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Do Clinicians Make the Best Leaders in Hospitals in the NHS Health System in England? Article Writing Example

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Article Writing

A Qualitative Analysis of Management and Leadership Styles in the National Health System

Introduction

The Purpose of this essay is to assess the effectiveness of leadership and management within hospitals and healthcare organizations, related to delivering basic and advanced health services. In this essay, the researcher will focus on the question of leadership in healthcare, trying to determine whether or not clinicians make the best leaders in hospitals in the NHS health system in England. The author takes the position that leadership and management play a vital role in effective health services. The author is utilizing a comparative method to examine the question and analyze the trends between the healthcare systems in Australia, the United Kingdom and the United States. Data will be retrieved from a selection of peer reviewed research on the topic and analyzed using qualitative, foundational, historical and grounded theory. The main finding presented in the below study is that the UK’s national health system’s increased clinician involvement in leadership initiatives have brought forward positive changes for service levels, patient outcomes, and effectiveness.

The thesis question of the research is: “Do clinicians make the best leaders in hospitals in the NHS health system in England?”

Background Information

Healthcare sustainability, innovation, and effectiveness is a major concern in all corners of the globe. However, for Western societies, such as Australia, Great Britain and United States, healthcare concerns are different from those experienced in less developed countries (Dupas, 2011: Lovett-Scott  & Prather, 2012: The Commonwealth Fund, 2013). For the less developed countries, the main challenge is meeting the basic needs for the given community (Dupas, 2011, p. 2). In the Western care system, the problems reach beyond basic health care, and providers do not only focus on saving lives and treating serious conditions, but also prevention and maintaining quality of life.

Today, citizens in all Western countries, such as Australia and the United Kingdom, have a longer than ever life expectancy, and this means that healthcare needs to be provided for longer (Lassey et al., 1996). Further, the aging population of the Western society also puts challenges on the health care system (Australian Institute of Health and Welfare, 2015). Additionally, health care continues to run a deficit when it comes to necessary personnel, including physicians, technicians, nurses and qualified support staff  (World Health Organization, 2010). According to Mountford (2009), “; the average US household, for example, spends more on health insurance than on mortgage repayments”. At the same time, health care systems across the Western world are being criticized for being expensive and ineffective. At the same time, leadership in many healthcare organizations, both public and private, are beginning to see changes in qualifications and personnel necessary to lead the organization and individuals within it. Contrasting the Australian and American health care’s effectiveness with the NHS syystem’s in the UK, the performance differences are clearly visible. Transforming leadership, and creating a collaborative leadership strategy described in detail within the UK context of hospitals by West et al.( 2014).  One debate that is present in all developed countries is whether practitioners, such as physicians or certified nurse practitioners, have special characteristics that make them more effective leaders (Blumenthal, Bohnen, & Bohmer, 2012).

The main context for this essay is the changing needs in leadership for health care and related systems in the Western world, and the impact of clinician involvement in leadership related to organizational effectiveness. The main argument the author makes is that the clinician involvement in leadership within the United Kingdom has proven to improve service levels and effectiveness, compared with the performance of US and Australian health systems. The main assumption of the current study is that management and leadership are important for the delivery of effective health services. A comparative method of qualitative research (Tracey, 2013) will be used to allow the researcher to closely examine the differences or similarities between leadership characteristics of developed nations’ healthcare organizations, in particular focus on leadership skills and qualities utilized by different countries’ health care systems.

Evidence Gathering Methods

The researcher will analyze peer-reviewed articles appearing in recognized journals, books or book sections, edited websites, and readings prescribed reading for the course. The reason for choosing the qualitative method is to allow the validity testing of the expected results.

The primary set of materials to be examined are those provided in the readings list. The first of these to be used isLeadership Styles found in the Encyclopedia of Educational Leadership and Administration. We begin the critical analysis by first examining common characteristics of good managers and leaders to determine of whether such characteristics are necessarily for improving the performance of healthcare organizations.

Critical Analysis of Leadership Skills Needed in Health Care

The main research question of the below critical analysis is: “What characteristics do the leaders of high performing NHS hospitals have in England?”

