Leadership Management in Health and Social Care

Clinical leadership is critical as it ensures high quality health care system. The hospitals and health care units have been in demand where the most vulnerable people, children and older people are exploited. The aim of this report is to investigate a primary health organization in New Zealand and refer to their leadership practices (Houser, 2013). The organization chosen for measuring leadership effectiveness is Aria Gardens. The research study shall critically analyse the organizational structure and help them evaluate ways of delivering sustainable change. The practices followed in Aria Gardens are analyzed. Accordingly, the changes that need to be made to help the organization become more effective are recommended (Daly et al., 2014).

Organization       

Aria Gardens Home and Hospital is a primary healthcare organization located in Albany, Auckland (Arvida.co.nz, 2016). It offers a safe and comfortable organization for the patients. The organization has a support of highly skilled and friendly staff. The environment is relaxing and three levels of care are offered: rest home, dementia and hospital. All the three levels have different areas so that they can cater to both short term and long term needs of the people. Their statement of intent is to offer a warm and welcoming environment to the needy. The goal is to pride the highest standard of support and address the needs of patients. The staffs take care of physical as well as emotional well-being by providing 24-hours service (Arvida.co.nz, 2016).

The mission of the healthcare team is to ensure the needs of the visitors is met. The organization makes sure that the individuals are provided with unique life experiences. They respect and appreciate the diversity that they bring in the community (Arvida.co.nz, 2016). The healthcare team comprises of carers, cleaners, podiatrists, activities team, cooks, doctors, nurses, physiotherapists and handyman who work together. The team establishes strong relationship with the residents and caregiver (Arvida.co.nz, 2016).

The purpose of this research study is to analyse the complexity of health and social care organization. The organization is chosen as it is not just a hospital, but offers a wide range of accommodation and care options. The healthcare system provides various accommodation options such as Rest Home, The Palms Boutique Hospital and The Kauri Wing Dementia Care (Arvida.co.nz, 2016). There are registered nurses to take care of the residents who are responsible to optimise and encourage the patients. The caregivers arrange a meeting every six months with the patients and the family members to review the existing care plan. The leaders identify the issues that are encountered and would respond to it by addressing needs (Arvida.co.nz, 2016). The leaders at the organization also believe in open communication as a priority. If the residents at the organization become unwell, the decision is taken jointly between Aria Gardens General Practitioner, possible resident, their family member and the nursing staff. Since joint decisions are to be made, there needs to be effective leadership. There needs to be effective management since health is a priority for every individual (Arvida.co.nz, 2016). There are activities conducted at the healthcare organization for patients that help in providing a relaxed lifestyle. There are intimate settings for personal care that require special attention on disabilities and the individual’s personal preferences. All the above factors require efficient leadership for which the organization is selected (Arvida.co.nz, 2016).

Research Question         

The central question of this study is: How do effective leadership styles have an influence over health care delivery?

Problem Statement

The research question is chosen by the researchers to analyze the link between theories and practices of leadership. This research question shall help in answering the ways about how a leader can motivate the followers and help the employees grow. This research shall help in addressing any low performance using effective leadership styles.

Scope of the Study

The scope of the study is not just restricted to Aria Gardens Home and Hospital, but various other healthcare facilities. The study examines purposes and challenges of leadership in the nursing practice. There is a scope for research in leadership behaviours and processes. The study identifies the competencies required by health service managers within an effective health service workplace. The extensiveness of this leadership study is a testament for the elusiveness or clear perception about the concepts. Multiple leadership styles are assessed that extends the scope of study, not just for healthcare organizations, but leadership in other industries as well. The research study helps in evaluating the role of senior manager and delivering effective change by using selective strategic approaches (Daly et al., 2014).

Limitations of the Study

The website does not provide much information about the current leadership style followed in Aria Gardens. Other constraints such as insufficient money to conduct the research more effectively are also prevalent. The researcher could not obtain everything thereby hampering the best work on the study. Due to security, primary data obtained through research is limited. The attitude of the staffs for the research was contradictory as they were hesitant to release information. Not all managers or staff members at the health service management are involved for conducting the survey which leads to response bias. Additionally, there was longer time required to get necessary and quality data.

