Transformational leadership and change management in hospital nursing units

Leadership is said to be effective if it helps a company or entity to achieve its goals and realize outcomes that are consistent with the majority. Overall, the qualities necessary to make leadership effective even in a hospital setting has been consistent -- the need to motivate, encourage, support, direction, organization, and to provide access able goals. However, what has been debatable is how leaders acquire these necessary qualities -- the debate centers around whether leadership skills are innate or whether they can be acquired, and which leadership type tends to be most effective in certain environments. The overall body of this paper will examine leadership styles that are present at a hospital nursing unit with a focus on the style of transformational leadership. There will also be a critical analysis of change management and what environments are conducive to different strategies. The analysis will be conducted within the context of the case in s hospital nursing unit with sections outlining strategic management, leadership, and strategy in the healthcare systems.

The analysis will be rooted in formal management theory to explore the types of leaders that exist and are effective in healthcare -- especially transformational leadership, and the necessary skills and talents that leaders should have to develop effective service sectors. The literature surrounding leadership seems to posit that the necessary qualities and skills can either be born with or they are made, the types of leaders that exist seem to show a diverse set of hypotheses. However, what is clear is that the nursing literature views transformational leadership as an important aspect of change management and some authors have identified this leadership style as one of the most effective processes that can lead to efficiency in the long-run. The paper will explore these issues and will highlight how this type of leadership style can be implemented and is practiced within the healthcare sector. The combination of leadership, change management, and related formal nurse management theories provides an excellent platform for examining operations within a healthcare environment.

The issue of leadership and management is closely intertwined however, it is clear that there are many issues that set the two apart, the study below will provide a good foundation to examine leadership at a hospital nursing unit.

LEADERSHIP STYLES and CHANGE Management

According to Sturm (2009), organizational outcomes are usually considered the combination of inherent values and learned mission. The importance of an organization's leadership and management structure is due to the fact that it feeds operational excellence and ensures that strategic objectives are achieved. It is therefore imperative that the leadership be embedded in this critical process, why?

Organizations are living social organisms, and need a link between them to survive; the leadership provides that link,

Organizational outcomes and the leadership of an organization is the fundamental support of an institution and will fail without a strong one,

Sturm (2009) sates that organizational outcomes are critical business strategies, goals, missions, and outcomes.

As stated by Sturm (2009), the leadership styles, whether consciously or unconsciously helps to create, hone, and develop organizational outcomes from their own personal history, nature, socialization experiences, and perception of what it takes to succeed in the market place. Table 1 below presents the four core outcomes that an organization can adapt.

Table 1: Leadership Styles and the Four Core Organizational Outcomes

Type of Outcomes

Brief Description

Control

The outcome is all about certainty. The leadership style exists to ensure predictability, safety, accuracy, and dependability. The leadership develops an outcome that is centered on organizational goal achievement.

Collaboration

This outcome is about synergy. The leadership makes sure that unity, close connection with the customer and is centered on dedication with the customer.

Competence

This outcome is about distinction. The leadership exists to ensure that the development and business strategies are unmatched.

TRANSFORMATIONAL LEADERSHIP at WORK -- ENGAGING the NURSING UNIT

Ralston (2005) argue that in using change management and recommendations and integrating the framework of a hospital nursing unit there has to be a focus on implementing policies and procedures that will increase efficiency at the hospital. This however, has to be accomplished via a leadership style that is focused on patient care, helps to achieve efficiency and develops teamwork. This type of multifaceted duty for a leader, the literature argues can only be supported via a transformational leadership model. In fact Cummings et al. (2010) present the following six principles are important to the overall strategic management implementation process and are integrated into change management and overhaul of a hospital nursing unit.

The strategic management program has to be compatible with the current organization outcomes and schedule.

Scheduling criteria has to be clearly defined so that the connection between achievements and rewards can be understood by the hospital nursing unit before activities commence.

The schedule has to be free of conflicts and should not interfere with productive activities of the hospital.

Programs should be scheduled for short life-cycles of six to 18 months with performance factors attached to understand its relative benefit to the organization

The schedule should not be used as a way to mask any inadequacies within the hospital that may require additional funding or program overview.

The scheduling process should be kept clean.

