Leadership for Advancing Quality, Safety and Healthcare Transformation

Maria R. Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FAAN Professor and Chair, Acute, Chronic and Continuing Care Department

University of Alabama at Birmingham, School of Nursing Birmingham, Alabama, USA

QSEN 1st Annual Summit on Leadership and Quality Improvement

Cleveland, Ohio, USA ● October 19, 2017

Objectives

Upon completion of this session, participants will be able to:

1. Describe evidence that links authentic leadership to safety outcomes.

2. Translate into practice best evidence associated with authentic leadership and safety outcomes.

3. Identify an authentic leadership 5-point action plan to advance quality, safety and healthcare transformation.

Road Map

Authentic Leadership

Primer Evidence Translation Pearls

Authentic Leadership

Primer

Authentic Leadership Conceptual Definition

• Positive leadership practiced by individuals who are genuine, trustworthy, reliable, believable

(George, 2003; Luthans & Avolio, 2003; Shirey, 2006)

Authentic Leadership Operational Definition

Authentic leadership is defined as:

“A pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive ethical climate, to foster greater

self-awareness, an internalized moral perspective, balanced processing of information, and relational transparency on the part of leaders working with

followers, fostering positive self-development.”

(Walumbwa et al., 2008, p. 94)

Authentic Leadership Questionnaire (ALQ)

• ALQ is valid and reliable instrument (Walumbwa et al., 2008)

• Initially tested using leaders in business and industry

• Has four scales to measure authentic leadership

Authentic Leadership Development Self-Awareness

Authentic Leadership Development Internalized Moral Perspective

Core Values:

• Empathy

• Respect

• Individualized consideration

Authentic Leadership Development Balanced Processing of Information

Authentic Leadership Development Relational Transparency

Cynthia Selleck, PhD, RN, FNP, FAAN Professor and Associate Dean

Office of Clinical and Global Partnerships UAB School of Nursing

Evidence

Flow Diagram to Identify Evidence for Discussion Id

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Records identified through database searching

Authentic Leadership and Safety Climate (n=2)

Records identified through alternative database searching Positive Leadership and Safety

(n=78)

Records after duplicates removed (n=79)

Records screened (n=79)

Records excluded (n=76)

Full-text articles assessed for eligibility (n= 3)

Studies included in evidence selection (n=3)

Hystad, Bartone & Eid (2014) Purpose Methods Findings

Test conceptual model to explore influence of AL style and psychological capital on safety climate and risk outcomes

Non-experimental, cross-sectional correlational design 4 surveys: ALQ, SCI, PCQ, and RPI Structural equation modeling 2 samples of offshore oil workers (n=220) and seafarers (n=513); mostly Nordic sample

AL exerts a direct effect on safety climate as well as indirect effect via psychological capital Shows importance of leadership qualities and psychological factors in shaping positive work safety climate and

reducing accident risk

Kristensen et al. (2016) Purpose Methods Findings

Investigate staff perceptions of safety culture before and after leadership intervention

Repeated cross-sectional quasi experimental design Safety Attitudes Questionnaire Paired Students’ t-tests (6 month lag) Sample of Danish healthcare professionals (pre n=358; post n=325)

Proportion of frontline staff with positive safety attitudes improved by >5% for 5 of 7 PSC dimensions over time Frontline staff became more positive on all Patient Safety Culture dimensions except stress recognition

Dirik & Intepeler (2017) Purpose Methods Findings

Assess nurses’ perceptions of AL and safety climate Determine if perceptions of charge nurses’ AL predicts safety climate

Predictive study design ALQ and Safety Climate Survey Hierarchical regression analysis Sample of staff nurses (n=350) employed in 3 large Turkish hospitals (> 650 beds)

AL increases positive perceptions of safety climate AL significantly predicted safety climate *Balanced processing and relational transparency subscales found to be significantly predictive of safety climate

Synthesis of Authentic Leadership Evidence Related to Quality and Safety

Matter

Enhance

Accelerate

Translation

Translation Framework for Practice Positive leadership styles (Authentic Leadership) associated with

creating and sustaining cultures of safety

Build psychological capital

Promote relational transparency

Incorporate balanced

processing

Positive work environments,

teamwork, and respect

Engagement in trusting relationships and

organizational commitment

Shared decision making and just culture

Resources

Optimal Patient Outcomes

Clinical Excellence

Healthy Work Environment

True

Collaboration

Skilled

Communication Authentic

Leadership

Meaningful

Recognition

Appropriate

Staffing

Effective

Decision

Making

AACN Healthy Work Environment Model

Resources

Leadership Competencies Framework on Patient Safety and Quality of Care (WHO, 2014)