Literature Review          

Leadership

In simple terms, leadership is the action of leading a group of people that helps in making sound decisions and inspiring others to perform well. Healthcare systems are composed of numerous groups of doctors, staffs, physiotherapists, caretakers, and various others. Effective governance is necessary for maximizing effective management in the hospital care setting (Martin et al., 2011).

Essence of Effective Leadership

The leaders share collective values and have responsibility of all. Effective leaders can help the people in understanding the relevance of events and identify emerging threats and opportunities. The effective leaders build task commitment and optimism (Daly et al., 2014). There needs to be increased enthusiasm for work and confidence. Effective leaders help people organize to perform collective activities efficiently, and they help to coordinate these activities as they occur. Effective leaders promote and defend unit interests and help to obtain necessary resources and support (Yukl, 2012).

There are a few necessary traits and behaviours necessary for clinical leadership. Leaders help in continuous learning. They know what questions to ask and help the employees apply them in regular life. Leaders must also focus their gear on efforts rather than the results. There must be relentless efforts to upgrade the team with confidence (Mannix, Wilkes, & Daly, 2013).

Leadership Styles and Theories

There are different kinds of leaderships namely: autocratic, Laissez-faire and democratic style. The autocratic leadership is a one-way communication in which the leader has authority over other people. The democratic leadership involves two-way communication in which the leader asks for employee to participate in presenting ideas and decision making process. The situational leadership model is very different from these two leadership models that facilitate group decision making (Gerrish, Lacey, & Cormack, 2012).

Situational Leadership Model:

According to Blanchard and Hersey (1980), the situational leadership model has four styles describing the leadership effectiveness and maturity level. The four types of leadership are: High task- Low relationship, Low task- low relationship, Low task- high relationship, High task- high relationship (Blanchard and Hersey, 1980).

This leadership model is selected by the rseearchers as it is easier to understand and interpret it. Group maturity and competence are the most crucial factors that affects the leadership effectiveness (Blanchard and Hersey, 1980).

Figure 1: Blanchard and Hersey Model (1980)

1. High Task Low Relationship- This style is also called as directing in which the leader has high focus on task and low focus on relationship. The followers have low comptence or commitment level in which they are either unwilling or unable to perform their task effectively. This inolves authoritarian style in which there is one way communication. If the followers are afraid to try things, then the leader takes directive role and tells them what to do (Blanchard and Hersey, 1980).
2. High Task High Relationship- This approach or style is also known as selling or coaching in which the leaders have high task as well as high relationship focus. The followers lack the ability but possess strong motivation to perform the job. These team leaders foster a positive team environment for helping their followers reach the highest potential. The leader guides, advises and listens to their followers so that they can provide necessary training or coaching (Blanchard and Hersey, 1980).
3. Low Task High Relationship- The approach is also called as supporting in which the leader has a low focus on task and high focus on relationship. In this style, the follower often refuses to perform the job and the leader focuses on finding the issue because of which the follower refuses to perform the task. The leader praises and listens to the follower so that they feel posiitve about the job and show required commitment (Blanchard and Hersey, 1980).
4. Low Task Low Relationship- This approach is called delegating in which the leader has low focus on bith the relationship as wel as task. Additionally, the followers are highly motivated and have the ability to perform the task. In this case, the followers do not require much support or frequent appraisals. There is a high degree of faith and belief between the leader and his followers (Blanchard and Hersey, 1980).

Relevant Studies to Situational Model of Leadership

The situational leadership model is divided into four different phases: Selling, Telling, Participating and Delegating. Telling is considered as one of the lowest level of leadership as the leader has to tell everything to the followers. The followers do not possess adequate knowledge for completing the task. The leader needs to spend more time with the employees so that they can guide them effectively. Selling is considered same as telling in which the leader makes a positive relationship with the employees so that they can understand it in a better way. The leader possesses active listening skills and advices so that clarity of objectives and doubts can be provide if any. The third style is participating in which a good relationship is formed between leader and the followers. The followers possess adequate skills and the leader need not provide much motivation or guidance. The leader shows the interest in idea or activities while listening to the followers. The fourth style is delegating in which the leaders focus on task and there is low relationship with the followers. The employees only need to be praised for performing job in the best way (Blanchard and Hersey, 1980).

