Clinical Leadership in Nursing and Healthcare offers a range of tools and topics that support and foster clinically focused nurses and other healthcare professionals to develop their leadership skills and strategies. The textbook is helpfully divided into three parts: information on the attributes of clinical leaders, the tools healthcare students and staff can use to develop their leadership potential, and clinical leadership issues. It also outlines a number of principles, frameworks, and topics that support nurses and healthcare professionals to develop and deliver effective clinical care as clinical leaders. Lastly, each chapter has a range of reflective questions and self-assessments to help consolidate learning.

The newly revised third edition has been updated in light of recent key changes in health service approaches to care and values. While it covers a wide spectrum of practical topics,Clinical Leadership in Nursing and Healthcare also includes information on:Theories of leadership and management, organisational culture, gender, generational issues and leaders, project management, quality initiatives, and working in teamsManaging change, effective clinical decision making, how to network and delegate, how to deal with conflict, and implementing evidence-based practiceCongruent leadership, the link between values and actions, authentic leadership, leaving behind control as an objective, and managing powerWhy decisions go wrong, techniques for developing creativity, barriers to creativity, conflict resolution and management, negotiation, self-talk, and leading in a crisis

With expert input from a diverse collection of experienced contributors,Clinical Leadership in Nursing and Healthcare is an invaluable resource for new leaders trying to establish themselves and existing leaders looking to perform at a higher level when it comes to quality and effective patient care.

Dr David Stanley, RN, RM, Gerontic Cert, Grad Cert HPE, Dip HE (Nursing), BN, MSc (Health Sciences), TF, NursD. David is a Registered Nurse and Midwife. He began his nursing career in the 1980s and his interest in clinically focused leadership came about because he was once a Nurse Practitioner. David was formerly an Adjunct Professor at Charles Sturt University and a Research Mentor at Fijis National University. He retains his passion for the development of empowered nurse leaders and frontline health professionals with a focus on high quality clinical care.

Dr Clare L. Bennett, D.Nurs, SFHEA, PGCE, MSc, BSc (Hons), Dip.N, RGN. Clare is a Registered Nurse with a background in Sexual Health, Immunology, HIV and Infectious Diseases. She is a Doctor of Nursing and is currently a Senior Lecturer at Cardiff University. She has taught Leadership, Quality Improvement and Patient Safety on undergraduate and postgraduate programmes for nurses and allied health professionals for over two decades. Clare is also an honorary lecturer at the University of Freiburg, Germany, where she teaches clinical leadership in the context of advancing clinical practice. Clare is Co-Director of the Wales Centre for Evidence Based Care and teaches and coaches in the field of evidence development and implementation.

Dr Alison H. James, DAHP, SFHEA, PGCE, MA, BA (Hons), Dip Critical Care, RGN, BA. Alison is a Registered Nurse and Doctor of Advanced Healthcare Practice with a background in Neurosciences, Critical Care, Osteoporosis and Knowledge Transfer in health and social care. She is a Senior Lecturer at the School of Healthcare Sciences at Cardiff University in Wales, UK. Alison teaches Leadership and Quality Improvement on programmes across the nursing and allied health programmes at undergraduate and postgraduate level and is a coach and mentor for student leadership in the UK. Alisons research is focused on leadership development in the healthcare workforce and education, how this impacts delivery and quality of patient care and influences cultures within healthcare environments.

