INTRODUCTIONLeadershipDefining leadership is a complex task, while many scholars and intellectuals have given meaning to this word, still people find another connotation or gives more meaning to it as time goes by. In the book Leadership Theory and Practice written by Peter Northouse, he defines Leadership as a process whereby an individual influences a group of individuals to achieve a common goal (Northouse, 2016). Leadership has four main components: (1) it is a process, (2) involves influence, (3) transpires in groups and (4) includes shared goals. It involves not only the leader but also its members as active participants in the process and must be accessible to everyone. Leadership involves influence rather than coercion and takes the group, not just the leader but also the members by persuading the whole organization to realize their mutual purpose or goals. Though many leadership theories and models have been developed overtime, the concept of leadership is relatively new in Healthcare sector and since most of leadership theories were based on business setting, an intellectual adaptation of these theories must be critically chosen to be effective in healthcare. Healthcare is not the same as running a business that manufactures products, it involves human beings and the complexities in dealing and treating them individually. One may improve the techniques, practices and even the system but might lose the whole purpose of healthcare. Healthcare leadership looks into the complex components of the organization such as the multidisciplinary staff, various departments and different medical professionals and give them support so that they will go in harmony and move as a whole towards the wellbeing of the patients (LG Bolman, 2003). Leadership in healthcare focus on the connection with patients and quality which also may be referred to as clinical leadership. Clinical leadership focuses on enabling evidence-based practice and delivering patient outcomes. This assignment will examine some of the leadership theories that may be applied to healthcare setting and how they can help in combating the challenges that arises. LEADERSHIP CHALLENGES IN HEALTHCARE ORGANIZATIONSChallenge of Multicultural and Diversity Peopleare becoming more interconnected as what can we observed in schools andorganisations, communities are far more global because of globalisation or the interdependence among nations, which startedduring the World War II. The challenges that globalisation brings does notexempt leadership as a function. Today, leaders has to faced many challengeslike understanding cultural difference, what leadership style to use for amultinational organisation and how to lead a culturally diverse group. Leadinga multicultural organisation takes into account an approach that must catervarious cultures such as Asian, American, African, European and Middle Easternor can also be by race, ethnicity, gender and age. It must also addressdiversity or the existence of different cultures or ethnicities within theorganisation. In healthcare setting it is a challenge for leadership becauseone must understand, accept and value peoples differences, avoid ethnocentrism(tendency for the individual to give priority to their own group above others) andprejudice (largely fixed belief towards an individual). Take for example in abig hospital, its hard for an Asian leader to lead an American nurse becauseone may think that the other is superior in terms of ethnicity. According to arecent research, the fast-changing demography and economies of our growingmulticultural world and the long-standing disparities in the health status ofpeople from culturally diverse backgrounds have challenged healthcare providersand organizations to consider cultural diversity as a priority (Bacote, 2003).Challenge of Education & LeadershipDevelopment Whena leader leaves, the organisation will be in chaos if there is only one personwho knows how to lead. In the environment where there is only one who decideson everything for everyone and no space or chance for others to contribute inthe decision-making because they are not trained to do so, like in the UK, theysee the need for current development on leadership programmes in the NHS that givespriority to the distributed nature of leadership instead of individualisticapproach which has become obsolete this time. There is a need to providetraining and education to more individuals in every level so that many willhave the skills and competencies that they might use when the situation callsfor it (Fulop and Day, 2010). Healthcareorganisations should also provide training for their staff so that they will beskilled and competent to deliver care. Leadership development and educationmust start from the pre-registration period of the individuals or when they arestill students, that they must fully understand their professional boundariesand must be practice-based rather than just theoretical in nature and will notstop there but will be an essential continuation when they are alreadypracticing the profession. Healthcare is a complex environment that require aset of skills and knowledge too broad to be possessed by any one individualthat makes the stress level of leadership too high.Challenge of High Turnover of Staff Withthe growing demand for providing excellent healthcare delivery, healthcareproviders are faced with many challenges, high turnover rates of staff is oneof these especially nurses. Nursing is a very demanding profession and whenthey are not lead effectively may result to burnout and attrition. Healthcareorganisations