Nursing Leadership of Healthcare

Introduction

Leadership is an acquired competency; a social phenomenon evolved from the interaction of the qualities of a person and the environmental factors that create change. It displays the potential and motivation to take up challenges, and influences the behavior of others through ideas and deeds (Manning & Curtis, 2012). Nursing leadership, therefore, needs skill and drive, in addition to ideas and deeds, to improve quality health care and patient safety in clinical practice. The nursing leadership styles in vogue are capable of promoting patient safety with the support of individual care approaches and evidence-based practices (Joseph & Hube, 2015). This essay attempts to unravel the significance of the leadership styles that augment patient safety by reducing medical errors in hospital inpatient settings.

Patient safety

Patient safety determines the effectiveness of quality health care. It can be defined as “prevention of medical errors and avoidable adverse events, protection of patients from harm or injury and collaborative efforts by individual healthcare providers and a strong, well-integrated healthcare system” (Kim, Lyder, McNeese-Smith, Leach & Needleman, 2015). That means patient safety practice is a course of action that reduces the chances of adverse events caused by exposure to health care.

Patient safety culture influences patient safety

Patient safety is pivotal in quality health care, and prevents patients from mortality and morbidity.  It reflects the quality of performance (Nygren et al., 2013), and is influenced by patient safety culture that is derived from shared assumptions, values and practices of the care givers (Danielsson et al., 2014). Thus, patient safety culture becomes the sum total of the organizational structure, organizational priorities, working processes, and the team interaction; all aiming at the overall patient safety. For this, a health organization must uphold hierarchical leadership, patient safety awareness, information network, and team unity (Ulrich & Kear, 2014).

Need for leadership in tackling adverse events in patient safety

The main issues in patient safety are the workload, surveillance, and care coordination of the nurses.  Though patient safety is fixed on all health care professionals, most of the adverse events are reported only by nurses, resulting in their recrimination. The attitude of the management in cornering nurses for their diligent alertness will only jeopardize the directives of the International Council of Nurses.  Any non-adherence to its stipulations can deteriorate the nurse-patient relationship, thereby thwarting patient safety (Kirwan, Mathews & Scott, 2013).

Patient culture is inherent in patient safety, and is a concord of behavior change, teamwork, and leadership.  The strategies that develop a patient safety culture are multifaceted, including system-level changes at the organizational level and workplaces. The team training imparted should be conducive to learning, communication, improvement, teamwork, cooperation, and leadership.  It enhances knowledge, skills, and change in attitude (Weaver  et al., 2013).  

Strategic selection of effective leadership

An effective nurse leadership should benefit all health care stakeholders, and support all functional groups.  It must motivate them to identify its existence in nurses, always influencing and guiding them (Negussie & Demissie, 2013). So, it is necessary to adopt a leadership style that promotes patient safety (Weselby, 2014) and team unity, as well as a shared goal. It is true that most of the leadership theories were developed for various business settings other than health care.  This problem can be solved by selecting a leadership style that can address at least patient safety and organizational goal (Al-Sawai, 2013).

Leadership styles

Healthcare is a complex system of several functional groups, specialties, disciplines, staff, and aims (Al-Sawai, 2013). It necessitates the adoption of a leadership style that promotes and produces optimal health outcomes in patient safety and system integrity.  In order to achieve these, three leadership styles are promulgated, namely Autocratic, Democratic, and Laissez-faire (Bhatti et al., 2012).

Transactional leadership

The transactional leadership is autocratic in nature and is task oriented.  It disallows the team’s shared values, and focuses mainly on group performance, as well as controlling others to meet emergencies. Autocratic leaders are close-minded, and comply with obedience, loyalty, discipline and rules. They reward the followers, compel the subordinates to work well, and transform their dislikes into appreciation by bringing positive results (Giltinane, 2013).

How a transactional leader promotes patient safety in medical errors

Efficient transactional leaders rise to the occasion and act in advance against adverse events.  They adhere to good practice-standards, communication, evidence-based practices, and emergency tactics. A recent analysis proved that they provided improvements and diagnosed using skills (Marquis & Huston, 2014). The transactional leader’s ability to reduce medical errors through communication was affirmed when the National Patient Safety goals were revised in 2011.  This proved that transactional leadership could reduce medical errors through effective communication (Hunter, 2014).

Transformational leadership

The transformational leaders are democratic, great visionaries and decision makers.  Their charismatic approach inspires and motivates others to teamwork for reaching common aims.  They empower others to excel by extending job satisfaction, giving opportunities, supporting skill development, and including them in decision making processes. However, the participation delay in this sort of leadership may slow down any achievement progress (Al-Sawai, 2013).

How a transformational leader promotes patient safety in medical errors

The transformational leaders inspire their staff for greater performance, and include them in decision making to reduce medical errors. A recent survey among 1579 nurses proved that transformational leaderships showed positive outcomes in safety dimensions, including management support, socialization, patient safety, and pharmacist help.  The survey analyzed 466 responses, and established that transformational leaderships could improve medication delivery, thereby reducing medication errors. The result indicates that transformational leadership is more efficient than the other leaderships in lowering medical errors (Merrill, 2015).

Laissez-faire leadership

The laissez-faire leaderships adopt a non-involvement policy and give complete freedom to their subordinates.  The authority of working, problem solving, and decision making is left to the employees completely.  This leadership is effective only if the staff is motivated, educated and skilled.  It is ineffective when the members fail to devote their time, energy, and skill in their work to achieve the desired goal (Amanchukwu, Stanley & Ololube, 2015).

How a laissez-faire leader promotes patient safety in medical errors

The recent study conducted by Merrill (2015) to determine the level of patient safety of each leadership style has indicated that the laissez-faire leadership style could not contribute much to patient safety, and that its socialized ICU setting would generate only negative safety result. The responses of the nurses confirmed positive outcomes of system effectiveness, satisfaction level, and patient safety only in transformational and transactional styles, and not in laissez-faire style.  The study proved that the laissez faire leadership was not effective in imparting system management and patient safety improvement (Merrill, 2015).

Conclusion

To conclude, it is established that the health care organizations require some sort of organizational environment, where patient safety and quality health care are of prime concern.  Since patient safety culture is inherent in patient safety, the organizational setting needs to inculcate the desired patient safety culture to promote patient safety. This could be satiated only through adopting relevant leadership style. The selection of a leadership style should be made according to its adaptability in addressing the problems of improvement of patient safety, while lessening the occurrences of medical errors.  In clinical practice, the development of organizational climate shows the level of leadership outcomes that could augment the competence of the nursing professionals.  On analyzing the different leadership styles, it was found that the most functional one is the transformational leadership.  However, one or multiple leadership styles could be employed to achieve the desired goals of the health care organization.

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