This document summarizes Jerry Mulondo's master's thesis which explored leadership approaches associated with positive change in healthcare. The thesis used narrative analysis of interviews with 19 physician leaders in Sweden. Five major themes were identified: an evidence-informed and problem-focused approach; driving goals from the front; leaders as facilitators; vision guiding leadership; and principles guiding leadership. These themes were linked to leadership theories. The study found that leadership development programs should draw from various leadership theories and develop capabilities for data-informed change processes. Further research is needed on physician leadership and the factors affecting leadership style choices in different healthcare settings.
A document prepared by Dr. Mustafa Salih, the former director of the Directorate General of Health Policy, planning and research at the Federal ministry of Health in Sudan.
Munro, S., Lewin, S., Swart, T., & Volmink, J. (2007). A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health, 7, 104-120.
A document prepared by Dr. Mustafa Salih, the former director of the Directorate General of Health Policy, planning and research at the Federal ministry of Health in Sudan.
Munro, S., Lewin, S., Swart, T., & Volmink, J. (2007). A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health, 7, 104-120.
Let's Talk Research 2015 - Michael Harrison Blount - An Action Research appro...NHSNWRD
An Action Research approach to facilitating the integration of best practice in the Assessment and Management of Diabetes Related Lower Limb Problems in India.
Michael Harrison-Blount MSc. BSc (Hons). MChS. MFPM RCPS (Glasg). CSci
Lecturer in Podiatry
School of Health SciencesUniversity of Salford
t: +44 0161 2953516
email; m.j.harrison-blount@salford.ac.uk | www.salford.ac.uk
To achieve the goal of Health Equity we need changes principles and values in healthcare and healthcare education, changes in systems for health and the use of patient driven data (Big Data) in order to develop a learning healthcare system.
The Effectiveness of Energy Conservation Techniques in Reducing Fatigue in C...Crimson-Arthritis
The Effectiveness of Energy ConservationTechniques in Reducing Fatigue in Clients with Multiple Sclerosis by Sarsak HI* in Researches in Arthritis & Bone Study Crimson Publishers: Journal of Bone Disease
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
Health workers competency is very critical in realization of quality health care which is a major pillar of Universal Health Coverage. This study assessed the influence of healthcare provider competency on Universal Health Coverage utilization in Seme Sub County, Kisumu County. The study targeted community households and health facility managers. The health facilities were stratified according to their tiers and randomly sampled. The catchment population was stratified by locations and a proportionate sampling technique applied in each stratum giving a computed sample of 377 participants. The descriptive statistics were summarized using tables and charts, while logistic regression was used to determine relationship between variables. The results revealed that quite a number of health service providers are not competent enough in their departments of operation and there is no periodic training on new guidelines. This study further revealed a statistical effect on competency of health service provider on UHC (OR=2.29, 95%CI=1.02-5.15, p<0.05). Healthcare service provider competency levels have direct significant influence on utilization of UHC services by community members.
Diabetic Care
Lanetra Evans-Shelton
Walden University
Nursing 6052- Dr. Smith
Essentials of Evidence-Based Practice
Diabetic Care
Introduction
The organization I am affiliated with is a correctional facility. It houses over 300 detainees with some being newly diagnosed diabetics. The officers need training because the facility doesn’t have 24-hour nursing and they are responsible for letting the detainees check their blood sugar levels at night and providing snacks. There is increasing interest in quality improvement strategies to improve diabetic management.
The purpose is to provide ongoing preventive care through new activities which will allow us to identify and interfere in the advancement of diabetes while in jail.
The current problem is over half the time the nurses are unaware of the people who have diabetes unless they puts in a medical request which sometimes takes days. The jail has an intake process of getting booked into jail but does not have a medical intake process. And that’s a big change that needs to happen. The stakeholders who needs to be part of the design and implementation for it to make a difference are the quorum courts, the Sherriff, and the Jail’s Chief Administrator. The risk associated with the change is jail administration have no standard strategies to follow when implementing something new..
Proposal
Patients with a diagnosis of diabetes should have a complete medical history and physical examination by a licensed health care team member in a timely manner. Goals should be individualized depending on the situation. This should be documented in the patient's record and communicated to all persons involved in his/her care, including security staff.
The necessity of the change must be acknowledged and acceptable. Staff must be trained for the new procedures. A training curriculum must explain the role, its technical procedures, its strengths and weaknesses, legal requirements, and professional relationship standards. The success of this project prompts conversation with the major, chief and the sheriff. With the organizational adaption and staff involvement the implementation of the change should be successful (Melnyk & Fineout-Overholt, 2018).
People with diabetes should obtain care that meets national standards. Being incarcerated does not change these standards. Patients must have right to medication and nutrition needs to manage their disease. In patients who do not meet treatment goals, medical and behavioral plans should be adjusted by health care providers in collaboration with the prison staff (Worswick, Wayne, Bennett, Fiander, Mayhew, Weir, & Grimshaw, 2013).
It is critical for correctional facilities to identify patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or recurrent DKA (ADA, 2011).
Outcomes
Critical Appraisal Summary
Diet and physical activity ...
Characteristics of successful changes in health care organizations: an interv...BenDarling7
Health care organizations are constantly changing as a result of technological advancements, ageing
populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and
policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable
environment. The present study poses the question: what characterizes successful organizational changes in health
care? The aim was to investigate the characteristics of changes of relevance for the work of health care
professionals that they deemed successful
Let's Talk Research 2015 - Michael Harrison Blount - An Action Research appro...NHSNWRD
An Action Research approach to facilitating the integration of best practice in the Assessment and Management of Diabetes Related Lower Limb Problems in India.
Michael Harrison-Blount MSc. BSc (Hons). MChS. MFPM RCPS (Glasg). CSci
Lecturer in Podiatry
School of Health SciencesUniversity of Salford
t: +44 0161 2953516
email; m.j.harrison-blount@salford.ac.uk | www.salford.ac.uk
To achieve the goal of Health Equity we need changes principles and values in healthcare and healthcare education, changes in systems for health and the use of patient driven data (Big Data) in order to develop a learning healthcare system.
The Effectiveness of Energy Conservation Techniques in Reducing Fatigue in C...Crimson-Arthritis
The Effectiveness of Energy ConservationTechniques in Reducing Fatigue in Clients with Multiple Sclerosis by Sarsak HI* in Researches in Arthritis & Bone Study Crimson Publishers: Journal of Bone Disease
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
Health workers competency is very critical in realization of quality health care which is a major pillar of Universal Health Coverage. This study assessed the influence of healthcare provider competency on Universal Health Coverage utilization in Seme Sub County, Kisumu County. The study targeted community households and health facility managers. The health facilities were stratified according to their tiers and randomly sampled. The catchment population was stratified by locations and a proportionate sampling technique applied in each stratum giving a computed sample of 377 participants. The descriptive statistics were summarized using tables and charts, while logistic regression was used to determine relationship between variables. The results revealed that quite a number of health service providers are not competent enough in their departments of operation and there is no periodic training on new guidelines. This study further revealed a statistical effect on competency of health service provider on UHC (OR=2.29, 95%CI=1.02-5.15, p<0.05). Healthcare service provider competency levels have direct significant influence on utilization of UHC services by community members.
Diabetic Care
Lanetra Evans-Shelton
Walden University
Nursing 6052- Dr. Smith
Essentials of Evidence-Based Practice
Diabetic Care
Introduction
The organization I am affiliated with is a correctional facility. It houses over 300 detainees with some being newly diagnosed diabetics. The officers need training because the facility doesn’t have 24-hour nursing and they are responsible for letting the detainees check their blood sugar levels at night and providing snacks. There is increasing interest in quality improvement strategies to improve diabetic management.
