to solve problems (Stanley & Karen, 2018).. This paper examines clinical leadership in the following past studies; (1) “Clinical Leadership in Mental Health Nursing: The Importance of a Calm and Confident Approach” (Ennis, Happell & Reid, 2015). (2) Gaps in governance: protective mechanisms used by nurse leaders when policy and practice are misaligned” (Knight, Kenny & Endacott, 2015). (3) “Developing and evaluating clinical leadership interventions for frontline healthcare providers: a review of the literature e” (Mianda & Voce, 2018). (4) “Clinical Leadership and the Changing Governance of Public Hospitals: Implications for Patient Experience” (Veronesi, Kirkpatrick & Altanlar, 2015).

Veronesi, Kirkpatrick and Altanlar (2015) denote that there is a positive impact on the general health care facility when the clinical leaders are included on the governing boards of the hospitals. The research focuses on the influence of inclusion of the clinical professions such as nurses and doctors on the governing board of the public sector’s hospitals in UK. It extended their autonomy leading to improvement in the performance of the hospitals.  McGivern et al (2015), point out that there is an increase trend in the health service where clinical professions are getting more involved in the clinical leadership and active management of the public hospitals’ governing boards.

On the other hand, critics argue that these trends undermine the clinical professions’ autonomy and reinforce division between nurses and doctors in the management positions. Conry et al (2012) emphasize on the positive impact this clinical leadership and management style has on the outcome of services. The study confirms the past literature findings showing the positive impact the inclusion of clinical professions on governing boards of hospitals have on performance outcome. It further investigates the differences in the level of moderation of the clinical professions participation on hospital governing boards of different organisations.

Veronesi, Kirkpatrick and Altanlar (2015) research used an empirical approach to collect data on the experience of the patients. The results shows a positive impact on the patient experience when the clinical professions are involved in the hospital management. It also noted that the environmental conditions also contribute to the patients’ experience. This is achieved more on when the clinical professions get more involved in the decision making at the board level. It highlights the benefits of clinical professions’ participation in strategic decision-making. It also illustrates the importance of organizational conditions in shaping the outcomes of clinical leadership.

Extending clinical leadership to board is necessary for the transformative change in delivery of services in the healthcare institutions. The study however indicates that more research needs to be done on the outcome of the patients experience in relation to inclusion of clinical profession on the governing board of hospital management.  It is relevant to the nursing profession as it shows the importance of involvement of the nurses in the governing boards of hospitals where their interests are considered.

Findings and recommendations

Mianda and Voce (2018) illustrate the significance of providing quality patient care in the health care systems. It also helps in critical issues such as settlement of clinical litigation cases.  In the high-income countries, the health care system invests in various interventions that are helpful in developing the clinical leadership for the frontline healthcare workers at the point of care. The paper identified different development interventions for the frontline healthcare providers for improved maternal and newborn care. Its main aim was to illustrate the characteristics of clinical leadership interventions necessary for frontline healthcare providers.

Mianda and Voce (2018) study used a structural review method where articles published between the years 2004 to 2017 were chosen from electronic database, search engines, journals and published articles. The study concludes that, the clinical leadership is a continuous process and should target both the veteran and novice frontline healthcare providers (Daly et al. 2014). The study findings show that clinical leadership interventions should focus on the clinical competencies and skills needed for providing the optimal clinic care services. Sarto and Veronesi (2016), add that, to sustain for sustainable development of clinical leadership among the frontline healthcare workers, more practice-based and work-based learning techniques needs to adopted to improve the overall service delivery.

The study is relevant as it discusses the interventions clinical leadership can use to improve the quality of service and care provided in the health systems. However, it does not discuss the limitation of the clinical leadership interventions to the healthcare system.

A study conducted by Knight, Kenny and Endacott (2015) indicates that, Rural Australian communities use the telephone to access care from their local health services. History shows that there are rural nurses providing care through the phone and the practice is faced by a lot of controversies (Knight, Kenny & Endacott, 2015). Australia is characterised by large geographical distance.  There is little information on how the practice is governed. The study aims at determining the clinical governing process linked to managing the telephone presentations. It also explores the perception of the director of nursing in relations to management of telephone presentation of health care services in rural Australia.

The study uses structured interviews and qualitative documentary analysis to examine the health care policies and also evaluate the director of nursing perception rural health service. The focus is on the policies put in place to for the provision of the health care services in the rural Australia. The director of nursing employs intuitive behaviors to protect the nurses within clinical governance context characterised by environmental complexities. Protective mechanisms provide indicators of clinical governance of leadership effectiveness. It helps the rural nurse leaders in strengthening the safe and quality care by nurses in the rural area. “Structural power theory by Kanter’s provides a mode of protective mechanism conceptualization which demonstrates how nurse leaders in rural areas enact power.” (Knight, Kenny & Endacott, 2015). It provides insight into cultural elements that the clinical leadership has to consider and also empowers the nurse leaders in the rural areas.