sometimes ask too highly from nurses but neglect them and dontgive such importance to them and dont see their value in the organisation.Staff nurses may feel dissatisfied and may feel toxic that would lead to a poorperformance or poor quality in their care delivery to patients, in turnpatients are also affected. According to a study conducted, an estimated 30-50%of fresh graduate nurses, decide on either to change positions or leave nursingtotally within their first three years of clinical practice. When nurses leave,the overall patient quality care is affected because of the loss of expertiseand it will be costly for the organisation to loose expert nurses (Belsky, 2016). Challenge of Bullying in the Organisation Workplacebullying among healthcare workers has become a persistent phenomenon. Accordingto Rowell, today, bullying in the workplace has predominantly increased and isfour times more rampant in the health and community care sectors than issues onsexual harassment (Rowell, 2005). Both nurses and physicians areoccasionally victims of hostility in the workplace. Bullying can be define byits social manifestations, such as aggressive behaviour (e.g. intimidation, harassment, victimization, aggression, emotionalabuse, and psychological harassment or mistreatment) that mainly occurs ininterpersonal interactions in the workplace. On the same note, the intention,frequency, duration, apparent imbalance and misuse of power between theperpetrator and target, inadequate support, and the inability of the target todefend himself from such aggression, as well as having to cope with negativeand constant social interactions, physical or verbal harassing, insulting comments,and intense pressure must be take into consideration when we speak of bullying.The impact of bullying does not only affects the victims health and but alsothe morale in the workplace which in turn affects the organisations productivityas a whole. Like when a new nurse started his first day in the hospital, he hasthis ideal perception of clinical setting but he will realize that he has to adaptthe kind of clinical set-up that is already going on and if he will not abideby it, he will encounter difficulties with the senior staff. Challenge of Role Ambiguity and Work Overload Accordingto a research done in Australia (Chang and Hancock, 2003), a new nursinggraduate first few months in the profession are the most challenging and moststressful. Role ambiguity was the most prominent part of role stress in thefirst few months, while role overload was prevalent source of stress after 10months. Role ambiguity occurswhen professionals are unclear or uncertain about a certain role in their workplace, it arises when the definition ofthe job is vague or not clearly define. While role overload is a situation inwhich there is no enough time in which to carry out all of the projected rolefunctions. This challenges arise when leaders do not effectively delegate taskto the staff. For example, in a ward, new nurses will mostly be doing most ofthe jobs to the extent that they dont have enough time even for a quick breakwhile their seniors are chatting and their alibi is that they want the newbiesto learn the hard way so they will be better in the future but sometimes itstoo much.LEADERSHIP THEORIES AND MODELS Cultural LeadershipLearnedbeliefs, rules, values, symbols, norms, and traditions that are mutual to agroup of people is called culture and it is dynamic in nature. It is theseshared collective qualities that make them distinct from others. In short,culture is the way of life, customs, and script of a group of people (Gudykunst, Ting-Toomey, 1988). Due to globalisation,the world became flat and most of the time, it is evident that we can see manycultures mixed together in one organization especially in multinationalcompanies and also in healthcare settings, so understanding different culturesare needed for the leaders to be able to be effective in leading. Culturalleadership requires three interactive components such as cognitive, motivational,and behavioural or the capability to generate actions needed. This type ofleadership style needs the understanding of ones own cultural biases andpreferences, which is the first step to understand that individuals in othercultures might also have different preferences, just like everyone else. Ina hospital where nurses are composed of different ethnicities, it is best thata leader must have a clear understanding of their diverse cultures in order tolead the organisation because different cultures have different ideas aboutwhat they want from their leaders. This will help the leaders in communicatingeffectively across geographical and cultural boundaries. This leadership stylecan address the challenge of multiculturaland diversity, by having an essential understanding on culturaldifferences, leaders can become more empathic and accurate in theircommunications with others that have different cultures. Information on cultureand leadership has also been applied in very practical ways like designing newemployee orientation programs, conduct programs in relocation training, andimprove global team effectiveness. These examples clearly indicate the widerange of applications for research on culture and leadership in the workplace. Integrationof skills in culturally competent care meets six aims for healthcare excellencethat is safe, effective, patient-centred, timely, efficient and equitable thatall care providers truly understand the patient individually while taking intoaccount cultural knowledge, differences and preferences. Transformational