Leadership
Effective leadership in a working environment contributes positively to a successful organization. In this environment, staff members would show extreme satisfaction and exhibit a high morale leading to a high productivity (Feltner, 2008). Just as we speak about a successful organization, the exact opposite situation can prevail if the leadership is ineffective. Diminished morale and productivity are seen if the leadership results in a negative impact. A study was undertaken to determine the characteristics of a desirable leader.
Here the term leader was defined as a person who leads and who is involved in change, innovation, growth, and empowerment of staff members (American Nurses Association, 2004). Leadership has also been defined “as an interpersonal process for influencing the actions of an individual or group towards establishing goals in a given situation” (Stichler, 2006 ). Welford has defined leadership “ as setting the pace and the direction for change, facilitating innovative practice and ensuring that policies are up to date; professional standards are set in relation to care and a comprehensive service is developed over time” (2002 ). “Leadership is an interpersonal relationship of influence, the product of personal characteristics rather than mere occupation of managerial positions” (Bowles and Bowles, 2000).
Transformation leaders with “interpersonal communication, mutuality, affiliation and empowerment” are the accepted leadership now. The awareness about the strategically transformed workplaces is more flexible than their counterparts.
Today’s healthcare settings require leaders in every field: their skills and knowledge, decision-making expertise and bearing accountability for the delivery of competent and safe outcomes for patients (Dickenson-Hazard, 2000). Decentralised and flexible decision-making is necessary at the moment when the organisation pyramid has become flatter (Perra, 2001). The image of the leader is changing due to decentralization. The evolving leadership behaviours must be described. The transformational leader is most suited to nursing environments (Wieck, 2003 cited in Cain, 2005). This type of leader centres on skills in interpersonal relationships.
Kouzes and Posner have identified 5 practices in exemplary leadership: modeling the way, inspiring a shared vision, challenging the process, enabling others to act and encouraging the heart. The learner’s inventory is a very easy instrument to use for analysis (Posners and Kouzes, 1988).
Modelling the way
Anyone can be granted good jobs but it is the credibility and behaviour which are the principal components which acquire respect. Credibility is a feature which is earned over time and must be nurtured constantly. Maintaining the fragile credibility is possible only through sincere effort. One incident of a thoughtless remark or unexplainable behaviour or a promise not kept may crumble an earlier reputation built up through years of hard work (Kouzes and Posner, 1990). A leader has to be respected and trusted before people follow him. His attempts to make time to spend with his staff and work with them, sharing jokes that have a significance among them go a long way in securing respect. Times of need and ambiguity are occasions for the leader to communicate with his staff or subordinates. Asking relevant questions and starting frequent discussions help to solder the relationship (Kouzes and Posner, 2002). The relationship should be one of trust and being trusted in return, focusing on honest communication. Apart from sharing information, the feedback on the assessment of people would be very honest. Only an energetic leader who is passionately involved in his work can be a model for others. Living a good life as a leader with a well-directed personal conviction is the right perspective to be observed by followers. Purpose and enthusiasm must be sufficiently infectious to influence other staff. Emotional intelligence and the ability to understand others’ difficulties are both essential to portray leadership qualities (Cain, 2005). The person who can honestly assess his skills and talents with the same significance as his shortcomings is the emotionally intelligent person. Self reflection should be a vital quality of an exemplary leader.
Inspiring a shared vision
A successful leader visualises a real situation and works backward to shape a few steps towards the situation (Cain 2005). He guides the following with confidence so that a change is evoked through his personal commitment to the issue. Making the vision real and achievable, availability and listening to the followers to solve their problems and supporting them in the process, a good leader would be in the making (Perra, 2001). The small number of obstacles and-risk-taking may need the strength of the leader behind the followers. Being honest reassures the others and convinces them about the significance of the change in their lives (Porter-O’Grady T, 2003). The art of persuasion is a handy characteristic for inspiration.
Challenging the process
Leaders trace potential risks, manage challenging processes as they arise and adopt many innovations on the way. Practice issues are challenged and constant research is done into existing patterns against innovative changes. Their confidence level and motivational attitudes provide the required inspiration to try new methods and adopt change (Kouzes and Posner, 2005). The flexibility of the mind in the process of accepting leadership and new ideas is a feature recognized in good leadership. Conflict is seen as a means for clarification and reinforcing meaningful change (Cain, 2005).
