Leadership and strategy in clinical audit

Clinical Audit

The concept of clinical audit was introduced in 1993 as a quality improvement process aimed at improving patient care and outcomes through a systematic review of care according to or against explicit criteria and the implementation of change (United Bristol Healthcare Trust 2005). It is distinguished from financial audit, organizational audit and internal audit. Financial audit looks at accounts. Internal audit is an internal activity on non-clinical systems through audit paths to see if things work as they should. Organizational audit is an external, independent and voluntary audit of the whole organization according to explicit standards. It traces if the organization is set up and runs on a daily basis according to those standards. Clinical audit focuses on the details of processes and the outcomes of specific healthcare interventions (United Bristol Healthcare Trust). The head of the clinical audit can carry his functions and duties out satisfactorily if he possesses the necessary attributes and uses effective strategies of an effective leader. Among these attributes are credibility, influence and communication. Among the effective strategies he can use to discharge his functions and responsibilities are in the pursuit of the principles of personal vision, interpersonal leadership and emphatic communication.

Leadership Attribute of Credibility

Organizational surveys say that the two most consistent and most critical organizational challenges today are improving customer service and product quality (Riley 2007). The explanation is that, even when these challenges are achieved to perfection, they persist because customers continually raise their expectations. Leaders must, therefore, establish directions on anticipating needs and meeting rising demands. The organization should be one where employees will want to stay because they have a leader with the capability of effectively enlisting them in supporting his inspiration. While it is the customer who decides if the quality of a product or service is satisfactory and if the leader possesses the qualities worth following, constituents get things done. Constituents are employees, customers, suppliers, shareholders, business partners and community members. Surveys say that most people look for honest, forward-directed, inspiring and competent leaders. These qualities constitute credibility. It is the ability to inspire belief or trust that he has what is required to get things done. People will not follow a leader without credibility. Competence is the key element of credibility. A leader cannot reform a department if he is incompetent or lacks credibility. It is not only worthwhile to possess credibility, it is also essential in engaging in any meaningful work. A credible leader sets up positive work attitudes, organizational pride, strong team work, personal responsibility and continuity between personal and organizational values (Riley)

Application of Attribute - in cases of delayed admissions, the clinical head can exhibit credibility by frankly going to the root cause or causes of the delays and confronting them head-on. If a lack of personnel is the cause of the delays, he promptly takes action on it by recruiting qualified employees to fill the vacancies or assigning other employees to the vacant posts. If the cause is inefficiency on the part of the employees involved, he confronts them and corrects the problem adequately. If the cause is poor logistics, he makes the appropriate recommendations to management. But under all circumstances, he must himself be responsive and responsible as well as efficient in order to accomplish these.

Leadership Attribute of Influence

This consists of using proper interpersonal styles and methods in inclining and guiding employees to take a certain course of action or accomplish a task (Farrell 2007). He asserts sway in establishing and maintaining group cohesiveness and cooperation, enabling group process and in obtaining commitment to plans, ways and courses of action. He possesses the capability of causing his followers to accept his ideas and ideals. It is not out of force or coercion that he is able to assert this sway but because he is able to accurately assess the skills, feelings, concerns and needs of his subordinates or employees. Seeing him as a model of enthusiasm, hard word, competence and commitment, employees or subordinates reward him with their willingness to be affected by him and what he stands for. They feel his capability and sincerity and trust him to take the initiative for them. They willingly acquiesce some of their powers to him. The key behaviors of an influential leader include the eliciting or soliciting of feedback or information, securing of help in solving problems, communication of vision, modeling commitment, acts in building trust and unity, honoring commitments, providing direction, setting measurable and achievable results, providing feedback, sharing feelings and thoughts on issues, checking for understanding, enhancing others' self-esteem and acknowledging subordinates' concerns and responding to these with empathy (Farrell).

The ability to influence is a key core leadership competency (Schneider and deNij 2006). Research shows that managers and leaders who assert excellent influence also excel in employee development, team development and customer relationships. Increasing influence through powerful relationships accounts for a 25% improvement in performance and productivity. Influence is said to be a foundational tool in establishing powerful conversations as well as difficult conversations and in developing a powerful leadership presence needed for development and success (Schneider and deNij).

Application of Attribute

The effects of genuine influence can be very helpful in times of steep work pressure. The leader or manager can set up guidelines on priorities, methods and other aspects most critical to the tasks. He can show and encourage by example on how to streamline a particular task by establishing the main objectives or directions, setting up an appropriate schedule of attaining these objectives, listing expected results and identifying a suitable evaluation process or system. He can also apply influence over the employees by assessing their capabilities and responsibilities and streamlining these as well. And while the work is being done according to schedule, he can monitor and supervise to insure that the objectives are achieved and the proper methods are used. He can also direct some of the employees to take in other responsibilities and encourage poor performers to do better.