Notes on Contributors xvii

Preface xxi

Acknowledgements xxv

Part I Clinical Leaders: Role Models for Values Based Leadership 1

1 Clinical Leadership Explored 5
David Stanley

Introduction 5

Clinical Leadership: What Do We Know? 6

Attributes Less Likely to Be Seen in Clinical Leaders 8

Clinical Leaders Are Not Seen as Controlling 8

Clinical Leaders Are Not Seen as Visionary 8

Clinical Leaders Are Not Seen as Shapers 10

Attributes More Likely to Be Seen in Clinical Leaders 11

Clinical Competence/Clinical Knowledge 11

Approachability 13

Empowered/Motivator or Motivated 13

Supportive 13

Inspires Confidence 14

Integrity/Honesty 14

Role Model 14

Effective Communicator 15

Visible in Practice 15

Copes Well with Change 16

Other Attributes 16

Values: The Glue that Binds 17

Who Are the Clinical Leaders? 18

Clinical Leadership Defined 21

Why Clinical Leadership Now? 21

A New Agenda 22

Changing Care Contexts 22

Change Equates to More Leadership 22

More Emphasis on Quality 23

Summary 25

Mind Press Ups 25

References 26

2 Leadership Theories and Styles 31
David Stanley

Introduction: Leadership What Does It All Mean? 31

Leadership Defined: The Blind Mans Elephant 33

No One Way 36

Leadership Theories and Styles 36

The Great Man Theory: Born to Lead? 36

The Heroic Leader: Great People Lead 37

The Big Bang Theory: From Great Events, Great People Come 37

Trait Theory: The Man, Not the Game 38

Style Theory: Its How You Play the Game 40

Situational or Contingency Theory: Its about Relationships 42

Transformational Theory: Making Change Happen 44

Transactional Theory: Running a Tight Ship 46

Authentic/Breakthrough Leadership: True to Your Values 47

Servant Leadership: A Follower at the Front 48

Other Perspectives 50

Shared Leadership/Collaborative Leadership 50

Compassionate Leadership 50

The Right Leader at the Right Time 51

Summary 54

Mind Press Ups 54

References 55

3 Values Based Leadership: Congruent Leadership 61
David Stanley

Introduction: A New Theory 61

Values Based Leadership 62

Values Based Leadership Theories Applied in Healthcare 62

Congruent Leadership: Another View 66

It All Started with Clinical Leadership 66

Congruent Leadership Theory Explored 79

A Solid Foundation 80

The Strengths of Congruent Leadership 82

Grassroots Leaders 83

Foundation for Other Theories 83

Strong Link between Values and Actions 84

Supports Further Understanding of Clinical Leadership 85

Anyone Can Be a Congruent Leader 85

The Limitations of Congruent Leadership 85

New Theory 85

Similar to Other Values Based Leadership Theories 86

Not Driven by a Focus on Change 86

Not Suitable for Leaders with Control as an Objective 86

Congruent Leadership, Change and Innovation 87

Congruent Leadership and Power 88

Congruent Leadership and Quality 91

Summary 96

Mind Press Ups 97

References 97

4 Followership 105
David Stanley

Introduction: From behind They Lead 105

Defining Followership 106

Followers Responsibilities 106

The Good Follower 110

The Not So Good Follower 113

Summary 116

Mind Press Ups 117

References 117

5 Leadership and Management 119
Clare L. Bennett and Alison H. James

Introduction: Why Delineate? 119

Who Should Take Centre Stage? 120

Skills 123

The Need for Education 125

Toxic or Misunderstood? 127

The Future 128

A Culture Shift 129

Summary 131

Mind Press Ups 132

References 133

Part II Clinical Leadership Tools: How to Influence Quality, Innovation and Change 137

6 Organisational Culture and Clinical Leadership 139
Sally Carvalho and David Stanley

Introduction: Values First 139

What Is Organisational Culture? 139

A Culture of Care and Compassion 142

Culture and Leadership 144

How Congruent Leaders Shape Culture 146

Clinical Leadership, Education and Training 150

Summary 152

Mind Press Ups 153

References 153

7 Leading Change 157
Clare L. Bennett and Alison H. James

Introduction: Tools for Change 157

All Change 158

Transformational Change 159

Approaches to Change 160

SWOT Analysis 161

Stakeholder Analysis 162

Pettigrews Model 163

The Change Management Iceberg 164

PEST or STEP 165

Kotters Eight Stage Change Process 166

Nominal Group Technique 166

Process Re Engineering 167

Force Field Analysis 168

Restraining Forces 169

Driving or Facilitating Forces 169

How Do You Find Either Restraining or Facilitating Forces? 170

Initiating, Envisioning, Playing, Sustaining: A Theoretical Synthesis for Change 171

