Critical Analysis Of Leadership And Change Management

Leadership and change management theories involved in QI project

For the development of the highest quality patient care, leadership is required to develop the culture of process improvement within a healthcare setting. Health system innovation leads towards innovation in operation designs, financial control, and negotiation. There are conflict resolutions observed as a part of a small quality improvement project (Borkowski, & Meese, 2020). Change management practices in healthcare allow an in-depth approach to organizational change. Navigation of the information process is indeed an important aspect of this. Here, discussion can be continued on Hinnings and Greenwood’s model of change dynamics. According to this theory, Interpretive schemes manage ideas, values, and beliefs of organizational change management in quality improvement. Situational constraints such as acceptance of healthcare people towards the quality management approach are required to be evaluated along with identification of cost (Wensing, Grol, & Grimshaw, 2020). For healthcare dissertation help, understanding these dynamics is crucial for implementing effective change strategies.

Kanter et al.'s big three models of organizational change is another relatable theory that can be explained in this context such as sticking to the changes made for quality improvement is harder and attempts might not always meet with success as isolated single efforts might be failed.

For appropriate leadership and change management in quality improvement of healthcare, an organization needs to build teams, culture, and co-production of care.

Discussion on different leadership styles and change management approaches

Leadership styles associated with quality improvement in healthcare such as:

Transactional leadership:

It highlights the importance of an organization with supervision power and group performance. Relationships between health care staff and executives are identified by accepting their positions and obeying the leadership. "Rewards and punishments serve as motivational tools for healthcare executives to encourage compliance with their directives", (ncbi.nlm.nih.gov, 2021). Transactional leadership does not tend to encourage any problem-solving approach or creativity. This emphasizes clearly defined roles, close supervision, and improved procedures. The main goal of staff members is to follow the orders and instructions of superior people. Pros of this style such as respect for rules, standards, and procedure, clear defined roles with close supervision, maximize productivity for looking after pressure ulcer cases

Cons of this leadership approach can be explained as individuality is eliminated, consequences are more focused and leadership competencies are difficult to counter.

The approach might be applicable in proposed quality improvement projects as it provides close supervision to staff that helps nurses in meeting their objectives (Barrow, Annamaraju, & Toney-Butler, 2017). Provisioning the best possible care by following the instruction of a quality improvement plan for the ulcer can be done in this case. Transactional leadership is also known as managerial leadership; they primarily focus on specific tasks and uses rewards and punishments for motivating followers. Now, in this healthcare domain, the centricity of leadership is expected to be engaged within the engagement of short term planning. Transactional managers focus on lesser creativity and more strength ability (Khojastehfar, Ghezeljeh, & Haghani2020). The tasks need to be completed with forward thinking ideas. A nursing staff requires having individual engagement of records within a communicative understanding of strengths. The transactional leader is promoting compliance through reward ship and managing the local healthcare guidelines. The poor performance of employees is punished and they warned by the authorities to generate healthcare benefits.

Transformational leadership:

This leadership comes across with a focus on empowering the staff members for participating and initiating the changes transforming the healthcare organization. Transformational leaders always try to incorporate the employees in a better position and develop quality improvement processes. Transformational leadership tries to build up confidence inside the people along with developing a thirst for achieving goals (Belrhiti, Giralt, & Marchal, 2018.). These styles have their pros such as creation and management of changes are done by the transformational leaders and quick formulation of visions and create enthusiasm within health care people. There is excellent communication for managing the morale of workers and engaging quality improvement. The ethical aspects are focused is this case.

Cons of this leadership are supposed as lack of Constant and consistent feedback along with followers required to agree with leaders. There are risks are found to be disruptive in transformational leadership and lead to employee burnout.

In this case, of a quality improvement project, transformational leadership might be applicable as it positively relates to effective nursing unit organizational culture (ncbi.nlm.nih.gov, 2021). Mortality patterns, patient safety, and equity need to be well defined in this case. Transformational leadership is more focused on caring of patients at a base level. Even within a sustainable period of learning, the effectiveness is measured. The nursing staff need to focus on the patient’s well being thoroughly (Khojastehfar, Ghezeljeh, & Haghani, 2020). The NHS guidelines are supposed to be engaged within the management of non -balanceable erythematic of intact skin, pressure injury management in partial thickness skin loss with exposed dermis. Pressure injury occurring due to the skin loss and full thickness of skin along with tissue loss is observed. Deep wound that reaches deep layers of the skin, which reaches muscle and bone, is essential to be relieved for patient for different levels of staff.

