The Nature of Leadership and Organizational Culture
According to Al-Sawai (2013), the leadership theory is an evolving aspect. It is indeed true that the nature of leadership influences the organizational culture within an institution. Organizational culture are the values and belief that an organization clings on to that influence the behavior and attitude of the staff members (Tsai, 2011). To ensure that the organization’s mission is accomplished administrators or rather leaders have to modify their leadership behavior. By so doing, the employees’ satisfaction towards the job is promoted and that consequently affects the job running positively. A good leadership-employee interaction/ relationship means better team work and collaboration thus better and more efficient accomplishment of the organizational goals (Tsai, 2011).
In health, the innocuous running of all medical practices depend on the nature of the health administrators. The modernization agenda and NHS all highlight the importance of the significance of effective leadership (Barr & Dowding, 2015).
A great leader is that one who aspires, inspires and consequently accomplish more as compared to a good leader who just get things done (Posner & Kouzes, 2017). I conform to this assertion and accept that a leader should acquire comprehensive insight into the leadership’s critical role in organizational health, motivate and inspire, enforce team work, adapt to the rapid change in the business sector, manage risks and even influence the electronic global village to achieve more (Posner & Kouzes, 2017).
Leadership in health requires charisma, team building skills, and authoritativeness. These are enforced by the perspectives of leadership which I find them defined by Hartley and Benington, (2010) as a leader’s personal abilities and the positions taken by the leaders in organizations in congruence with the social practices that bring about mutual collaboration.
In this study, I will look into some leadership theories in health and the crucial position taken by leaders in healthcare sectors in the matters to do with individual, healthcare teams and the health service delivery. I will draw evidence from published texts as well as personal experiences in the development of a clear cut discussion on how and why leadership informs the organizational culture in a health care facility, drawing multiple examples to illustrate the validity of this hypothesis.
According to the Trait Theory, leaders are born and not made, meaning that it is difficult to acquire the best leadership skills by learning (Ray, 2013). There is a substantive relationship between personality and leadership and this has proved to me in one of my clinical experiences. In a certain institution I worked as an operation nurse, the lead clinician was not a natural leader. This is despite the fact that he had a PhD level educational accolade. He was hesitant and sometimes would panic during operations shaking hands and being unable to make sound and quick decision. Most of the time his juniors took his role in making very important decision. A natural inborn leader is not hesitant. He is naturally swift in critical thinking in evaluation of unexpected situations.
According to Al-Sawai (2013) and Barr and Dowding (2015), good leadership ensures that there is efficient use of the organization’s resources when designing a management plan. This is in line with the transactional theory that state a leader is that person who values order and structure in the management of large organizations. The leader of the Royal Melbourne Hospital in Victoria is an example of a transactional leader that has enabled it to maintain ist position as one of the best public hospitals in Australia. In my interaction with one of the staff members, she told me that the leaders in the institution value rules and from that they lead in a very organized manner. The leaders in the health facility also take so much interest in maintaining a good leader- employee relationship, whereby there is empowerment, inspiration, as well as influence. It is interesting to learn that leaders of various departments in Royal Melbourne Hospital are not dictators; they seek to influence rather than direct. As the team leader, I should not be a dictator, but should also listen to the opinions of the rest of the members to ensure that the concept to shared leadership is well put into practice, and at the same time inspire them to reach that common goal (Stone et al., 2017)
Leadership in Healthcare
The present day leadership theory which emphasizes on high quality systems of healthcare proves efficiency as well as safety (Jie-Hui Xu, 2018). Most of the Leadership theories I find in clinical practice vary and it is the duty of the leaders to identify the most suitable ones to adopt; that one that is relevant to the particular context. Good leadership also entails improving the relationships with colleagues (Jie-Hui Xu, 2018)
One way by which leadership influences the organizational culture in health is by embracing diversity (Lee, Kun Lee, Seo & Choi, 2015). The leadership team should acknowledge the individual difference amongst providers in the healthcare sector. As a leader I should ensure that all people feel a sense of inclusion in the day to day health care practice. Promoting workforce diversity ensures that there is improved employee morale, improved corporate culture, acquirement of better skills, retention of the available staff, better and effective employee recruitment, increased employee productivity and problem solving, better innovative ideas, decreased conflicts among colleagues, and generally better care for the diverse consumer population among others (Valantine & Collins, 2015).