The purpose is to provide ongoing preventive care through new activities which will allow us to identify and interfere in the advancement of diabetes while in jail.
The current problem is over half the time the nurses are unaware of the people who have diabetes unless they puts in a medical request which sometimes takes days. The jail has an intake process of getting booked into jail but does not have a medical intake process. And that’s a big change that needs to happen. The stakeholders who needs to be part of the design and implementation for it to make a difference are the quorum courts, the Sherriff, and the Jail’s Chief Administrator. The risk associated with the change is jail administration have no standard strategies to follow when implementing something new..
Proposal
Patients with a diagnosis of diabetes should have a complete medical history and physical examination by a licensed health care team member in a timely manner. Goals should be individualized depending on the situation. This should be documented in the patient's record and communicated to all persons involved in his/her care, including security staff.
The necessity of the change must be acknowledged and acceptable. Staff must be trained for the new procedures. A training curriculum must explain the role, its technical procedures, its strengths and weaknesses, legal requirements, and professional relationship standards. The success of this project prompts conversation with the major, chief and the sheriff. With the organizational adaption and staff involvement the implementation of the change should be successful (Melnyk & Fineout-Overholt, 2018).
People with diabetes should obtain care that meets national standards. Being incarcerated does not change these standards. Patients must have right to medication and nutrition needs to manage their disease. In patients who do not meet treatment goals, medical and behavioral plans should be adjusted by health care providers in collaboration with the prison staff (Worswick, Wayne, Bennett, Fiander, Mayhew, Weir, & Grimshaw, 2013).
It is critical for correctional facilities to identify patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or recurrent DKA (ADA, 2011).
Outcomes
Critical Appraisal Summary
Diet and physical activity ...
Characteristics of successful changes in health care organizations: an interv...BenDarling7
Health care organizations are constantly changing as a result of technological advancements, ageing
populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and
policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable
environment. The present study poses the question: what characterizes successful organizational changes in health
care? The aim was to investigate the characteristics of changes of relevance for the work of health care
professionals that they deemed successful
Running head ANNOTATED BIBLIOGRAPHY 1 Annotated Bibliogra.docxjoellemurphey
Running head: ANNOTATED BIBLIOGRAPHY 1
Annotated Bibliography
u04a1
Student Name
BSN 4008 Organizational and Systems Management for Quality Outcomes
Capella University
Dr. Pape
Due date
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 2
Annotated Bibliography
We have seen that in a health-care organization there are multiple responsibilities
including assessments of priorities in areas that require attention in an organization. The
following annotated bibliography compiles a summary of the references that will be used
to prepare a final paper that will identify nursing leadership priorities at Fantastic
Medical Center (FMC) and proposed resources for addressing the priorities.
Previously identified nursing leadership priorities at FMC that will be the focus of
the literature review are (a) nursing staff turnover, (b) nursing staff competency, and (c)
medication errors of omission. Accordingly, the literature and available resources were
searched utilizing terms that included the above listed priorities and terms to reflect any
proposed resources for addressing the priorities in order to support strategies with
evidence-based references.
Additional references will include readings from the course that involve systems
leadership, organizational structure, and use of a systems-based approach for analysis of
organizational issues. These may include Lewin’s change theory, or the diffusion of
innovation theory. The synthesis of these references will help me build the foundation of
to address strategies that can be used within FMC, both as an analysis for the project.
American Nurses Association. (2010). Nursing: Scope and standards of practice. (2nd
ed.). Silver Spring, MD: Nursesbooks.org.
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 3
The American Nurses Association (ANA) provides standards and scope of
practice for professional nurses (p. 1) including the importance of ongoing
nursing education and the important role employers have in providing educational
opportunities for nurses (p. 28). The book further establishes important nursing
profession standards in regards to quality of patient care and nursing leadership
(p. 55) thus creating an important foundation upon which priorities and strategies
can be established.
American Nurses Credentialing Center. (2013a). Magnet designation for initial
applicants. Retrieved from http://www.nursecredentialing.org/magnet-initial-
designation.aspx
The American Nurses Credentialing Center (ANCC) is a component of the ANA
whose purpose is to provide certification and accreditation of individual nurses
and health care organizations who have met certain criteria that include
excellence in quality patient care and excellence in work environment (American
Nurses Credentialing Center [ANCC], 2013b). One such designation that signifies
excellence in care and practice is Magnet designation which among many
requirem ...
This white paper discusses physicians’ medical training and its relationship to effective leadership qualities, and demonstrates how the soft skills associated with emotional intelligence are essential in guiding physicians in the practice of leadership.
Running head SEARCHING AND CRITIQUING THE EVIDENCE1SEARCHING .docxtoltonkendal
Running head: SEARCHING AND CRITIQUING THE EVIDENCE 1
SEARCHING AND CRITIQUING THE EVIDENCE 4
Searching and Critiquing the Evidence
Student’s Name
Institution
Date
Searching and Critiquing the Evidence
There are various research studies that have been done on the outcome of self-care on Type 2 Diabetes Mellitus patients. In most of the studies, the most prevalent results are that self-care is an effective method of improving the health and lifestyle outcomes of Type 2 Diabetes patients. Krishna and Boren (2008) conducted a systematic review of evidence-based studies done between 1996 and 2007. The study analyzed 18 researches done within the selected time period and found that using phone calls and text messages to assist diabetes patients could improve the self-management outcomes. Shrivastava et al. (2013) analyzed the effectiveness of self-management for the diabetes mellitus patients. The study found that self-care helps to reduce the rate of morbidity and mortality among diabetes patients.
In addition, Steinsbekk et al. (2013) conducted a meta-analysis comparing the differences between the outcomes of group based self-management education and routine treatment for Type 2 diabetes patients. The study analyzed 21 studies that included studied on 2833 participants. The results of the meta-analysis showed that group-based self-management education helped to improve the psychosocial, clinical, and lifestyle outcomes among the diabetes patients. Lastly, Tang et al. (2008) examined the impact of social support and quality of life on the self-care behaviors of African American Type 2 diabetes patients. The study followed an observational design with 89 African-American adults, who were aged 40 and above. The study found that social support is vital for self-management to be effective in diabetes treatment.
The selected studies have helped to strengthen the merit of my selected theoretical framework. The theory selected for the study was Dorothea Orem’s Self Care Theory. These studies have helped to demonstrate some important evidence-based facts about the effectiveness of self-care for diabetes patients hence helping to prove the credibility of the theory. The scrutiny of these studies has helped to discover the degree of effectiveness of this theory and the best application methods that can make it an effective approach to improving the outcomes of patients with Type 2 Diabetes Mellitus.
Levels of Evidence in the Articles
The classification of the level of evidence of a given research is important in evidence-based studies because they help to show how accurate, credible, or reliable a research is (Gray, Grove & Sutherland, 2017). The most prevalent evidence in the research articles analyzed is Level II evidence. Level II evidence is one that is obtained from at least one randomized control trial (Moran, Burson & Conrad, 2017). The articles by Krishna and Boren (2008) and Steinsbekk et al. (2013) conducted meta-analyses of various rese ...
Running Head HEALTH NEEDS ASSESSMENT1HEALTH NEEDS ASSESSMEN.docxwlynn1
Running Head: HEALTH NEEDS ASSESSMENT 1
HEALTH NEEDS ASSESSMENT 7
Health Needs Assessment
Student’s Name:
Course Number:
Course Title:
Professor’s Name:
Date:
Health Needs Assessment
Health assessment can be defined as a care program which involves the identification of special needs of person or a group of people and the way those needs are addressed by health facilities or the entire health system. Health assessment also involves the evaluation of the health status of an individual(s) through the performance of a physical examination after recording their health history. Health assessments are different from diagnostic tests because the latter is carried out when a person is already exhibiting the signs and/or symptoms of a particular disease (Turnock, 2012).