As opined by House and Mitchell (1975), the four styles based on situation are Supportive, Participative, Directive and Achievement-oriented. Supportive approach establishes a friendly relationship with the employees as the leader increases confidence and self-esteem of the followers. In case of telling, the leaders need to guide the followers regarding their direction. In case of achievement- oriented leadership, there is high level of trust in the organization. The leaders and followers possess high level of trust for accomplishing tasks. Participative approach is considered as the best approach as the leader takes ideas from the followers for taking action.

Murray et al. (2006) states that the leadership effectiveness depends upon the situation and has two orientations- task oriented and people oriented leadership. Task-oriented leaders are the ones who are willing to complete the task at hand. The leaders like to be in control of the whole process. In the healthcare setting, the leadership orientation can be beneficial as there is clarity of purpose. The leadership style helps in organizing groups and ensuring that the individual roles are well understood (Wong, 2015). However, it excludes the scope of innovation and might leave the employees unsatisfied. In a healthcare setting, the staffs or nurses may need to respond to threats and opportunities as soon as they can. But with the risk involved it may be considered as breaking the rules. For example, it may be appropriate for surgery and post-operative recovery systems (Wong, Cummings, & Ducharme, 2013). People-oriented leaders believe that the best way to get a job is done through people. Such leaders believe in maintaining relations and focus on motivating people. In a healthcare setting, it is necessary to establish mutual trust, confidence and respect to accomplish objectives (O'Sullivan & McKimm, 2014). The clinical leaders must be motivated as there needs to be a balance between the needs of patients, nurses, physicians and other professionals. The orientation shall be beneficial in the hospital-setting as to take care of people, the staffs require care. For example, the nurses or administrative staffs that are involved in admitting or taking care of patients require high levels of compassion and sensitivity (Higgins et al., 2013).

Methodology       

Research Design

Qualitative research does not involve numbers or numerical data. It involves observations and semi-structured interview that help in exploring the perceptions of respondents. The approach is selected as it helps in describing the problem or conditions that people face at the hospital setting (Strauss & Corbin, 2014). The approach can be valid and reliable and largely depends on the skill of the researcher. The method is selected as it gives a self-conscious approach for nursing leadership. It ensures a unique perspective and is often a relatively deep insight into nursing leaders (Gerrish, Lacey, & Cormack, 2012).

The phenomenological design of qualitative research was adopted for this study because the researchers were in close contact with the participants. Their experience has been described as in relation with the phenomena that helps in understanding and interpreting people’s perceptions. The research approach is also helpful for the researcher to gather data rather than presenting information from secondary sources. The perception of the participants is well understood when the participants are asked questions by the researcher. The researchers also understand the perception of the researchers regarding the views related to leadership and its styles (Smith, 2003).

Data Collection Methods           

Both primary data and secondary data are used in the hospital setting so that the researcher has sufficient information about the clinical leadership The collected data shall answer the research questions for the study (Houser, 2013).

Primary Data Collection

A face-to-face interview was collected as the primary instrument for collecting data in the research study. The process of collecting data through face-to-face interview shall be considered a part of the phenomenological study. This method shall help the researcher in interpreting one’s own experience, perceptions, views and opinions regarding a particular topic. The reason for choosing this method is to create a direct interaction between the researcher and respondent. A set of questionnaire was prepared for conducting the interview. Open-ended questions were formulated with leadership and the leadership styles as its theme (Maltby, 2011). A set of questionnaire has been attached in the Appendix. The open ended questions provide an opportunity to the respondent for giving elaborate answers and describing their experiences deeply. Further, the researcher can add questions such as why, how, where and others to make the process flexible.

Firstly, a letter was sent to the manager of Aria Gardens seeking to conduct an interview. Further, after gaining approval, the researcher conducted an interview with the manager on 31^st July, 2016 at 3 p.m. The venue for the interview was the office of manager at Aria garden. Before beginning the interview, the manager was informed about the purpose of research study, aims and objectives and its rationale. After answering the queries of the manager related to the project, the interview process began. A total of eight questions were asked in the interview process. The questions were related to leader and their leadership styles. Participation in the study was voluntary, and all the responses were confidential. The entire interview process consumed approximately 30-45 minutes and separate notes were taken for each member. The following day, the group members or researchers met to discuss the interview.  The transcript was read several times because it helped in clarifying doubts, understand the perception better and finding correct information. The final findings were reported relating to the research.