In line with situational theories, a good leader is that one who is so keen in changing the style of leadership with changing circumstances (depending on changing situations) (Martin, Breunig, Wagstaff, & Goldenberg, 2017). The diverse external circumstances could affect the organization negatively in absence of a flexible leader. Paul Hersey and Ken Blanchard’s Situational Leadership Theory requires that leadership match two key elements which are the style of leadership and the maturity and alertness of the followers (employees/ subjects).
As a leader, I should follow four approaches in line with the situational theory: authoritative, persuasive, democratic and delegating approaches (Barrett, 2012). My friend who works as a nurse in a Hospital in Victoria complains about the leadership style within the institution. She narrates that the leadership system is autocratic with no power vested to nurses in taking decision making responsibility. She narrates of a certain experience when a patient died because she feared intervening without the management’s permission. The leadership in the institution is does not follow the situational theory of Paul Hersey and Ken Blanchard, whereby the nurse can make certain decisions without necessarily consulting the management.
The emergency department requires approaches of the situational theory in many ways. The role of a leader in Emergency Department is a very sensitive responsibility that requires a swift and flexible mind in handling the often unexpected fatal scenarios. It is prospected, according to Kayden, Anderson, Freitas and Platz, (2014), that ED’s have managers and lacks in true leadership. I prefer a leader who is knowledgeable in handling continuous change, dealing with the consumer’s wishes, shortage of resources like beds during winter (from overcrowding), among other specific requirements for the patient’s side. Winters are often associated with chronic cardiorespiratory disorders with urgent rise in the demand for care sometimes above than the capacity manageable by the available clinicians (Penner, 2013). A leader can develop more convenient consultation and admission systems, introducing triage systems (Iacobucci, 2017), and more flexible protocols for diagnoses. In one of experiences in the Emergency department during winter, I was subjected to a very harsh working environment with overcrowding and reduced beds. Leaders in the institution were poor in making swift ambulance diversion, seeking interdisciplinary or inter-institutional help in dealing with shortage of beds. That led to prolonged stay in the departments and it took quite some time before the situation was controlled.
Leadership Theories in Health and Their Importance
Organizational culture only comes when the leadership understand the significance of variables that relate to employees (Tsai, 2011). These variables include job satisfaction, performance and organizational dedication. The leadership model I have used and witnessed its use in the past was a two dimensional one that is focused on people and productivity. However I find the present leadership also concerned about the behavior surrounding the organizational change and development.
From a nursing managerial point of view, administrative management is the key course of action in the influence of employee behavior and achievement of the organizational perspectives (Tsai, 2011). As a leader, I should develop strong unity among colleagues within my organization, strong values, and beliefs, indirectly develops a strong organizational culture (Parris, & Peachey, 2013). It is my role of a leader in ensuring that the strong culture developed is also maintained. This will ensure that the staff has developed a consistent behavior between themselves, thus reducing chances of collisions in duty as the working environment is optimally conducive.
According to Stone et al. (2017), effective communication should be a key leadership goal. With poor communication between a team that is conducting an operation, the probability of errors is very high and also poor outcomes from the operations. I have witnessed many operation fail in my clinical experience because of poor collaboration and miscommunication because the leader could not take the role of leading communications. TQM is a distinct framework of steps like evaluation of performance and projection of unanticipated variations. I should also lead in TQM practices like nonstop improvement, collaborations, flexibility, and evidence-guided decision making. In an operating theatre for example, a lead surgeon is very necessary. The operation theatres greatly depend on good conflict management, team work and interdisciplinary working (Catchpole, Mishra, Handa & McCulloch, 2008). It is also my concern as a leader to minimize the occurrence of errors in operations.
Quality as a journey and a clinically individual safe care is supposed to be continually made better through increased participations, proper structures and well thought out procedures, which are all roles of a leader (Gottwald & Lansdown, 2014). That requires a diligent leader who can design improvement on the existing services and organizational culture (McLaughlin & Kaluzny, 2006).
In Continuous Quality Improvement, leaders should be tactical enough to the develop incentive policies for incentive and involvement in the improvement procedures. It also requires that I as the leader to introduce a distinct education program for the staff including recruiting extra subordinate staff (McLaughlin & Kaluzny, 2006).