Measure of Public Health
Measures used in assessing health are different and the first measure of public health is mortality. Mortality is the rate of deaths occurring in a particular population. It has been very common for the numbers and rates of death to be used in measuring public health. Globally, some diseases such as cancer, cardiovascular diseases, diabetes and hypertension among others have been observed to be the leading causes of death. In order for policies to be formulated mortalities which are specific on particular age groups are considered as they provide more awareness on health status of that age group. The same way, when mortality data is stratified on the basis of ethnicity or race, the health disparities available are quantified (Pennel, McLeroy, Burdine, Matarrita-Cascante & Wang, 2016).
Morbidity is the second measure that is used to measure public health. It can literally be said to mean the rate of incidence of a disease or illness in a specified group of individuals or a population. This rate of morbidity can be estimated through use of the rates of hospitalizations recorded among a group or a population. This kind of measure is easy and advantageous in that it is not difficult to get access to the rates of hospitalizations. Although they are of very good use when carrying out certain analyses, they can be biased indicators of the health status (Turnock, 2012). For example, in cases where there are increasing rates of outpatient treatment when handling conditions which require hospitalization can adversely and substantially affect the usefulness of the information or data recorded for assessing health status.
Measuring disability is another dimension of morbidity that looks into non-fatal health complications. Certain problems such as pain in joints and bones often a result of arthritis can be said to be main contributors of disability. Other chronic conditions such as lung problems, heart disease, stroke, diabetes etcetera are also known to be causers of disability. High rates of disability could be taken to mean that the general health status of the population is at risk diseases (Giger, 2016). Apart from the mentioned three, the other m.
Chapter 2Factors influencing the application and diffusion of .docxcravennichole326
Chapter 2
Factors influencing the application and diffusion of CQI in health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and preventative care) as well as across geographic and economic boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little improvement over the last decade despite best efforts of clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have been shown to facilitate or impede the implementation of CQI in health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications develop via continuous, ongoing learning and sharing among disciplines about ways to use CQI philosophies, processes and tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009) is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on a global scale
The Surgical Safety Checklist:
a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication rates from 11.0% at baseline to 7.0% plus, and a reduction in death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands, showed a statistically significant decrease in the proportion of patients with one or more complications, from 15.4% to 10.6% (de Vries et al. 2010).
So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical science or copy the “best known” practices reliably, quickly, and even gratefully into their daily work simply as a matter of course?
Limitations of Checklists
May be too simple a tool and what is required is more complex system solutions to quality and safety issues (Bosk et al. 2009).
Problems with checklists are indicative of broader CQI and quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balanc ...
RESEARCH ARTICLE Open AccessAn organizational perspective .docxronak56
RESEARCH ARTICLE Open Access
An organizational perspective on the long-
term sustainability of a nursing best
practice guidelines program: a case study
Andrea R. Fleiszer1*, Sonia E. Semenic1,2, Judith A. Ritchie1, Marie-Claire Richer1,2 and Jean-Louis Denis3
Abstract
Background: Many healthcare innovations are not sustained over the long term, wasting costly implementation
efforts and often desperately-needed initial improvements. Although there have been advances in knowledge
about innovation implementation, there has been considerably less attention focused on understanding what
happens following the early stages of change. Research is needed to determine how to improve the ‘staying
power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in
nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was
sustained over a long-term period in an acute healthcare centre.
Methods: We conducted a qualitative descriptive case study to examine the program’s sustainability at the nursing
department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada.
The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three
BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following
program initiation through 14 key informant interviews, document reviews, and observations. We developed a
framework for the sustainability of healthcare innovations to guide data collection and content analysis.
Results: Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization,
and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These
factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing
program sustainability and characteristics of program sustainability accounted for how the program had been
sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership
actions and both institutionalization and development; and a reflection-and-course-correction strategy and
development.
Conclusions: Study findings indicate that the successful initial implementation of an organizational program does not
automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of
committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders
should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or
program benefits. The development of an organizational program may be necessary for its long-term survival.
Keywords: Sustainability, Program, Organizational change, Innovation, Cl ...
Running head CAPSTONE PROJECT 1CAPSTONE PROJECT 3.docxsusanschei
Running head: CAPSTONE PROJECT 1
CAPSTONE PROJECT 3
Capstone Project Topic Selection: Improving Workflow for Nurses Working in Primary
Care Settings
Capstone Project Topic Selection and Approval
Problem or Issue
One of the major problems that affect nurses is improving workflow in a busy environment. When nurses are few and, healthcare professionals often face work overload. This has the potential to affect the quality of care given to patients in busy environments. When workload is high, efficiency reduces, thus making nurses vulnerable to errors (Cain & Haque, 2009). The healthcare sector has often faced a lot of demands to develop or reestablish its workflow. In many situations, the desire for evaluating workflow is the need to respond to new ways in which tasks are completed. There are various workflow issues that continue to face nurses in their working environments. They include challenges related to providing services to critically ill patients, and emergence of multidisciplinary teams in care. In such environments, all healthcare professionals struggle with the need to implement change that makes the care team more patient-centered.
Setting/ Context
The context under which this problem is common is primary care setting. Primary care settings are those that provide medical and psychological diagnosis and treatment. Primary healthcare settings are also involved in the provision of personal support for patients of all backgrounds, and in all stages of illness (Goroll & Mulley, 2012). In primary healthcare settings, nurses and other professionals are involved in the communication of information about prevention, diagnosis, treatment, and prognosis, as well as the prevention and care of chronic disease and disabilities through risk evaluation, health education, and early disease detection.
High-Level Detail of the Problem
Nurses operating in primary healthcare settings are often overburdened with many tasks that interfere with the workflow. This is particularly true when they are working in multidisciplinary teams that require coordination and cohesion. In such cases, it might be difficult to clearly determine each professional’s roles and responsibilities (Hickey & Kritek, 2011). At the same time, when the number of nurses is few, the available one’s face stress and physical strain that might interfere with the quality of care given to patients and increase likelihood of errors. In an environment where technological interventions do not sufficiently meet the objectives of healthcare groups, it might also cause workflow issues. Such alternative flows arouse worries since the non-formal mechanisms depend upon the health professionals’ memory and may overlook the safety systems that might be offered.
Impact of the Problem
Workflow issues often generate vinous negative impacts on both the nurses and the patients. For instance, poor coordination among healthcare professionals can result in errors that pose many harms to the pa ...
I need between 100-120 words for each assignment, and I want ind.docxflorriezhamphrey3065
I need between 100-120 words for each assignment, and I want individual references with each response. Please, no plagiarized work
Module 1
DQ 1
Outcome measures are significant in showing the worth of the Doctor of Nursing Practice's role in health care. Identify a practice-level outcome study or project and describe the expectation of its effect on health care. Which outcome measure do you think aligns with your DPI project (Quality Improvement Project)? Why? Provide examples and literature support.
DQ 2
In this week's readings, theories of accident causation, human error, foresight, resilience, and system migration were discussed. Identify a safety theory and propose quality measures to improve patient safety. Which theory or framework are you using to guide your DPI Project's intervention and outcome? Please define what constructs of your chosen DPI Project theory will help you change/improve clinical practice to improve a specific patient outcome? Provide examples and literature support.
Resources
Henneman, E. A. (2017). Recognizing the ordinary as extraordinary: Insight into the “way we work” to improve patient safety outcomes.