LeadershipJamesMcGregor Burns, a political sociologist tried to see the relationship betweenthe roles of leadership and followership in order to better achieve their goalsand its not about power after all. Transformational is different and better thanthat of transactional leadership because the latter focuses on an exchangedimension wherein the followers will be rewarded if they will do this and that,like when a tutor gives high mark for students after completing a goodassignment. On the other hand, transformational leadership is a practicewherein a person take part with others and creates connection that nurtures thelevel of motivation and morality in both the leader and the members (Northouse, 2016). Transformationalleader not only focuses on making today better but also the future. They have aclear vision that is well-communicated with all the members and at the sametime inspires them to achieve their goals through their integrity and authenticcommitment to the mission and not for their personal gratification. They alsoexhibits an advanced mind-set by investing time and effort to attain personaland professional development together as an organization. Creativity is alsoencourage to develop new ideas through allowing measured risks to build aculture of innovation and continuous transformation for the better. Transformationalleaders are vision driven and must be a shared one to be truly effective. In healthcare setting, transformational leadership has been mainly positive in the organizations driving force for progressive change (Manley, 2000) and also for developing and empowering the team (Thyer, 2003). This leadership style enhances nurses creativity to bring about meaningful change. An example of this is the creation of clinical nursing consultants in the UKs National Health Service. It supports the role of expert nurses as clinical leaders that will improve the quality of service and being more responsive and it also solves the shortages in junior doctors. It guarantees that nurses with the highest levels of clinical skills and practice will be at the forefront to the delivery of care. This ensures that the nurse consultants, as the leaders will have a great influence in care delivery strategies and spent most of their time in clinical environment. A concrete example of this, was the creation of Older Persons Outreach and Support Team (OPOST) a core team consisting of consultant nurse, senior elderly care nurses, senior elderly care occupational therapist, and superintendent physiotherapist, social worker, audit facilitator and team administrator, to improve the older peoples care management in an acute settings and the model of choice is transformational leadership. Everyone was articulated by the teams vision and captures their hearts and minds about their objectives as a team and their specific roles in the group to avoid role ambiguity and to achieve their commitment in developing services for older people. Everyone is encourage to do what they seem beneficial to the client but taking full responsibility as well. It significantly reduces the length of confinement associated with complications by working and collaborating with the staff. Likethat of the OPOST setting, the core team members belong to different specialtyfields so when they go back to their professional groups they were treated asoutsiders and they are experiencing confidence crisis. Transformational Leadershipcomes in when dealing with the challengesin diversity, where leaders must motivate, inspire and remind the team theimportance of their role and what they are doing. After 9 months, team memberssaw their achievements in the project and counted them as positive experiencesthat will help the organisation change for the better and ultimately for the benefitof the patients. CLINLAP and LEADLAP ModelClinical Nursing Leadership Learning andAction Process Model (CLINLAP)is specifically used for nursing and midwifery or known as Leadership Learning and Action Process Model (LEADLAP) in a moregeneral perspective is a result of a 15-month Action Science Research Projectdesigned to specify the set of attitudes, skills and knowledge needed for the46 District Nurse Team Leaders (DNTLs) to carry out their roles efficiently andways how to develop such characteristics (Jumaa, 1997).The research outlined the core problems that clinical teams face are generallycircling around the goals, roles, processes and relationships and the viablesolutions would be having specified and agreed goals, explicit roles whichavoids ambiguity or confusion, clear processes and an environment that encouragesopen relationships, be present in the education of health and social care, inresearch, in practice and also in clinical environments (Moxon, 1993).The Modernisation Agency (in the UK) launched in 2001, positively recognizedthe roles of the professions and healthcare managers, specifically nurses, tomanage the organization and healthcare delivery more effectively andefficiently according to the framework of clinical governance which has 3aspects: setting quality standards, delivering quality standards and monitoringquality standards (Department of Health, 1998). Ina complex environment setting, as that of healthcare with many uncertaintiesand dilemma which are present in a day to day occurrence, knowledge andexperience is the competitive advantage of the team so they need to educate andupdate the skills of the whole organization and overcome the challenges of education and leadershipdevelopment in the long-run. The CLINLAP model as a whole is a strategic clinical leadership process