translating knowledge into leadership practice · translating knowledge into leadership practice...
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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
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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
• 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
Healthcare Restructuring
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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 Moon
Raising a Child
The recipe is essential Formulae are critical and necessary
Formulae have a limited application
Tested to assure easy replication
Sending one rocket increases assurance that the next will be OK
Raising one child provides experience, but no assurance of success with the next
No particular expertise is required. Cooking expertise increases success rate
High levels of expertise in a variety of fields are necessary for success
Expertise can contribute but is neither necessary nor sufficient to assure success
Recipes produce standardized products
Rockets are similar in critical ways
Every child is unique and must be understood as an individual
The best recipes give good results every time
There is a high degree of certainty of outcome
Uncertainty 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.
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Leadership is action, not
position
Context
Facilitation
Evidence
Evidence-based practice
(Kitson, et al., 1998, QSHC)
PARiHS Framework for Research Implementation
Evaluation
Leadership
Culture
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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
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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
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Emotional Intelligence Self
• Self-Awareness
• Self Management
Others • Socio-political
awareness
• Managing relationships with others
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Emotional Intelligent Leadership Styles
Resonant • Visionary • Coaching • Affiliative • Democratic
Dissonant • Pacesetting • Commanding Goleman, Boyatzis & McKee, 2002
Context
Facilitation
Evidence
Evidence-based practice
(Kitson, et al., 1998, QSHC)
PARiHS Framework for Research Implementation
Evaluation
Leadership
Culture
Evidence
1. For improving nurse outcomes through relational Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011)
Nurses relationships to their work
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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
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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)
Leadership Behaviors &
Practices
Autonomy
Working Relationships
Resources
Individual Nurse Char. factors
Performance Motivation
(8)
(4)
(7)
(5)
(1)
(2)
(3)
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)
Odds Ratios and 95% confidence interval†
Leadership Style Unadjusted
model P-values Adjusted model P-values
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%
Influence of Leadership Styles after Adjustment
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 ….
Inspire a shared vision Empower managers Recognize others
contributions and accomplishments
Managers’ report significantly increased
• autonomy
• recognition
• community
• perceived fairness
• Job satisfaction
• Intentions to stay
30 Lee & Cummings 2008. Journal of Leadership Studies
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).
Context
Facilitation
Evidence
Evidence-based practice
(Kitson, et al., 1998, QSHC)
PARiHS Framework for Research Implementation
Evaluation
Leadership
Culture
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
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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.
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Leadership Empowerment and Quality Clinical Outcomes
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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
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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
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ONS PEP Resources
ONS PEP Weight of Evidence Classifications
• Recommended for Practice • Likely to be Effective • Benefits Balanced with Harms • Effectiveness Not Established • Effectiveness Unlikely • Not Recommended for Practice
Recommended for Practice
Interventions for which effectiveness has been demonstrated by strong evidence from rigorously conducted studies, meta-analyses, or systematic reviews, and for which expectation of harms is small compared with the benefits
Effectiveness Not Established
Interventions for which there are currently insufficient or conflicting data or data of inadequate quality, with no clear indication of harm
Not Recommended for Practice
Interventions for which lack of effectiveness or harmfulness has been demonstrated by strong evidence from rigorously conducted studies, meta analyses, or systematic reviews, or interventions where the costs, burden or harms associated with the intervention exceed anticipated benefit
Oncology Nurse Leaders
• Evaluation of the application of the practice based evidence
• Accountability • Sustainability • Reevaluation
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References • Given, B.A., Beck, S., Gobel, B.H., Lamkin, L., &
Marsee, V. (2004). Oncology nursing-sensitive patient outcomes. Available at http://onsopcontent.ons.org/toolkits/evidence/Clinical/outcomes.html.
• Given, B.A., & Sherwood, P.R. (2005). Oncology nursing society report Nursing-sensitive patient outcomes-A white paper. Oncology Nursing Forum, 32, 773-784.
• Hadorn, D.C., Baker, D., Hodges, J.S., & Hicks, N. (1996). Rating the quality of evidence for clinical practice guidelines. Journal of Epidemiology, 49(7), 749-754.
References
• Melnyk, B., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams and Wilkins.
• Oncology Nursing Society (2004c). Oncology Nursing Society strategic plan: 2003 through 2005. Retrieved March 15,2010 from http://www.ons.org/about/strategicplan.shtml
• Ropka, M.E., & Spencer-Cisek, P. (2001). PRISM: Priority Symptom Management project phase I: Assessment. Oncology Nursing Forum, 28(10), 1585-1594.
• Rutledge, D.N. & Grant, M. (2002). Introduction. Seminars in Oncology Nursing, 18(1), 1-2.