Leadership: Impact On A Healthcare Organization

Leadership: Impact On A Healthcare Organization The field of health-care is labor intensive and based on powerful know-how (Kanste, 2008). In contemporary medicine both therapeutic as well as nursing tasks are performed by a team, rather than an individual, being it a doctor or a nurse, respectively. No team work can be effective without a leader; this is also true for good nursing in which the leadership is very crucial and vital. All the results of good nursing à ¢Ã¢â€š ¬Ã‚ ¦may be spoiled or utterly negative by one defect, viz: in petty management (Florence Nightingale as cited in McEachen Keogh, 2007, pg.01). The health care environment becomes more competitive every day. There are few professions in which the complications of poor performance are as serious as in nursing and there are few professionals who feel the pressure of responsibility more keenly than nurses (Kenmore, 2008). This paper presents discourses on the contemporary leadership styles and highlights the characteristics and development of an effective leader a nd discusses the impact of effective leader on organisations potential to succeed. Leadership styles The continued search for good leaders resulted in the development of many leadership theories. Although leadership is not a new concept, and its fundamental function is well documented, there is no theoretical agreement or a universal definition of leadership (Farag, Mc Guinness Anthony, 2009; Mahoney, 2004 and Murphy, 2005). However, some scholars believe that certain leadership characteristics or personality traits are innate in effective leaders (Murphy, 2005). Thus the perspectives of Great man or trait theories which dominated until 1950s, states that leader are born and not made (Murphy, 2005). In the 1950s, behavioural and social scientists began to analyse leadership behaviour. The behavioural theory says that leaders are not born to lead, but learn leadership behaviour (McEachen Keogh, 2007). The efforts of these researchers were fundamental in isolation of three common leadership styles: autocratic, democratic and lassiez-faire (Murphy, 2005). The Contingency theory by Fi edler was further expanded by Herset, Blanchard and Johnson as the Situational theory (Murphy, 2005). Later, some contemporary leadership theories such as the charismatic, transactional, transformational and shared leadership theory gave rise to the contemporary leadership styles (Murphy, 2005). The contemporary leadership styles include quantum, charismatic, transactional, transformational, relational, shared and servant leadership (Murphy, 2005).Though there are many leadership styles identified in the literature, laissez-faire, transactional and transformational leadership styles are the primary leadership styles identified in the nursing and management studies (Farag et al., 2009). Laissez-faire leadership indicates the absence of leadership (McGuire Kennerly, 2006). This leadership style is ineffective in promoting purposeful interaction and it contributes to organizational demise (McGuire Kennerly, 2006). Transactional leaders view the leader-follower relationship as a process of exchange (McGuire Kennerly, 2006). On the other hand, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values (Trofino, 2005). The transactional leader sets goals, gives directions and tends to gain compliance by offering rewards for performance (McEachen Keogh, 2007). Whereas, by inspiring a shared vision through clear roles, effective teamwork and providing feedback on individual or team performance transformational leaders enables the staff to explore their professional practice (Halm, 2010). The three elements of transactional leadership are: contingent reward, where the leader provides reward that is dependent on the performance; passive management by exception, where the leader takes corrective action when problems arise and active management by exception, where the leader takes corrective action in anticipation of problem (Chen, Beck Amos, 200 5; McGuire Kennerly, 2006; Rukmani, Ramesh Jayakrishnan, 2010). Similarly, the four elements of transformational leadership are idealized influence, inspirational motivation, intellectual stimulation and individualized consideration (McGuire Kennerly, 2006; Halm, 2010). The expected outcome of transactional leadership is enhanced role clarity, job satisfaction and improved performance (McGuire Kennerly, 2006). On the contrary, the ultimate outcome of transformational leadership is to change the mental model of employees, to link desired outcome to values held by employees and to build strong employee identification within the group or organization (McGuire Kennerly, 2006; Halm, 2010). There are also some pitfalls and limitations of transactional leadership. Transactional leadership might not yield the same results across