Secondary Data Collection

Secondary Data is collected using qualitative techniques. The data is collected from reliable sources such as published journals, academic books, articles, and magazines. The method is chosen as the researcher need not rely solely upon the primary data collection as the cost of obtaining data could be expensive. Also, the researcher cannot be held responsible for quality of data (Maltby, 2011).

The reason for choosing the secondary research methodology is that the academic journals and articles help the researchers to widen the knowledge base, and grow as researchers regarding leadership. Reading journals and articles shall help in making comparisons between the past experience and current perceptions regarding leadership and their styles.

This research method is chosen so that the researcher can improve the knowledge in the most efficient and cost-effective manner. The process can also be conducted by the researchers from any place and at any time. For providing better research findings, there is a need for general improvement and knowledge base so that appropriate conclusions can be made. The situational leadership model was selected after reviewing the literature and studies.

Data Analysis      

Phenomenological Approach- For analyzing the data, the phenomenological approach was selected. Using this analysis method, the inner perceptions about life can be measured. The approach provides a systematic and logical link with the research findings. The theory is integrated into practice by documenting the final outcomes. Detailed observations were made by generalizations and ideas. The approach intends to derive at the conclusion using different experiences and findings. The main aim of the phenomenological approach is that it helps in clarifying the meaning of life and situations in comparison with previous studies and findings.

This method is used because the research as based on the qualitative approach. It is a suitable approach for data analysis in the project. The learners are likely to become more engaged using this process. The data was analyzed after selecting suitable phenomena in which the concepts and methods related to the research study are developed. The data was collected using primary and secondary data collection methods. The collected data was hen detailed and summarized. A link was established with the previous studies and theories. Finally, the findings were reported.

Results and Discussion

The researchers were able to determine the appropriate leadership style after conducting interview at Aria Gardens. The manager at Aria Garden was interviewed. The manager has been around at Aria Garden for quite some time and has been a part for over three years. It is interpreted that the manager is well acquainted with the system, procedures and the ways to manage employees. According to the manager, leadership is something that helps the employees in gaining positive results and leading to growth of an organization. There have been change in processes and systems in the previous years. About the willingness to accept change in the working environment, the manager said that the staffs are not willing to accept change in the environment. They offer resistance as the hospital setting cannot have much changes often as the staffs have a chain of conducting activities such as taking care of patients, giving them medicines and looking after their emotional well-being. It is important to keep the staffs happy because the patient’s well-being depends on it.

Further, the manager stated that training and development programs are conducted once in a year. However, they may also be trained and developed if any new process of practice takes place in the organization. The employees at Aria Gardens are enthusiastic and look forward to the training programs. They training programs helps in their personal as well as career development. It also helps in improving team cohesiveness as tasks are provided that involve team work. In this way, the conflicts among employees are also resolved.

The manager stated that he handles conflict by avoidance, compromise, obliging, dominating, and integrating. If the matter can be avoided and does not cause significant negative impact, he lets it go. Otherwise, he asks for the parties to compromise and acknowledges them for the same. When the matters may affect the vision and mission of the organization, the manager dominates and orders to follow the action regarding the situation. The manager believes in taking advice from the employees for decision making and achieving common goals. Therefore, it is interpreted that the manager follows situational leadership. The manager switches between autocratic and democratic leadership style depending upon the situation.

There is open communication in the organization among nurses, staffs, physiotherapists and the manager. The employees are not hesitant to bring up issues they face in the organization. There is upward and downward feedback in the organization that helps in maintaining effective relations with the employees. The causes of low productivity among employees could be the monotonous job. As healthcare units involve developing a personal and understanding relationship with the patients, it might be too hard on the care-takers to look after the employees well being. If they do not see progress among their patients, it may de-motivate them and with low confidence, the productivity is low.

The manager conducts rewards and recognition program once in six months through appraisals that help in motivating employees. The employees are assessed on the basis of their performance, customer feedback, behaviour and administration. They are motivated for their effective performance both verbally, and monetarily. In case of poor conduct, not very stringent actions are applied. The manager prefers to give opportunities to the employees for improvement in performance. However, if there is damage in patient’s health, disciplinary or termination actions are taken.