In the first part of our critical analysis, we will explore the specific characteristics of a good leader described by different authors, and the areas of knowledge which are commonly needed across disciplines.  Because there can be such differences based on the individual job type or section of the healthcare industry it is important to note that knowledge generally comes from formalized education or through specific experiences related to the job type (Covey & Maxwell, 2013). This distinction carries forth whether we examine issues of time management, personnel management, routine or extraordinary circumstances.

A second common characteristic worth noting is that of continuing education and improvement for the individual manager. As an example, the management of personnel within the organization is often performed quite differently depending on whether the person in management position is a practitioner, late manager or political appointee. Each of these individuals, regardless of their background, must have certain characteristics that are necessary for good personnel management. The leader that lacks such characteristic must first identify the need and then seek out sources from which improvement can be made (Lisaz, 2014).

One area of leadership where physicians and practitioners often excel is in understanding the necessary practices or changes which a patient may/must undertake in order to obtain better health. Within the literature of leadership, this is known as transformational leadership (Ginanto et al., 2014), and calls upon the person to develop skills they may already possess but which are then applied as a manager rather than clinician (Huynh & Sweeney, 2014). It is evident that a practitioner has specific characteristics, which will help in the administration of informational delivery systems. More precisely, while the late person can perform similar tasks the fact that the clinician has experience and formal education tends to make the practitioner a better choice based on this leadership model. Cormack (2012, p.  15) created a health care leadership literature review, and found that some of the most prominent examples of utilizing transformational leadership within health care is the Clinical Leadership Programme UK, and the program created by the King’s Fund. The author found that transformational leadership addresses the demands of health care management the most effectively, namely: valuing individuals, networking and achieving, enabling teams, being accessible, being decisive, and acting with integrity (Cormack, 2012, p. 16).

Recognizing that leadership has become an important part of the clinical practice, many institutions of higher education have begun including classes on leadership and management to route healthcare studies (Gabel, 2014). Within both the healthcare industry and higher education, the necessity to frame leadership and management education has become necessary. The reason is that many practitioners and clinicians are stepping forward, either through the necessity for good leadership or the absence of qualified non-clinician candidates, and this has called for a change in overall curriculum (Webb et al., 2014).

Application of Theories

Leadership as a discipline and theory has been studied for more than two centuries. Specifically, the characteristics of a leader are the focus of the study and in many instances the application of any theory that arises is then given within an institutional or industry setting (Nohria & Khurana, 2010). This may include leadership within higher education, business practice, politics and government, or the healthcare professions. As noted, many of the characteristics or traits of leadership are common between industries and often rely on either education or the inherent characteristics of the individual. When examining these types of characteristics the common method is to use trait theory, which typically concentrate or identify particular personality or behavioral characteristics of the specific leader within the group studied (Landis & Hill, 2014).

Trait theories are commonly defined as habitual patterns of behavior, thought, and emotion (Kassin, 2013) month-to-month one. When applied in the healthcare professions the first question that arises is whether the particular trait is inherent or something obtained from outside sources. The two most common sources or formal education and experience (Dinha et al. 2014).

Contingency theory focuses on the individual’s ability to change or adapt their personal style based on particular variables related to the environment that might determine which particular style of leadership is best suited for the situation. Under contingency theory. there is no best way to manage an organization, individual or particular situation. Leadership is not something necessarily found in a textbook or learned in a classroom. In this way contingency theory is sometimes seen as an extension of trait theory  (Hall, 2005).

A slightly different approach to leadership is that known as behavioral theories. Within behavioral theories the primary idea is that good leaders are not born but are made. Rooted in behaviorism, this theory of leadership focuses on the individual’s ability to take action based on their education or training rather than on inherent skills of identification or response. In many ways, the idea is that a given organization has specific sets of rules and methods for operation, and it is the leader’s job to identify those rules or operations and then adapt based on their education and experience (Lussier &  Achua, 2012).

Behaviorial theories define different leadership styles. Autocratic style (Webb et al., 2014) means that leaders spell out “the goals, deadlines and methods” (Brady, 2013), while making decisions on their own without any or much consultation with others.