culture; such as, most North American culture which emphasize individualism, whereas many Asian culture emphasize collectivism (McGuire Kennerly, 2006). Hence, transactional leaders need to understand at which level to establish their reward system- individual or collective reward (McGuire Kennerly, 2006). Transactional leaders cannot provide leadership over task areas in which they have no expert knowledge (McGuire Kennerly, 2006). Likewise, there are some limitations to transformational leadership. Transformational leaders need to be updated in their knowledge and skills (McGuire Kennerly, 2006; Halm, 2010). There is a growing demand for evidence-based decision making, where, to show leadership, a transformational leader need to cite hard and factual evidence, as transformational leaders have nothing worth saying without strong evidence. Fin ally, the transformational leaders will be needed to inspire flexible, multi skilled work forces to bridge the barriers established by rigid job description and functional departments (Trofinio, 2004). Transformational leadership is not an alternative to transactional leadership, but it augments transactional leadership (Spinelli, 2006). Therefore, an effective leader achieves a balance between transformational and transactional behavior, thus creating a leadership style which matches the needs of followers (McGuire Kennerly, 2006). The current shortage of nurses at the bedside magnifies the importance of having a strong, clear, and supportive and inspiration leadership across health care organization (McGuire Kennerly, 2006). Characteristics and development of effective leader While there is disparity amongst the theorist definitions of leadership, there is consensus pertaining to qualities necessary to realize effective leader (Murphy, 2005). There are various traits of an effective leader mentioned throughout the literature. Having a vision is a key feature of effective leadership and it is the clarity of vision evolved by the leader about the future of the organization that distinguish them as effective (Joyce, 2009). An effective leader has a vision for the future, which helps him to set objectives, aims, goals and standards and to achieve the set goals; the leader has a plan to implement (Fletner, Mitchell, Norris Wolfe, 2008). Tomey (2009) mentions some of the essential leadership traits which also empower people. These include accessible, collaborative, communicative, flexible, good listener, honest, influential, knowledgeable, positive, supportive and visible (Tomey, 2009). An effective leader should also posses job knowledge, positive attitude, d elegation skills, positive partnership and should be a role model, dependable, motivating, and compassionate (Fletner et al., 2008; Cook Leathard, 2004). An effective leader must recognize the individual strength and weakness of each person involved, shifting focus as necessary in an effort to elevate each persons level of effectiveness as an individual and as a part of a team (Fletner et al., 2008). As Joyce, 2008, rightly quotes that effective leaders walk the talk. Consequently, there is consistency between their values, vision, standards and behavior (Fletner et al., 2008; Joyce, 2008). A good leader should ideally possess all of the identified characteristics, or at least a majority of them (Fletner et al., 2008). Fletner et al. (2008) also reveal that any characteristics can be a leaders strength or weakness depending on the situational needs and persons involved in the given scenario. Neither there is just one characteristic that defines a leader, nor should, the entire identified characteristic be required when determining whether an individual would be an effective leader (Fletner et al., 2008). Likewise, to say one character istic is more important than the other is to fragment the idea of leadership (Fletner et al., 2008). A leader with insufficient leadership training might become exhausted in trying to achieve the organizational goals and thus, in turn, a leader might burnout and dissatisfaction among subordinates might increase (Chen, Beck Amos, 2005). One of the greatest challenges we face in nursing profession is to develop future nurse leaders (Jumaa, 2008; Kleinman, 2004; Mahoney, 2004; Murray DiCroce, 2003). Hence, training effective leaders has been proposed as a key to increase professionalism in nursing (Chen, Beck and Amos, 2005). Although it remains unclear, how to best prepare effective leaders, evidence suggest that graduate education may be an important precursor to the development of effective leadership style (Kleinman, 2004; Mahoney, 2004). Developing a relationship with specific academic provider of registered nurse to Bachelor of Science in nursing programs and graduate education in nursing administration may facilitate nurse managers returning for advanced education (Klienman, 2 