Concluding Insights

As a nurse for more than 30 years, I have spent the great majority of that time in a leadership position. I have learned many leadership lessons during this time, yet there is always more to know. Just as the world is continually changing, leadership methods must also adapt. Methods that worked well when I was a new nurse may now be obsolete as technology continues to advance and drive much of the day-to-day operations in our institution.

The past several weeks have been a great opportunity to think about what I know and what I have experienced over the years. It has also been a time of reflection, providing a context for some of those experiences and allowing me to see them with a different perspective. I have learned some new things, thought about some old things in a new way, and found areas that I am interested in learning about in more depth. Not a bad outcome! I will summarize some of my observations and insights here.

Systems Thinking

I have always appreciated the collaborative style of leadership in my unit. Our organization gives nurses many opportunities to contribute, reflected by the recent achievement of Magnet status for the fourth time! Over the past few weeks, I have learned these relational leadership methods are essential in the complex systems we face today. Technology forges ahead in all aspects of the workplace, and leaders cannot possibly be the sole source of knowledge. Strength comes from a team of employees working together, with each contributing his or her particular knowledge.

As hospitals and other healthcare institutions grow, they become increasingly complex with many departments, initiatives and priorities. Add in the ever-growing use of technology, specialization and an increasingly diverse workforce, and the need for leadership that can adapt quickly and smoothly is undeniable. Uhl-Bien (2012) explains the most effective approach to leading in complex systems is to respond with complex solutions. Rather than having one leader at the top who hands down the vision and organizes people to support it, the organization should establish leaders who gather information and ideas from employees throughout the organization, and utilize the talents of those employees to implement solutions in a more horizontal fashion. Understanding the difference between this new relational leadership style and the more traditional hierarchy will definitely have an impact on my approach as I more consistently apply the components of horizontal leadership.

One significant aspect of systems thinking is the idea that a small change can have a ripple effect that results in much larger impacts to the organization. An example from my own institution started with a simple product change. The manufacturer abruptly discontinued the brand of adhesive tape, which many departments had used for years. It would seem simple enough to switch to a new brand of tape, but the tape was used differently throughout the organization. Because patients moved frequently between units (i.e. med-surg to OR to ICU), using a variety of products was not a good solution. The nursery had concerns about tape allergies for their neonatal patients with sensitive skin. The med-surg RNs were adamant the new tape must be waterproof to prevent coming loose if it became wet from secretions or IV fluids. The ICU and OR were concerned with the adhesive properties and whether the new tape was sticky enough to hold the endotracheal tube securely in place. Each type of tape offered for consideration met some criteria, but not all. Before long, the entire organization was talking (and at times, arguing) about tape. It was somewhat unbelievable that so much commotion was occurring over such a minor product. Such are the ripple effects that can occur in a complex system.

An understanding of the inter-relatedness of everything should affect the way we operate. Decisions must be made with awareness of the potential, far-reaching impact. All stakeholders must be involved, and this especially includes the direct caregivers. The selection of team members for any project should be broad and inclusive, adjusting as needed as things progress. Nurses, doctors, therapists and anyone else providing patient care are in the best position to judge the effect of a process change. While they may not be the ones who make the final decision, the input they give should be carefully considered.

Self Reflection

The use of the blog format for learning lends itself to self-reflection. It has encouraged me to find examples from my own experiences and think about how they relate to the topics each week. Some experiences from years ago suddenly have a new meaning. I have found self–reflection to be valuable in several ways.

Understanding Motivation

Simon Sinek talked about learning our “why”. I have always known my personal motivation was to help others, but reflection helped me to delineate the idea even further. I specifically enjoy helping others grow and find their confidence, mentoring new employees into achieving a strong nursing career. Both of my current roles position me well to do this work, and defining it clearly will help shape my own goals and learning. Sinek also says caring for those you lead will inspire them to work towards the vision you set out for them. As I support people and help them see their capabilities, we build a trusting relationship, and as they feel more competent, they become more engaged. This knowledge lets me feel comfortable supporting nurses as I do, because it ultimately furthers the goals of the organization. Win and win!

Appreciating Differences

The personality test was fun (INTJ here!), and it pointed out areas of both strength and weakness. All personality types have both. It is good to know your own, but it is also important to understand others. Sometimes people may respond in a way that I find less desirable, but a moment of reflection may point to a personality factor at play. Understanding these variations helps me be more understanding and less irritated than I might have in the past.

As a Girl Scout leader, when one of the girls would fall and scrape her knee, I was not likely to run and give her a hug (which is exactly what my co-leader would do), but rather I would examine the injury and assess the need for first aid. The other leader may have thought I was heartless, while I usually thought she was too dramatic. In reality, she had strong empathy skills, and I have a very practical nature. Both commodities were necessary, and our girls benefited from the combined personalities of the two of us! Taking these types of differences into consideration when dealing with others will help me be slower to assume negative motivations.

I also gave considerable thought to the idea of conflict as the basis for innovation. I have seen much conflict over the years, and I have seen teams successfully resolve differences. The idea of conflict as desirable to inspire creativity is intriguing. Jeremy Gutsche says most innovation is the result of a simple idea that builds on many other ideas that came before it.

A leader in my organization told of a group that worked for several months on a project with no progress. A personality test given to the team demonstrated that all of the members were the same type. With this new information, several more people were added to the team, specifically selected for their different personality types. The team suddenly began making progress and soon successfully completed the project. If everyone thinks the same way, it is hard to come up with new and innovative ideas. A little conflict can make all the difference.

Learning from Errors

While the idea of learning from mistakes seems obvious, thinking and reading about this concept gave me some new insight. One idea I read was that the learning is not from the mistake, but from the reflection on it afterwards. A small but significant point! When I make an error, I often think about what happened and what I will do differently next time. I have coached nurses this way at times, but it has not been a routine practice to help them reflect. Sometimes it happens, other times it does not.