thatpositions strategic learning as a force that drives the health and social careorganisations on a day to day basis, in the management of clinical nursinggoals; nursing roles; nursing processes; and nursing relationships (Jumaa, M.O. and Alleyne, J., 1998). CLINLAP modeladdresses the issue on role ambiguityand work overload since this provides a clear strategy and specified goalsand how to deliver quality care to patients. Each member has explicit roles inthe group and they know the clinical process that needs to be followed in acertain clinical scenario. It also encourages up to date education and trainingfor their staff to be highly competitive in practice.Other Contemporary Models/TheoriesServantLeadershipItis an approach that focuses on the leaders point of view of leadership and hisbehaviours. Its emphasis is on the leaders attentiveness to his followersconcerns, showing empathy and nurturing the group. Followers always come firstand servant leaders must empower them so they will develop their fullpotentials as individuals. And also, these leaders are considered ethical, whoserve in ways that seek the greater good of the organisation and the society asa whole. To summarize this model, one can remember the 3 components thatconsists servant leadership these are antecedent conditions, servant leaderbehaviours, and outcomes. The primary focus of the model is on the 7behaviours, servant leaders must have (conceptualizing,emotional healing, putting followers first, helping followers grow and succeed,behaving ethically, empowering, and creating value for the community) thatmainly influenced by ones context and cultures, the leaders attributes, andthe followers receptivity to servant leadership style. Improvement atindividual, organisational and societal levels will be observed if individualswill take part in servant leadership. It is similar to transformational andauthentic leadership at some point but altruism at its centrality makes itunique. Othersargued that servant leadership may be the best model for a healthcare settingfor the reason that the teams strength, trust development and serving theneeds of others are its main focused as a model. Servant leaders help peopledevelop individuals and let them flourish to attain their full potential as aperson and as a professional. This kind of leadership show genuine concern forothers and put their interests first. Ahigh turnover of staff which is a major threat in healthcare organisationsis a result of staff burnout in their jobs and servant leadership style mayhelp in facing this challenge. A significant study showed that this kind ofleadership promotes psychological well-being of nurses because it can decreaseemotional exhaustion thus improving job performance and satisfaction thatdecreases their intention to leave the organisation. Treating nurses as humanswith emotions and the tendency to be exhausted as well, is an important aspectthat servant leaders can address because they do not only care professionallybut also for the personal well-being of their followers. They support followersto overcome their personal problems so their job will not be affected, they wanttheir followers to be whole so that they can build a community or a place wheneveryone feel safe, valued and connected with others but are also encouraged toexpress their individuality. Sharedor Distributed LeadershipSharedleadership is when members of the team assume leadership behaviours toinfluence the team and to take full advantage of its effectiveness. Membersknow when to step forward when situations arise, providing necessaryleadership, and then step back to let other members lead. This kind ofleadership has becoming important in different organisations today to allowfaster responses to complex issues. Also, team leaders make sure they delegatesufficient autonomy and responsibility to all members of the team, involve themin decision-making, and encourage to self-manage its performance to the extentpossible. Healthcareorganizations have responded to the need for new leadership styles, and sharedleadership is one that can improve outcomes because it is highly practical inthis environment, as the nature of the healthcare environment requires muchcollaboration (Merkens & Spencer, 1998). According to astudy (Konu & Viitanen, 2008), patient carequality mostly depends on how well a group of diverse medical and administrativeexperts work together and shared leadership can create uniform decision-makingand define responsibilities but it must be an ongoing process that requirescontinuous assessment and evaluation in order to be responsive to the ever-changinghealthcare environment. A study showed that nonmedical staff favoured sharedleadership than clinicians, but both groups were generally satisfied with theshared leadership model, according to them it seems to provide nurseempowerment and promotes good nurse-physician relationships (Steinert, Goebel & Rieger, 2006). Shared leadershipmay give a solution for education andleadership development challenge since one of its benefits is that itpromotes an inclusive decision-making process and emphasize on participativestyles of leadership, where members take on leadership tasks for which they aregood at and where they are most motivated in accomplishing, thus gives theorganisation the luxury of wealth of talent of all the members. Take forexample a group of doctors, shared leadership enhances doctors engagement inthe decision-making process and add to the improvement of cost-effectivesystems of delivery and are likely to be important drivers in the process of