The Six Domains of Health Care Quality

Resources

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Team Level

The HRSA Heart Failure Clinic Supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services through a

Nurse, Education, Practice, Quality and Retention (NEPQR) Grant # UD7HP26908 (Interprofessional Collaborative Practice Enhancing Transitional Care Coordination in Heart Failure Patients), July 2014 to June 2017 ($1.5 million, Maria Shirey PI)

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Organizational Level

Structure of the Heart Failure Clinic • Transitional Care Model across clinic, hospital and home

• 18 hours outpatient clinic/week • Round on inpatients • At least 1 home visit

• Interprofessional Collaborative Practice Team • Nurse Practitioner (1.5 FTE) • Clinical Nurse Leader (1.0 FTE) • Social Worker (1.0 FTE) • Cardiologist ( .10 FTE) • Patient Care Technician/Community Health Worker (1.0 FTE) • Students • UABH consultation from Care Transitions, Pharmacy, Dietary, and others

Processes of the Heart Failure Clinic

• Heart Failure Patient Management Bundle

• Transitional Care Coordination Bundle

• Patient Activation Bundle

Who are our Patients? • 84% do not have Insurance

• 72% have no Income or less than $10,000

• 41% do not have Housing of their own

• 60% have NYHA Class Functional Status I or II

• 59% have Reduced Ejection Fraction

• 60% have more than 3 Co-morbidities

• 25-54% have Substance Abuse (tobacco, alcohol, drug)

• 22% have Mental and Behavioral Health illness

Outcomes of the Heart Failure Clinic

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Team Level

Reasons for Success

• Leverage strengths and resources of robust academic/practice partnership

• Convey unwavering support for quality and safety within context of teamwork and patient centered care

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Team Level

Reasons for Success

• Hire individuals who share common mission, vision, and values

• Invest in cultivating individuals to strengthen the team

Adjourning, transforming and mourning

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Team Level

Reasons for Success

• Create forums to teach/support principles of teamwork and interprofessional collaborative practice

• Engage team in shared decision making

Case Study: Translation of Framework into Practice Authentic Leadership Evidence for Q&S at Team Level

Reasons for Success

• Build healthy work environments that support excellent outcomes including care team well-being

• Leverage electronic health record and business intelligence analytics to measure what will be rewarded, celebrated, and sustained

Case Study: Challenges and Lessons Learned

• Hiring and engaging the right people for IPCP team model matters

• Moving from the forming to performing stages of team development does not happen overnight; investing in building teams is essential

• IPCP is not easy; if it were, everybody would be doing it

• Overcoming the social determinants of health in caring for an underserved patient population is difficult; has implications for quality and safety

• Success in IPCP requires authentic leadership practices that are boundary spanning and can incorporate innovative care delivery models to enhance quality and safety outcomes (Shirey & White-Williams, 2015)

• Outcomes difficult to sustain without also focusing on care team well-being

2017 Recognition

Erica Arnold, MSN, RN, CNL, CHFN, CCTM (left) receives JoAnn Barnett Award for Compassionate Care

Coming Soon November/December

2017 Issue

Forthcoming Publication

Case Study: Moving Forward with Translation Into Practice Authentic Leadership Evidence for Q&S at Organizational Level

Summary of Key Points

Authentic Leadership

Primer Evidence Translation Pearls

Pearls

5-Point Action Plan 1. Learn about authentic leadership - start with developing yourself then

cultivating your teams, your environment, and your organization

2. Strategically use available resources; grow and leverage relationships and networks

3. Quantify the outcomes of your leadership; start with the end in mind

4. Get back up every time you fall

5. Prepare yourself to seize opportunities - many arrive when least expected

Closure

“To each there comes in their lifetime a special moment when they are figuratively tapped on the shoulder and offered the chance to do a very special thing, unique to them and fitted to their talents. What a tragedy if that moment finds them unprepared or unqualified for that

which could have been their finest hour.”

Sir Winston Churchill

Questions and Answers Contact Information

Maria R. Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FAAN

Professor and Chair, Acute, Chronic and Continuing Care Department University of Alabama at Birmingham, School of Nursing

Birmingham, Alabama, USA mrshirey@uab.edu

Editor-in-Chief, Journal for Healthcare Quality

Jhq.eic@gmail.com