004). Onsite and distance education programs may offset obstacles of scheduling and geography (Kleinman, 2004). The feasibility of mandating graduate education requirements for all practicing nurse managers is limited; therefore, continuing education strategies must focus on nurse manager leadership training (Kleinman, 2004; Mahoney, 2004; Wilson, 2005). An effective continuing educational program should consider providing monetary incentive and an organizational commitment that allows sufficient time to be spent on course work, in addition to management responsibilities (Kleinman, 2004). Conley, Branowicki and Hanley (2007), recommend a three component orientation for nursing leaders including nurse manger competencies, precepting by supervisor and written and classroom resources. Learning about the history of nursing, and especially about people who greatly influenced the development of nursing, has a fundamental meaning in fulfilling the vocation for nursing (Kosinska Niebroj, 2 004). In this context, the statement saying that history is a teacher of life seems to be true and of paramount importance for creating leaders (Kosinska Niebroj, 2004). The Leading Empowered Organizations(LEO) program, shared between United Kingdom and United State of America, is constructed around a model that identifies consensus decision making, interdependence, positive discipline, responsibility, authority and accountability as key areas of effective leading (Cook Leathard, 2004). Recognizing the need to invest in nurse managers to reduce turnover, the Pacific Northwest Nursing Leadership Institute was created in Washington State, in 2002, to support the development and preparation of nursing leaders (Wilson, 2005). Thus, there are various programs, education and institutions, to encourage the development of leadership skills among nurses; which highlights the impact that an effective leader can have on the organization. Impact of effective leadership on organization The inability of hospital to retain staff nurses threatens the adequacy of health care delivery and increases personnel and patient care costs (Kleinman, 2004). Many factors have led to rising health care costs, which have increased faster than the general inflation over the past three decades (Spinelli, 2006). Performance standards for effective leaders require them to be accountable for transactional processes such as budgets, productivity and quality monitoring; while at the same time displaying transformational characteristics by acting as a coach, mentor and a leader (Kleinman, 2004; Spinelli, 2006). A creative work climate has a strong relationship to job satisfaction and the nurse manager is an important link in creating such a climate (Sellgren, Ekvall, Tomson, 2006; DeCasterle, Willemse, Verschueren Milisen, 2008). Job satisfaction has been described as the most important predictor for nurses intention to remain employed (Sellgren et al., 2006; Carney, 2008). The perception of staff nurses towards the leadership behavior of their manager was significantly related to their job satisfaction (Sellgren et al., 2006; Klienman, 2004). Staff that perceives job satisfaction is essential for the ability to give high quality and safe care (Sellgren et al., 2006). Job dissatisfaction leads to absenteeism, problems of grievances, low morale and high turnover (Wong Cummings, 2007). On the contrary, poor leadership was found to be one of the main reasons for dissatisfaction and intention to leave (Neilsen, Yarker, Brenner, Randall and Borg, 2008 and Sellgren et al., 2006). Altered perfo rmance, affecting patient outcome, which in turn results in higher employment cost is also found to be associated with decreased job satisfaction (Wong Cummings, 2007). The findings of the study done by Wong and Cummings (2007) and Kenmore, (2008), suggest that there is a relationship between leadership and patient satisfaction, patient mortality and patient safety outcomes, adverse events and complications. Positive leadership behavior increased patient satisfaction, and decreased incidences of patient mortality, adverse events and complication (Wong Cummings, 2007). Effective nursing leadership is essential to the creation of practice environments with appropriate staffing level, that support nurses in preventing unnecessary death, adverse events and complications (Wong Cummings, 2007). A recent study done in mental health service organizations show that, both organizational culture and organizational climate impact work attitude and subsequently staff turnover (Wong Cummings, 2007). Effective leaders can also help in the recruitment process by recruiting staff as per the job description and thus help in the organizational development (Neilsen et al., 2008 and Sellgren et al., 2006). The study done by Wong and Cummings (2007), in Singapore, to determine the effect of leadership behavior