When applying the authoritarian approach (Nursing Leadership Styles, 2013)  the leader generally does not engage individual members of the group but instead relies on a system of hierarchy within which the leader can disseminate (Lussier & Achua, 2012) broader ideas of success instead of actually laboring in the production of success.

Participative Leadership is a different approach, and is  greatly promoted in the United Kingdom’s NHS. Under this approach, the leader shares their values, goals and possible methods with the group, and then encourages a democratic style relationship. In the right environment this approach passes much of the power traditional to a leader to those within the group, and when it works well the individuals within the group use their new power to effect change and create a better system (Dinha et al., 2014).

Delegative style, often identified by a Laissez-Faire approach, the style creates an environment in which the duties for goals, work methods and a definitive rule on production or service duties is handed off to the managers or supervisors at lower levels. We see such an approach used in major corporations where the chief executive officer is removed from the daily operations of the business and instead focuses on managing the first level team which is given the duty of seeing that operations are successful. Of course, a prime example is the executive branch within an American-style government.

Based on the above leadership styles and theories, the author would like to examine how clinician leadership in the United Kingdom supports collaborative and transformative style of management.

Comparison of Leadership Approaches – The UK Example

Squires (2013) compared the health care systems of the developed world. Interestingly, since the introduction of innovative leadership development and collaboration tools, and the implementation of strategies described by West et al. (2014), the costs associated with running the health care system in the United Kingdom have declined, while they have been rising in the United States and Australia.

Cormack & Webb (2012, p. 5), however, found that in the United States, there is room for development. The authors state that there is “an ingrained skepticism among clinicians about the value of spending time on leadership, as opposed to the evident and immediate value of treating patients”. This obstacle makes creating an effective clinical leadership plan problematic.

West et al. (2014) show positive examples of integrating collaborative, transformational, and clinical leadership in the United Kingdom. Salford Royal’s example is mentioned, where significant quality improvements were made, due to implementing cross-organizational learning. This approach of sharing expertise, knowledge, and insight is one of the most effective methods of implementing leadership development programs focusing on practicing clinicians. A full staff engagement was created through sharing the values and communicating goals, brainstorming, and assessing individuals’ leadership potentials for development plans. As a result, patient outcomes, as well as job satisfaction of staff improved. Wrightington, Wigan and Leigh NHS Foundation Trust implemented a new structure of communication to empower dialogue within the hospital. Creating the “Pioneer Teams” programme, all members of staff were given the opportunity to contribute towards making a positive change.

Mountford & Webb (2009, p. 3) found that “effective clinical leadership lifts the performance of health care organizations”. The author also states that in the United Kingdom, health care facilities where clinicians are actively participating in leadership and organizational decision-making, great improvements of effectiveness and service quality were found. Similarly, in the United States, data analysis shows that in health care facilities where there is a close working relationship and collaboration between managers and clinicians exists, the performance is positively affected.

Conclusions

The purpose of this essay was to examine leadership and management necessary for the delivery of effective health services. By examining various characteristics and theories of leadership across the Western world, the researcher has been able to use comparative methods to identify similarities and differences. It has been found that the implementation of different clinical leadership development, collaborative, and transformational leadership approaches in the United Kingdom have brought forward dramatic positive changes in different fields, such as productivity, worker engagement, collaboration, shared asset based on knowledge, and patient outcomes. The costs of providing health care for an aging population were reduced, while they increased in both Australia and the United States. This indicates that the transformation of the NHS should serve as an example for health care leaders in the rest of the Western world. Utilizing the shared knowledge of the organization, and involving practitioners in decisions, planning, and innovation is thought to bring positive changes to any health care system. The initial assumption of the study, therefore, is confirmed: clinicians can be more effective leaders in organizations than those without a hands-on work experience. They can connect with staff better, promote the culture more effectively, and engage with different stakeholders.

After the identification of theories and analytical discussion of their application, the reader should gain a better understanding of specific issues within healthcare as well as the possible leadership theories that apply to leaders at the various levels. For that reason, the author argues that the best leader is one that does have a clinician experience, has received comprehensive leadership training, and utilizes transformational leadership approaches. Clinician  leaders within the NHS were found to be more effective leaders than those who have no hands-on work experience in health care.

