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) 7

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 others

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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

30 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 or 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 or 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/Clinical/outcomes.html.

• Given, B.A., & Sherwood, P.R. (2005). Oncology nursing society report Nursing-sensitive patient outcomes-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.