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Discussion: Strategic Management and Leader Innovation

Purpose

The purpose of this discussion is to explore strategic management strategies and successful leadership skills. The U.S. healthcare delivery system is complex and rapidly changing. The DNP-prepared nurse faces many challenges and opportunities to impact positive change in healthcare organizations.

Reflect upon your readings and professional experience regarding strategic management and innovation and address the following.

  1. Examine ways that a DNP-prepared nurse can be more involved in strategic management decisions.
  2. Explore initiatives and/or strategies that the DNP-prepared nurse can employ to build a culture of quality and safety.

Instructions:

Use an APA 7 style and a minimum of 250 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used

*attached week lecture.***

Strategic Management and Leader Innovation

The healthcare system has been undergoing radical change for the last decade. This radical transformation has impacted healthcare access, delivery, and reimbursement structures and processes to achieve patient care outcomes that are predictable and reliable over time. In 2010, the Affordable Care Act (ACA), signed into law by President Obama, and the Healthcare and Education Rehabilitation Act, have been the most significant overhaul of the healthcare system since Medicare and Medicaid in 1965. Additional societal drivers such as the aging population, chronic disease management, healthcare provider shortages, patient management systems, and innovation of medical care and new technology continue to impact overall healthcare improvements in the areas of cost and quality. The overarching goal that these changes impact is the ability to develop clear paths to improve quality and safety, reduce cost, and maximize the patient care experience.

Care delivery, payment methods, patient engagement, integrated healthcare delivery systems, accountable care organizations, and value-based purchasing changes require a transformational leadership style to embrace and lead change. System challenges for the nurse executive include a shift from a volume-driven fee-for-service system to an integrated patient-centered approach receiving rewards and penalties based on the delivery of efficient, quality-focused care. Leaders outsource services to reduce costs and develop evidence-based quality standards to reduce variation in practice. Payment capitation promotes the development of integrated, cost-effective, interdisciplinary team-based approaches to care delivery.

Transformational leadership characteristics will promote successful innovations to guide the team through this complex change. Transformational leaders motivate others to focus on the good of the organization by using charisma, inspiration, intellectual stimulation, and individual considerations. Healthcare organizations need nurse executives who can both lead and develop transitions to deliver low-cost, quality healthcare while maximizing the patient care experience.

Teambuilding Strategies and Self-Awareness

High-performing organizations and teams include team members from all levels of the organization working together to achieve a common goal. The unique perspectives that members bring to the team is important for overall success. Team characteristics such as trust, mutual respect, transparency, clear goal setting, and member accountability are essential components of highly effective teams. Often factors such as lack of commitment, competing issues, mistrust, conflict, lack of shared accountability, and communication deficiencies create stress on the team as a whole. Adding personal agendas, toxic communication patterns, and dysfunctional interpersonal and group dynamics further complicates the situation. Overall resistance to change among leaders and team members creates additional stress on the team, which hinders achieving the mission and goals.

Creating conflict-management strategies that do not sacrifice individual team members but create shared team experiences is essential to overall team success. The more the team members can develop collaborative team skills to meet team goals, the less competing and assertive behaviors will be demonstrated by team members. Conflict management techniques stress the importance of open and honest communication to include a respect for others. Very often, team communication involves high-stakes situations in which emotions run high. Leadership strategies to coach and mentor individuals through these situations include taking time to analyze the situation fully, the ability to articulate a clear goal so that individuals can achieve it with mutual purpose, listening with genuine understanding, speaking persuasively and clearly, articulating a clear plan of action, creating a safe, risk-free environment for members to have discussions, and taking charge of your emotions and developing self-awareness. Fostering a sense of shared accountability helps individuals move from self and also develops a cooperative, collaborative environment fostering the genuine appreciation of strengths that each team member brings to the team.

Rath and Conchie (2008), in the book titled Strengths Based Leadership, summarized that if a leader focuses on people’s weaknesses, they will lose confidence. Being aware and focusing on individual strengths will improve team engagement and satisfaction. Followers have four basic needs: trust, compassion, stability, and hope. Developing trust in the workplace will increase efficiency. Genuine compassion from leaders create a work environment such that individuals are substantially more productive and are more likely to stay with their organizations. Leader stability equates with the words securitysupport, and peace.

Understanding and Developing Self-Awareness

Areas of self-awareness include personality, values, how you perceive change, habits, and interpersonal interactions. The DNP-prepared nurse will gain insight into her or his own motivations as well as the motivations of others based on understanding and becoming self-aware. Self-awareness promotes an understanding of team members’ diversity of interactions. Surrounding yourself as a leader with those like you will only lead to stagnation. Understanding your modus operandi will sensitize the leader to differences with others in order to bring forth creativity, growth, and success in the workplace.

