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Respiratory Therapists in Non-Traditional Leadership Roles Dan Belford RRT. MEd, MBA (c)

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Leadership

• There are almost as many definitions of leadership as there are persons who have attempted to define the concept.

• Google search for leadership = about 496,000,000 results.

• No one leadership definition is correct.

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Adaptive Leadership

• Our personal leadership definition can be very different from other’s leadership definition.

• “Leadership is the ability to step outside the culture... to start evolutionary change processes that are more adaptive” (Schein, 1992, p. 3).

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Leading Change

• There are some theorists that argue that leading change is the fundamental role of a leader everything else is secondary.

• “Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall." — Stephen R. Covey

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Leadership’s Traits

• Psychologists have not sorted out which traits define leaders or whether leadership exists outside of specific situations.

• Culture. • Context. • Process. • Outcome.

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What we know…. • We know with absolute certainty that a

handful of people have changed millions of lives and reshaped the world.

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What does it take to become a Respiratory Therapist?

• Strong back ground in math and science. • Good physical and Mental Health. • Ability to work under intense pressure. • Stamina. • High degree of integrity. • Tact and discretion. • Critical Thinking Skills. • Teamwork and leadership skills.

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What does it take to become a Leader?

• If knowledge is possessing facts, and thinking is the application of knowledge “critical thinking” in the simplest of terms is the application of knowledge in more complex ways.

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What does that mean…

• Critical thinkers strive to be clear, accurate, precise, logical, complete, significant and fair when they listen, speak, read and write.

• Critical thinkers think deeply and broadly. • Their thinking is adequate for their

intended purpose (Paul, Scriven, Norris & Ennis).

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Critical Thinking Skills

• The six core critical thinking skills are: • Analysis. • Inference. • Interpretation. • Explanation. • Self-regulation. • Evaluation.

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Decisions

• Leaders deal with complex problems that require complex solutions.

• Leaders who can think critically will be more effective.

• Evidence suggests that formal classroom instruction rarely leads to critical thinking (Lizzio & Wilson, 2207)

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Self-Reflection

• Without self-reflection it is difficult for students to develop critical thinking skills.

• Utilizing context based knowledge with real world inputs demonstrate increased critical thinking compared to those who experience traditional classroom lectures (Tiwari, 2006).

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What Organizations want… • Organizations are

seeking well trained individuals that have technical skills and have critical thinking skills to be effective in a constantly changing environment.

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Patient Care

• Critical thinking is required during clinical simulations and during clinical placements.

• Nowhere is critical thinking more impetrative than in the life and death world of critical care.

• Without critical thinking patients can be mismanaged, leading to adverse outcomes.

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Failure to Critically Think

• In the business setting, failure to think critically can result in missed opportunities, faulty decisions, inefficiencies, and ineffectiveness.

• “The downfall of many organizations can be tied to faulty leadership” (Carroll & Mul, 2008, Spreier 2006).

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Research in Motion

• RIM’s leadership did not respond more quickly to a fast-changing market.

• RIM’s technology had transformed it into a global technology leader over the past decade.

• Assumed the BlackBerry technology would be enough to keep it at the top indefinitely.

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Decision Making

• How leaders make decisions impacts the quality of their decisions.

• For some of us the most challenging leadership development opportunities arise when moving from being subject matter experts to assuming leadership positions.

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From Clinical Profession to Leader

• It can be challenging because in the previous role a strong emphasis is placed on data and logical reasoning.

• We need to learn soft skills leaders require to manage people and teamwork.

• Such as showing empathy (emotional intelligence) and listening.

• Typically not part of our education or training • And these skills do not necessarily reflect our

natural preferences.

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The Transition

• There are several factors for success: • Be willing to take risks. • Having mentors. • Being part of a support network. • Commitment to life long learning. • Using failure as a learning experience.

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Career Path Progression

• ACLS Instructor • Critical Care Instructor. • Regional Charge RRT. • OPSEU President. • Interprofessional Practice Leader. • Clinical Manager: Emergency Department

and a Urgent Care Center. • Clinical Manger: Level 3 ICU, Respiratory

Therapy Department and a Telemetry Unit.

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Organizational Challenges

• Organizations face key challenges as they try to transform and evolve.

• The ability to lead change has become a skill as organizations, are required to transform in order to meet higher expectations of success.

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Organizational Culture

• In healthcare effective leaders create fertile, supportive environments for creative thought and can challenge assumptions about how particular branches of healthcare are delivered.

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Managing Change

• Organizational culture is an important factor affecting strategy execution.

• A recent Wharton School of Business Study assesses that managing change is the single most important requisite for execution for success.

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Leading Organizational Cultural Change

• To many leaders, the ability to change is synonymous with the ability to manage organizational cultural change.

• Because culture is enduring and difficult to change, strategy formulation must consider culture.

