Practice Greta Cummings RN PhD FCAHS Professor, Faculty of - - PowerPoint PPT Presentation

Translating Knowledge into Leadership Practice

Greta Cummings RN PhD FCAHS

Professor, Faculty of Nursing, University of Alberta CLEAR Outcomes (Connecting Leadership Education & Research) AHFMR Population Health Investigator President, International Society of Nurses in Cancer Care

August 29, 2012

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64% of employees report being depressed, anxious and wish they worked elsewhere

Gallup Polls, 2006

59% of workers are disengaged ¡and ¡can’t ¡wait ¡ to go home 14% actively disengaged (total 73% - disengaged)

Gallup Polls, 2006

87% of workers believe their work lacks any meaning beyond getting paid

Gallup Polls, 2006

• Closure of hospitals, facilities, beds and programs
• Aggregation of patients needing similar resources
• (De)centralization of decision-making and resources
• Process change to increase efficiency
• Flattening/delayering structures
• Regionalization of health authorities
• Skill mix changes
• “Rightsizing” ¡of ¡the ¡healthcare ¡workforce

Healthcare Restructuring

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Current Healthcare Issues

30%-40% of patients do not receive care based on current evidence 20%-25% of care provided is not needed or potentially harmful

(Grol & Grimshaw, 2003)

10,000-20,000 annual preventable deaths from adverse events in Canadian healthcare

(Baker et al., 2004)

Simple Complicated Complex

Following a Recipe Sending a Rocket to the Moon Raising a Child The recipe is essential Formulae are critical and necessary Formulae have a limited application Tested to assure easy replication Sending one rocket increases assurance that the next will be OK Raising one child provides experience, but no assurance of success with the next No particular expertise is

• required. Cooking

expertise increases success rate High levels of expertise in a variety of fields are necessary for success Expertise can contribute but is neither necessary nor sufficient to assure success Recipes produce standardized products Rockets are similar in critical ways Every child is unique and must be understood as an individual The best recipes give good results every time There is a high degree of certainty of outcome Uncertainty of outcome remains

(Glouberman & Zimmerman, 2004)

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Leadership

…is ¡being ¡able ¡to …see ¡the ¡present ¡for ¡what ¡it ¡really is, …see ¡the ¡future ¡for ¡what ¡it ¡could be, and ¡then, ¡…take ¡action to close the gap.

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Leadership is action, not position

Context

Facilitation

Evidence

Evidence-based practice

(Kitson, et al., 1998, QSHC)

PARiHS Framework for Research Implementation

Evaluation Leadership Culture

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Leadership Distinctions

• Management is doing things right; leadership is doing

the right things.

Peter Drucker

• Management is about reducing risk; keeping things

the same, standardized.

• Leadership is about taking calculated and planned

risk, in order to achieve a preferred future. Cummings

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Leadership Styles

• How you accomplish leadership.
• Reflects your approach to accomplishing the

goal

• Arises from your self-awareness
• Frames your relationships with others
• Can lead to good or bad results

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Emotional Intelligence

Self

• Self-Awareness
• Self Management

Others

• Socio-political

awareness

• Managing

relationships with

• thers

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Emotional Intelligent Leadership Styles

Resonant

• Visionary
• Coaching
• Affiliative
• Democratic

Dissonant

• Pacesetting
• Commanding

Goleman, Boyatzis & McKee, 2002

Context

Facilitation

Evidence

Evidence-based practice

(Kitson, et al., 1998, QSHC)

PARiHS Framework for Research Implementation

Evaluation Leadership Culture

Evidence

• 1. For improving nurse outcomes through relational

Leadership Styles (Cummings et al. 2005, 2007, 2010, 2011)

Nurses relationships to their work

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Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al, 2010; Schalk et al.,

2011)

Work Environment

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Interventions to Improve the Healthcare Work Environment

11 controlled intervention studies

• primary nursing (two studies)
• educational toolbox (one study)
• individualized care and clinical supervision (one study)
• violence prevention intervention (one study)

Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al, 2010; Schalk et al.,

2011)

• 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)

Leadership Behaviors & Practices Autonomy Working Relationships Resources

Individual Nurse

• Char. factors

Performance Motivation

(8) (4)

(7) (5) (1) (2) (3)

Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al, 2010; Schalk et al.,

2011)

• 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)
• 4. For improving patient outcomes (Cummings et al., 2010)

Relationships between Leadership Practices and Patient Outcomes

• Systematic review through 2007
• 7 studies

Transformational leadership is related to

• significantly fewer patient adverse events (3 studies)
• significantly fewer complications (2 studies)
• significantly higher patient satisfaction (2 studies)
• significantly lower mortality (1 study)

Odds Ratios and 95% confidence interval† Leadership Style Unadjusted model P-values Adjusted model P-values High Dissonant 0.51 (0.34-0.76) 0.001 0.74 (0.49-1.12) 0.151 Moderate Dissonant 1.09 (0.96-1.24) 0.155 1.08 (0.95-1.22) 0.323 Moderate Resonant 0.90 (0.79-1.03) 0.115 0.92 (0.79-1.06) 0.236 High Resonant 0.62 (0.49-0.78) 0.001 0.69 (0.54-0.89) 0.004 Relative contribution * 22.77% 6.18%

Influence of Leadership Styles after Adjustment

Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al. 2010; Schalk et al.,

2011)

• 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)
• 4. For improving patient outcomes (Cummings et al., 2011)
• 5. For supporting staff to collaborate on care decisions (Cummings

et al 2005, 2007)

Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al, 2010; Schalk et al.,

2011)

• 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)
• 4. For improving patient outcomes (Cummings et al., 2011)
• 5. For supporting staff to collaborate on care decisions (Cummings

et al 2005, 2007)

• 6. For empowering managers to do their best work (Lee &

Cummings 2008)

When ¡Senior ¡Healthcare ¡Leaders ¡….

