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Objectives:

  1. Examine the implications of change on interorganizational culture.
  2. Assess the impact that culture has in managing change and sustainability in a health care organization.


Describe the business perspective for inclusion of diversity management in a health care environment. Include how diversity management has been addressed in your organization, including the positive and negative impacts on patient care that you predict from cultural differences. Provide supporting references for your response. 

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Varied Approach

Recent graduates might benefit from transactional leadership because it offers direct, hands-on training and specific steps and protocols needed to accomplish the work. A transactional leadership style can also be useful for more experienced employees whose jobs are evolving, such as R.T.s who recently received a new certification or promotion.

In contrast, using a transactional leadership style with seasoned employees performing routine tasks might cause them to become bored or feel that their skills and knowl- edge aren’t valued — more experienced employees often prefer to be self-directed and then gain recognition for their work. In this scenario, it would be more appropriate for a leader to choose the transformational style, which requires communicating expected results without manag- ing every aspect of the process.

Leaders can also transition from one style to another as a project develops. For example, a leader might hold a meeting to explain each aspect and expectation of a new project (a more transactional style), and then, as employees become more comfortable, begin checking their progress toward established goals (a more transfor- mational style). This ability to switch from one style to another is at the heart of the situational leadership style.

Find Your Style

From the smallest clinic to the largest hospital, all health care professionals work to achieve numerous goals, interact with a variety of departments and master complex systems. This article briefly outlines how three leadership styles can be used in this evolving environment, but what’s most important is that leaders remember to be flexible and adaptable.

MELISSA R. BOWMAN FOSTER joined ASRT in 2005 and is a member of the Computed Tomography Chapter.

Dynamic Administration A tale of three leadership models. BY MELISSA R. BOWMAN FOSTER, D.H.A., R.T.(R)(CT), RMA, CPT, CET

Q UALITY LEADERSHIP in health care ensures the success of an organization, which is why it’s something we should all work toward. A great leader can work

within an extremely complex system, train new employees, and help seasoned employees engage in new projects or adopt new roles. In addition, they must implement changes without disrupt- ing the normal workflow of the organization or affecting the quality of care provided. Different leadership styles are available, but choosing from a multitude of options can be overwhelming.

Three Kinds of Leadership

Let’s evaluate some of the valuable aspects of three leadership styles that are highly relevant to the vast majority of situations in a health care setting: transactional, transformational and situational.

Transactional leadership is a system of rewards and punishments — such as praise for a job well done or disciplinary actions — to ensure that employees stay on track and complete the necessary tasks. This style uses a strict organizational structure where variance from the routine is discouraged. Leaders recognize employees who closely follow the protocols to meet organizational goals.

The transformational leadership model is less structured. Instead of providing a set of steps and protocols to follow, leaders provide employees with a series of goals and explain the expected outcomes of their work. In this model, employees have more flexibility to be creative and find efficient and accurate ways of accomplishing their tasks.

In the situational leadership model, the leader takes on different roles and demonstrates expertise in a multitude of leadership styles. These leaders adapt to meet the needs of their employees, the situation and the goals of the organization, so they must be well educated on the benefits and downfalls of a variety of leadership styles and efficiently implement each method.

18 ASRT SCANNER x   DECEM BER 2018/JANUARY 2019 x   ASR T.ORG

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34 healthleadersmedia.com n July/August 2019

3 WAYS NURSE LEADERS CAN CHANGE WORKPLACE CULTURE To achieve organizational goals, nurse work environments must support an optimal staff member experience. By Jennifer Thew, RN

Is the old adage, “Happy nurses equal happy patients” true? Healthcare leaders at North Carolina–based Vidant Health have put

this saying to the test. The organization committed resources to change the workplace culture for its nurses with the philosophy that engaged and motivated nurses provide better care to patients. Linda Hofler, PhD, RN, NEA-BC, FACHE, senior vice president and nurse executive at Vidant Medical Center, describes the implementation as a “holistic approach to organizational excellence” that benefits the nurses and trickles down positively to the patients.

The goal of the approach, she explains, is “to improve team member experience and rebuild joy in the workplace. [It’s not just] focused on patient experience but on team member, provider, and environmental experience as well.”

The Institute for Healthcare Improvement treats on the idea that cre- ating joy in the workplace is also an antidote to burnout, which is a major issue among clinicians. In 2017, the organization released its white paper, IHI Framework for Improving Joy in Work.

Hofler became interested in a holistic approach to improving or- ganizational outcomes when Vidant’s chief experience officer Julie Kennedy Oehlert, RN, DNP, was doing doctoral research on the healthcare environment.

“[Her idea was] that if you just focus on the patient experience that you [don’t] really get the engagement of your team members,” Hofler says.

TAKEAWAYS > Nurses’ workplace experience is a key component to achieving organizational outcomes. > Organizational excellence is developed through a holistic approach. > Nurse job dissatisfaction affects patient mortality.

To test this theory, Oehlert and Hofler, along with their chief quality officer, assessed correlations among data related to employee engagement, complaints and grievances, patient experience, employee turnover data, and various nurse sensitive quality indicators.

“Sure enough, there are patterns and trends that would lead you to believe—at least our theory is—that if you can improve the team member experience, then the other things will get better too,” Hofler says.

The finer points of engagement A recent meta-analysis from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) seems to support this idea. CHOPR researchers synthesized 16 years of studies to show the association between the nurse work environment (i.e., organizational elements that influence nursing care quality, such as nurse- physician collaboration, nurse manager support, and nurse involvement in decisions affecting clinical care) and four sets of outcomes: nurse job outcomes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction.