Beckhard and Harriss Change Equation 172

People Mover Change Model: Effectively Transforming an Organisation 172

Instituting Organisational Change: An Examination of Environmental Influences 172

Change Is Never Simple, Even with a Model 172

Resistance to Change 173

Self Interest and Conflicting Agendas 173

Increased Stress 173

Uncertainty 174

Diverging Points of View 174

Ownership 174

Recognising the Drivers 175

Some People Just Do Not Like Change 175

Recognising Denial and Allowing Time for Reflection 175

Successfully Dealing with Change 176

Summary 179

Mind Press Ups 180

References 180

8 Patient Safety and Clinical Decision Making 183
Clare L. Bennett and Alison H. James

Introduction: A Choice 183

Patient Harm 183

What Is Patient Safety? 184

Leadership and Patient Safety 185

Clinical Decision Making and Patient Safety 186

Terminology 188

Decision Making Approaches 188

Theories of Clinical Decision Making 190

Knowledge and Information 191

Intuitive Humanistic Model 191

Systematic Positivist, Hypothetico Deductive and Technical Rational Models 192

Integrated Patient Centred Model 192

IDEALS Model 193

Managerial Decision Making Process 193

Clinical Leadership and Decisions 194

Why Decisions Go Wrong 195

Not Using the Decision Making Framework 195

Flawed Data 195

Bias 195

Seeking to Avoid Conflict or Change 196

Ignorance 196

Hindsight Bias 196

Availability Heuristics 196

Over Confidence in Knowledge 196

Haste 196

How about Emotion? 197

Group Decision Making 197

Advantages of Group Decisions 198

Disadvantages of Group Decisions 198

Challenges 198

Summary 200

Mind Press Ups 201

References 201

9 Creativity 205
David Stanley

Introduction: A New Way Forward 205

What Is Creativity? 206

Building Creative Capacity 209

Techniques for Developing Creativity 210

Relax 211

Keep a Notebook or Journal 211

Journaling 211

Record Your Ideas 211

Do or Learn Something New Each Day 211

Learn to Draw 211

Become a Cartoonist 212

Learn to Map Your Mind 212

Try Associational Thinking 212

Go for a Walk 212

Adopt a Genius 212

Open a Dictionary 213

Study Books about Creative Thinking 213

Flood Yourself with Information 213

Attend Courses 213

Listen to Baroque Music 213

Face a New Fear Every Day 213

Develop Your Imagination 213

Leave Things Alone for a While 214

Find a Creative Space 214

Develop Your Sense of Humour 214

Define Your Problem 215

Know Yourself Well 215

Use Guided Reflection 215

Be Mindful 215

Focus 215

Do Not Be Afraid to Fail 215

Develop Some Techniques for Creative Thinking 215

Barriers to Creativity 216

Organisational Barriers 217

Competition 217

Organisational Structure 217

Being Too Busy to Address a Problem 217

Too Hectic an Environment 217

A Sterile Environment 217

Poor or Harsh Feedback 218

Rules 218

Unrealistic Production Demands 218

The Boss Is Always Right 218

Poor Communication 218

Personal Barriers 219

Fear of Criticism/Fear of Failure 219

Our Belief that We Are Not Creative 219

Fear of Change 219

Ego 219

Beliefs and Values 219

Lack of Confidence 219

Stress 220

Previous Negative Experiences with Risk 220

Negative Self Talk 220

Routines 220

Other Barriers 220

Daily Distractions 220

Not Having a Place to Go or Time to Get There 220

Drugs 220

Leadership and Creativity 221

Summary 224

Mind Press Ups 224

References 225

10 Leading Teams 227
Alison H. James and Clare L. Bennett

Introduction: Identifying Dynamics and Self Role within Teams 227

Do We Really Need Teams? 228

Are We a Team or a Group? 229

Established Teams 230

High Performance Teams 230