References

Australian Institute of Health and Welfare. (2015, April 14). Australian Institute of Health and Welfare. Retrieved from Life Expectancy: http://aihw.gov.au/deaths/life-expectancy/

Blumenthal, D. M., Bernard, K., Bohnen, J., & Bohmer, R. (2012, April). Addressing the Leadership Gap in Medicine: Residents’ Need for Systematic Leadership Development Training. Academic Medicine, 87(4), 513–522.

Brady, D. (2013). Commonalities in Leadership, Membership, & Structure of Quality Improvement Teams at America’s Top Hospitals: A qualitative multi-case study. Raleigh, NC: Healthcare Publishing Company.

Cormack, M. (2012) Leadership for the sustainability of the health system. Health Workforce Australia. Literature Review.

Covey, S. R., & Maxwell, J. C. (2013). The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You. Nashville, TN: Thomas Nelson Publisher.

Dupas, P. (2011). Health behavior in developing countries. Annu. Rev. Econ.3(1), 425-449.

Dinha, J. E., Lordb, R. E., Gardner, W., & Meuser, J. (2014, June). Leadership theory and research in the new millennium: Current theoretical trends and changing perspectives.           Leadership Quarterly, 25(1), 3692.

Gabel, S. (2014, June). Expanding the Scope of Leadership Training in Medicine. Academic Medicine, 89(6), 848–852.

Ginanto, D., & Wang, X. (2014). Leadership Theory Research: Transformational Leadership. Journal of Leadership Studies, 7(2), 88-95.

Hall, M. (2005). Shaping Organizational Culture: A Practitioners Perspective. Retrieved April 15, 2015, from Peak Development: http://peakdevelopment.com/wp-content/uploads/2013/09/PDC_shaping_culture.pdf

Huynh, H. P., & Sweeny, K. (2014, November ). Clinician styles of care: Transforming patient care at the intersection of leadership and medicine. Journal of Health Psychology, 19(11), 1459-1470.

Kassin, S. (2003). Trait Theory and Individual Industries. New York: Prentice Hall.

Lassey, M. L., Lassey, W. R., & Jinks, M. J. (1996). Health Care Systems Around the World: Characteristics, Issues, Reforms. New York: Pearson.

Lovett-Scott , M., & Prather, F. (2012). Global Health Systems: Comparing Strategies for Delivering Health Systems. Burlington, MA: Jones and Bartlett.

Mountford, J. & Webb, C. (2009) When clinicians lead. McKinsey Quarterly. February 2009.

Lisaz, M. (2014). How to Improve Your Leadership and Management Skills – Effective Strategies for Business Managers. Seattle: Amazon Digital Services, Inc.; Lisaz   Publishing.

Lussier, R. N., & Achua, C. F. (2012). Leadership: Theory, Application, & Skill Development.  Cengage.

Nohria, N., & Khurana, R. (Eds.). (2010). Handbook of Leadership Theory and Practice. Cambridge, MA: Harvard Business Review Press.

Nursing Leadership Styles (Part I): Authoritarian Leaders. (2013, July 3). Retrieved from AllNurses: http://allnurses.com/nurse-management/nursing-leadership-styles-752337.html

The Commonwealth Fund. (2013) Multinational Comparisons of Health Systems Data, 2013. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2013/Nov/PDF_OECD_multinational_comparisons_hlt_sys_data_2013.pdf

Tracey, S. J. (2013). Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. Hoboken, NJ: Wiley-Blackwell.

Webb, A., Tsipis, N. E., McNeil, M. J., Xu, M., Doty, J. P., & Taylor, D. (2014, November). A First Step Toward Understanding Best Practices in Leadership Training in Undergraduate Medical Education: A Systematic Review. Academic Medicine, 89(11), 1563–1570.

West, M., Eckert, R., Steward, K. & Pasmore, B. (2014) Developing Collective Leadership for Healthcare. The King’s Fund, London.

World Health Organization. (2010). Models and tools for health workforce planning and projections. Geneva, Switzerland: World Health Organization

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