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Cultural Leadership • Leadership is an important component in

building and maintaining organizational culture • Cultural leadership performs 3 important tasks: • It sustains the mission, creates a distinctive role,

and establishes the basic commitments of the organization.

• It embodies its purpose by actually implementing its mission and in the process gives shape to its culture.

• It maintains organizational values and identity.

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A Case Study in Organizational Cultural Change

• Implementation of Interprofessional Care (IPC) within a multi-site community based hospital in Ontario.

• A collaborative, team-based approach that enables improved patient care.

• IPC leverages individual and team capacity to optimize health outcomes.

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Why IPC

• A non- controlled study of the impact of a medical emergency team in a 300 bed hospital found that the incidence of unexpected cardiac arrest declined by 50%>( Buist,M.D., et al. Effects of a medical emergency team on the reduction of incidence of mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002;324(7334):387-390.

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Deliverable:

• Development of a formal strategic plan for interprofessional care that will encompass interprofessional models of care to support collaborative practice among care providers.

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Timeline 2008-2009

• All levels of administration, union leadership,

and various disciplines representing frontline health care professionals were engaged.

• Focus groups were conducted with respect to Interprofessional care with over 140 participants.

• Organizational “snap shot” of Interprofessional care

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Predominant Themes: Barriers

• Resistance to change/fear factor. – Hierarchies

• medical model dominance. – Physician & Nurse driven organization. – Turf wars & silos/territorialism.

• Individual groups vs. collective good.

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Predominant Themes:

Enablers • Provincial and federal support and funding are now

available – Time and resources available.

• MOH, Professional Colleges, Government all

working together.

• Strong Senior leadership endorsement. – Commitment from organization and individuals –

Dedicated Project Lead

– Right people are at the table in Steering Committee, Focus Groups, Education, working groups.

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All Health Professionals Share Similar Standards of Practice

• Client Centered Care. • Interdisciplinary Collaboration. • Accountability. • Practice knowledge - assess, plan, implement,

and evaluate. • Applied Knowledge. • Code of Ethics. • Communication. • Continuing Competence.

Belford & Matthews

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Sustainability

• The core strategy for sustainability is your desire to create and commitment to an organization or a business unit, or a product or service or even a process that will endure long after you are gone (Werbach, 2009, p.82)

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Sustainability Reporting • The Global Reporting Initiative de facto global standard

for sustainability reporting. • Key organizational values, policies, strategies,

operational management systems, goals, and targets (e.g. employees, shareholders, and suppliers)

• The interests and the expectations of stakeholders specifically invested in the success of the organization.

• Significant risks to the organization. • Critical success factors for organizational success. • The core competencies of the organization and how

they can or could contribute to sustainable development (Werbach, 2009, p.114).

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Interprofessional Core Competencies

I. Interpersonal and Communication Skills

II. Patient/Client & Family Centred Care

III. Collaborative Practice: A. Collaborative Decision-Making B. Roles and Responsibilities C. Team Functioning D. Continuous Quality Improvement

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Clinical Simulation

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Education

• Focus on Interprofessional Core Competencies, not technical performance.

• 180 Participants – RN, RPN, RRT, HCA, Pastoral Care, Social Work, Administrators

• Realism of scenarios. • Debriefing led by Clinical Educators.

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Evaluation • Informal evaluation amongst participants

as the program progressed good word-of-mouth.

• Formal evaluation (qualitative and quantitative) resulting in a formal study.

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Application of Interprofessional Practice Model

• Application of an interprofessional practice

model in the ED and ICU during clinical manager roles.

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Emergency Manager Role

• Introduced Interprofessional practice model within the Emergency Department.

• Within a “See and Treat” area. • Team composed of MD, Nurse Practioner,

Register Nurse, Registered Practical Nurse. • Ministry funded “Pay for Results” Program • Goal was to decrease CTAS 3 waiting time by

improving provider to be seen times.

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Scope of Practice

• 2 MDs coverage 24/7. • Introduced Nurse Practioner Role to treat

patients within ED: CTAS , 3, 4, and 5. • Registered Nurse: introduced 27 medical

directives to implement care at Triage. • Registered Practical Nurse: ACLS Course,

IV insertion, Pediatric clinical up grading.

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Emergency Manager Role

• Created an Interprofessional team that applied LEAN methodology that results in process improvement.

• Physical redesigned the “See and Treat” area to improve patient flow.

• Provider to be seen times for CTAS 3 patients decreased from 8 hours to 1.8 hours (Ministry Bench Mark 2 hours).

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CANADIAN TRIAGE AND ACUITY SCALE (CTAS) NATIONAL

GUIDELINES

• CTAS Level 1 - Patients need to be seen by a physician immediately 98% of the time.

• CTAS Level 2 - Patients need to be seen by a physician within 15 minutes 95% of the time.

• CTAS Level 3 - Patients need to be seen by a physician within 30 minutes 90% of the time.