American Journal of Critical Care
,
26
(4), 272–277. doi:10.4037/ajcc2017812
Smith, S. A., Yount, N., & Sorra, J. (2017). Exploring relationships between hospital patient safety culture and Consumer Reports safety scores.
BMC Health Services Research
,
17,
1-9. doi:10.1186/s12913-017-2078-6
Module 2
DQ 1
Discuss economic methodology, including the concept of cost-based analysis. If you will not be addressing this in your DPI Project, provide an example of a program where it could be used to show outcomes. Provide examples and literature support.
DQ 2
Discuss a change theory and how it can be or has been applied in nursing practice to integrate care delivery sustainability. How will you use change theory in the design of your project to support the sustainability of your practice improvement intervention? Provide examples and literature support.
Resources
Uluskan, M., McCreery, J. K., & Rothenberg, L. (2018). Impact of quality management practices on change readiness due to new quality implementations.
International Journal of Lean Six Sigma
,
9
(3), 351-373. doi:10.1108/IJLSS-05-2017-0049
Steele Gray, C., Wilkinson, A., Alvaro, C., Wilkinson, K., & Harvey, M. (2015). Building resilience and organizational readiness during healthcare facility redevelopment transitions: Is it possible to thrive?
HERD: Health Environments Research & Design Journal
,
9
(1), 10-33. doi:10.1177/1937586715593552
Allen, B. (2016). Effective design, implementation and management of change in healthcare.
Nursing Standard
,
31
(3), 58. doi:10.7748/ns.2016.e10375
Module 3
DQ 1
New health care delivery models are being presented to accommodate the shift in health care objectives. Many of these models are community-based and focused on improving quality outcomes, population health, and reducing readmissions.
Leading change in healthcare- thesis_Mulondo_160601
1. Jerry Mulondo_Master’s thesis
1
Department of Learning, Informatics, Management and Ethics
Master’s program in Public Health, Health Economics, Policy and Management
Spring Semester 2016
Degree thesis, 30 Credits
Leading change in health care: A narrative study in Sweden
Author: Jerry Mulondo
Supervisors: Carl Savage, PhD, Medical Management Centre, Karolinska Institutet
Pamela Mazzocato, PhD, Medical Management Centre, Karolinska Institutet
Examiner: Andrea Eriksson, PhD, KTH Royal Institute of Technology
May 11 2016
2. Jerry Mulondo_Master’s thesis
2
Declaration
Where other people’s work has been used (either from a printed source, internet or any other
source) this has been carefully acknowledged and referenced in accordance with the
guidelines.
The thesis “Leading change in health care: A narrative study in Sweden” is my own
work.
Signature: _________________________
Date: 2016/05/11
3. Jerry Mulondo_Master’s thesis
3
Abstract
Background
Health systems are facing the double burden of meeting demands for care today, while
making the strategic and structural changes necessary to thrive in the future. Attempts to
address this challenge by developing physician leaders have had modest effects. In addition,
several leadership approaches have been proposed for health care, but with limited empirical
evidence.
Aim
The aim of this study was to explore the leadership approaches associated with positive
change in health care adopted by physician leaders.
Methods
This was a qualitative study using thematic narrative analysis of nineteen interviews with
physician leaders in health care settings from different parts of Sweden. The narratives of the
descriptions of leading change were extracted and analysed for themes. These themes were
then illustrated by developing new narratives.
Findings
Five major themes were identified from the narrative analysis, namely: Evidence-informed
and problem-focused approach, Driving goals from the front, Leaders are facilitators, Vision
guides leadership, and Principles guide leadership. These themes were then linked to
established theories of leadership identified from a literature review.
Conclusion
This study has empirically identified five leadership approaches used by physicians leaders to
implement successful change in health care. These findings suggest that leadership
development programs should draw from a variety of leadership theories to inform their
training curricula. In addition, capabilities for data-informed change processes should be
developed. The role of data and how to manage and use it to inform leadership in health care
also needs more exploration.
Further research is necessary on physician leadership in health care to determine the factors
affecting the choice of leadership style and how it varies among different health care settings.
Keywords: physician leadership, change management, healthcare, narrative analysis
4. Jerry Mulondo_Master’s thesis
4
Table of Contents
Abstract .................................................................................................................................................. 3
Background ............................................................................................................................................ 5
Perspectives on leadership for health care ......................................................................................... 7
Perspectives on positive change ......................................................................................................... 8
Rationale of the study ........................................................................................................................ 8
Aim ........................................................................................................................................................ 9
Research questions ................................................................................................................................. 9
Methods ................................................................................................................................................. 9
Study participants ............................................................................................................................ 10
Data collection ................................................................................................................................. 11
Data Analysis ................................................................................................................................... 12
Ethical considerations .......................................................................................................................... 12
Discussion ............................................................................................................................................ 17
Credibility ........................................................................................................................................ 20
Reflexivity ....................................................................................................................................... 21
Transferability .................................................................................................................................. 21
Strengths and Limitations ................................................................................................................ 21
Implications ..................................................................................................................................... 22
Conclusion ........................................................................................................................................... 23
References ........................................................................................................................................... 24
Appendices ...................................................................................................................................... 30
Appendix A: Semi-structured interview guide ................................................................................ 30
5. Jerry Mulondo_Master’s thesis
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Background
Health care systems the world over are facing the challenge of adapting to changing times.
The need for adaptation has been caused primarily by the rising costs of health care,
workforce shortages, and a growing burden of chronic disease. This situation is further
complicated by the strain from rising population, shifting demographics along with increasing
demand for affordable and quality health care (World Health Organization 2015; OECD
2015). The failure to adequately address these problems could widen the social gaps in
equitable access to health care and result in failure to attain global targets of universal health
coverage (World Health Organization 2015; Gower 2012). Thus, health systems face the
double burden of meeting demands for care today, while making the strategic and structural
changes necessary for the future.
In order to address these challenges, health systems have adopted a variety of approaches. An
example is Lean health care, which streamlines work processes so as to minimize waste in the
system, while maximizing value for the patient (Mazzocato et al. 2010). Some scholars have
also championed Value based health care, which focuses on linking health outcomes that
matter to patients, with the cost of achieving these outcomes, in order to maximise value
(Porter & Teisberg 2015). Others propose the STEEEP model that calls for all health
organizations to aim for six major objectives: safety, timeliness, effectiveness, efficiency,
equity, and patient-centeredness (Institute of Medicine 2001). It has also been suggested that
health service delivery can be improved by realizing that health care actually has a Triple
Aim of costs, population health and quality of care (Berwick et al. 2008).
In the end, all of these approaches require skilled leadership within health care to guide the
process of initiating and sustaining the improvements needed to adapt to changing times. The
urgency of the need to develop leadership skills of medical workers has been emphasized by
several scholars (Reinertsen 1998; Czabanowska et al. 2014; Stoller 2009; Dickinson et al.
2013). The concern for the quality of leadership has been further strengthened as studies have
established a link between medical leaders and their critical role in cutting health care costs,
reducing morbidity and improving quality of care, especially when physicians are the leaders
(Colla et al. 2014; Goodall 2011; Veronesi et al. 2013). Some progress has been made in
identifying the necessary competencies for physician leaders. The key attributes mentioned
are several, including empathy, initiative, emotional self-awareness, organizational
6. Jerry Mulondo_Master’s thesis
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awareness, service orientation, developing others and influence (Hopkins et al. 2015;
National Center for Healthcare Leadership 2012; NHS leadership 2011).