The transformational theory emphasizes on transformational factors such as being considerate, stimulating the intellectual abilities and motivating the employees (charisma) (Christison, & Murray, 2012). This means as a leaders I should empower my employees so they can work without fear of reprimand. The leader in a healthcare team is the motivation to the other colleagues and providence of a suitable environment to enhance care. I have experienced a positive transformational leadership experience in my attachment in a health related non-governmental institution two years ago. Leaders in this organization believed in employee empowerment and support. As a result there was a free leaders-employee interaction making the working environment very convenient. That had a boost on the employee’s satisfaction.
Trait Theory and Leadership
On the relationship between organizational culture and job satisfaction, a leadership developed organizational culture brings about collective values and codes of conduct for the individuals and teams that indirectly lead to the mission accomplishment within the organization (Tsai, 2011). Most of the decisions that regard patient care are never made by an individual but teams. The position I take as a leader in such a situation is to encourage and convince the team to work towards the common goal. Should conflict also arise from this situation, I take the sole responsibility of solving it (Bala et al., 2015). In one of my clinical experiences when working in a certain medical institution’s emergency department during winter, there was extreme overcrowding. That being the case, there was serious staff shortage and prolonged stays in the hospital. The management was not competent enough to handle the sudden foreseeable but unexpected change. The ambulance diversion was very poor and some clinicians still took long durations in consultations. The consequences of the incompetence in leadership was that there was unavoidable deaths that occurred and so many nosocomial infections contracted.
Apart from quality care, there is the concept of patient’s safety that is my role as the lead personnel in the nursing and medical fields of practice. According to Singer and Vogus (2013), reduction of errors involves an active involvement of patients, health providers (teams) and the organizations themselves. I should therefore adopt a safe leadership policy that also learns from errors as much as it tries to prevent them. There is no organizational goal that does not have the patient safety as one of its components, directly or indirectly. As the leader I should always aim at ensuring that the staff is well acquainted with safety practices during diagnoses. In my nursing experience in a theatre at another institution, the lead surgeon helped me in performing a safety practice of using sterile barriers while putting a central intravenous catheter to a patient. I had the theoretical knowledge about the same and by the couching of the leader I was able to perform the exercise myself and that way the patient did not report to have any post operation infection.
My role also as a leader is being chief risk manager in all health related activities (Posner & Kouzes, 2017). What a leader does in managing risk is basically ensuring that there is safe and quality care performed to the patients and the staff. One risk management practice I would do is ensuring that there is safety in healthcare by making sure the practitioners do not acquire infections or injuries in their duty of care (Vincent & Amalberti, 2016). By improving the working conditions in healthcare environments, I minimize the risk of suffering more harm for both consumers and provider. I should also facilitate structural and communicative studies of safety in order to transform the workplace environment as purely risk free (Institute of Medicine, Board on Health Care Services, Committee on the Work Environment for Nurses and Patient Safety, 2004).
Efficient Use of Resources through Good Leadership
I was part of nurse recruitment program 2 years ago, and I witnessed a recruitment exercise characterized with corruption and poor engagement of the leaders in supervisory roles. The recruits found their way into the organization but most of them were dismissed in less than three months because of incompetence. Furthermore, the output of the facility regarding quality and safe care was decreasing at an alarming rate. Recruitment of new staff members requires high skills in choosing the right and competent members to fill in positions left by sometimes very experienced clinicians (Poikkeus, Leino?Kilpi, & Katajisto, 2014). Corruption is one aspects that I should consider in ethical leadership. (Poikkeus, et al., 2014). Allowing people into an organization without following the organizational framework for the same has negative outcomes especially when the selected fellows are incompetent for the positions. That is one of the factors that can pull my organization behind. Therefore, a good leader considers aspects of moral leadership (Poikkeus, et al., 2014; Valentim, 2016).
In conclusion, workplace culture requires good leaders to introduce and maintain it. Leadership is essential in the proper running of health care practices like operations, recruitment and handling of emergency among others. Leadership is a like an influence tool that brings about unity, conflict resolution, collaboration and consequently good decision making. And since it is a changing aspect, leadership requires flexibility. Good leaders listen, and not just commanding. Leadership entails team work and shared decision making from open discussions free from fear of reprimand or misjudgment.
References
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