Similarly, transformational leadership and change management also require reviewing and monitoring the implemented process aimed at improving efficiency. Ralston (2005) states that, change management is the "planned systematic development and diagnosis of an organization so as to identify and execute a plan for improvement and how to provide adequate resources for an entity." Nevertheless, it is necessary to augment this process with a leadership style that will maximize the outcomes of workers. Lunn (2008) argue that transformational leaders usually seek to develop a vision for the organization. The important characteristic of this leader is that the necessary energy and commitment to the goals of the organization are translated to the followers in very passionate and energetic ways. Transformational leaders are usually charismatic, since it is necessary for them to have the trust of followers, and can usually provide the fostering and embracing of the common values embedded within the organizational outcomes, develops teamwork, acts as a problem solver, and aims to improve processes and procedures within the organization, states Lunn (2008).

However, it is noted that by McGuire and Kennerly (2006) that change management has allowed entities to continually be successful if it is effective at integrating leadership styles such as transformational leadership models within the strategy of the unit. This processes the helps the supervisors to be better at:

Identifying credible information services and products on affect the current insurance policies and procedures

Prioritizing and analyzing strategic, so that the current system can achieve its maximum efficiency

Using research methodology and other analytical tools to monitor the overall performance of the strategic management program chosen.

Review and seek measurable savings and reduction in total strategic management alternatives.

Evaluating the current hospital policies and strategic management options and test the models effectiveness in overcoming the potential administrative hurdles associated with high strategic procedures and/or activities.

AL-Hussami (2009) states that as the highest level of direction in an organization it is imperative that the roles of the leadership be identified as 'strategic roles', since they are the core of the organizational structure and are processes that have to be embedded via a process that is learnt and are developed as tasks and outcomes are processed within organizations. Figure 2 below identifies the strategic roles of the leadership.

Figure 2: Strategic Roles of the Leadership

It is common knowledge that motivating the workforce is a necessary prerequisite for effective leadership. Many companies have gained tremendous success, by enforcing being able to correctly identifying rewards to performance and hence motivating the workforce to support the organizational structure. Other organizations have failed to realize their strategic objectives because they have not realized how important the overall mechanism of the organization is. Leach (2004), shows that these roles of leadership can only be developed if they are practiced and used in situations that can benefit from the process -- that is effective leadership styles, especially transformational leaders are made from practice.

Transformational leadership and change management cab act as the champion of change at the hospital. Employees use the leadership as a model for the organization's direction and development. This is why a transformational leader within a nursing unit, has to be able to scan the external market environment and be able to predict and analyze the future changes within the industry. Employees have confidence in leaderships that act as "visionary, a problem solver, and a communicator, which are all processes that are learnt for leadership," states Sturm (2009). Sturm (2009) also posits to the fact that a transformational leadership has to set performance standards and promote these standards as part of the structure associated with the organizational structure. These standards are not arbitrary, but should be necessary prerequisites for the company to maintain a competitive edge in the nursing industry.

A hospital nursing unit with effective transformational leadership is a source of competitive advantage, if and only if, employees are motivated towards the outcomes, as argued by Stanley (2006). Atter (2008) also identified some major strategies that have proven to be common among numerous successful nursing units, which have used the change management timetable as a support mechanism for motivating employees to work towards corporate objectives. Transformational leadership and change management as integrative processes incorporates the following strategies:-

Strategy #1: Identify environmental factors that will utilize the skills and talent of the employees -- this will motivate the workers. It is clear that a motivated employee wants to contribute to work areas outside of their specific jobs and to help enhance the work environment by embracing the leadership.

Strategy #2: Correct rewards have to be based on performance designed to boost employee morale -- change management and leadership style has to support these programs thinking that paying the employee is enough is obviously an erroneous assumption. Research shows that workers are demoralized when they don't receive the recognition they want or feedback on how they are doing.

It is pointless to have a leader who has the ability and aptitude to predict market trends and make sound business decisions, but not be able to communicate these changes to the corporation; this Adams (2010) argues is what makes a transformational leader so effective within a nursing unit. The key to motivating employees towards a set of principles embraced by the organizational outcomes is via communicating the necessary information or changes to the corporation as needed, states Adam (2010).

As an essential strategist, the leadership sets the future direction of a company; the process for creating effective strategy inevitably involves a team-centered strategic planning approach. The success of the team depends solely on effective communication. Studies show that leaders who communicate with workers and get to know the work outcomes and integrate that process with the organizational outcomes have higher profit margins and smaller turnover ratios -- the outlined processes and procedures conducted by transformational leadership is to ensure that the hospital can be successful and the employees feel important to the overall strategic development of the hospital.