Safeguarding protocols for pressure ulcer management and engagement of avoidable and unavoidable circumstances are observed to be performing well in some particular aspects of life (Courvoisier et al. 2018). The greater number of reports is associated with patient safety Scotland, the greater appreciation is required to be engaged within the management of transformational leadership in this nursing.

Change management models can be identified in terms of:

Kurt Lewin Change Model

Pros of this model are identified as the most comprehensive way of following human psychology and it has a bottom-up approach that focuses on involving three steps such as unfreezing, changing, and refreezing (Zoutman, & Ford, 2017). All this process moves forward with a perception of solidifying behavior changes. Steps of using the framework in healthcare will include gaining strong support from senior management and creating a need for change. Surveying the healthcare setting for gaining an idea of what needs to be changed. Strong support from management should be ensured. Managing and understanding each person's doubt and concerns helps in the management of each staff in the organization. Uncertainty towards applying the change management ideas and resistance to change is also managed (Jambawo, 2018). Cons of this model come with insecurity among the employees and employees usually tend to get worried about their performance while a quality improvement is focused. The effectiveness of this change model can be aligned in this case scenario in terms of creating an organization-wide communication strategy that will be favorable in applying suggested quality management projects.

Mckinsey 7s Framework

This model helps in strategic planning of the healthcare process and analyzes the internal elements affecting organizational success. This framework is applicable in quality improvement projects as it helps in the successful execution of new strategies in the healthcare domain. There are changes facilitated in the organization that help in managing taking important sets of actions in the quality improvement process (Leite, Bateman, & Radnor, 2020). The pros of using this change management model in healthcare help are aligning essential components with vision and bring upon different departments together. Process synchronization is also done with each other while the healthcare organization is going through a phase of quality improvement. It is applicable in the research of quality improvement as the impact of future organizational changes is appreciated. A comprehensive framework of organizational processes is also processed during the merger and acquisition phase. Some cons of this model are identified in terms of difficulty in assessing the degree of fitting inside an organization. Sometimes the model misses fine-grain areas where strategy conception and execution arises. It is a static model that requires senior management help for managing benchmarks of quality, hence the entire process consumes enormous amounts of time (Mosavi, & Santos, 2021). Criticizing the loopholes of development is remaining undiscovered with time.

A preferred application of approaches for implementation of QI project

Application of approaches that integrate the implementation of QI project in the most suitable way is Mckinsey 7s Framework model for change management and transformational leadership for leadership effectiveness. The applicable effectiveness of this models have already been discussed in this research context.

Potential enablers and barriers encountered

While implementing the QI proposal in practice, some potential enablers and barriers can be discussed in this section. Barriers of QI are:

Barrier of sustainability

As explained by Scot Webster, cultural changes improve quality in healthcare. Employees need to understand that change is inevitable and they need to accept the changes. Bottom-up sustainability is required and here a comparison can be drawn from grassroots. Barriers are always caused at the system level (Rahbi, Khalid, & Khan, 2017). System-level issues can understand that change is complex. "Purely mechanistic approaches for changes in complex systems are identified to be inadequate in a healthcare setting". Interventions and quality improvement projects affect healthcare employees, as they might not find them as a “short-term solution”. Some healthcare practitioners might not consider a quality improvement project of pressure ulcers as a sustainable one and this might lead to a lack of sustainability perspectives for employees (Delmore et al. 2018). Hence, sustainability acts as a barrier in case of quality improvement

Resource barriers

Resources allocated to healthcare quality improvement are quite limited and a lack of data is observed in this field. According to the coalition for health services research, there is an estimation of $1.5 billion of federal funding spent on health services in 2006 which was the highest (Stone et al. 2018). Lack of appropriate channelizing of money and medical infrastructure is creating a barrier to include quality improvement. Lack of diversifying funding sources is becoming a barrier. There is a lack of trained nurses and healthcare professionals seen in many organizations. This becomes a primary reason for resource barriers in the healthcare setting. Quite a little funding comes for the concept of laminated guideline that reduces the chances of pressure ulcer.

Barrier of focus

Pressure ulcer has never been in concern before within a healthcare setting. Quality improvement efforts can have divergent purposes. The main focus of this project is to improve care for pressure ulcers. This directly links with learning care and focusing on the effectiveness of quality improvement interventions (Weintraub, & McKee, 2019). This project might not get enough attention. The lack of focus can reduce the potential of this project.