• CTAS Level 4 - Patients need to be seen by a physician within 60 minutes 85% of the time.

• CTAS Level 5 - Patients need to be seen by a physician within 120 minutes 80 % of the time.

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CTAS 3

• Level 3 - Urgent • Could potentially progress to a serious problem. • Can be associated with significant discomfort • Can affect activities of daily living. • Conditions: moderate trauma, asthma, GI bleed,

vaginal,bleeding and pregnancy, acute psychosis and/or suicidal thoughts and acute pain.

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Urgent Care Center • Conversion of a 30,000 visit per year Emergency

Department into an Urgent Care Center. • Redirection of CTAS 1,2, and 3 to a Full Service

Emergency. • First Urgent Care Center in Ontario to accept

Ambulances (CTAS 4 and 5). • Introduction a RN/RPN collaborative practice

model. • Increased UCC visits and improved patient/client

satisfaction results.

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Results

• All healthcare providers working to full scope of practice.

• Decrease CTAS 3 “provider to be seen times” from 8 hours to 1.8 hours ( below Ministry bench mark of 2 hours)..

• Improved retention and recruitment of staff.

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ICU Manager Role • Introduced Unit Council/Shared governance

model. • Unit Council promotes staff empowerment to

participate in excellent patient client centered care and advancing professional practice.

• Able to retain and recruit staff long standing Full time vacancies .

• Improved Infection Control practices utilizing a standard work tool developed during a Nursing Clinical Practice Fellowship.

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Organizational Restructuring…

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Giving back to the Profession! • Manager Cardio Respiratory, Neurodiagnostics,

and Sleep Lab • 115 staff composed of RRTs, RNs, Echo

Technologists, Cardio Technologists, ECG Technicians.

• Reorganization of reporting structure within areas.

• Moving towards full scope of practice for all healthcare providers.

• Process of establishing RACE Team, Anesthetic Assistant role.

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Being Recognized…

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References • Kilminister, S., Hale, C., Lascelles, M., Morris, P., Roberts, T., Stark, P., Sowter, J.,

and Thistlewaite, J. (2004). Learning for real life: Patient-focused interprofessional workshops offer added value. Medical Education 38, 717-726

• Marlow, A., Spratt, C., and Reilly, A. (2008). Collaborative action learning: A professional development model for educational innovation in nursing. Nurse Education in Practice 8, 184-189.

• Redfern, L. (2008). The challenge of leadership, 15, pp. 1-3. Retrieved March 2.2012, from Academic Search Complete

• Shirey, M. R. (2011). Addressing strategy execution challenges to lead sustainable change. The Journal of Nursing Administration, 4, pp. 1-4. Retrieved February 12, 2012, from Academic Search Complete

• Salas, E., Wilson, K., Lazzara, E., King, H., Augenstein, J., Robinson, D., and Birnbach, D. (2008). Simulation-based training for patient safety: 10 principles that matter. Journal of Patient Safety 4(1), 3-8.

• Werbach, A. (2009). Strategy for Sustainability (1st ed.). Boston, MA: Harvard Business Press.

• Zakaria, S., Fadzialh, W., Yusoff, W., Hisham, R., & Madun, R. (2012). Leadership challenges during the change transformation process. The International Journal of Interdisciplinary Social Science, 6, pp.224-232. Retrieved, from Academic Search Complete

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References • Baldoni, J. (2010). What does the organization need to do? Journal for Quality and Participation,

pp. 10-14. Retrieved March 02, 2012, from Academic Search Complete Booth, A., and Falzon, S. (2003). Working together supporting projects through action learning.

Health Information and Libraries Journal 20, 225-231. • Bennis, W. (2012). The challenges of leadership in the modern world: introduction to the special

issue. American Psychologists, , pp.1-7. Retrieved March 1, 2012, from Academic Search Complete

• Bond, A. S., & Naughton, N. (2011). The role of coaching in managing leadership transitions. International Coaching Psychology Review, 6, pp. 165-179. Retrieved March 1,2012, from Academic Search Complete

• Eiser, B. J. (2008). Meeting the challenge of moving from technical expert to leader. Leadership in Action, 28, pp. 13-24. Retrieved, January 15

• Flores, K. L., Matkin, G. S., Burbach, M. E., Quinn, C. E., & Harding, H. (2012). Deficit critical thinking skills among college graduates: implications for leadership. Educational Philosophy and Theory, 44, pp. 212-230. Retrieved January 17, 2012, from Academic Search Complete

• Kerfoot, K. M. (2010). Doing what only what you can do: the challenge to the promoted leader. Nursing Economics, 28, pp. 403-404. Retrieved January 16,2012, from Academic Saerch Complete

• Khan, O. (2005). The challenge of adaptive leadership. Leader to Leader, pp. 52-58. Retrieved April 15, 2012, from Academic Search Complete

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Thank You to the Canadian Society of Respiratory Therapist !

Questions?