on employee outcome, shows that in times of stress and chaos, leadership styles that transform, create meaning in the midst of turmoil and produce desirable employee outcome are more beneficial for organizations existence and performance. Conclusion In conclusion, it is apparent that nurses can lead the health care industry as they comprise the major component of all health care employees; being on the front line and having the most frequent direct contact with the patients and their families. The increasing emphasis on fiscal accountability in global recessionary times places even greater emphasis on measuring organizational effectiveness (Joyce, 2009). The need to move a health care organization forward in an era of declining profit margin, diminishing capacity, manpower shortages and technological expansion cannot be overstated. The call for the nurses to become recognized leaders of health care industry; possessing the knowledge, skills and attitudes relevant for effective leadership and the necessity to use the technology of the 21st century to aim for an essentially global community are the key perspective significant to nursing leadership and management(Jumaa, 2008). Effective leadership behavior is the key to productive and happily satisfied nurses with great organizational commitment. Nevertheless, it is how the leader leads in the context of the setting which is paramount. To sum up, positive or effective leadership is critical towards achieving and driving organizational effectiveness. Lymphatic Filariasis Disease: Causes and Treatments Lymphatic Filariasis Disease: Causes and Treatments Abstract Lymphatic Filariasis is a disease that is on the World Health Organizations (WHO) top ten list of diseases to eliminate by 2020. Left untreated and undetected, it can lead to a condition called Elephantiasis. The name comes from the severe swelling of the limbs that occurs during the chronic state of the disease. It is transmitted via mosquitoes to humans in tropical and sub-tropical climates and it is endemic in a large number of countries around the world. Prevention is possible via some very basic methods and early detection and treatment can prevent long-term consequences associated with the disease. Lymphatic Filariasis is a little known disease in the United States but it is on the World Health Organizations top ten list of diseases to eliminate along with Malaria and leprosy (Narain, J.P., Dash, A.P., Parnell, B., Bhattacharya, S.K., Barua, S., Bhatia, R. et al., 2010). A large portion of the population of the planet is at risk of contracting this often debilitating disease. Common Names Lymphatic Filariasis is also referred to as Bancrofts Filariasis and Elephantiasis when the disease it has progressed to its chronic state. (Elephantiasis, 2010). Causative Organisms The main causative organism is a microscopic parasitic roundworm. There are three different types of this worm: Wuchereria bancrofti (most common and makes up 90% of all cases), Brugia malay and Brugia timori (Longe, 2006). Wuchereria bancrofit lives in warm regions on every continent except North America (Callahan, 2002). Brugia malayi is primarily found in India, Southeast Asia and Indonesia (Callahan, 2002). Brugia timori is found to a very limited extent in Timor. Symptoms The disease has two stages, acute and chronic. When the disease is in the acute phase, the symptoms usually include a recurring fever and infections of the lymph vessels or nodes in the arms, legs or genitals which can lead to severe and permanent swelling of the lymph vessels and secondary infections (Elephantiasis, 2010). In the chronic stage, the worms block the lymphatic areas of the limbs which cause overgrowth of the limb or body part because the lymphatic system is not able to perform its function of draining fluid out of the area (Callahan, 2002). Males may also have swelling in the scrotum. This is how the disease gets the name of Elephantiasis because the limbs enlarge to the point where they resemble elephant limbs and the skin takes on a rough texture like elephant skin (Ferrara, 2010). Incubation Period The precise mechanism that causes the pathology of the disease is not known and some people who are infected may not show any signs or symptoms for many months and sometimes even years (Rajan, 2003). The parasite apparently only infects humans and has never been found to affect animals. The parasite migrates to the lymphatic vessels and takes up residence. It then matures into the worm over the course of a few months to one year and begin producing the microfilariae which is suspected of causing the initial fevers and chills that are the first symptoms of the disease (Rajan, 2003). Also, if a person is infected once, they may never actually develop any symptoms even though the worm is living in their lymphatic system and the microfilarasia are