A crucial factor dominating health organisations in NSW, Australia and the world has been identified as patient safety and quality of care. Literature indicates that in order to achieve these objectives, there is need for effective clinical leadership to occur. This essay will discuss and analyse the impact of leadership development, with a focus on transformational leadership and related matters, on both the individual and health care.
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To understand how and why leadership in health care emerged as a necessity to avoid failure in health care, it is important to consider the Garling Report (2008) and the Mid Staffordshire Report (2013), of which both provided a multitude of recommendations for NSW and British public hospitals, following an inquiry into their systems after a number of high profile incidents which brought into question patient safety and quality of care.
Garling SC (2008) and Francis QC (2013) both identified that in order to overcome these endemic issues, it is necessary to make a widespread cultural change within the public hospital system and as part of that process, it is imperative to engage frontline clinicians in ongoing leadership education and training. Garling SC (2008) also indicated the need to reform and redesign traditional leadership models in order to improve the delivery of health care, which is increasingly reliant on effective clinical leadership at all levels. Focus should be on creating an inter-disciplinary team approach to patient care, which according to evidence, produces the greatest possible outcomes (Garling SC 2008). This aims to continuously provide the best level of patient-based care and patient safety.
Having considered why effective leadership emerged as a necessity, it is important to review the concept of leadership. It is an interactive relationship between the leader and followers (Kouzes and Posner 2012). For a culture shift towards a patient based care model to occur, leaders must effectively define, communicate and guide the vision for the organisation in order to ensure engagement at all levels Frampton et al. (as cited in Cliff 2012, p381).
Effective leadership is vital for inspiring, engaging and motivating others to achieve greatness. Govier and Nash (2009), highlight that is through having a shared vision that moves people towards achieving the necessary common goal of providing safe and high quality health care, that leadership can occur at all levels. Covey 2006 (as cited in Govier and Nash 2009), indicated that in order to increase the effectiveness of management, leadership needs to come first. This therefore indicates the need for management and frontline clinicians to work together to tackle the many challenges that exist within health care. Furthermore, this is indicated by Vaill 1996 (as cited in Govier and Nash 2009) who argued that there is always a need for management in order to effectively run everyday procedures, however successful handling of the constant changes and instability, begins with effective leadership.
As Kouzes and Posner (2012) suggest, to achieve this success, effective leaders must employ their Five Practices of Exemplary Leadership, including; Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act and Encourage the Heart. This incorporates leading by example, inspiring others through shared desires, making changes through risk taking and challenging oneself, whilst promoting an environment where team work, mutual respect and trust is exercised and where successes are celebrated.
Personal experience suggests that through the variety of courses and workshops now offered via NSW health, the necessary ongoing education in leadership is occurring. As Health Workforce Australia (2013, p.4) prominently state ‘capable leadership, governance, and management are cornerstones of successful efforts to improve the quality of lives and to achieve the maximum impact from health investments’. Having worked the past three years within a team leader role in Occupational Therapy, continuous education has enabled successful running of a strong, caring, hard-working, energetic team, whose primary focus is on patient care and safety. After all, these are the core values of Occupational Therapy practice.
Literature supports the ongoing education of leaders, as Kouzes and Posner (2012) state, leadership is a skill set obtainable by anyone. This is also consistent with Health Workforce Australia (2013) who highlights in their LEADS framework, that in order for successful improvement to occur and endure the ever-changing health care system, specific knowledge and skills are required to become an effective leader. As Covey 2006 (as cited in Govier and Nash 2009) emphasised, by employing a solid foundation of core values, incorporating trust, contribution, dignity, empowerment and growth, the ability to react and adjust appropriately to these changes is possible.