In this regard, various leadership training programs have been introduced for both medical
students (Varkey et al. 2009; Steinert et al. 2012) and practicing physicians (Dine et al. 2011;
Scheck Mcalearney 2008; NHS leadership 2011; National Center for Healthcare Leadership
2012; Block & Manning 2007). However, evaluation studies have concluded that these
programs and other leadership training initiatives have achieved modest results (West et al.
2015; Elizabeth D. Rosenman 2014; Frich et al. 2014; Straus et al. 2013; Steinert et al. 2012).
The unsatisfactory results of all these efforts have been attributed to some common
weaknesses of leadership development programs.
First, most leadership programs are grounded in management theories and business values
from other industries and have not been translated well enough to the health care contexts.
The leadership styles that succeed in business culture may not necessarily be applicable to
other settings, such as health care (Gurdjian et al. 2014). Secondly, most leadership training is
focused on individuals, offered in the form of theoretical knowledge, and it is disconnected
from their work environment. As a result of this, leaders usually fail to integrate the new
knowledge into their work processes and so the training has little lasting impact on the
participants (Bergman et al. 2009) and no lasting impact on the organization (Frich et al.
2014; Gurdjian et al. 2014). Finally, there has been limited application of leadership theories
to understand and guide the leadership training in health care. The absence of leadership
theories has limited the study and understanding of what approach to leadership works best in
health care (Steinert et al. 2012; Elizabeth D. Rosenman 2014).
One of the first and obvious challenges of leadership development is coming to terms with
and defining what leadership actually is. Following a study of different definitions, Northouse
described leadership as “a process whereby an individual influences a group of individuals to
achieve a common goal” (Northouse 2015). In defining leadership as a process, he agrees
with the argument that leadership is not merely a trait in the leader. Rather it is a two-way
process resulting from the effect leaders have on their followers and vice versa (Horner 2004;
Day & Antonakis 2012). And, just as there are several definitions of leadership, there are
various models used to explain styles of leadership. These classifications have been based on
among others, the leader’s character (such as trait theory, great man theory), circumstances in
which the leadership occurs (path-goal theory, contingency theory), or the approach used by
7. Jerry Mulondo_Master’s thesis
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the leader (servant leadership, autocratic leadership, situational leadership) (Northouse 2015;
Dinh et al. 2014; Horner 2004; Day & Antonakis 2012). Leadership is an ever-evolving
subject of research with some new theories formed from combinations of established
theories. Moreover, whereas leadership has been extensively studied in sectors like politics,
business and military science, there has been relatively little empirical study of medical
leaders. This could partly explain why there is limited understanding of what kind of
leadership is most suitable for health care, especially in the case of physician leaders (West et
al. 2015).
Perspectives on leadership for health care
It has been suggested that due to their hierarchical culture and operational systems, medical
organizations would be more inclined to follow a transactional leadership approach (Ham &
Dickinson 2008). Transactional leadership entails the use of rewards or punishment to guide
people to achieve the aims of the group. It has the advantage of reinforcing desired behaviour
and so giving people incentive to comply with team goals. Ham & Dickson (2008) advocated
for such an approach by rewarding physicians for taking up leadership positions. In contrast,
(Schwartz & Tumblin 2002) proposed that combining transformational, situational and
servant leadership styles is best for medical organizations today. Transformational leaders
involve the people in identifying what to change, creating a vision and inspiring them to
achieve that vision. This approach would be desirable in health care because, in comparison
to transactional leadership, it has a more sustainable effect on the people’s motivation and
commitment to the organization (Bass 1990). On the other hand, situational leaders believe
that the best way to lead is not by having one leadership style, but by adapting the approach
used to the ongoing situation. It requires leaders to have a good understanding of the maturity
of their followers and the prevailing circumstances (Hersey & Blanchard 1969). In the
servant leadership approach, the leader puts the well-being of followers first, so that they
maximize their potential. Servant leaders seek to earn authority through serving the people
and to develop a similar attitude in their followers (Greenleaf 1977).
Other proposals have suggested that purely transformational leadership approaches (Vimr &
Thompson 2011; Xirasagar et al. 2005), collaborative leadership (VanVactor 2012) or
adaptive leadership (Thygeson et al. 2010) would be most appropriate. Collaborative
leadership emphasizes interaction and interdependency among followers, in order to enrich
skills, ideas and inspiration to achieve the team goal (VanVactor 2012). On the other hand,
adaptive leadership is “the practice of mobilizing people to tackle tough challenges and
8. Jerry Mulondo_Master’s thesis
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thrive” (Heifetz et al. 2009). Adaptive leadership has two steps, diagnosis and action. First
the leader seeks to understand themselves, the organization and its people, in order to
“diagnose” the problem. Afterwards, the leader does not impose solutions, but mobilizes the
people to identify and solve problems (Thygeson et al. 2010; Heifetz et al. 2009). This
adaptive leadership approach to raising solutions from within the group makes it suitable for
addressing the conflicts and uncertainty that are usually associated with change.
Authentic leadership has also been associated with successful health organizations. A study
by (Wong & Laschinger 2013) found that authentic leadership styles increased the
motivation, work performance and job satisfaction of nurses. Authentic leaders gain influence
by building relationships based on transparency, open communication, valuing the input of
their followers and observing high ethical standards. Such an attitude sustains trust, interest in
the group’s aims, and high performance among team members (Avolio & Gardner 2005;
Gardner et al. 2011).
Perspectives on positive change
The term “Positive change” as used in this paper is based on the model of appreciative
inquiry by (Cooperrider & Whitney 2005). This model was used as the guiding framework
for the interview guide, which generated the data for this study (See Appendix A).
(Cooperrider & Whitney 2005) argue that common approaches to change, which focus on
finding and fixing problems, create a negative mindset and a feeling that change is difficult.
In contrast, appreciative inquiry works on the premise that people tend to “evolve in the
direction of questions that are asked most often” (Cooperrider & Whitney 2005). Instead of
asking “What is wrong”, appreciative inquiry asks “What is right”. Thus, by asking positive
questions or questions that focus on the good things, people can search, reflect and discover
the good within their organization or situation. These good aspects are the foundation on
which to start the process of personal and organizational change. The people can then
visualize what changes could be made and redesign their ways of working in order to achieve
these desired changes.
Rationale of the study
The various suggestions of leadership approaches in health care underscore the need for more
research into this subject. There is need to understand what approach would work best in
health care and why. This study focused on physician leaders, in order to build on knowledge
9. Jerry Mulondo_Master’s thesis
9
from previous studies which found physician leaders have greater impact on health care than
non-physician leaders (Colla et al. 2014; Goodall 2011; Veronesi et al. 2013).
Due to various changes occurring within and outside health care organizations in response to
the challenges they are facing today, this study focused not just on leadership, but leadership
during times of change. The knowledge gained form this study would provide more clarity on
what skills and qualities are necessary for successful leadership in healthcare today. Such
information would be valuable to academic and medical organizations in designing effective
physician leadership programs. The end result would be more competent physician leaders, to
guide health organizations in delivering services more efficiently and make strategic changes
to cope with the challenges in health care.
Aim
The aim of this study was to explore the leadership approaches associated with positive
change in health care adopted by physician leaders.
Research questions
The above aim was addressed through one research question, namely:
Which leadership approaches can be identified from experiences of leading positive change
in health care?
Methods
Study design
This was a qualitative study using thematic narrative analysis (Riessman 2008). It was based
on secondary data from previously conducted interviews with physician leaders from
different parts of Sweden. A qualitative approach is suitable for an in-depth exploration of the
experiences of the participants in leading change in their organizations (Creswell 1998). It
allows the researcher to develop a clear understanding of the context in which the participants
acted and the thought processes that influenced their actions. By listening to people narrate
their experiences and analysing such reports, we are better able to understand their experience
during those events (Creswell 1998).