OK or Functional Teams 232

Struggling Teams 232

Teaming for Healthcare 233

Creating Powerful and Positive Teams 234

Psychological Safety 236

Team Building 236

Team Roles 237

Leadership and Teams 239

Summary 241

Mind Press Ups 241

References 242

11 Networking and Delegation 245
Tracey Coventry

Introduction: Strength in Numbers 245

Networking 245

The Skills of Networking 246

Get Yourself Known 247

Volunteer 247

Join a Professional Organisation 247

Look Beyond Your Own Organisation 247

Be Professionally Committed and Have Clear Messages 247

Join Professional Discussion Groups 248

Use Social Networks 248

Engage with Professional Development 248

Go to Conferences 248

Mentor Others or Be Mentored 249

Travel (for Professional Reasons) 249

Develop a Clinical Supervision Process 249

Expand Your Informal Coffee Network 249

Publish 250

Other Ideas 250

Networking Through Social Media 250

Networking Tips 251

Delegation 252

Effective Delegation 253

Common Mistakes in Delegation 255

Under Delegation 255

Over Delegation 255

Inappropriate Delegation 255

Failing to Provide Sufficient Supervision 256

Resistance to Delegation 256

Delegation and Clinical Leadership 256

Summary 258

Mind Press Ups 259

References 260

12 Dealing with Conflict 261
Kylie Russell

Introduction: Collaboration or Clash 261

Past Conflict 262

Influencing Factors 262

Conflict Styles 263

Conflict at Work 266

Conflict Resolution 267

Responding to Conflict 268

Conflict Management and Clinical Leaders 270

Building Bridges: Negotiation and Mediation 271

Pre Negotiation Phase 271

Negotiation Phase 271

Post Negotiation Phase 272

Non Productive Behaviour 273

Negativity 273

Being Talkative 273

Attention Seeking 273

Arrogance 273

Arguing 274

Withdrawing 274

Aggression 274

Complaining 274

Active Listening 275

Self Talk 276

I Messages 277

Communication Styles 278

Mindful Communication 279

Assertive Communication 279

Communication Tools 279

CUS/S 280

CUS 280

PACE 280

Benefits of Conflict Management 280

Summary 282

Mind Press Ups 283

References 284

13 Motivation and Inspiration 287
David Stanley

Introduction: Inspiring Others 287

What Is Motivation? 288

Models and Theories of Motivation 288

Maslows Hierarchy of Needs 288

Expectancy Theory 290

Job Characteristics Model 290

How to Motivate Others 290

Signs that People Are Demotivated 293

The Motivational Power of Failure 294

Inspiration 296

Summary 298

Mind Press Ups 299

References 300

14 Creating a Spirit of Enquiry (Enhancing Research) 303
Judith Anderson, Sarah Dineen Griffin and David Stanley

Introduction: Is the Spirit with You? 303

Two Keys 303

Evidence Based Practice 304

How to Create a Spirit of Enquiry 306

Being Involved in Research 306

Role Modelling Use of EBP 306

Mentorship 307

Understanding the Value of a Nexus 307

Encouraging Quality Improvement Initiatives 307

Fostering Innovation 307

Rewards 308

Professional Development Opportunities 308

Collaboration 308

Journal Clubs 309

Making It Relevant to Practice 309

Benefits of Evidence Based Practice and a Spirit of Enquiry for Health Professionals 309

Barriers to the Development of a Spirit of Enquiry and the Use of Evidence Based Practice 310

Applying Evidence Based Practice 311

Strategies for Breaching the Evidence/Practice Nexus 312

Diffusion: A Simple Form of Nexus Development 314

Dissemination: More Involved with Wider Nexus Results 314

Implementation: Key Nexus Activity Integration 314

What Can Clinical Leaders Do to Promote Evidence Based Practice and a Spirit of Enquiry? 315

