Assignment: Leadership and Change Theory Synthesis

Assignment: Leadership and Change Theory Synthesis

Assignment: Leadership and Change Theory Synthesis

LEADERSHIP AND CHANGE THEORY SYNTHESIS ASSIGNMENT INSTRUCTIONS
OVERVIEW
The Doctorate of Nursing Practice (DNP) has its focus in clinical practice, translating research
into practice, while the PhD focuses on generating “new” knowledge. For the DNP students,
scholarly projects often focus on quality or practice improvement, which requires strong
leadership around change against the status quo in healthcare settings. PhD students are often
navigating educational systems and guiding students in various aspects of clinical preparation.

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INSTRUCTIONS
You will write a 12–15-page research-based paper in current APA format that focuses on
leadership and change theory. A clinical scenario will be provided in the course. From that
scenario, The Institute for Healthcare Improvement’s (IHI) system, variations, theories and
human behavior framework will be used. You will discuss the system, potential variations (such
as human behavior and EI), 2 leadership theories and 1 applicable change theory. Potential
leadership skills/traits/theories must be discussed to help improve the clinical problem.

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Leadership and Change Theory Synthesis

Abstract

Healthcare organizations should embrace change to address current clinical issues and improve the quality of patient care and health outcomes. The presented cases indicate that healthcare professionals are overworked, making them leave the practice. Change is needed in these healthcare settings to address the current issue, resulting in clinicians’ retention. The implementation of the proposed change is supported by leadership theories, including moral leadership theory and transformational leadership theory. By adopting the moral leadership style, leaders would uphold morality and respect their subordinates (clinicians), thus implementing new policies, which would reduce clinicians’ workload and working hours, preventing them from leaving the practice. On the other hand, by adopting the transformational leadership style, leaders would focus on preparing clinicians to become leaders. Hence, leaders would encourage healthcare professionals to focus on achieving the best outcomes despite their current working conditions. Clinicians will then continue working in their respective healthcare settings despite the high workload and long working hours. Additionally, the IHI, including system, variations, theories, and human behavior would result in the successful implementation of the desired change. Lastly, the new change would be achieved by adopting the six steps of Havelock’s change model.

Leadership and Change Theory Synthesis

In the contemporary world, hospital care is faced with various challenges, including workforce shortage, fast-changing technology, diverse consumer needs, fiscal constraints, increasing demand for quality healthcare services, requirements to provide patient-centered care, and directives to provide high-quality and safe patient care. According to Sfantou et al. (2021), effective leadership in healthcare organizations plays a significant role in strengthening the integration, quality, and safety of patient care. Therefore, having good governance and leadership in hospital settings is paramount for effective management of all hospital operations to meet all the requirements. This paper focuses on the changes needed in the provided clinical scenarios based on the Institute for Healthcare Improvement’s (IHI) system, variations, theories, and human behavior framework.

What is likely going on here?

            The scenarios present challenges and sufferings facing healthcare professionals in their respective clinical settings. Work-related issues are depicted by grievances expressed by the healthcare professionals to their respective managements. Unfortunately, the management is not concerned with presented issues, terming them as “attitude,” forcing healthcare professionals to quit.

What are the Clinicians Experiencing? 

            The provided scenarios present challenges facing healthcare professionals in different clinical settings. Medical professionals are working for long hours to meet the increasing demand for healthcare services and high workload, in their respective clinical settings. Healthcare professionals are left with no time to seek standard healthcare services, engage in physical activities, or interact with their loved ones. Healthcare providers feel that the management is not concerned about their health since nothing is done despite notifying the management about the challenges they are experiencing in their clinical practices. Consequently, most of them decide to leave the practice. Thus, changes should be made to address issues facing healthcare professionals in various clinical settings, which will lower the high turnover rate among healthcare providers.

Leadership Theories for Addressing this Problem

            In healthcare organizations, leadership styles influence staff job satisfaction, retention, and turnover rates. Thus, leadership theories would effectively address this clinical problem. The selected leadership theories include moral leadership theory and transformational leadership theory.