One less experienced nurse was admitting a trauma patient for the first time. After arriving from the ER, he was quickly given blood products and sent to the OR. It all happened very quickly, and it did not go smoothly. Once he was gone, the nurse and I talked about the experience and discussed what could have made it less chaotic. She had several ideas and I was able to make some suggestions as well. The few minutes we took to reflect helped us both learn from the experience. We would be better prepared the next time. After learning more about the benefits of self-reflection, I will definitely make this a routine part of my work with our nurses.

Reviewing a process and what could improve is beneficial for other aspects of work, not just errors. Reflecting after a presentation can make the next one more engaging, more concise, or more clear. Thinking about the results of a meeting could result in changing the agenda, adding additional people to the team, or starting a list of discussion points for the next meeting.

Our unit has debriefings after a significant event occurs. Although these happen inconsistently, I see them more and more frequently. The entire team takes a few minutes to review the event. The staff appreciates the chance to ask questions, hear positive feedback, and receive constructive suggestions in a non-threatening venue. These are great opportunities to learn and improve, and they also build team rapport.

In my own role as a QI coordinator, I think making a point of reflecting on each project on a regular basis would be beneficial. Reviewing what a group is working on, what follow-up needs to be done, whether the right people are included and what else they might need from me are all things to think about. I do this intermittently, but not routinely. Clearly, regular reflection is worthwhile!

Leaders Set the Tone

Porter – O’Grady and Malloch conclude that leadership is not a personality type or a specific set of traits, but it involves learned skills and can be accomplished by all personality types. The skill set, emotional competency, and vision of the leader determine the ability and success of the team. This concept is one I have seen in action, but I had not heard it explicitly stated before. Ken Blanchard expresses it simply (and humorously)!

As a CN, I know my attitude will influence everyone’s mood as we start the day. If I walk into shift report and announce we are short two nurses, the care assistants both called in, we have several surgery patients scheduled to come, and there are no patients transferring out, it sets everyone up for a bad day. Why would I want to do that to the nurses at the beginning of a 12-hour shift? Even if all of that were true, it would be so much better to say something like, “It is going to be a busy day, but we have a plan. Call me if you need help!”

Simon Sinek describes a leader’s role as caring for those she leads. I love this definition! If a leader can give the team what they need to succeed, the possibilities are limited only by the creativity of the team. I appreciated seeing this idea spelled out. All of these ideas are concepts we have explored:

• Hire (or select) a great team - embrace diversity, don’t be afraid of conflict. Choose people who know the content. Pick a few people who may resist the change. They can help fix the problems they will undoubtedly be pointing out!
• Give the direction or goal – The Elephant and the Rider example explains this idea in detail. The big take-away is to keep things simple and clear, and remove barriers. I took notes!
• Use emotional competency - meet the team where they are and model EQ behaviors. People are ALWAYS watching. If you have a positive attitude and model the changes, others will follow.
• Be vulnerable – admit what you don’t know, and be willing to learn from others. Though it seems counterintuitive, vulnerability builds trust, and trust is necessary for good leadership.

Colin Powell talks about the idea of trust and caring for your team in this short, but powerful video:

Keep Learning

As I reflect on the idea of complex systems and responding to change, I remember Jeremy Gutsche’s discussion of innovation. He likened people who prefer the status quo to farmers, and compared innovators to hunters. The idea of constantly looking for change may seem daunting, but especially as a QI coordinator, I know there are always things to improve. Moreover, if I am honest with myself, I am more engaged when I am working on a new project than when things seem to be on auto-pilot. This particular talk has encouraged me to strive for a hunter mindset.

I have loved watching all of the leadership videos and reading about the experiences of others in their leadership journeys. I have saved much of the content for future reference after our class has ended. Every new thing I learn is one more thing in my toolbox. Old tools can be repurposed to solve new problems, so nothing is ever wasted. Our roles as leaders is ongoing, but our leadership must be open to adapting to the constantly changing environment. We must learn continuously so that we, too, may be repurposed as needed.

P.S. ONE MORE THING: It is never too soon to start learning these skills. As a pediatric nurse, I leave you with a few thoughts from some young leaders…

References

4-H iGrow Video Resources (Director). (2014). The elephant and the rider [Video file]. Retrieved from https://www.youtube.com/watch?v=-XYxudAQk5w

Forum Corps (Director). (1990). Kids on leadership [Video file]. Retrieved from https://www.youtube.com/watch?v=UQfrcOX5tW4

Heath, C., & Heath, D. (2011). Switch: How to change things when change Is hard. S.l.: Random House US.

Porter-O'Grady, T., & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Raffo, D. (2012). Blogging as a reflective tool for leadership development: An exploratory study of a leadership practicum grounded in the relational leadership model. Delta Pi Epsilon Journal, LIV(2).

TED (Director). (2009). Simon Sinek: How great leaders inspire action [Video file]. Retrieved from http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en

The Ken Blanchard Companies (Director). (2011). Ken Blanchard - It's always the leader[Video file]. Retrieved from https://www.youtube.com/watch?v=dS0cpKj1bLY

Trendhunter (Director). (2017). Disruptive innovation keynote speaker Jeremy Gutsche on trends & change [Video file]. Retrieved from https://www.youtube.com/watch?v=J7B9xvzawmY

Uhl-Bien, M. (2012). Complexity leadership in healthcare organizations [PowerPoint]. Retrieved from Http://c.ymcdn.com/sites/www.plexusinstitute.org/resource/resmgr/files/complexity_leadership_plexus.pdf.

YouTube (Director). (2011). The essence of leadership [Video file]. Retrieved from https://www.youtube.com/watch?v=ocSw1m30UBI