Garling SC (2012) emphasises that by creating individual clinical leaders throughout the health care system, patient safety and quality health care will be continuously achieved. It is through the reflection, ongoing development and improvement of one’s self, that enables this leadership to begin occur (Kousez and Posner 2012; Health Workforce Australia 2013). Health Workforce Australia (2013) have created a model which encompasses the concepts of the transformational leadership theory whereby, once self-awareness and personal development is achieved, individual leaders within the organisation are able to engage others by sharing values, communicating openly and honestly, supporting other team members in growing and developing to continue to strengthen as a department, team and organisation. From here, leaders will work closely with colleagues and patients to ascertain, guide and set achievable goals that realise the shared vision. They will continue to evaluate outcomes, celebrating successes along the way. An environment fostering the awareness and need for positive changes will be promoted and encouraged, this in turn will continue to inspire others to achieve positive outcomes and best possible care for patients.
The results of a study by Wylie and Gallagher (2009) around transformational leadership behaviours in allied health professionals revealed that one of the most significant influences on self-reported leadership behaviours is that of leadership training. Those who received training within the leadership area were able to score a significantly higher aggregated transformational leadership score, compared with those allied health professionals who had not. These results correspond with the findings of Kouzes and Posner (as cited in Wylie and Gallagher 2009), found that transformational leadership and self-awareness are more evident those who received leadership training.
To best rise to the challenge and meet the recommendations of both inquiries, there is the need for implementation of not only leadership, but more specifically transformational leadership. This because, although over time there have been many other leadership theories, they have generally concentrated on what an effective leader is, rather than how to effectively lead (Armandi et al. 2003). Transformational leadership embodies the principles that are able to combat the instability and constantly changing environment in hospitals.
Research by Halter and Bass (as cited in Armandi et al. 2003, p. 1079) and Weberg (2010), indicated that when transformational leadership is implemented within the health care setting, there is a positive impact on staff retention, job satisfaction, loyalty, burnout rates and overall staff well-being. From experience, this positive impact results in safer, improved patient care. This is supported in the article by Govier and Nash (2009), who reported that in large organisations such hospitals, there are increased levels of pressure on frontline staff to produce quality work and outcomes. If this occurs, stress levels and reduced performance also occurs and this leads to the potential harm of those being cared for. If leaders empower frontline clinicians and place ownership of care in their hands, then health care can be transformed from the bottom up, rather than top down, therefore meeting the recommendation of Garling SC (2008).
Having previously worked closely with a manager and mentor, who embodied transformational leadership principles, had open, honest communication, trust and respect for all staff, this enabled both personal and professional growth, as well as positive development as a clinician and leader. As the article by Rolfe (2011) indicates, transformational leadership is a cyclical process whereby leaders empower their followers, which in turn fosters the growth and development of these followers into leaders themselves. Having experienced this first hand, it is safe to say that this enabled better leadership of the inpatient Occupational Therapy team, empowering and inspiring them to achieve positive improvements in patient care.
Stepping into a team leader role three years ago was an enormous challenge. After gaining insight into recent times and history of the Occupational Therapy department, it was clear that instability, uncertainty and low morale had taken over. There had been a multitude of changes both within the hospital and wider organisation as well as within the department itself. Facing the challenge head on was the only way to make significant improvements. By closely building relationships with the individual team members and gaining an understanding into their driving forces, trust and mutual respect began to emerge. Through the implementation of a weekly inpatient team meeting, a structured environment was created to facilitate open communication and allow the discussion of complex cases and individual issues together in order to increase knowledge and solve problems as a team.
This further instilled a sense of trust and confidence by showing commitment to self and the organisation, demonstrating strong open, honest communication skills and being supportive with a mentorship approach, with the main purpose of ensuring best possible care for patients. As Kouzes and Posner (2012) state that when a relationship is built on mutual respect and confidence, the greatest of difficulties can be overcome and a lasting impact remains.
This is supported in the article by Govier and Nash (2009), who emphasise the importance of being a proactive leader, by solving problems with a positive approach, rather than reporting problems whilst others resolve them. They go on to say that leadership is then seen as a choice rather than a position and will therefore be focussed on ensuring that things get done in a positive way, therefore enhancing patient care.