Moral Leadership Theory

In moral leadership, leaders depict superior virtues, unselfishness, and self-discipline. Moral leaders aim at setting an example for their subordinates about actions that are considered right or wrong (Wang & Li, 2019). Additionally, a moral leader emphasizes integrity, morality, and fulfilling obligations. Specifically, morality is the defining characteristic of a moral leader. Emler (2019)refers to morality as a set of rules, guidelines, principles, and standards of conduct, which aim at supporting and facilitating the survival of a particular culture. Emler (2019) further stated that extraordinary moral qualities form the basis of good leadership. Additionally, Egorov et al. (2020) stated that consideration, honesty, and fairness are key qualities of ethical leaders. Moral leaders possess moral character; hence they do not take advantage of others or use his or her power to exploit their subordinates. Instead, a moral leader serves selflessly and guides the subordinates in doing the right thing to meet the organization’s short- and long-term goals. Moral leaders set examples for their followers through possessing the required virtues, qualities, and characters. These leaders also motivate their followers by exercising their responsibilities and serving as an example of right and wrong (Wang & Li, 2019). Furthermore, moral leaders cultivate concern for their common good in their respective organizations, influencing workers’ awareness and sense of ethical competence and responsibility. Responsibility becomes an individual’s identity for the employees, serving as the moral basis for good action, making employees get attached to the social moral standards under moral leadership. The moral character of moral leaders motivates the employees to identify with their leaders and follow their instructions. Being a leader’s subordinate then becomes the identity of individual leaders. The subordinates are motivated to act on behalf of leaders and the entire organization (Wang & Li, 2019). Such employees want to make their leader happy; hence putting the leader’s and organization’s interests above theirs. Consequently, the organization’s performance, productivity, and revenue are improved. Therefore, moral leadership benefits the whole organization.

Moral leadership can be applied in addressing challenges facing healthcare professionals in their respective clinical settings. By adopting moral leadership, the leaders will uphold superior virtues, unselfishness, and self-discipline in doing the right thing. Additionally, moral leaders emphasize responsibility and being responsible for one’s actions. Thus, the leaders will have a responsibility to protect their subordinates’ (healthcare professionals’) health and well-being by giving them a reasonable workload, listening to their grievances, and taking appropriate actions. Additionally, leaders will be responsible for challenges facing the healthcare professionals in their respective clinical settings. As a result, leaders will not allocate long working hours and high workloads to healthcare professionals. By working for the recommended working hours and having an appropriate workload, healthcare professionals will get time to attend to their matters, including engaging in physical activities and spending time with their loved ones, preventing them from leaving the practice, which will benefit healthcare organizations.

Transformational Leadership Theory

Transformational leadership is a leadership style that focuses on changing individuals and social systems. The primary goal of this leadership model is to create positive and valuable change in the subordinates, aiming at preparing them to become leaders (Seljemo et al., 2020). Transformational leaders inspire their followers to achieve remarkable or unexpected results (Seljemo et al., 2020). In transformational leadership, the leaders can inspire staff respect and confidence. The leaders communicate loyalty to their subordinates via a shared vision, strengthening employee morale, increasing productivity, and boosting job satisfaction. In nursing, transformational leadership is adopted as a management style, which is used to motivate nurses to own the assigned duties and responsibilities and perform beyond minimum expectations (Sfantou et al., 2017). Consequently, team members are motivated to demonstrate high integrity and moral values in clinical practice.

Adopting transformational leadership in healthcare organizations is associated with positive outcomes. Leaders use a transformational leadership style to stimulate the employees to share a vision and be inspired by their goals, resulting in positive results. According to Seljemo et al. (2020), the transformational leadership style creates a culture of patient safety in healthcare facilities and balances available resources and high demand for healthcare services.