Enablers of this QI project are explained as:

Culture, ethics, and behaviour

The healthcare organizational culture is quite patient-friendly and they focus on patient development aspects. The ethical competency of a person is also remarkable in this case as it reduces the faith issues (Amrani, & Gefen, 2020). Healthcare people are spreading their hands towards the acceptance of this project.

Policies, process, and framework

Uses of NHS-based policies on treating ulcers and making the health carers understand the handling of the situation in a flawless manner with the laminated guidelines have created sustainability. The framework will be used of COBIT 5, which is essential in today's context.

Management of enablers and barriers using leadership theories

Mckinsey 7s Framework framework helps in creating an organizational chart as it provides the duty name associated with each person. Shared values are associated with the management of goals and representing the healthcare organization's standards. All elements of the proposed quality improvement plan such as style, systems, skills, staff, strategy, structure, and shared values are expected to manage the barriers effectively (Xu, 2017). Reviewing the seven elements timely is managing the enablers and improvising on relationship goals to be processed. On the other hand, transformational leadership encourages innovation and individual development that aids in the synchronization of the proposed model and organizational values. Team culture barriers are quite problematic and this model helps in the effective management of shared vision within an organizational setup. The quality improvement plan is expected to manage pressure ulcer disease and enhance the productivity of staff (Ellis, 2017). The transformational theory is for strengthening healthcare staff morale and enabling organizational sustainability in healthcare.

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References

Books

Borkowski, N. & Meese, K.A., 2020. Organizational behavior in health care. Jones & Bartlett Publishers.

Wensing, M., Grol, R. & Grimshaw, J. eds., 2020. Improving patient care: The implementation of change in health care. John Wiley & Sons.

Journals

Amrani, G., & Gefen, A. (2020). Which endotracheal tube location minimises the device‐related pressure ulcer risk: The centre or a corner of the mouth?. International wound journal, 17(2), 268-276.

Barrow, J.M., Annamaraju, P. & Toney-Butler, T.J., 2017. Change management. https://europepmc.org/article/nbk/nbk459380

Belrhiti, Z., Giralt, A.N. & Marchal, B., 2018. Complex leadership in healthcare: a scoping review. International journal of health policy & management, 7(12), p.1073. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358662/

Courvoisier, D. S., Righi, L., Béné, N., Rae, A. C., & Chopard, P. (2018). Variation in pressure ulcer prevalence and prevention in nursing homes: A multicenter study. Applied Nursing Research, 42, 45-50.

Delmore, B., Ayello, E. A., Smart, H., & Sibbald, R. G. (2018). Assessing pressure injury knowledge using the Pieper-Zulkowski pressure ulcer knowledge test. Advances in skin & wound care, 31(9), 406-412.

Ellis, M. (2017). Pressure ulcer prevention in care home settings. Nursing older people, 29(3).

Gordon, A. & Pollack, J., 2018. Managing healthcare integration: Adapting project management to the needs of organizational change. Project Management Journal, 49(5), pp.5-21. https://www.academia.edu/download/57159572/Gordon___Pollack__2018.pdf

Jambawo, S., 2018. Transformational leadership & ethical leadership: their significance in the mental healthcare system. British Journal of Nursing, 27(17), pp.998-1001. https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2018.27.17.998

Khojastehfar, S., Ghezeljeh, T. N., & Haghani, S. (2020). Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study. Journal of tissue viability, 29(2), 76-81.

Mosavi, N. & Santos, M., 2021. Implementation considerations for the applied business intelligence in healthcare. https://repositorium.uminho.pt/bitstream/1822/71883/1/M2049.pdf

Rahbi, D.A., Khalid, K. & Khan, M., 2017. The effects of leadership styles on team motivation. Academy of Strategic Management Journal, 16(3). https://www.academia.edu/download/57425577/THE_EFFECTS_OF_LEADERSHIP_STYLES_ON_TEAM.pdf

Weintraub, P. & McKee, M., 2019. Leadership for innovation in healthcare: an exploration. International journal of health policy & management, 8(3), p.138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462199/

Xu, J.H., 2017. Leadership theory in clinical practice. Chinese Nursing Research, 4(4), pp.155-157. https://eprints.utm.my/id/eprint/81622/1/ZatulIffahMohdFuzaP2019.pdf

Zoutman, D.E. & Ford, B.D., 2017. Quality improvement in hospitals: barriers & facilitators. International journal of health care quality assurance. https://www.emerald.com/insight/content/doi/10.1108/IJHCQA-12-2015-0144/full/html

Website

ncbi.nlm.nih.gov, 2021. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746707/ [Retrieved on 01/06/2021]