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Case Study 4 - Leadership

The document from Foundations of Professional Nursing discusses the im...
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Fdtns Of Professional Nursing (NSG 252)

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Chapter 4

Innovation and Opportunity: Leading Through the White Water of Change

Case Study 4-

Developing a Culture of Interprofessional Collaboration

As the chief nursing officer (CNO) of a large metropolitan hospital, Jesse has established a strong reputation as a “mover and shaker” in nursing leadership circles. He is greatly admired by his colleagues who are CNOs at other hospitals in the region. For the most part, Jesse is proud of his many accomplishments and very satisfied in his current role at the hospital, but lately he has been feeling restless and is concerned that the entire organization could do a better job of creative thinking to address needed changes to ensure excellence in patient care, excellence in the work environment, and excellence in individual professionalism. Jesse shares his concerns with his colleagues on the hospital executive team, and they all reassure him that he should simply be satisfied with the hospital’s reputation as a premier place to work, receive care, and practice professionally. Despite his colleagues’ opinions, Jesse feels that there is an opportunity to make the best even better. He feels that there are a number of age- old issues confronting nursing that never seem to be completely addressed or resolved. The notion of interprofessional practice and collaboration is one example. Jesse realizes that the nursing profession has talked about the importance of interprofessional practice for at least 45 years, and in 2010, interprofessional practice was cited as critical for optimal patient outcomes in the Robert Wood Johnson Foundation’s Future of Nursing report, the Institute of Healthcare Improvement’s report, and the Agency for Healthcare Research and Quality’s report. Jesse realized that the healthcare literature is replete with articles citing the benefits of interprofessional collaboration and its importance in enhancing job satisfaction, organizational commitment, and professionalism and for minimizing job stress and interprofessional conflicts. In spite of all of the evidence and rhetoric about interprofessional collaboration, Jesse realized that the hospital had not achieved interprofessional collaboration or practice. Although the hospital had made great strides in improving the organizational culture by addressing behavioral standards and values that were to be the norm for every employee and every physician affiliated with the hospital, there were many instances when physicians practiced very independently from the nurses caring for their patients. Both nurses and physicians were frustrated, feeling that they were not valued or respected by the other party for their knowledge and skills in caring for patients and families. Several particular situations triggered Jesse’s concern about the subject, and he felt that there was an underlying tension that could be a platform upon which to initiate some creative dialogue and ideas for changing the culture to support and encourage interprofessional collaboration and practice. He realized, however, that it was impossible to motivate others to make a change in their relationships and interactions with others, but he considered his options for developing some internal motivation that would spur individuals to take the lead in championing such a change. Jesse wanted to ensure that there was alignment among nurses and physicians with the hospital’s behavioral standards and values, which were widely accepted by employees and physicians throughout the organization. It seemed, however, that some physicians and nurses felt that collaboration was not a part of the accepted values. Jesse wanted to change this perception so that interprofessional collaboration would be a valued behavior among all disciplines and specifically between nurses and physicians.