Furthermore, transformational leadership positively impacts work-life balance, nursing outcomes, staff well-being, patient safety, medication error reporting rate, and patient and staff satisfaction (Sfantou et al., 2017). Nurses prefer participative, facilitative, and emotionally intelligent managers. Such leaders lower work-related stress, boost team cohesion, lower stress, and promote self-efficacy and empowerment (Sfantou et al., 2017). More so, effective leadership in nursing is associated with collaboration, flexibility, power sharing, and promotion of high-quality performance using personal values. Additionally, effective leadership promotes safety, quality, effectiveness, accessibility, and equity in healthcare delivery. Sfantou et al. (2017) reported that transformational leadership boosts structural empowerment and organization culture, impacting nurses’ organizational commitment, which results in staff job satisfaction, nursing retention, higher productivity, overall safety climate, patient safety, and positive health outcomes. Lastly, transformational leadership leads to staff satisfaction, improved team performance, a positive organizational climate, and lower turnover rates. These results are mainly achieved when the transformational leadership style is applied among junior employees than senior healthcare staff. Thus, transformational leadership should be adopted in contemporary healthcare organizations in which Generation Y constitutes the highest percentage of employees. According to Calk and Patrick (2017), approximately 76 million of the United States’ workforce are aged 28 and below. This data indicates that Generation Y has significantly impacted U.S labor force size and characteristics. This trend is applicable in the U.S. healthcare sector, indicating that transformational leadership should be adopted to influence staff performance and productivity.

            Adopting a transformational leadership style will resolve challenges facing healthcare professionals in their respective clinical settings. Leaders use the transformational leadership style to stimulate their followers to be inspired and motivated by their goals and share their visions. Transformational leaders encourage their subordinates to see challenges individually and view old problems in new ways. Additionally, in transformational leadership, trustworthy, dedicated, and respectable leaders influence subordinates. Transformational leadership enables leaders and subordinates to cope with a rapidly changing and complex working environment. Thus, through transformational leadership, leaders will encourage healthcare professionals to cope with high workloads and long working hours in their respective clinical settings. They should focus on providing safe, quality, and effective healthcare services to meet patients’ needs even if they will be left with no time to attend to their personal needs such as engaging in physical activities and interacting with family members. Consequently, the rate of turnover among healthcare professionals will reduce, benefiting the facilities.

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The IHI: System, Variations, Theories, and Human Behavior

The Institute for Healthcare Improvement’s (IHI) system aims at improving performance and capability at various levels, including individual, system, and organizational levels. According to Aladin et al. (2019), the IHI is among the leading innovator, which applies a unique strategy to develop creative solutions that are used to address complex issues within healthcare systems, including equity, quality, and cost reduction, safety, accessibility, and health outcomes. The proposed solutions within the system focus on improving individuals’ and communities’ mental health, quality of life, and overall well-being. Deming developed quality and operation management models, which are used by corporations to boost their performance, quality of output, productivity, and revenue (Silva et al., 2018). The development of a theory of quality improvement acknowledges Deming’s contribution and his system of profound knowledge. Consequently, the most successful production systems such as the Toyota production system have been based on Deming’s contribution (Silva et al., 2018). Deming emphasized that corporations should work together to develop a theory of profound knowledge; hence improving their quality outcomes and overall productivity. Additionally, organizations would increase their revenue since quality outputs are the backbone of higher sales and increased revenue. Deming’s concept constitutes four key interrelated components, including system appreciation, knowledge concerning variation, knowledge theory, and psychology knowledge (Wong & Headrick, 2021).

The first component of Deming’s principles for transforming an organization’s management is an appreciation for a system. Deming stated that one should consider team players and an aim as essential components when defining a system. Thus, the effects of an action are interconnected with one another, and an organization’s goal or aim can only be achieved through teamwork. More so, embracing teamwork enables an organization to avoid unintended consequences. Therefore, a system and its operation should act as a guide for leaders and team members in all their operations (Wong & Headrick, 2021). The presented case scenarios indicate that healthcare professionals are exposed to high workloads and long working hours in their respective clinical settings and the current policies are not accommodating their grievances. Consequently, healthcare professionals are opting to leave the practice, which adversely affects the organizations. Thus, change in these organizations is inevitable and it’s the only way through which these healthcare organizations can meet their needs. Nonetheless, the management should engage all the affected healthcare providers in implementing the proposed change to ensure that the new policies and rules effectively address their needs. Based on the complaints raised by clinicians in the provided cases, healthcare providers did not appreciate the current system since it was not meeting their needs. Hence, considering their needs before implementing the proposed policies and guidelines will result in the appreciation of the new system.