“Our quantitative synthesis of the results of many studies revealed that better work environments were as- sociated with lower odds of negative outcomes ranging from patient and nurse job dissatisfaction to patient mor- tality,” said the study’s lead investigator Eileen T. Lake, PhD, MSN, FAAN, the Jessie M. Scott Endowed Term Chair in Nursing and Health Policy, in a news release.

Vidant’s focus on its team members’ experience has been ongoing for about two years, Hofler says.

“This is probably the most rewarding work I’ve done in a long time, but it’s hard work because in the business of healthcare, people want to check a box and go on to the next thing,” Hofler says. “And this is not about check- ing a box. It’s about building networks and finding ways to create new and different ways of doing and being.”

In a recent interview with HealthLeaders, Hofler shares three ways she and the leadership team at Vidant have reshaped the nurse work environment to achieve organizational excellence.

healthleadersmedia.com n July/August 2019 35

“IN THE BUSINESS OF HEALTHCARE, PEOPLE WANT TO CHECK A BOX AND GO ON TO THE NEXT THING. AND THIS IS NOT ABOUT CHECKING A BOX. IT’S ABOUT BUILDING NETWORKS AND FINDING WAYS TO CREATE NEW AND DIFFERENT WAYS OF DOING AND BEING.”

WAY 2: Games Adding a little friendly competition among nurses when practicing problem-solving skills seems to be paying off at Vidant.

“We did a game with all of my leadership team and their direct reporting lines where they had an hour to devise a plan for how they were going to do something to focus on engagement [with] their teams,” Hofler says. “They were going to get $100, so [the question was], ‘How would they use that [money to engage with their employees]?’ ”

One group created a circus theme to help connect with their employees. They designed a cart that looked like a circus tent, dressed like circus performers, and took circus- related snacks to the employees on the unit. The group used that as an opportunity to start conversations “about what was the most important thing that leadership should be doing to support patient care at the front line,” she says. >

WAY 1: Nursing salons In the tradition of Ancient Greece and the French Enlightenment, Vidant has launched small gatherings known as salons. Historical- ly, salons have been places where individuals increase their knowledge and share ideas and experiences through rich conversations.

During Vidant’s salons, attendees—with the help of a facilitator—focus on a specific topic and engage in dialogue and learning. Hofler says the groups are limited to no more than 30 partici- pants and meet for about an hour.

For example, the organization has a salon for leaders that focuses on the topic of empathy and is designed to be highly interactive, where par- ticipants engage in storytelling and sharing of experiences.

“During that hour, not only are you learning content, but you’re learning from the experiences of the other people in the room, so it becomes very rich,” Hofler says of the group. “It’s kind of a recommitment to why you came into a healthcare profession. For nurs- ing, that resonates with folks because it’s so easy in the business to forget why you really wanted to do the work to begin with.”

FOR FURTHER READING

To learn about improving joy in the workplace, read: Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI framework for improving joy in work. Cambridge, Massachusetts: Institute for Healthcare Improvement. https://hlm.tc/2S1jdlD

To learn more about nurse work environments and outcomes, read: Lake, E. T., Sanders, J., Duan, R., Riman, K. A., Schoenauer, K. M., & Chen, Y. (2019). A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes. Medical Care Journal, 57(5), 353–361. https:// hlm.tc/30uO9xN

WAY 3: Support breaks “[Part of Vidant’s philosophy] is to create a culture where team members can be resilient, where they find joy in what they do, and where they’re able to show up and be their best every day,” says Hofler.

“[PART OF OUR PHILOSOPHY] IS TO CREATE A CULTURE

WHERE TEAM MEMBERS CAN BE RESILIENT, WHERE THEY FIND JOY IN

WHAT THEY DO, AND WHERE THEY’RE

ABLE TO SHOW UP AND BE THEIR BEST

EVERY DAY.”

36 healthleadersmedia.com n July/August 2019

One example of this culture of support is a change that occurred in the emergency department, which sees about 120,000 patients a year, says Hofler.

On a particularly busy day, she asked to see the department’s breakroom.

“They asked, ‘Why do you want to see the breakroom?’ I said, ‘Well, [the ER] is like a war zone. People are just coming and there’s no stopping. Where do you go get yourself centered again?’ ” Hofler recounts.

The answer was typical of most nurses: “We don’t do that.”

And, even if the nurses did take a break, the ED space was not conducive to grounding oneself during a frenzied shift.

Hofler was able to help carve out a space that is visually appealing, and is outfitted with refrigerators, a microwave, and a serenity room painted with calming colors and inspirational quotes.

“Now [nurses] will go in there and talk to each other,” she says.

Hofler says getting the physicians and the nurses committed to taking breaks, and hav- ing charge nurses ensure that staff members are taking the much-needed recovery time, has helped the nurses’ workplace experience.

Jennifer Thew, RN, is the nursing editor at HealthLeaders. She can be contacted at jthew@healthleadersmedia.com.

In the end, Hofler estimates she spent about $1,500 on that exercise. “They all implemented their projects, took pictures, and

came back, and we had a celebration at the end. We saw a change in our [employee] engagement scores. It was a small incremental change, but that’s what you want … small changes over time that are sustainable,” she says.

Additionally, the organization had a “Rounding Olympics.” “It was a system process, and it was to determine what units could

get the highest scores [regarding patient] answers to the question, ‘Did a leader round on you during your hospital stay?’ ” she says.

The winners received $1,000 to have a party or redecorate the breakroom.

“Again, not terribly expensive, and it got a ton of people engaged, and they were excited about it and it was fun,” says Hofler.

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“THERE ARE PATTERNS AND TRENDS THAT WOULD LEAD YOU TO BELIEVE—AT LEAST OUR THEORY IS—THAT IF YOU CAN IMPROVE THE TEAM MEMBER EXPERIENCE, THEN THE OTHER THINGS WILL GET BETTER TOO.”

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