McIntosh and Tolson (2009) argue that without a capable management team who is informed of the organizational processes as well as embracing the organizational outcomes, then the operational processes of a company will be stagnant. In essence it is impossible for leader to not have traits similar to transformational leadership and function or be successful. Adding value to an organization is embedded in linking strategy to the organizational structure, which was the process that transformational leadership and change management used to achieve success at a hospital nursing unit. Callaghan (2006) argues that it is communication that allows a leadership to impart vital information, so that employees can become a part of the system and thus understands the organizational outcomes.

Whatever strategic and business strategies are chosen it is essential that the leadership is consistent with production/operational trends. In fact the following seven principles are important to the leadership. Transformational leadership and change management uses these processes, so as to help achieve efficient communication:

Communication channels have to be compatible with the current organization outcomes and schedule and have to be developed with change management and leadership style

There has to be a connection between achievements and rewards and this should be understood by the staff.

There has to a scheduled time at benchmarks to help with communication and motivating forces so as to acknowledge and communicate desired behavior and performance -- processes that are developed rather than enhanced with innate qualities in a leader

Change management and leadership style should integrate well with the distribution channels, so that it is does not interfere with productive activities.

The communication and motivating process should be kept clean and included in the taught change management and leadership style.

Optimizing communication functions implies that the leadership has a relationship with workers that involve providing feedback, evaluation of employee activities, and rewarding efforts geared towards effective communication is also essential. Effective communication implies that the leadership includes these differences within the communication plan development and the overall organizational structure as stated by Lunn (2008).

Since there can be fundamental problems related to the operations at a hospital nursing unit, action usually needs to be taken quickly and the plan has to incorporate elements of event identification, risk assessment, and a thorough financial analysis.

A hospital nursing unit would only stand to gain from the recommendations of change management framework if the hospital used the underlying strategies suggested and followed by transformational leadership after an internal assessment -- this would act as a strategic business element to increase efficiency.

At a hospital nursing unit the issues that require immediate attention can stem from capital constraints, state's regulatory roadblocks, and local related staff problems with the nursing unit. Internal issues related a nurse's workload, training and human resource management, ineffective medical payments infrastructure as well has high utilization and increased cost of healthcare adversely affected the operational and financial aspects of the hospital as it struggled to survive in the changing managed care environment. Risk assessment procedure undertaken by transformational leadership and change management needed to be integrated within the general operational plan includes: overview of nursing staff to understand the problems affecting the unit, tackling human resource problems, data collection to identify the frequency and severity of operational losses can be based on gathering information from external or internal stakeholders. The strategic development process involved quantifying unknown variables; however transformational leadership and change management needed to foster relationships with hospital personnel such as doctors and nurses who would be able to provide good estimates based on prior experiences. Patients were essential to the operations at the hospital and were also a primary source of information and can provide useful parameters that can be applied to methodologies to collect data,). The frequency and severity of potential problems a nurse manager can address can be identified through various mechanisms including, but not limited to notices of intention, claims, quality reviews, risk assessments, incident reports and survey findings. Risk identification and quantification can also be obtained from quality investigation on all departments and units operational processes to understand the severity of potential losses.

A hospital nursing unit needs leadership that can help rationalize event identification and risk assessment and can also use objectives-based risk identification to find the relative factors or activities that deter from the hospitals goals and objectives -- this is usually attainable via transformational leadership. This requires a certain style of leadership and motivational strategy that is very useful in a quality management setting that sees the hospital depending on accreditations and standards to secure funding or infrastructural development from funding sources, especially in wake of increased regulatory frameworks and requirements from the state. Hospitals usually face similar losses and risk factors, and as such a common factor methodology can be employed, where similar risk and losses within other hospitals can be applied to a hospital nursing unit and used as a basis for identifying the frequency and severity of potential losses, hence change management and experience at Waltham Hospital was invaluable in nurse manager current role.

Whatever strategic and business strategies are chosen it is essential that the hospital nursing unit makes this compatible with the current control mechanisms so as to improve communication and monitoring. In fact given the recommendations of the change management and strategic development process optimizing communication functions and improving control activities implies that a hospital nursing unit has to integrate strategic management within its relationship with workers - that involve providing feedback, evaluation of employee activities, and rewarding efforts geared towards effective communication.