The second component of Deming’s principles is Knowledge of the theory of variation, which focuses on reducing variation to improve the quality of outputs (Roehrs, 2018). A leader should understand all types of variations and potential causes, paying more attention to predictable causes especially those with high probabilities. The leaders should then develop the most appropriate strategy for preventing the variation to improve the quality of the outcomes. Failure to address common variations is likely to hinder these organizations from achieving the desired quality outcomes. In the provided cases, clinicians were overworked, which left them with limited time to attend to their matters. The management was not concentered even after healthcare professionals raised their issues forcing them to leave the practice, which disadvantaged the medical facilities. Therefore, the leaders should focus on implementing new policies and rules, which will improve clinicians’ working conditions and reduce their workload and working hours, preventing them from leaving clinical practices. However, the leaders should not implement the new guidelines abruptly but should rather have a consensus agreement with the clinicians, making them comply with the adopted policies and rules and continue working in their respective clinical settings (Roehrs, 2018). Thus, it is recommendable to change the implementation process and adopt a conscious agreement that will be supported by the clinicians instead of forcing them to comply with the new guidelines.

Thirdly, Deming proposed the theory of knowledge as a significant principle for transforming management. It is relatively challenging to understand the complicated management process. Thus, leaders should focus on understanding and predicting outcomes of the management process based on theory. According to Roehrs (2018), theory can help leaders to test a particular prediction and determine if it is right or wrong. Consequently, Deming emphasized ton the significance of basing knowledge on theory. Leaders can use theory to predict outcomes of improvement interventions, which are associated with uncertainties. In the provided scenarios, healthcare providers were not happy with their current working conditions, resulting in adverse outcomes, which negatively affected the organizations. Thus, considering the theory of knowledge would help the leaders to develop an intervention for resolving the problem and eliminating all uncertainties. The leaders should test different interventions and continue implementing new approaches until they get the most appropriate strategy, which would address the outcomes and achieve the desired outcomes.

 Lastly, Deming proposed knowledge of psychology as a significant component of an effective system. Management that understands psychology boosts teamwork and achieves the desired outcomes and success. According to Roehrs (2018), leaders use psychology knowledge to understand issues facing their subordinates and motivate employees, creating a conducive workplace, which improves organizational productivity and outcomes. Enhancing interaction between leaders and the work system results in organizational success and achievement of the desired outcomes. However, leaders must understand psychology for them to work well with team members and resolve conflicts among the team to achieve organizational goals within the set timeline.  In the provided scenario, the leaders failed to understand psychology. They assumed that the healthcare providers would comply with the current policies and rules and continue working in the clinical settings despite being exposed to high workloads and unconducive work conditions. Nonetheless, leaders’ expectations were not met since healthcare professionals opted to leave their respective clinical settings, instead of complying with the current rules and policies. Their actions affected organizations negatively, indicating the significance of understanding psychology.

Change Theory

The change plan for addressing and improving the reported problem will be based on Havelock’s Change Model. Ronald Havelock modified Lewin’s change theory to include six change phases, ranging from planning to monitoring (Udod & Wagner, 2018). Furthermore, the unfreezing-change-refreezing model was developed to cover two social forces, which were gaining momentum in society during that period. These forces include the rising expectation of key stakeholders, including policy-makers, business entities, society, and government agencies, and the explosion of scientific knowledge. The six steps of this change model will be applied in implementing the desired change in clinical settings.

The first step of this change model involves building a relationship. Havelock considered this phase as the “pre-contemplation” stage. The need for change in the system is established in this stage (Udod & Wagner, 2018). This stage will be applied in implementing desired change in a clinical setting. Based on the presented cases, healthcare professionals are exposed to a high workload and long working hours in their respective clinical settings, forcing them to quit the practice, which affects healthcare organizations adversely through a reduced workforce. Thus, the leaders of various clinical settings would identify a need for change in this phase to prevent high turnover among clinicians, which is a significant issue facing them.