Leadership Quality of Communication

Nothing makes for failure better and more surely than the lack of communication or poor communication. The advent of the computer may have blessed the world but it has also debited a lot from the need to communicate personally. Employees still much prefer to communicate face-to-face with their supervisors or leaders than through print or over the video (D'Aprix 1993). With the current communication gap created by high technology, it is most welcomed and necessary for a leader to communicate personally. Communication is an un-ending process, especially within an organization. Newsletters, memorandums and the products of high information technology do not fulfill the purpose of a leadership. The effective leader is one who orchestrates clear issues and messages directly and not through channels. That quality or attribute is the preference for face-to-face and direct communication, which should be a priority consideration in confronting disruptive work conditions or when the organization is striving to be more competitive in the market. A study of 1,000 British companies showed that, while these companies recognized the value of an integrated and consistent approach to communication, few of them have been able to put this conclusion into practice in any appreciable measure. Communication is seldom restricted in senior management. It is not even discussed during the planning process (D'Aprix). In the healthcare industry, communication is a particularly important quality in the leader or manager of a section performing clinical audit. He needs to and must rely on listening, explaining perceptions, acknowledging and discussing the differences and similarities in views, in recommending appropriate treatment and negotiating agreement (Geriatric Interdisciplinary Team Training 2001). The attribute becomes even more critical in our increasingly diverse workplaces where language and cultural barriers can and do exist between the section and the healthcare facilities under it and between the employees and the patients and their families. This attribute can save a lot of misunderstanding concerning meanings, intentions and reactions. In decision-making and conflict resolution, the attribute is most valuable

The leader who is also a habitual and effective communicator prevents, closes or reduces the communication gap, which pervades in many organizations. He endows himself with reliable information from regular and direct feedback from his subordinates and other staff. In the process, he also makes his thoughts and feelings clear by communicating back to them during their meetings and encounters. The habit or attribute of communication also prevents, solves or reduces conflict with subordinates because communication lines are open.

Application of the Attribute of Communication

If the health care organization has placed greater emphasis on the staff and services than the patients' needs, the situation can be helped if the leader possesses the quality of communication. He can express his observation to top management and seek out a dialogue with the officials. He can point out the significance of shifting organizational focus from the staff and services to the patients who are the direct beneficiaries of the organization's services and manpower. All the leadership and staff training and improvement of facilities have meaning only if the patients' needs are adequately served. Their satisfaction is the only true test of the effectiveness of the organization and its staff. But unless these needs and preferences are promptly and adequately communicated to the right recipients, the objective cannot be achieved. The head of clinical audit must posses this attribute because he must be able to transmit the goals of his section clearly to those under it, those above it and those with which it functions or deals.

Leadership Strategy of Personal Vision leader who is highly attuned to himself and his personal vision and the greater world will be most effective (McKee 2006). Unprecedented global change, pressure from all directions, and ever-increasing competition in the field require personal vision in a leader. Today's leader is not just an effective worker who works harder. He must now create powerful, positive relationships and healthy organizational environments, which will establish optimism, innovation and team work, necessary in achieving the organization's more and more challenging goals. He needs to create resonance with the greater world, both local and global. But in order to do so, he must resonate with himself. He must be fed from within by a vision all his own. A resonant leader possesses what is called emotional intelligence. He can manage himself and guide others at the same time through difficult or trying circumstances. While others may use fear and control under those circumstances, he knows that using force or fear steals employees' sense of value of themselves and this reduces their commitment to organizational goals. On the other hand, a leader with personal vision engages his subordinates' hearts and minds to build and share common purposes. He inspires them to give their best, to willingly work or collaborate fruitfully with him. He produces results because of this. His personal vision enables him to examine all the aspects of his leadership. He keeps track of what works and what must be changed. He creates an environment where his subordinates feel safe and are encouraged to express themselves (McKee).

His personal vision also leads him to adapt to customary ways of leading (McKee 2006). It enables him to be open-minded, non-defensive and deeply committed to learning about himself and adjusting his behavior. He is able to empathize or understand the perspective or feelings of the other. As far as he can empathize because of his strong personal vision, he extends himself. Others get to know him. Because of they know, trust and believe in him, he can influence them. He can create positive and trusting relationships. These are not opportunistic, instrumental or incidental but authentic. He seeks out mutual interests, which go beyond working relationships, but which connect him to persons. He resonates with their emotions and thus moves these emotions in a positive direction. He is, thus, able to handle even difficult persons and in difficult situations because of his authentic relationships with them. His personal vision makes this possible and makes it happen. Such a leader is not common because of the amount of sacrifice it requires of him. He must constantly give himself to others (McKee).

Application of the Strategy of Personal Vision leader with personal vision will monitor and supervise the doctors and hospital staff for their public service ethos. He will check out if they are doing what they deem best according to their individual inner light. Clinical experience is no longer sufficient in service delivery today. Regulatory bodies now consider individual competence. Training standards are now inspected to see if they come up to standards. Clinical performance, which includes the number of deaths in the hospital, prompts the head of a clinical audit to immediately seek out complete and updated information on the incidents. He does not tolerate the number of medical errors and near-misses and will come right to the bottom. It may be traced to organizational problems, clinical incompetence or merely bad media publicity by competitors. But he confronts and contends with the true cause or causes of the mishaps.

Strategy of Interpersonal Leadership

Globalization has the answer for it. Employees are getting more and more diverse and this situation also explains the new developments in managing interpersonal relationships with them in the past decades (Roper 05). Managers and other leaders found that they must increase or improve their skills, such as active listening, adaptability and decision-making. These skills will greatly help them in confronting problems and issues in the workplace. Interpersonal leadership hangs on interpersonal communication as the foundation of all the leader's dealings with his subordinates..The changing nature of the workplace now requires a corresponding increase in interaction, which if positive, creates the right climate and the right attitudes, beliefs and attitudes on both sides. The leader or manager must also respect his subordinates in order to accomplish goals (Roper).