implementingpolicy reforms at local level such as services redesigning and resourcesshifting from acute to primary care.Emotional IntelligenceInthe 20th century, intelligence quotient (IQ) which measures onescognitive ability and intellect became the gold standard to test ones abilitybut many argued that IQ is not the sole basis to gauge ones capability becausetheres the existence of many types of intelligence. Thus, emotionalintelligence come to being. It is the combination of abilities in personal,emotional and social aspects that influence a persons ability to becomesuccessful in coping with the demands and pressures of his environment (Reuven, 1992). Let us look at thefive-competency model of emotional intelligence according to Golemansdescription that includes: (1) self-awareness:understanding your emotions that will guide you confidently in decision-making,(2) self-regulation: handlingemotions well that it will not interfere with work and be able to recover fromemotional distress, (3) motivation:perseverance even in times of frustrations, (4) empathy: can sense anothers feelings and understand people thatcultivates rapport despite diversity, and (5) social skills: smooth interaction that comes from negotiatingdifferences.Inany organisation, challenges of bullyingin any form may take place, thus having EI, prepares an individual on how to processand handles such conditions. It will help the person to cope with theseill-behaviours around him and how to address such so that it will not affecthis personal life and also his job. A person with EI knows how to negotiatedifferences in a win to win situation. If for example, a senior nurse is meanto her junior nurse, the junior must show her skills to her senior in a waythat the former will see that the latter knows what she is doing and will notbe intimidated by her but will use this scenario to prove her value and worthin the organisation. One must persevere in trying times and not just give upbecause there is challenges everywhere, it just depends on how you handle it. CONCLUSIONLeadershipstill is a word that is hard to give a specific meaning that is why the searchand research about this topic is still on-going especially in healthcareenvironment because leadership is essential to transform and in pursuingexcellence in the delivery of care. With the many books, journals, researchpaper and other sources I have read, an individual that assumes leadership inhealthcare must have the personal qualities, may be innate or acquired throughtime that aids the person to lead and set the direction for the organisation inorder to deliver care in an excellent way. The heart of all healthcareorganisations is the patient, giving them the highest quality care possible andan effective leadership is fundamental in meeting that ultimate goal. There aremany models and theories about leadership but the choice of style depends onthe organisation and the leaders because what may be effective to one, may notbe effective to the other. Though there is no gold standard for leadershipstyle in healthcare, for me, transformational leadership stands out. Itsassumptions are very ideal but it is in application that it became difficult.Many have tried, but many also failed because leadership, just like in thisliterature cannot stand alone by the presence of the leader but also with thesupport and cooperation of the members. Change is something that must bemutually wanted to be attainable but there will always be a reluctant tochange, so the challenge still lies on the leader on how to inspire and motivatethe whole organisations so they can all attain the change they want and needfor the organisation. The most important for leadership is trust, a leader musthave trust in himself and his abilities, trust with his followers, trust withtheir shared vision or goal. For the healthcare sector, whatever leadershipstyle you will select for your organisation, may it be servant,transformational, cultural, CLINLAP or shared leadership, the success lieswithin the leader and his followers because there is no perfect theories ormodel, its the people who wants to make it work, succeeds. REFERENCES: Bacote, J. (2003). Many faces: addressing diversity in health care. The online journal of issues in nursing.Belsky, J. (2016, August 26). Servant leadership can save the health care profession. Smart business.Chang and Hancock. (2003). Role stress in Australian nursing graduates. Nursing and health sciences, 155-163.Department of Health. (1998). A First Class Service: Quality in the New NHS. London: The Stationary Office.Fulop and Day. (2010). From leader to leadership: clinician managers and where to next. Asutralian Health Review, 344-351.Gudykunst, Ting-Toomey. (1988). Culture and interpersonal communication. Newbury Park, CA: SAGE.Jumaa, M. (1997). 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Working with emotional intelligence, 371.Rowell, P. (2005). Being a target at wotk or william tell and how the apple felt. Junior Nursing Administration, 377-379.Steinert, Goebel & Rieger. (2006). A nurse-physician co-leadership model in psychiatric hospitals: results of a survey among leading staff members in three sites. International Journal of Mental Health Nursing, 251-258.Thyer, G. (2003). Dare to be different: transformational leadership may hold the key to reducing nursing shortage. Journal of Nursing Management, 73-79.Get Help With Your AssignmentIf you need assistance with writing your assignment, our professional assignment writing service is here to help!Find out more
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