Enabling others to act
Clinical leaders have the power of turning other staff who are subordinate into leaders themselves (Kouzes and Posner, 2002). In every leadership position, decision-making is decentralized and those at the lower rung are allowed to have the taste of leadership. Allowing them to develop their own practice is part of a collaborative relationship (Kouzes and Posner, 2002). Guiding critical thinking, negotiation and clear communication, the other staff are led through the intricacies of leadership. The mentoring and coaching are experienced on a daily basis and continuous in nature. No specific date or time or exercise is defined for the coaching. It just becomes a long run with intermittent training. The leaders explore occasions for leadership training of the others with various types of people, some higher in post and some in similar ranks and others at a lower level. The other leaders are supported by the senior leaders in risk-taking, new behaviours and the acceptance of efforts which led to disaster or a failure (Cain, 2005). The ability to collaborate and foster a relationship through teamwork, engendering trust is the feature of a good leader. Leading the followers to develop their own initiative triggers all-round success (Cain, 2005). The leader’s success is based on the success of the followers. This kind of sharing of leadership and the enabling of other leaders produces leaders at all levels through the sustainability of initiatives. The departure of the leader will not harm the general performance of the outfit if the leaving leader has taken pains to produce several leaders who would continue in his place; many for one.
Encouraging the heart
Performances are rewarded by the leaders (Cain, 2005). This recognition would do well for the morale of the “student’ leaders. Strong feelings of collective identity build up keeping the leaders very much with the leader who has been mentoring them. Exposure to difficulties in dealing with issues in their field of action and risks assist the learners to exhibit their prowess in times of difficulty and crisis using their new found knowledge in leadership. Rewards make a difference in the lives of the leaders (Cain, 2005). This attitude is for them to practise giving rewards to their trainees. The process touches the hearts of the juniors and provides encouragement for more. Keeping the friendship of the colleagues and the trainees results in a wonderful cooperation and sincerity which would be reflected in the efforts at best performance. The culture that evolves out of the reward-giving is developed by all the leaders in course of time. A large family of “relations” is the consequence. Their everyday work experience would consist of their goals, values, hopes and insecurities (Cain, 2005). Some groups of leaders allot time intentionally for collecting opinions, listening to various perspectives, visiting patients or families and for sharing work-time. They would note occasions which re energize them and use them when a slump is noted in the relationship. Values, beliefs and integrity are inborn characteristics of good leaders (Cain, 2005). Sincere appreciation is welcomed and projected as determination and reinforced resilience.
Clinical leadership
Policy-making and multi-level collaboration at all levels of Health Services are steps towards effective clinical leadership (Watson, 2008). Mentoring and supervision demonstrate leadership. Conflict resolution, effective communication, critical thinking, delegation of powers, careful documentation are all occasions which need effective small actions which cumulate into strategic acts of leadership (Kerfoot, 2001). Methods used to influence the behaviours of others can be inspirational, providing intellectual stimulation and individual consideration (Bass and Avolio, 2000). Followers are motivated beyond their area of interest (McGuire and Kennerly, 2006). A primary element of transformational leadership is to be a visionary (Daly et al, 2004). Motivation may foster a sense of purpose guiding the pathway towards the goal. Leadership is a collective process and focused upon by theories. Leaders are not mere pioneers or change agents, mentors or advocates (Watson, 2008). They exhibit leadership qualities in different manners. The pioneering role involves the establishing and maintaining the role of leadership. Real change can be mooted by sharing the experiential relationships. Being able to influence health care policy and practice, amounts to assuming the role of a change agent.
Advocacy involves the group of actions which have the support of the community and politicians and is usually for a particular health program (Watson, 2008).
The role of medical records director
Clinical leadership roles have different parameters of work to evaluate competency. My role as medical records director allowed me to use the strategies of a leader before my subordinate staff. There were 8 of them in one place and 35 of them in another bigger hospital where I worked.