Based on experience with clinical supervision with junior staff, the traits of transformational leadership are also carried out. Regular supervision sessions with staff have enabled growth within the leadership area as well. It has enabled ongoing education and knowledge to be imparted on staff through discussion of their practices on the ward, with attention to solving complex issues and cases. Through the method of asking reflective, open-ended questions, it has empowered the team to review their own values and performance, which has resulted in an increase in staff engagement and a stronger sense of purpose, as a direct result of a leader investing in them. Evidence supports this, for instance Porter-O’Grady and Malloch (as cited in Weberg 2010 p. 246), report that transformational leaders are not only inspiring, however also assist their staff or followers to solve problems by assisting them to be aware of issues and develop the necessary means to overcome their difficulties.
Transformational leadership looks at the relationship between the leader and followers and states that when followers are able to have input into a team or organisational vision, there is an increase in their sense of value and hence this relationship is improved (Rolfe 2011, p. 55). From personal experience as a trained Essentials of Care facilitator, this is accurate. The process involved being trained in working with frontline staff to make the necessary changes to improve patient-based care. Through working closely with multi-disciplinary staff to review their personal and professional values, a shared values statement emerged. It is through this shared value and vision, that staff became empowered to start making frontline changes to improve patient care. Daft (as cited in Rolfe 2011, p. 55) stated that when staff feel empowered and have a sense of purpose, then the workplace environment becomes more positive, with increased motivation and job satisfaction. This then has a direct impact on quality of patient-based care.
From personal experience, being the representative for Occupational Therapy on the hospital falls advisory committee has demonstrated such leadership characteristics as leading by example and being a role model for other members of the department. This committee focusses directly on patient care and is comprised of a multi-disciplinary team who guide and lead the hospital in falls prevention best practice. It is through teamwork and shared leadership and expertise that successes are generated (Ward as cited in Rolfe 2011, p. 56).
In summary, it can be seen that in order to achieve and maintain best possible patient-based care and safety, leadership must be developed throughout all areas of health care, focussing on frontline clinicians. It is through ongoing investment in training and education in the field of leadership that this can be accomplished. Through learning and practicing transformational leadership, staff at all levels are empowered, motivated and inspired to provide the best possible care for patients. This in turn has a positive impact, which affects individual staff, teams and organisations within health care and as a result, the quality of patient care.
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REFERENCE LIST
Armandi, B, Oppedisano, J, & Sherman, H 2003, ‘Leadership theory and practice: a “case” in point’, Management Decision, vol. 41, pp. 1076-1088.
Cliff, B 2012, ‘Patient-Centered Care: The role of healthcare leadership’, Journal of Healthcare Management Nov/Dec, p. 381-383.
Garling SC, P 2008, Final Report of the special commission of inquiry: Acute care services in NSW public hospitals, Overview, prepared for State of NSW, through the special commission of inquiry, NSW.
Govier, I & Nash, S 2009, ‘Examining transformational approaches to effective leadership in healthcare settings’, Nursing Times, vol. 105, no. 18, viewed 29 March 2014,
Health Workforce Australia 2013, Health LEADS Australia: the Australian health leadership framework, Health Workforce Australia, Adelaide, SA.
Kouzes, JM & Posner, BZ 2012, The leadership challenge: how to make extraordinary things happen in organisations, 5th edn, Jossey-Bass, San Fransisco, CA.
Rolfe, P 2011, ‘Transformational Leadership Theory: What every leader needs to know’, Nurse Leader, April, p. 54-57, viewed 29 March 2014,
Weberg, D 2010, ‘Transformational leadership and staff retention: An evidence review with implications for healthcare systems’, Nursing Administration Quarterly, vol. 34, pp. 246-258.
Wylie, DA & Gallagher, HL 2009, ‘Transformational leadership behaviors in allied health professionals’, Journal of Allied Health, vol. 38, no. 2, pp. 65-73.
Frances QC, R 2013, ‘Mid Staffordshire NHS Foundation Trust Public Inquiry Report: Executive Summary’, Crown, The Stationery Office Limited, UK.
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Patient safety is the prevention and avoidance of adverse circumstances or injuries coming from health care process. Accidents, errors are common events that can occur in the clinical area. Safety arises from the interaction from different parts of the system: it does not live in a person, department or device. Patient safety is a branch of health care quality.
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