circulating in their blood. It is repeated exposure with multiple worms along with the worms excretions and blockage of the lymphatic system that seems to cause the disease to progress to its most severe form especially since the worm will norm ally die sometime after seven year (Rajan, 2003). Duration of Disease The duration of Lymphatic Filariasis varies depending on the number of re-infections suffered by a host. A person with Elephantiasis can live with the disease and usually dies from complications and secondary infections from the worms both living and dead (Wallace Kohatsu, 2008). The disease can last a lifetime and can worsen over time if left untreated. The disfiguring growth of the limbs or genitalia is another side effect as well as permanent damage to the lymphatic system, kidneys and secondary infections. There is also a social stigma to the deformities that accompany the chronic stages of the disease. Those who suffer from the disease are often ostracized. The adult worm normally lives from three to five years and the microfilariae will die after twelve months if not taken up by a mosquito to begin the next phase of the lifecycle (Longe, 2006). Transmission A person contracts the disease by being bitten by an infected mosquito of the genera Culex, Aedes or Anopheles. The mosquitoes are the intermediate hosts and when they bite someone, they inject the third-stage larvae into the blood of the host (Elephantiasis, 2010). Once injected into a human host, the larvae mature into worms which move to the lymphatic system and after about one year, produce embryo called microfilariae (Callahan, 2002). Adult worms live for about seven years (Ferrara, 2010). It is the buildup of adult worms in the lymphatic system over time that causes lymph fluid to collect which leads to severe swelling of the limbs and groin area (Ferrara, 2010). The microfilariae circulate in the blood stream waiting to be taken up by a mosquito. Interestingly, the microfilariae are at their most active in the blood at night when mosquitoes are also most active (Wallace Kohatsu, 2008). This increases the chance of being taken up by a mosquito and continuing the lifecycle. Whe n a mosquito bites and infected host, they take up the microfilariae along with the blood. The larvae mature to the second state in the mosquitoes. Repeated exposure and repeated transmission of larvae that can mature into adult worms is usually what brings on the symptoms (Ferrara, 2010). A person who is bitten once and infected may never actually experience any symptoms. Prevention and Treatment The disease is being attacked from many angles by the WHO. Those who have an active parasite are normally treated with the drug Diethylcarbamazine (DEC) which will both limit the number of microfilariae in the blood stream and gradually kill the parasite (Lammie, Milner Houston, 2006). The drug will cause some nausea and vomiting and sometimes fever depending on the level of microfilariae in the blood (Elephantiasis, 2010). However, because the treatment lasts for over one year, it is sometimes difficult to get the needed medical supplies to the areas with the highest incidence in a cost effective manner. Since the drug DEC seems to act as a deterrent as well as a cure, there is a proposal to add DEC to salt for distribution in the affected areas of the world in much the same manner that iodine was added to salt (Lammie, Milner Houston, 2006). Trials with DEC fortified salt have been carried out in China, Brazil, Haiti, India and Tanzania with great success since DEC laced salt acts as a protective measure as well as providing benefits for those already infected (Lammie, Milner Houston, 2006). Other drugs used in treatment include ivermectin and albendazole and more recently doxycycline (Wallace Kohatsu, 2008). Albendazole will kill the worms but does not have any effect on the microfilaria in the blood so the transmission cycle will continue unless the intermediate host is also reduced or eliminated (Wallace Kohatsu, 2008). In addition to drug therapies, movement of the affected limbs is encouraged along with antibiotics for any secondary infections caused by damage to the lymphatic system (Ferrara, 2010). There is little that can be done once the lymphatic swelling has set in other than attempting to force the lymph out via compression bandages (Elephantiasis, 2010). The other alternative is surgery to correct the affected limbs but this is sometimes not cost effective. Because the causative agent spends a portion of its lifecycle in the mosquito, the preventative measures that are being undertaken include the use of insect repellent and protective clothes in affected areas as well as water treatment to reduce the insect population that transmits the disease to humans (Wallace Kohatsu, 2008). Other measures include the use of mosquito netting, screens on windows