Developing clinical leadership interventions

The study however is limited and cannot represent the population of rural Australia due to the small sample used. Scholars argue that, size alone cannot be used to judge qualitative samples and adequate description, in-depth data should be collected to attain the information required. It is relevant in exploring the challenges of the nursing professions in different location, and the different modes used by nurses to provide care under the right leadership.

Ennis, Happell and Reid (2015) explore the effectiveness of clinical leadership based on the perceptions of nurses working in mental health care.  Nurses work in challenges and stressful environments such as unpredictable emergency, acute mental health settings and intensive care units (Moreland & Apker, 2016). These environments require one to be calm in their approach. The special skills required of the nurses has led to the emergence of importance of the clinical leadership. Effective clinical leaders facilitate a positive environment for the nurses (Sarto & Veronesi, 2016). Clinical leadership is significant to addressing different challenges facing the nurses. The paper explains the “relationship between the clinical leaders’ ability to portray sense of calmness and confidence” (Ennis, Happell & Reid, 2015).

The study used qualitative research method where registered nurses from the mental health settings were interviewed. The study aimed at gaining the observations and experience of nursing in mental health clinic on clinical leadership. It was limited to one clinic and the sample of participants is too small and may not reflect the views of larger numbers of nurses.

The study shows that, it is significant for those in leadership roles in a clinical setting to exhibit the ability to stay confident and calm in unpredictable situations or emergencies as evident in the healthcare system. The role can influence the service outcome for patients Koen & Koen, 2016). This ability requires nurses offering healthcare services to develop high level of skills and experience in order to solve the challenging situations. The study focused on nurses in the mental health care setting and they identified that, effective clinical leaders should have the ability to work clients through unpredictable situations and manage to remain confident and calm. This minimizes the impact of damage to the relationship between the healthcare provider and the patient (Stanley & Karen, 2018).

The study is relevant to the nurses as it brings in new insights into the importance of practicing calmness in different clinical situations and the role played by the clinical leaders in promoting good clinical environment.  It is important to understand how the skills are developed and also the influence they have on the patients. This may influence the future of nursing training at different levels; therefore more research should be done on this area for further improvement and development of necessary skills (Ennis, Happell & Reid, 2015).

In conclusion, these articles explore the significance of clinical leadership and its application to nurses working in health care settings. It emphases on the need for healthcare to provide good leadership in to the workers and also explores the issues arising in the healthcare settings.

References:

Daly J, Jackson D, Mannix J, Davidson P, & Hutchinson M. (2014).The importance of clinical leadership in the hospital setting. J Healthc Leadersh, 6: 75–83

Ennis, G., Happell, B., & Reid, S. K. (2015). Clinical Leadership in Mental Health Nursing: The Importance of a Calm and Confident Approach. Perspectives in Psychiatric Care, 51(1), 57–62. https://doi.org/10.1111/ppc.12070

Knight, K. M., Kenny, A., & Endacott, R. (2015). Gaps in governance: protective mechanisms used by nurse leaders when policy and practice are misaligned. BMC Health Services Research, 15(1), 1–9. https://doi.org/10.1186/s12913-015-0827-y

Koen, M. P., & Koen, V. (2016). Scholarly Leadership and Future Leaders in the South African Nursing Context. Journal of Multidisciplinary Research (1947-2900), 8(3), 5–22. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=121227250&site=ehost-live

McGivern, G., G. Currie, E. Ferlie, L. Fitzgerald and J. Waring. 2015. ’Hybrid Manager–Professionals’ Identity Work: The Maintenance and Hybridization of Medical Professionalism in Managerial Contexts’, Public Administration, online first, DOI: 10.1111/padm.12119.

Mianda, S., & Voce, A. (2018). Developing and evaluating clinical leadership interventions for frontline healthcare providers: a review of the literature. BMC Health Services Research, 18(1), N.PAG. https://doi.org/10.1186/s12913-018-3561-4

Moreland, J. J., & Apker, J. (2016). Conflict and Stress in Hospital Nursing: Improving Communicative Responses to Enduring Professional Challenges. Health Communication, 31(7), 815–823. https://doi.org/10.1080/10410236.2015.1007548

Sarto, F., & Veronesi, G. (2016). Clinical leadership and hospital performance: assessing the evidence base. BMC Health Services Research, 16, 85–97. https://doi.org/10.1186/s12913-016-1395-5

Stanley D., & S. Karen. (2018). Clinical Leadership and Nursing Explored: A Literature Search.Journal of Clinical Nursing, 27 (9), 1730-1743. DOI: 10.1111/jocn.14145.

Veronesi, G., Kirkpatrick, I., & Altanlar, A. (2015). Clinical Leadership and the Changing Governance of Public Hospitals: Implications for Patient Experience. Public Administration, 93(4), 1031–1048. https://doi.org/10.1111/padm.12183.