After much thought Jesse decided to form an interprofessional task force composed of nurses, physicians, and key individuals from other divisions such as radiology, dietary, surgery, and laboratory services. In choosing individuals to be a part of the task force, he invited individuals who were exemplar collaborators and some who were referred to as “problem” individuals. He also identified a group of individuals who could be champion leaders on each of the nursing units from the recommendations of the directors of the respective nursing services. The plan was to roll down the work of the task force to the point-of-service and to bubble up ideas from the point-of-service to the task force. One of the directors suggested that all newly hired nurses and nurses in the nurse residency program be rotated for a day or more in each of the ancillary departments, which would give the orienting nurses the opportunity to see the internal workings of each of the departments and how they interfaced with the respective nursing units. All directors felt that this was a very worthwhile plan, although there were some front-end investment costs because the on-boarding of new nurses would take at least an extra week. They all believed that this action would create a better understanding of the intersections between nursing and ancillary support departments. The first meeting of the interprofessional task force was very introductory in nature, and most participants were a bit skeptical about the efficacy of such an initiative. The “problem” physicians and nurses were the most skeptical, and their body language spoke loudly that they did not value this new initiative, nor did they value the notion of collaboration. Some of the more skeptical physicians were of the belief that physicians were the authority for the patient plan of care and that nurses were simply to follow physician orders. A few nurses on the team were quite content simply to follow physician orders and had no need for any further interaction to discuss a patient’s condition, needs, or plan of care. On the other hand, a few very progressive physicians and nurses were excited about an initiative to improve communication and collaboration among all team members for the benefit of patients and families. Fortunately, Jesse noticed that these individuals were more vocal in the task force, and he hoped that they would create the context for an innovative strategy to improve point-of-service interprofessional collaboration and provide some peer pressure for the others to follow. Jesse realized that this entire initiative was a cultural change and that it would need time to be formulated, implemented, and solidified in the minds of individuals for collaboration to become a new value and behavior. The interprofessional task force convened a number of meetings, and the group brought forth many ideas. Part of the process included presentations of studies in both the medical and nursing literature that demonstrated the importance of interprofessional collaboration in ensuring optimal patient outcomes. Most task force participants were very engaged in the process, inquired as to how certain actions might be initiated at the unit level, and asked how they might ensure that nurses and physicians at the unit level could take ownership of the change. Jesse and the rest of the executive team reviewed the progress of the task force and attended many meetings to assure the team that they were supportive of their work. The executive team also brought in an industrial organizational psychologist who was a noted specialist in organizational change to facilitate the team meetings and discussions. The group was quite energized with this external consultant, who brought a new perspective and fresh ideas to the table. After several months of meetings, the task force was finally ready to roll out an innovative strategy to promote interprofessional collaboration at the unit level. Jesse and the rest of the executive team were amazed at the ownership that the team had taken and how enthusiastic they were to launch the initiative. One physician leader offered to be the physician champion, and the

 How did Jesse and the rest of the executive team create the context for an innovative solution to this age-old problem in health care?

“Innovation is essentially a point-of-service activity. Everyone has a role to play in the processes associated with successful innovation” (Albert et al., 2022, p. 162). Therefore, Jesse and the rest of the executive team had to think that how to bring people together so they can work collaboratively because to for successful innovation everyone has to work together. Jesse found the problem and was trying to encourage everyone to address the problem. Jesse was available to help everyone who wanted to be part of the team for this change. He was trying to motivate team members and wanted them to encourage more people so they can make this change successful.

 What were some of the initiatives that motivated the interprofessional task force to become engaged in the process and to become owners of the solution?

The interprofessional task force convened a number of meetings, and the group brought forth many ideas. Part of the process included presentations of studies in both the medical and nursing literature that demonstrated the importance of interprofessional collaboration in ensuring optimal patient outcomes. Most task force participants were very engaged in the process, inquired as to how certain actions might be initiated at the unit level, and asked how they might ensure that nurses and physicians at the unit level could take ownership of the change. Jesse and the rest of the executive team reviewed the progress of the task force and attended many meetings to assure the team that they were supportive of their work. The executive team also brought in an industrial organizational psychologist who was a noted specialist in organizational change to facilitate the team meetings and discussions. The group was quite energized with this external consultant, who brought a new perspective and fresh ideas to the table.

 How would you have handled the dissenting providers/physicians and nurses who did not recognize the importance of collaborative behavior and who held on to past values of hierarchy, authority and submissive, task-based nursing?

According to Albert et al., “Each discipline makes an intentionally equal and unique contribution to the work of other disciplines and to the evidence and impact of patient care” (2022, p. 142). I would have handled the dissenting providers/physicians and nurses who did not recognize the importance of collaborative behavior by providing them evidence that how each of them are interrelated when it comes to patient care. I would have educated them that how they are significant members of the organization who provides quality care to the patients and their contribution is essential and can affect their and other members’ work. When they all will be working together or collaborate, both sides will get benefit and can bring a successful change which further improve patient quality care. The idea of rotating shifts for newly hired nurses

is great because it can help the new nurses to know how each department works independently but still need to collaborate with other departments.

 Using the four core competencies from the IPEC (Interprofessional Education Collaborative), which competency/sub-competencies will be the most challenging to implement in this case study?

The competency that will be the most challenging to implement in this case study is #4 “Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. (Teams and Teamwork)” (“Core Competencies for Interprofessional Collaborative Practice: 2016 Update”, 2016, p). The sub-competencies TT7 “Share accountability with other professions, patients, and communities for outcomes relevant to prevention and health care” (“Core Competencies for Interprofessional Collaborative Practice: 2016 Update”, 2016, p. 14). Bringing everyone together and telling them to have shared accountability I believe it would be hard for Jesse to convince everyone for that because most of the time, team members do not want to become accountable for the things they are not directly connected. It would be a huge responsibility on every team member. Therefore, Jesse might have to work hard to implement this core competency and sub competency.