When I moved to the bigger hospital, I was surprised to find that the records section was an eye-wash. In my earnest desire to upkeep a high reputation in the office and to maintain a good service, I read a lot on leadership and the methods required to elicit the best from my staff. I planned to establish standards and departmental objectives for achievement. As the previous director had left a few months back and the staff was just making a feeble effort at keeping the show running, I found myself moving into a place which had forgotten its rules. Supervision and direction of the staff came to be my first attempt at overhauling things. At my first meeting with the staff, I gained some knowledge about the drawbacks in the department. Medical officers were not being given the records on time. The collection of the records was unnecessarily delayed from the wards. A quick scrutiny showed the laxity with which records were being maintained. Worst of all, the arrangement of the incoming records was being postponed and records were being missed at times. Bundles were found waiting for the arrangement. I realised that I had something to do.
My work encompasses the planning, organization and provision of medical records services in hospitals. The responsibility to provide high customer service, effective and efficient daily operations describes my job partially. Another significant responsibility is to keep up a positive physician interaction throughout the hospital. My education and my previous experience helped me to prepare some strategies for handling my department expertly. With the cooperation of the Hospital Manger, a meeting of all the physicians and other staff who are in some way connected to the records section was arranged. Thankfully the attendance was 93%. I had already informed the persons invited, the nature of the meeting and a request for complaints about the records section. Discussion helped me to find more room for improvement. Following the meeting, I streamlined the notes and filtered out similar complaints so that I had a whole lot of issues waiting to be set right. A few more points were noted other than what I had already gauged..
The first thing I did was to set a time schedule for finishing pending work. I conveyed the image of a strong person with a positive nature at our first meeting. The next meeting that I held was after the cut-off time for the pending work. The staff were not very enthusiastic about seeing me. My next effort was to be more friendly with them and get closer to one or two of the leaders among them.. They were a little afraid of me but with a little push, I found them eating out of my hands. My targets were easier to achieve now. At meetings with them, I coaxed them into finding solutions to our problems and ways to achieve them without creating issues. They told me so much that I got a better feel of my position and the manner to solve the problems. As the suggestions came from them, the execution part became easier. They became aware of their responsibility and how their laziness could affect others in the hospital, the police and the judiciary and the unfortunate patients who had court cases. Soon I identified more leaders and provided opportunities for them to practice their leadership qualities. Keeping abreast of current issues in the hospital and the places where our shortfalls had created confusion, the staff members were trained gradually into a more responsible group with specific objectives. Exhibiting myself as being above board and being very straight as far as punctuality of work goes has helped me model the way ahead. The belief in the person’s sincerity and the innovative changes that they exhibited helped me to continue being a good leader by allowing them to become leaders in their own right. Frequent discussions helped them acquire knowledge on the coding of records. Medical and procedural terminology; anatomy and physiology, abnormal laboratory results and disease process documentation; regulations governing confidentiality of medical records; release of information laws and statutes were the topics that were selected as topics for continuing education. Effective and courteous manners of communication orally and in writing were other methods I used to enable them to act their part in the records section. This motivated them a great deal.
Inspiring them by sharing my vision of a fully automated system of health records was my next success. They were convinced that quality health care can only be provided by completely accurate and timely data (GAO, 1993). Automated medical records have had obstacles due to lack of leadership. Many hospitals are still keeping records as large paper files in some corner of their institution and do not provide any help to involved patients by securing the necessary record. Delivery of health care can be improved by providing doctors with a good knowledge of their patient’s medical histories. Comprehensive standards must be followed for sharing medical information (GAO, 1993). These efforts would reduce the number of tests repeated for each doctor. Insurers would be better informed and thereby increase their efficiency.
The future of this system would be to share information among hospitals and doctors and the existence of only one set of records for a person. Comprehensive messaging standards should be implemented to transmit patient information effectively. Security systems must be installed alongwith. All these would materialize only if hospital administrators, doctors, researchers and policy makers agree totally to automate records. However my vision has instilled enthusiasm in my staff.
My guidance has helped my staff face and survive potential risks. Challenging the process has become much easier now. Using new methods and innovative ones at that has become a natural process. I have started giving rewards to my staff. Defining certain targets which I maintain, I ensure that the person who wins gets the reward. Recently I started having family get-togethers where I get to see the family of the staff. This is another way I am “encouraging the heart.” We have extended our get-togethers to include their close family.
I have used the five practices of leadership in my practice as medical records director.
References
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- Wieck, K.L. and Evans, M.L., 2003. Developing the role of leader, In Leading and Managing in Nursing, (eds). Yoderwise P.S., 3rd Ed, St.Louis MO: Mosby, p. 19-34