When not necessary, the opinion of the employees is not considered. When there is some specific work that needs to be done, the manager directs the employees using authoritative style thereby following S1 type of situational leadership model. The manager further stated that she involves the opinions of employees whenever it is required. When working towards a common goal, the manager believes in discussing the matter and listening to the views of the employees thereby supporting S2 type of situational leadership model. Further, the employees are provided with safe equipment and there is respect among the staffs. There is high support and low authoritative style thereby supporting S3 type of situational leadership model. Depending on the responsibilities, there are different committees divided such as infection control, health and safety and various others. Therefore, the S4 type of situational leadership model is supported.

Research Findings

After discussing the results, a few valid findings that have been interpreted from this research is that there are times when the manager uses autocratic leadership style. In this pattern, there is only one-way communication and the employees are not involved in the decision making process. This decreases the motivation as well as creativity among employees. Further, it was found that the manager also follows democratic style of leadership in which the views of employees are considered by the manager. There are times when the manager considers and ignores the views of employees depending upon the situation. There are times when the manager does not listen to its employees or supports them.

It was also found that the employees are guided and motivated with education and coaching. However, other motivational factors such as rewards, appreciation and appraisals are used less often. While delegating task to the subordinates, the manager is unable to focus on his own work. The manager has selected leaders in the organization so that they cna provide support and direct the employees in the healthcare unit. 

Conclusion        

Conclusively, there is a positive relationship between leadership behaviours and styles as it controls staffs and nurses thereby impacting patient well-being. Aria Gardens Home and Hospital is a primary healthcare organization located in Albany, Auckland. It is concluded that the effective leader must change his or her behaviour depending upon different situations. Effective leadership plays a critical role in the organization and to derive higher productivity, the employees must be guided and motivated for the same. Team work and team spirit are integral components in a healthcare system. There needs to be effective management since health is a priority for every individual. There needs to be increased enthusiasm for work and confidence. The organization can apply transformational and transactional leadership as strong leadership is crucial in any profession. There are intimate settings for personal care that require special attention on disabilities and the individual’s personal preferences.

Recommendations        

The results of the clinical leadership indicate that a few recommendations need to be made. The clinical and communication skills need to be enhanced for successfully motivating the staffs and nurses. It shall also help in change management skills, clinical decision making skills and guiding skills. The clinical leaders must add value to the services they need to avail for best patient and staff satisfaction. It is suggested in the study that the clinical leaders have good working relationship with their team members.

Since the staff members in a hospital setting have a particular way of working, it is recommended that the changes should be made less often. It is because hospital setting is crucial and the patient well-being is related with it. The nurses can be trained and developed so that they deliver standard services. With the delivery of standard services, there shall be greater patient satisfaction.

It is further recommended that transformational and transaction leadership style should be followed in Aria Gardens. According to the research, literature and data collected, it is interpreted that the staffs require a combination of both leadership styles. In emergency cases and poor performance, the staffs deserve to be punished as the likelihood of the patients depends on the nurse activities. There must be no compromise related with it. However, the staffs must also be rewarded for their efficient performance as it shall motivate them to take care of patients in a better manner. Both monetary and verbal motivation is necessary.

Strategic Plan   

Behavioural health services organizations often deal with change as a function of internal initiatives or in response to external demands. Leaders at different organizational levels often spearhead or manage such changes. With the implementation of transformational leadership style, the nurses and staffs in the clinical setting shall be able to communicate the issues to their leaders. The nurse leaders shall be able to address the needs and fulfil the gaps. The manager needs to analyse the potential among leaders, determine gaps and create individual development plans (Huber, 2014).

The strategic plan involves several steps to effective leadership. The staff members must learn from their mistakes. It is the responsibility of the leader to determine potential within their staff members. Also, through open communication and constructive feedback, the staff members can communicate their issues to the leaders. The leaders must listen effectively so that they can identify the gaps (Huber, 2014).

Based on the identified gaps, individualized development plan shall be created that would help the staffs in development. A successful leadership development program begins with the alignment of leadership development with company strategy and an understanding of the type of leadership style(s) needed to execute that strategy. The leaders must encourage the staff members often and possess a good attitude towards them (Aktas, Gelfand, & Hanges, 2015).

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