and staying inside after dark when mosquitoes are the most likely to be active (Ferrara, 2010). In addition, while the mosquitoes are being dealt with, the population near the affected area can be given DEC as a preventative treatment so that the cycle of transmission is broken (Elephantiasis, 2010). Antibiotics have also been shown to be effective in the past but because antibiotics should not have any impact on a nematode, the effect of antibiotics was dropped until recently. There has also been some investigation into the possibility that a certain population of the worms themselves have a bacterial symbiont which is susceptible to the antibiotics (Rajan, 2003). The suspicion is that the two species have become dependent and if the symbiont dies, the host dies as well. If this is proven true, then antibiotics may also be used at some point in the future to treat lymphatic Filariasis in some cases. It is also suspected that some of the inflammation and other secondary infections might actually be caused by the symbiont rather than the nematode. Incidence: World, USA and Colorado Approximately eighty to one-hundred million people in 75 countries around the world are at risk of contracting Lymphatic Filariasis and forty million are in the chronic stages of the disease and suffer from the disfiguring disability known as Elephantiasis (Lammie, Milner, Houston, 2006). Lymphatic Filariasis occurs primarily in tropical and subtropical countries mostly in coastal areas with high humidity although it also occurs in Japan and China and come European countries (Elephantiasis, 2010). The area with the highest risk is south-East Asia. Lymphatic Filariasis at one point appeared in Charleston, South Carolina until about 1920 but then dies out before World War II (Elephantiasis, 2010). The reason for the disappearance in the United States is due to mosquito control and water sanitation (Elephantiasis, 2010). It occurs in the United States primarily where it has been contracted elsewhere and brought back to the United States (Elephantiasis, 2010). There does not seem to be any incidence of the disease in Colorado primarily because the climate and altitude and mosquito population do not generally offer a good climate for the life cycle. Mortality Rate: World, USA and Colorado Lymphatic Filariasis although impacting millions does not have a high mortality rate. The chief issue with the disease is the ongoing illnesses and secondary infections along with lost productivity and economic hardship suffered by those affected. According the World Health Organization, Lymphatic Filariasis is a targeted disease for elimination due to the large number of people at risk (Weekly epidemiological record, 2009). Those who contract the disease can live with it for all or most of their lives and it is the repeated infections via mosquito bites that eventually lead to the progression to the chronic state of the disease and eventual death ((Narain, J.P., Dash, A.P., Parnell, B., Bhattacharya, S.K., Barua, S., Bhatia, R. et al., 2010) Isolation Technique The disease is difficult to detect because the initial infection may not present any symptoms as the worm moves to the lymphatic system and matures. It can also take some time for the Microfilaria to show in the blood in sufficient quantity. The isolation technique will either focus on detecting the adult worm or the microfilariae. Blood samples can be taken and the sheathed microfilaria can be detected in a Giemsa stain which is a stain specifically used for detecting the presence of microfilaria in the blood (Wallace, Kohatsu, 2008). A methylene azure B. stain is used on the blood sample and if there is microfilaria in the blood, they will appear blue or purple. It is important that this blood be taken in the evening when the microfilaria is most active. The microfilaria can move out of the blood during the day so blood samples taken in daylight hours can sometimes result in false negatives (Longe, 2006). Also, it is possible that an infected person will not have any microfilaria in the blood. The worm itself is very hard to detect because it is buried in the lymphatic system. Another technique used is to look for what is called the filarial dance sign in the scrotum (Wallace Kohatsu, 2008). This is a visible detection of the worms movements via ultrasound. Conclusion Lymphatic Filariasis is a preventable disease that strikes poor countries in tropical and sub-tropical countries. Its debilitating effects have made it a target for elimination in the countries affected. Prevention methods are basic and include proactively spraying for the mosquitoes and treating the population with DEC laced salt or administration of DEC in tablet forms in order to break the cycle of infection. In addition, common precautions against mosquitoes can also be used such as protective clothing, netting and sprays.