Inspire a shared vision Empower managers Recognize others contributions and accomplishments

Managers’ ¡report ¡ significantly increased

• autonomy
• recognition
• community
• perceived fairness
• Job satisfaction
• Intentions to stay

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Lee & Cummings 2008. Journal of Leadership Studies

Evidence

• 1. For improving nurse outcomes through relational Leadership

Styles (Cummings et al. 2005, 2007, 2010, 2011)

• 2. For improving work environments (Cummings et al, 2010; Schalk et al.,

2011)

• 3. For coaching staff performance (Brady et al., 2011; Carey et al., 2011)
• 4. For improving patient outcomes (Cummings et al., 2011)
• 5. For supporting staff to collaborate on care decisions (Cummings

et al 2005, 2007)

• 6. For empowering managers to do their best work (Lee & Cummings

2008)

• 7. For empowering clinical staff to make patient care decisions

(Laschinger et al, 2008, 2009, 2010, 2011).

Context

Facilitation

Evidence

Evidence-based practice

(Kitson, et al., 1998, QSHC)

PARiHS Framework for Research Implementation

Evaluation Leadership Culture

Leadership is unlocking people's potential to become better

Translating Knowledge into Leadership Practice

Mary M. Gullatte, PhD, RN, AOCN, FAAN

President Oncology Nursing Society Pittsburgh, Pennsylvania, USA Vice President of Patient Services and Chief Nursing Officer Emory University Hospital Midtown Atlanta, Georgia, USA

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Learner ¡Objective…

• Explore ways nurse leaders can use evidence based

knowledge to inform the development of policies, procedures and practice.

• Develop quality improvement measures.
• Strategies for implementation and

embedding in practice.

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Leadership Empowerment and Quality Clinical Outcomes

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Why Evidence-Based Practice?

• Information overload

– Knowledge explosion – Consumer awareness

• Professional responsibility

– Evidence-based medicine – Nursing Research (American Nurses Foundation [ANF], National Institute for Nursing Research [NINR])

• Regulation and Accreditation

– Tie process to outcomes

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Role of the Oncology Nurse Leader In Advancing Practice through Evidence.

• Lead the transformation
• Educate to the critique, synthesis, and application of the

evidence

• Navigate for staff nurses to be able to know how to apply the

evidence

• Form teams and workgroups to implement the evidence

through

– Policies – Procedures

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ONS PEP Resources

ONS PEP Weight of Evidence Classifications

• Recommended for Practice
• Likely to be Effective
• Benefits Balanced with Harms
• Effectiveness Not Established
• Effectiveness Unlikely
• Not Recommended for Practice

Recommended for Practice

Interventions for which effectiveness has been demonstrated by strong evidence from rigorously conducted studies, meta-analyses, or systematic reviews, and for which expectation of harms is small compared with the benefits

Effectiveness Not Established

Interventions for which there are currently insufficient

• r conflicting data or data of inadequate quality, with

no clear indication of harm

Not Recommended for Practice

Interventions for which lack of effectiveness or harmfulness has been demonstrated by strong evidence from rigorously conducted studies, meta analyses, or systematic reviews, or interventions where the costs, burden

• r harms associated with the intervention

exceed anticipated benefit

Oncology Nurse Leaders

• Evaluation of the

application of the practice based evidence

• Accountability
• Sustainability
• Reevaluation

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References

• Given, B.A., Beck, S., Gobel, B.H., Lamkin, L., &

Marsee, V. (2004). Oncology nursing-sensitive patient outcomes. Available at http://onsopcontent.ons.org/toolkits/evidence/Cl inical/outcomes.html.

• Given, B.A., & Sherwood, P.R. (2005). Oncology

nursing society report Nursing-sensitive patient

• utcomes-A white paper. Oncology Nursing

Forum, 32, 773-784.

• Hadorn, D.C., Baker, D., Hodges, J.S., & Hicks, N.

(1996). Rating the quality of evidence for clinical practice guidelines. Journal of Epidemiology, 49(7), 749-754.

References

• Melnyk, B., & Fineout-Overholt, E. (2005).

Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams and Wilkins.

• Oncology Nursing Society (2004c). Oncology

Nursing Society strategic plan: 2003 through

• 2005. Retrieved March 15,2010 from

http://www.ons.org/about/strategicplan.shtml

• Ropka, M.E., & Spencer-Cisek, P. (2001). PRISM:

Priority Symptom Management project phase I:

• Assessment. Oncology Nursing Forum, 28(10),

1585-1594.

• Rutledge, D.N. & Grant, M. (2002). Introduction.

Seminars in Oncology Nursing, 18(1), 1-2.