Summary 318

Mind Press Ups 318

References 319

15 Reflection and Emotional Intelligence 323
David Stanley

Introduction: The Noblest Way to Wisdom 323

What Is Reflection? 323

Reflection and Learning 324

Benefits of Reflection for Clinical Leaders 324

Better Self Knowledge/Increased Self Awareness 325

Identification of Your Values 325

Connection to Caring 325

More Effective Working Relationships/Stronger Teams 325

Empowerment 325

Learning from Mistakes 326

Models to Support Reflection 326

Using Reflective Models 327

Approaches to Reflection 327

What Is Emotional Intelligence? 329

The Five Building Blocks of Emotional Intelligence 329

Reflection on Reflection and Emotional Intelligence 331

Summary 333

Mind Press Ups 333

References 334

16 Quality Improvement 337
Clare L. Bennett and Alison H. James

Introduction: What Does Good Quality Healthcare Look Like? 337

Systems Thinking 338

The Quality Cycle A Quality Management System 340

Quality Initiative Stories 343

Project Management 344

Project Management Explored 345

What Is a Project? 345

What Is Project Management? 345

What Is the Role of a Project Manager? 346

How Is Project Management Structured? 346

Phase 1: The Initial Phase 347

Project Management Team 347

Time, Money and Scope 347

Charter 347

Scope Statement 347

Phase 2: The Intermediate Phase 348

Planning the Project 348

Baseline 348

Progress or Executing the Project 349

Acceptance or Controlling the Project 349

Phase 3: The Final Phase 349

Closure of the Project 349

Key Issues 349

The Components of Project Management 350

Final Project Management Issues 350

Implications for Clinical Leaders 350

Summary 352

Mind Press Ups 352

References 353

Part III Clinical Leadership Issues: The Context of Values Based Leadership 355

17 Gender, Generational Groups and Leadership 357
Julie Reis and Denise Blanchard

Introduction: The Impact of Gender and Generations 357

Is There a Difference? 357

The Case for a Difference 358

The Case for No Difference 359

Challenges for Women in Leadership 360

The Causes of Gender Differences in Leadership 362

Personal Differences 362

Professional Differences 363

Potential Barriers that Female Leaders Face 364

Recommendations and Strategies to Address Gender Differences Manage Gender Bias 367

Gender and Congruent Leadership 369

Generational Differences and Leadership 369

Builders 370

Baby Boomers 370

Generation X 370

Generation Y 370

Generation Z 371

Generation Alpha 371

Summary 376

Mind Press Ups 376

References 377

18 Power, Politics and Leadership 385
Alison H. James and Clare L. Bennett

Introduction: Power and Politics 385

A Beginning 386

Professional Power 386

Power Base 387

Powerlessness and Abuse 388

Influencing Styles 389

Critical Social Theory 392

Healthcare and Politics 394

Practical Politics 396

Dealing with the Media 396

Becoming Politically Active 397

Its How You Use It! 398

Summary 399

Mind Press Ups 400

References 400

19 From Empowerment to Emancipation Developing Self Leadership 403
Alison H. James and Clare L. Bennett

Introduction: Elevating Your Voice 403

Defining Empowerment 404

The First Perspective: Empowerment as a Tool 405

The Second Perspective: Empower Walking 406

Oppression: Bridging the Power Divide 410

Liberated Leaders or Co Oppressors? 412

How Can Oppressed Groups Liberate Themselves? 414

Summary 416

Mind Press Ups 417

References 418

20 Leading Through a Crisis 421
Alison H. James and Clare L. Bennett

Introduction 421

Defining Crisis 422

Flexibility, Innovation and Resilience 424

Lessons Learnt for the Long Term 425

Maintaining Compassion and Empathy in Leadership 426

Considering the Emotions of the Experience 428

Leading for Self Care and Well being 428

Stories of the Crisis 429

Summary 433

Mind Press Ups 433

References 434

21 Clinical (Values Based/Congruent) Leaders 439
David Stanley

Introduction: Clinical Heroes 439

Many Marys 440

Values Based or Congruent Leaders beyond the Ward 442

The First Step: Finding Your True Voice 443

Innovation, Change and Quality 444

Two Final Examples of Values Based/Congruent Leaders 445

Mother Teresa 445

Tank Man 446

Conclusion 447

Summary 447

References 448

Index 451