The second phase entails diagnosing the problem. The change agent decides if the change is desired or needed in this phase. The process of implementing new change continues if change agents decide that change is needed to resolve a particular issue in the organization (Udod & Wagner, 2018). On the contrary, the change process can end at this stage of the change agent decides that change is not needed in the organization. The presented scenarios indicate that clinicians are exposed to long working hours and overload, which make them leave the practice, creating a shortage of workforce. Thus, the change team will establish that change is needed at this point to improve working conditions, which will prevent healthcare providers from leaving the practice. Consequently, healthcare organizations will not experience workforce shortages, which would occur if the managements fail to implement the change needed to address issues facing healthcare professionals.

The third stage of this change model is acquiring the resources needed for the implementation of the proposed change. The leaders now understand the need for change to address current issues (Udod & Wagner, 2018). The change team then starts the process of developing solutions. The change agent embarks on gathering relevant information needed to change the current situation. In the presented cases, the clinicians are leaving the practice as a result of the high workload and long working hours imposed on them by their respective organizations. Thus, the leaders should gather information on effective strategies for preventing turnover among healthcare professionals.

The fourth stage is selecting a pathway for developing the most appropriate solution. The change agent selects the most appropriate option from available alternatives (Udod & Wagner, 2018). The best option is selected after considering the benefits and shortcomings of available options. The leaders should compare potential solutions for preventing a high turnover rate among healthcare professionals in their respective clinical settings. The leaders opt to implement new policies and rules that would reduce the high workload assigned to individual healthcare workers. The new guidelines should allow healthcare providers to attend to fewer patients to reduce their workload, which will give them to attend to their person. According to McDermid et al. (2020), unconducive working conditions are a significant factor contributing to the high turnover rate among healthcare workers. Hence, clinicians would continue working in their respective clinical settings once their workplace conditions are improved by reducing their workload and working hours.

The fifth stage involves establishing and accepting change. In most cases, employees and the management are reluctant to embrace proposed organizational change, which affects the successful implementation of the proposed change (Udod & Wagner, 2018). Therefore, leaders of healthcare organizations should embrace the proposed change and make it part of organizations’ routines. Making a reduced workload part of organizations’ practice will allow healthcare professionals to attend to their issues, which will encourage them to continue working in their respective organizations.

The last stage of this change model involves maintenance and separation. In this stage, change agents ensure that the proposed change is successfully stabilized and maintained as part of the organization’s practice (Udod & Wagner, 2018). Making the change to the new normal results in the desired results. Thus, the management of the affected healthcare organizations will make a lower workload the new norm, which will prevent clinicians from leaving the practice.

Conclusion

            Change is inevitable and it’s the only way of addressing challenges facing organizations. The presented scenarios indicate that change is needed to address issues facing clinicians in their respective healthcare organizations. The proposed change is supported by leadership theories, including moral leadership theory and transformational leadership theory. By adopting a moral leadership style, the organization’s leaders would uphold morality, respect for employees, and focus on good actions. The management would embrace new policies and guidelines, which advocate for the allocation of a lower workload on individual clinicians, preventing them from leaving the practice. On the other hand, the transformational leadership style will prepare employees to become future leaders and motivate them to give the best results in their working environment. For this reason, clinicians would continue working in their healthcare organization despite being exposed to a high workload. Additionally, the implementation of the proposed change is supported by the IHI, including system, variations, theories, and human behavior. Finally, the new change is supported by the six steps of Havelock’s change model.

References

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McDermid, F., Mannix, J., & Peters, K. (2020). Factors contributing to high turnover rates of emergency nurses: A review of the literature. Australian critical care, 33(4), 390-396. DOI: 10.1016/j.aucc.2019.09.002

Roehrs, S. (2018). Building of profound knowledge. Current Problems in Pediatric and Adolescent Health Care, 48(8), 196-197. https://doi.org/10.1016/j.cppeds.2018.08.013

Seljemo, C., Viksveen, P., & Ree, E. (2020). The role of transformational leadership, job demands and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study. BMC Health Services Research, 20(1), 1-8. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0082-x

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Udod, S., & Wagner, J. (2018). Common change theories and application to different nursing situations. Leadership and influencing change in nursing. https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-common-change-theories-and-application-to-different-nursing-situations/

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Wong, B. M., & Headrick, L. A. (2021). Application of continuous quality improvement to medical education. Medical Education, 55(1), 72-81. https://doi.org/10.1111/medu.14351