The DNP-prepared nurse executive toolkit includes resources needed to effectively lead interdisciplinary teams to improve complex healthcare system challenges. In order to optimize effectiveness, interdisciplinary teams must have a combination of the following skills: decision making, technical, problem solving, and interpersonal. It is imperative that team members understand why the team exists and how the team goals align with addressing the organization’s priorities. Old paradigms of winning and losing must be replaced with collaboration and mutual goal setting and shared accountability. Members must be willing to let go of the past and focus on the future. Allowing teams to develop through the stages of forming, storming, norming, and performing is essential for the nurse executive leader to navigate. Review the activity below to gain insight on team effectiveness:

Leadership presence and understanding of the various stages and behaviors in team development is essential to ensure the team develops in a goal-driven way. If leadership style becomes controlling or autocratic during the forming and storming stages of team development, it is highly likely the team will develop dysfunction, members will be sacrificed, and fear driven behaviors will result. However, if the nurse executive leader employs leadership skills that creates effective teams by establishing the team’s orientation (purpose, identity, membership), builds trust (mutual respect, candid dialog, reliability), clarifies team goals (shared vision), develops commitment (assigned roles, resource allocation, makes decisions based on team goals), then healthy sustainability of the team will develop. The team will then be able to implement and surpass team goals set, perform with synergy, and recognize and celebrate team success.

Quality and Safety Initiatives in Healthcare

The Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System (2000) was the first report that presented aggregate data on the depth and breadth of quality and safety gaps in U.S. hospitals. The subsequent report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001), further detailed a need for sweeping reform of the healthcare system in America. Other reports on the topics of Health Professions Education: A Bridge to Quality (2003), Keeping Patients Safe: Transforming the Work Environment for Nurses (2004), Identifying and Preventing Medication Errors (2006), and others further detail quality and safety concerns in the healthcare system. The healthcare industry is seeking wisdom from other industries to develop high-reliability organizations. One primary gap in comparing safety and quality practices of healthcare to other industries is that healthcare does not have a single designated agency that sets and communicates goals for organizations to achieve and systematically collects and analyzes reports for broad dissemination to ensure that safety best practice and safety alerts are communicated across all healthcare settings (Sherwood & Barnsteiner, 2017). 

In 2001, the IOM issued four recommendations with a national focus on improving safety and quality. The recommendations aim to increase safety standards, improve safety systems in healthcare organizations, and provide an opportunity to learn from errors through the establishment of reporting systems to ensure that care improves.

Progress reports have been submitted at 5-year and 10-year intervals to assess the progress made on these four recommendations. Key improvements made during this time frame focused on leadership engagement and reporting systems. Stronger accreditation standards and error reporting have produced the business case for concentration in the area of safety efforts system wide. 

Organizations such as the Joint Commission (TJC) and the Institute for Healthcare Improvement (IHI) have gotten involved with establishing safety standards. TJC annually formulates updated National Patient Safety Goals, and the IHI has brought all professions together to advocate for quality and safety. In addition, Medicare and Medicaid programs have revised payment structures to reduce hospital-acquired conditions. Healthcare organizations are no longer being reimbursed if patients acquire any of 10 preventable conditions (many of which are nursing-focused interventions) (Center for Medicare and Medicaid Services, 2008).

Various professional nursing organizations have responded to the call to increase safety and quality within health systems. The American Nurses Association (ANA) formulated a National Database of Quality Indicators (NDNQI) that details nurse-sensitive indicators aimed at monitoring improvements in nurse-driven outcomes. The American Association for Critical Care Nurses developed competencies related to healthy work environments with key initiatives focused on teamwork and collaboration. In addition, the Quality and Safety Education for Nurses (QSEN) project focused on prelicensure and graduate nurse competencies imperative to preparing future nurses (Sherwood & Barnsteiner, 2017).

References

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

Centers for Medicare & Medicaid Services (CMS). (2008). Hospital acquired conditions. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html

Institute of Medicine (IOM). ( 2001). Crossing the quality chasm: A new health system for the 21st century. http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Institute of Medicine (IOM). (2000). To err is human: Building a safer health system. http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Rath T., & Conchie, B. (2008). Strengths based leadership: Great leaders, teams and why people follow (8th ed.). Gallup Press.

Sherwood, G., & Barnsteiner, J. H. (2017). Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.). Wiley Blackwell.

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