The secondary analysis was motivated by the need to explore a new research question using
the available data. This was also enhanced by the rich nature of the data (Heaton 2008; Long-
Sutehall 2010). In addition, due to the busy nature of the study participants’ work, it was
deemed difficult to access the same group of respondents again (Long-Sutehall 2010). Thus,
10. Jerry Mulondo_Master’s thesis
10
the work done in the context of this thesis started with the analysis of the qualitative data
previously collected by two researchers at Karolinska Institutet.
Narrative analysis works on the basis that language and stories are the most direct way that
people use to convey the meaning they find in life’s experiences (Riessman 2008). However,
these stories are not usually told in a structured format with beginning, middle and an end.
A narrative approach allows the researcher to reconstruct the story in a chronological order
that reveals the meaning more clearly to the audience. In addition, using narratives allows for
the understanding of how the meaning people derive from their experiences determines their
actions in those situations (Riley & Hawe 2005). This cause-effect relationship is best
revealed when events are arranged in sequential order that shows how one event led to
another (Greenhalgh 2005). Therefore, by reconstructing the story, the researcher can even
uncover hidden meanings that could have been missed by the storyteller.
Study participants
Purposive sampling was used in order to ensure a well-informed group of respondents who
could provide detailed narratives of their experiences of leading change in their health
institutions (Creswell 1998). First, a group of senior physician leaders with many years of
insight into the Swedish health care system, was identified by researchers at the Medical
Management Centre, Karolinska Institutet. Afterwards, another group of emerging physician
leaders was selected from the MedUniverse list of nominees for the “Future Physician
Leader” prize. MedUniverse is an independent online platform where Swedish physicians can
share knowledge and discuss professional experiences with peers (Meduniverse 2016). The
criteria for the MedUniverse nomination were: physicians aged 45 years or less, with
evidence of being visionary, influential role models in leadership roles within Swedish health
care. More participants were added by snowball sampling, using referrals from the initial
respondents, until saturation was achieved (Creswell 1998; Guest et al. 2006).
The twenty-one respondents consisted of eleven senior executives and ten emerging leaders
from various fields of health care in Sweden. Their professional backgrounds were in
academia, research, medical consultancy, pharmaceuticals, and hospital management. Twenty
of the respondents had medical degrees and one had a degree in dentistry. Fourteen of them
had a PhD, nine were active in clinical work and six had formal business education. In
addition, two emerging leaders and six senior executives had international management
experience. Nine of the respondents were female. Characteristics of the respondents are
11. Jerry Mulondo_Master’s thesis
11
summarised in Table 1.
Table 1: Summary of respondents’ characteristics
Characteristics Senior Executives
(n=11)*
Emerging leaders
(n=10)
Total
(n= 21)
Sex
Female
Male
2
9
5
5
7
14
Qualification
PhD 10 4 14
Professors 2 0 2
Business education
(MBA BSc or BA)
3 3 6
Clinically active 2 7 9
Non-clinical work
Consultancy
Industry
Research
2
3
10
5
3
4
7
7
14
* 11 interviews were done, but only the nine in English were analysed
Data collection
The data was obtained through semi-structured interviews conducted by two researchers from
the Medical Management Centre, Karolinska Institutet, from October 2013 to June 2015. The
interview guide was developed and pilot-tested by the researchers to ensure trustworthiness
(Elo et al. 2014). Respondents were contacted via email. Eighteen face-to-face interviews
took place in locations convenient for the respondents (mostly their offices) and three
interviews were done over the phone. The questions explored the leadership background of
the respondents, what motivated them to lead and what traits and attitudes they considered
valuable to their work. The respondents also suggested ways in other health workers could be
trained to develop similar leadership traits. One section of the interview asked them to
describe an experience of leading what they regarded as positive change within their
organization. They were encouraged to give detailed descriptions and asked to explain any
parts that seemed unclear to the interviewer. Interviews were conducted in English except for
two which were in Swedish, as preferred by those respondents. The interviews lasted from
sixty to eighty minutes. They were digitally recorded and later transcribed verbatim. The two
researchers compared the transcripts with the audio recordings to verify their accuracy. Due
to time constraints and the lengthy process required for back translation and verification of
12. Jerry Mulondo_Master’s thesis
12
translated text, the two transcripts in Swedish were excluded from this secondary study.
Data Analysis
The data analysis was done in a series of steps as described by (Riessman 2008; Greenhalgh
2005). First, the author did a review of published literature on physician leadership to
discover the available knowledge on the subject. This review provided knowledge on existing
theories of leadership which would be used later in the analysis. The full transcripts of the
interviews were then read repeatedly to understand the background of the respondents and to
gain familiarity with the data. This was followed by extraction of the narrative in which the
leaders reported their experience of leading change (narrative finding). Each narrative was
then read several times to identify its core themes from the respondents’ accounts of their
actions and experiences. These themes were then compared to the rest of the interview to
identify additional text that could explain and support conclusions made about the data.
After the identified themes were discussed with the primary researchers (MJ, CS and PM), a
table was created to extract data about what were determined to be important aspects in each
narrative. The following aspects were identified: key drivers, overall approach to change, key
strategies and steps in the change process, how the leader related to others, and the essence of
the story in 1-2 sentences. Each row of information from the table was printed out on paper.
The data in each row provided the themes which were used to categorize the narratives into
five thematic groups.
Later, for each theme, one narrative provided a frame, which was then enriched and refined
with phrases and concepts from the other narratives which shared that theme (narrative
construction). The pauses, interviewer comments and other breaks in the original
conversation were removed in order to create a flowing text that could be easily read, while
retaining the original meaning. This resulted in the creation of condensed narratives that
illustrated each theme, but maintained the general sequence of events from the original story.
This process of rebuilding narratives is characteristic of narrative analysis (Riessman 2008;
Greenhalgh 2005). The analysis was done using Microsoft Word 2013.
Ethical considerations
The participants were informed by email about the purpose of the study and verbal consent
was sought before the interviews were done. Participation was voluntary and the respondents
13. Jerry Mulondo_Master’s thesis
13
were assured of anonymity and confidentiality in handling the information they provided.
The respondents were not given any compensation for participating in the study. The study
was approved by the Stockholm regional ethical vetting board (2015/197-31/5).
Findings
The data analysis process involved identifying key aspects of each narrative finding (See
Table 2 for an example).
Table 2. Sample from table of extracted narratives.
Narrative
#
Key driver Overall approach
to change
key strategies
and steps in the
change process
Relating to
others
Essence of the
story? (1-2
sentences)
1 Achieving goals
through working
with creative,
skilled people
Leading by
example and
galvanizing skilled
people to get the
goals
Being a role model
by walking the talk
Using reward
systems to create
an org. culture by
promoting people
with the right
attitudes and
behavior – role
models.
People are the
means for
achieving a
goal. His role is
to keep the
goals in focus
and find good
people
I know what my
goals are. Now I
need to find the
skilled and
creative people
who would
achieve these
goals. I promote
them in the
organization to
reward or
suppress certain
types of behavior
and attitudes.
By comparing each narrative finding, five dominant themes were identified:
1. Evidence-informed and problem-focused approach
2. Driving goals from the front
3. Leaders are facilitators
4. Vision guides leadership
5. Principles guide leadership
Each theme was then summarized with a narrative construction that described the leaders’
different approaches to leadership. Each of these themes and the narrative construction are
presented below. The source(s) for the narrative constructions are indicated with the numbers
in parentheses referring to the appropriate respondent.
Theme 1: Evidence-informed and problem-focused approach (Respondents 7 and 10)
These leaders stressed the importance of having reliable data to guide their leadership roles.