CONCLUSION

Understanding and integrating the organizational structure with the company objectives is the key to effective leadership; the role of a leader such as transformational leadership and their duties is the best example of how pivotal this is. This paper has tried to explore the idea behind whether effective change management and leadership style is pivotal to a company's success with an application of leadership styles to a hospital nursing unit and transformational leadership. The issues presented, highlight the fact transformation leadership has the role of formally integrating within the strategic plans of the organization and these traits are essential to the success of the firm which was clearly outlined in the health environment via the case analysis of a hospital nursing unit -- since transformational leadership and change management had to embrace these plans and finding innovative ways of motivating and communicating objectives to employees, which will not negate the appropriate organizational structure. Leadership is an important aspect of any organization, however, the ability to maintain, change, and develop the appropriate business strategies depend primarily on skills that are learnt, irrespective of the fact that some leadership traits maybe innate.

Adams, C. 2010. "Dying with dignity in America: the transformational leadership of Florence Wald." Journal of Professional Nursing 26, no. 2: 125-132. CINAHL Plus with Full Text, EBSCOhost (accessed May 5, 2010).

AL-Hussami, Mahmoud. 2008. "A Study of Nurses' Job Satisfaction: The Relationship to Organizational Commitment, Perceived Organizational Support, Transactional Leadership, Transformational Leadership, and Level of Education." European Journal of Scientific Research 22, no. 2: 286-295. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Atter, Lynda. 2008. "Using creative transformational leadership in shaping our hospice's journey to excellence." Practice Development in Health Care 7, no. 3: 134-142. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Callaghan, Leonard. 2006. "The use of collaboration in personal outcomes." International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 19, no. 4-5: 384-399. MEDLINE with Full Text, EBSCOhost (accessed May 5, 2010).

Cummings, Greta G., Tara Macgregor, Mandy Davey, How Lee, Carol a. Wong, Eliza Lo, Melanie Muise, and Erin Stafford. 2010. "Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review." International Journal of Nursing Studies 47, no. 3: 363-385. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Kanste, O. 2008. "The association between leadership behavior and burnout among nursing personnel in health care." Nordic Journal of Nursing Research & Clinical Studies / Vard I Norden 28, no. 3: 4-8. CINAHL Plus with Full Text, EBSCOhost (accessed May 5, 2010).

Leach, LS. 2005. "Nurse executive transformational leadership and organizational commitment." Journal of Nursing Administration 35, no. 5: 228-237. CINAHL Plus with Full Text, EBSCOhost (accessed May 5, 2010).

Lunn, Cora. 2008. "Clinical leadership and patient care." Nursing Management - UK 15, no. 6: 16-17. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

McGuire, Elaine, and Susan M. Kennerly. 2006. "Nurse Managers as Transformational and Transactional Leaders." Nursing Economic$24, no. 4: 179-185. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

McIntosh, Jean, and Debbie Tolson. 2009. "Leadership as part of the nurse consultant role: banging the drum for patient care." Journal of Clinical Nursing 18, no. 2: 219-227. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Nielsen, Karina, Joanna Yarker, Raymond Randall, and Fehmidah Munir. 2009. "The mediating effects of team and self-efficacy on the relationship between transformational leadership, and job satisfaction and psychological well-being in healthcare professionals: A cross-sectional questionnaire survey." International Journal of Nursing Studies 46, no. 9: 1236-1244. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Ralston, Rossana. 2005. "Transformational leadership: leading the way for midwives in the 21st century." RCM Midwives: The Official Journal of the Royal College of Midwives 8, no. 1: 34-37. MEDLINE with Full Text, EBSCOhost (accessed May 5, 2010).

Stanley, D. 2006. "In command of care: toward the theory of congruent leadership... Second of two papers." Journal of Research in Nursing 11, no. 2: 132-144. CINAHL Plus with Full Text, EBSCOhost (accessed May 5, 2010).

Sturm, Bonnie a. 2009. "Principles of Servant-Leadership in Community Health Nursing." Home Health Care Management & Practice 21, no. 2: 82-89. Academic Search Complete, EBSCOhost (accessed May 5, 2010).

Suliman, WA. 2009. "Leadership styles of nurse managers in a multinational environment." Nursing Administration Quarterly 33, no. 4: 301-309. CINAHL Plus with Full Text, EBSCOhost (accessed May 5, 2010).

VISIONARY

ROLE MODEL

SET PERFORMANCE STANDARDS

IMPLEMENT and MAINTAIN OBJECTIVES

Leadership Processes: Strategic Roles