 Which core competency would be the most challenging to implement in your current healthcare work environment to increase interprofessional collaboration? As a nurse leader, how would you address this needed change?

“Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice)” (“Core Competencies for Interprofessional Collaborative Practice: 2016 Update”, 2016, p. 10). I believe not only the place where I work but everywhere, people still do not show mutual respect and shared values. Everyone says we respect but when the time comes to show, there is always a lack of respect either because of being busy or just people do not like the other people. As a nurse leader I would address this needed change by having anonymous surveys where employees will be open to express their feelings because no one is here to judge them. Mostly, employees do not express their feelings or tell the truth because if they say something it might count bad towards them. Therefore, having anonymous surveys let them speak up.

References

Albert, N. M., Pappas, S. H., Porter-O’Grady, T., & Malloch, K. (2022). Quantum Leadership: Creating Sustainable Value in Health Care (6th ed.). Jones & Bartlett Learning.

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Case Study 4 - Leadership

Course: Fdtns Of Professional Nursing (NSG 252)

25 Documents
Students shared 25 documents in this course

University: Miami University

Was this document helpful?
Chapter 4
Innovation and Opportunity: Leading Through the White Water of Change
Case Study 4-1
Developing a Culture of Interprofessional Collaboration
As the chief nursing officer (CNO) of a large metropolitan hospital, Jesse has established a
strong reputation as a “mover and shaker” in nursing leadership circles. He is greatly admired by
his colleagues who are CNOs at other hospitals in the region. For the most part, Jesse is proud of
his many accomplishments and very satisfied in his current role at the hospital, but lately he has
been feeling restless and is concerned that the entire organization could do a better job of
creative thinking to address needed changes to ensure excellence in patient care, excellence in
the work environment, and excellence in individual professionalism.
Jesse shares his concerns with his colleagues on the hospital executive team, and they all
reassure him that he should simply be satisfied with the hospital’s reputation as a premier place
to work, receive care, and practice professionally. Despite his colleagues’ opinions, Jesse feels
that there is an opportunity to make the best even better. He feels that there are a number of age-
old issues confronting nursing that never seem to be completely addressed or resolved. The
notion of interprofessional practice and collaboration is one example. Jesse realizes that the
nursing profession has talked about the importance of interprofessional practice for at least 45
years, and in 2010, interprofessional practice was cited as critical for optimal patient outcomes in
the Robert Wood Johnson Foundation’s Future of Nursing report, the Institute of Healthcare
Improvement’s report, and the Agency for Healthcare Research and Quality’s report.
Jesse realized that the healthcare literature is replete with articles citing the benefits of
interprofessional collaboration and its importance in enhancing job satisfaction, organizational
commitment, and professionalism and for minimizing job stress and interprofessional conflicts.
In spite of all of the evidence and rhetoric about interprofessional collaboration, Jesse realized
that the hospital had not achieved interprofessional collaboration or practice. Although the
hospital had made great strides in improving the organizational culture by addressing behavioral
standards and values that were to be the norm for every employee and every physician affiliated
with the hospital, there were many instances when physicians practiced very independently from
the nurses caring for their patients.
Both nurses and physicians were frustrated, feeling that they were not valued or respected by
the other party for their knowledge and skills in caring for patients and families. Several
particular situations triggered Jesse’s concern about the subject, and he felt that there was an
underlying tension that could be a platform upon which to initiate some creative dialogue and
ideas for changing the culture to support and encourage interprofessional collaboration and
practice. He realized, however, that it was impossible to motivate others to make a change in
their relationships and interactions with others, but he considered his options for developing
some internal motivation that would spur individuals to take the lead in championing such a
change. Jesse wanted to ensure that there was alignment among nurses and physicians with the
hospital’s behavioral standards and values, which were widely accepted by employees and
physicians throughout the organization. It seemed, however, that some physicians and nurses felt
that collaboration was not a part of the accepted values. Jesse wanted to change this perception
so that interprofessional collaboration would be a valued behavior among all disciplines and
specifically between nurses and physicians.

Students also viewed

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