The data was used to understand the present status of the organization and which problems
14. Jerry Mulondo_Master’s thesis
14
needed to be solved. With this information, they could confidently defend their arguments for
change to both their followers and external stakeholders. By using data, they could also
measure the effect of any interventions made and progress towards organizational goals.
These leaders believed that organizations could be improved by having well-functioning
processes for the accurate collection and handling of data.
As the director of this hospital, I realized something had to change if we were to increase our
reimbursement. First, we had to take a step back and try to understand the situation in the
organization. The best way to do this was to identify the most important indicators, measure them
and use that data to understand the whole process. In that way, we identified what the problem was
and then we could explore possible solutions. This was the most critical step. With the reliable data
available, I could confidently stand before the entire organization and defend the case for changing
our coding system. By improving our coding and patient survey systems and measuring the correct
parameters, we got quality data to track our progress. More importantly, this also increased our
reimbursement. I believe information is important for any leader to make wise decisions about the
organization, its people, work processes and the clients. It was not just about gathering data, but
working with it, using it to analyse questions and problems to come up with evidence-based
solutions. I absolutely advocate for collecting and using data. It is what makes good leaders within
health care.
Theme 2: Driving goals from the front (Respondents 1, 2, 6, 9, and 18)
These leaders had a visible presence, at the forefront of change in their organizations. They
had clear goals in mind and focused on achieving results as soon as possible. This was done
whether they were physically present or driving the work process from a distant location.
By making quick decisions and executing them swiftly, they set the momentum of change in
the organization and gave the people an example to follow. They identified skilled, results
focused employees whom they groomed using rewards and promotions to become junior
leaders in the organization. They understood how the different people, systems and
departments in the organization worked. In this way, the different needs in each department
could be anticipated and activities prioritized accordingly.
I brought in to lead a pharmaceutical organization of about six thousand people. It was clear in my
mind that I was here to fix the organization. As a leader, my primary function is to ensure that the
group is working, like a well-oiled machine, that we have the right resources in place. I see myself as
a football coach, I want to be on stage and lead the team. It is very important that the leader is seen
17. Jerry Mulondo_Master’s thesis
17
can’t just tell people to change – they have to want to change. I motivate them to change by painting
a clear picture of the future that they want to be part of. That is what gets them enthusiastic and
motivated to work. My role is to be an inspiration to people, so that they feel like they are capable of
doing things themselves. That way, in the end they get all the credit and believe they did it on their
own.
Theme 5: Principles guide leadership (Respondents 3, 15 and 20)
These leaders were guided by their personal principles and values. Once the leader knew their
principles, it gave their work purpose and direction. Their values included such ideals as
transparency, equity and service to others. These clear principles and values, guided them
both in making decisions and in their approach to their patients, clients, followers, and other
people they interacted with. Even when they encountered resistance to change, they stuck to
their values. In this way, they set a standard for the organization and attracted to themselves
people who shared the same attitude as they did.
The greatest challenges I faced in leading change was as head of the academic department. Before I
mention how I handled it, I will tell you what comes first. I believe leadership begins with knowing
who you are and what you believe in. The leader’s personal principles set the tone for the entire
organization. You need to be clear about what you stand for and let that guide you in leading
change. When you know your principles, you can align them with what your purpose is in the
organization. This gives meaning to your work, however humble your position may be in the
organization.
When I was a junior doctor, I knew I was there for the good of my patients, to serve them and adapt
to what they needed. In every role since then, I used the same attitude, doing what was necessary to
make the work of others easier. I believe in transparency and fairness for all. When I called for
increased financial transparency in my department, there was a lot of resistance from different
people. But over time, they came to see my point and that was the only way I could win them over
to my side. All worthwhile change will meet difficulty or resistance, but when you stick with your
principles, it offers you a strong foundation on which to stand and endure. I believe that is the way
you make things better and bring lasting change in the organization.
Discussion
This study explored the approaches used by physician leaders in Sweden to lead successful
changes in their organizations. The findings show that the physician leaders used a variety of
18. Jerry Mulondo_Master’s thesis
18
leadership approaches, just like was the finding of some other studies (Chapman et al. 2014;
Xirasagar et al. 2005). Within each of the five themes, both emerging and senior physician
leaders were represented. This suggests that no particular leadership style was favored by the
junior or senior leaders.
In the first group under the theme of “Evidence-informed and problem focused approach”,
the leaders relied greatly on data to guide their leadership role. This preference for using data
was not mentioned in the previous leadership approaches advocated for medical settings.
However, the need for evidence based management of health care organizations has been
proposed by some scholars (Axelsson 1998; Walshe & Rundall 2001). The argument for
“evidence based healthcare management” was inspired by the reported success of “evidence
based practice of medicine”. This approach to medicine emphasizes the use of data from
research and clinical trials in the diagnosis and management of patients. Since it had worked
for clinical medicine, there was reason to believe that it research different styles of
management in health care could yield data that supports the use of one management style
over another. The narratives in this theme suggest that there could also be a case for evidence
based leadership approach to health care.
In contrast, the leaders in the second group, (Driving goals from the front) were very action
oriented and never had a high regard for data. They manifested transactional leadership in
their use of rewards to honour performance and suppress undesired qualities in their teams
(Bass 1990). The leaders’ high level of proactivity is also consistent with entrepreneurial
leadership, which had not been previously advocated for health care. Entrepreneurial
leadership has been defined as “influencing and directing the performance of group members
toward the achievement of organizational goals that involve recognizing and exploiting
entrepreneurial opportunities” (Renko et al. 2015). Such leaders usually act quickly to take
advantage of opportunities for the benefit of their organizations. Such skills could be relevant
for leaders to exploit changes that occur within or outside the health care organization.
The third group (Leaders are facilitators) depicted collaborative leadership (VanVactor 2012)
in their tendency to assemble people to communicate, bond and maximize the skills and
knowledge available in the group. Their approach was also typical of adaptive leadership in
the way the leaders first sought to understand the problem, then supporting the people to
gather and discuss possible solutions (Heifetz et al. 2009). In addition, they manifested
19. Jerry Mulondo_Master’s thesis
19
resonant leadership (Boyatzis & McKee 2005), which was not mentioned previously in
relation to health care. Resonant leaders have high emotional intelligence, seek a personal
level connection with their teams and foster harmony in their teams. They take time to build
relationships based on trust, not on manipulative or transactional tactics.
The visionary style of leadership used in theme 4 (Vision guides leadership) was
characteristic of transformational leadership. By painting a clear picture of the desired future,
they challenged the people to achieve a higher ideal. They too had elements of collaborative
leadership, in getting their teams to work together and resonant leadership in seeking to
understand how the group could work together in line with the shared big vision of the future.
Under the fifth theme (Principles guide leadership), the leaders depicted servant leadership
(Greenleaf 1977) in the way they put the needs of the team first. The leader gained influence
through serving their people and seeking to improve their wellbeing.
This is closely related to Level 5 leadership. Jim Collins defines a Level 5 leader as one who
“exhibits a paradoxical mix of personal humility and professional will” (Collins 2006). Just
like the servant leader, such leaders are determined, humble and tend to put the well-being of
their followers first. Furthermore, the leaders in this theme were guided by strong personal
convictions and principles. Such an approach is typical of principle centred leadership,
authentic leadership and value based leadership. According to (Covey 1992), principle-
centred leaders are guided by their principles. These principles are like a compass that always
shows the leader what direction is “true North” and so helps them to make the right decision
in times of uncertainty. Covey (1992) also asserts that “Principle-centeredness” starts at the
individual level, then the interpersonal, managerial and organizational levels.
As highlighted earlier, authentic leaders are guided by their experience, personal attributes
and high moral standards to develop similar characteristics in their people (Avolio & Gardner
2005; Gardner et al. 2011). On the other hand, value-based leadership involves connecting
the values or moral principles of the organization to the personal values of its people. This
brings the people into harmony with the values of the organization and creates a sense of
unity and shared identity in the group. Value based leaders sustain this commitment by
continuously reminding their people of these values and leading by example (Mills &
Spencer 2005).
The emphasis on strong values and principles among the leaders in this theme could find
particular relevance for leading change in health care. Much as it is necessary for leaders to
20. Jerry Mulondo_Master’s thesis
20
adapt to changing times, there is also need for strong values to create a sense of stability and
preserved identity amid the turbulence of change. The emphasis by value-based, authentic
and principle centred leaders on ethics and putting people first is in alignment with the high
ethical standards, integrity and care for people in need that are attributes cultivated among
physicians. It could be one of the reasons why these leadership styles fit in well with health
care settings where having strong values and integrity are regarded as qualities of successful
health care professionals (BMA Medical Ethics 2013).
Physicians serve a major role in health care, which includes building relationships of trust as
they save lives and provide medical care to patients. The physicians are bound by a strong
ethical code to preserve life and relate to both patients and fellow medical staff in with
respect, ethics and integrity (BMA Medical Ethics 2013; West et al. 2015). This is the
guiding philosophy as they perform their duties both in clinical and non-clinical contexts.
This includes among others hospitals, pharmaceutical companies, medical schools, health
consultancy whose leaders were represented in this study.
Generally, the findings of this study agree with previously proposed approaches to leadership
in health care. One question that this study raises is whether similar approaches to leadership
would apply in both clinical and non-clinical settings. It seems that leadership styles were not
dependent on years of experience. In other words, the leaders under each theme were both
senior and emerging leaders and from various work settings. For example the theme of
“principles guide leadership” included a senior professor, an experienced health consultant
and a junior doctor.
Methodological considerations
Given that this was a qualitative study, trustworthiness is discussed in terms of credibility,
dependability, transferability and reflexivity (Guba & Lincoln 1994).
Credibility
First, the semi-structured interview guide was piloted by the researchers to ensure open ended
questions to collect in-depth descriptive data. During the interviews, the respondents were
encouraged to tell detailed stories about their experience and to clarify any unclear areas.
This provided rich detail for the analysis and gave the interviewers a better understanding of
the context in which these narratives were created. The stories were not broken down into
codes so as to preserve the as much of the original structure and meaning as possible.
21. Jerry Mulondo_Master’s thesis
21
Since it was a secondary analysis, a description of the methods used in both the primary and
secondary studies was given, to enhance the validity (Heaton 2008; Elo et al. 2014).
The reason for the secondary analysis and ethical considerations were also mentioned in this
study to enhance transparency.
Dependability and confirmability
The accuracy of the interpretation was enhanced by the verbatim transcripts of the interviews
and by involving the primary researchers (Long-Sutehall 2010). The author performed the
initial analysis, which was then reviewed by the three primary researchers, who had
experience in qualitative analysis. Any differences in the categorization were then discussed
to ensure that the findings sufficiently represented the original narratives. This combined
analysis by a team with both insider and outsider perspective from different backgrounds
enhanced the dependability and confirmability of the analysis. Other information about the
study context, participant characteristics and selection criteria were included to enhance
dependability.
Reflexivity
Narrative analysis is a very subjective process, involving a back and forth process of reading,
reflecting and referring back to the original data. Thus there is a risk that the author may get
so embedded in the data, lose objectivity and impose new meaning in the re-written
narratives which is different from that expressed by the respondent (Bell 2002; Riley & Hawe
2005). The interpretation of meaning in the story is always subject to the researcher’s
interpretation. In this case, the author was a physician with a background in leadership, which
could have affected the perspective with which he approached the analysis.
Transferability
The study involved physician leaders from various specialities of health care, including
hospitals, pharmaceutical industry, medical consulting and academia. This enhanced the
transferability of the findings to different health care settings.
Strengths and Limitations
This study has several strengths. First, it links established leadership theories to the
approaches used to lead change in health care. In this way, it seeks to explore if leadership
theories that have been proposed for health care do have any practical relevance in today’s
22. Jerry Mulondo_Master’s thesis
22
times of change. Secondly, it involved both emerging and senior physician leaders, in both
clinical and non-clinical settings. Thus, it offers a broader insight into the attitudes and
approaches used by physician leaders in their different roles in health care. Finally, due to its
focus on leadership in times of change, it is very relevant to health organizations today,
which are challenged by changes, both in their internal and external environments.
There are some limitations to this study. It was based on a Swedish population and this may
limit its transferability to different cultural or organizational settings. This is because
different cultures have different approaches to leadership (House 2004). Also, the study only
involved physician leaders and its findings may not apply to non-physician leaders in health
care. Finally, due to the nature of the study design, it could not determine the effect of various
factors on the choice of leadership style. Thus, the influence of age, gender, years of
experience and work setting among others, could not be conclusively determined from this
study.
Implications
The findings of this study have several implications for leadership in health care. First, this
study revealed that physician leaders use various approaches to leading change. Leadership
development programs could therefore be designed in a way that exposes physicians to
various approaches to leading change. This would help the leaders in the reflective process of
improving their leadership styles by learning from others. Secondly, it was interesting to note
the emphasis that physician leaders place on the importance of data in leading change. This
suggests the need for more research into what kind of data physicians would find most
important and how to use that data to guide leadership decisions. This would add to the
research that has already been done on evidence based management in health care.
In addition, health organizations could benefit from building or improving their capacity for
proper collection, analysis and use of data to guide leadership decisions.
Finally, future studies could adopt a mixed methods approach, to explore what factors affect
choice of leadership style and what leadership style would be best suited to different sectors
within health care. Such robust studies could also generate evidence about the long term
effectiveness of different leadership theories proposed for health care. This could help health
organizations and leadership trainers to know what leadership approaches would offer the
best investment for their limited resources.
23. Jerry Mulondo_Master’s thesis
23
Conclusion
This study found that physician leaders used a variety of leadership styles in leading change.
It also found that several leadership approaches such as use of evidence to inform decisions
and principle centred leadership were closely connected to the values, attitudes and ethics of
physicians. There is need to understand what factors influence choice of leadership style, in
order to generate evidence in support of leadership approaches for different sectors of health
care. This would help to develop competent leaders in health care, who can steer their
organizations through turbulence of change that health institutions face in the 21st century.
Acknowledgements
I would like to thank Carl Savage, Pamela Mazzocato and Mairi Jüriska, for the supervisory
guidance and support. Thank you for the valuable comments and sharing your knowledge
about the exciting field of medical management research. I am also grateful for the help and
advice from George Keel, Rafik Muhammad and the team at the Medical Management
Centre, Karolinska Institutet.
My gratitude to the physician leaders who spared the time to share their insights on this very
intriguing subject. Thanks to the faculty and the course leader Ulrika Schudt Haardt for
facilitating such a conducive learning environment.
I am very grateful to the Swedish institute and the Swedish people for the generous
scholarship that funded my studies in Sweden.
Finally, my deepest thanks to my parents; Aunt Beatrice, Uncle Edmund, Paul and Salima
Mulondo, and my dear wife Ruth…this work is dedicated to you.
Thanks to the Lord Jesus, my guide and model of the greatness in servant leadership.
“Let the senior among you become like the junior and the leader like the servant.” Luke 22:26.
24. Jerry Mulondo_Master’s thesis
24
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