The Art of Leadership

Author(s): 

Dona M. Hoffman, RN, BSN, MHA, BC-NE, Manager Invasive & Noninvasive Cardiac Services and Interventional Radiology, Advocate Good Shepherd Hospital, Barrington, Illinois

Dona Hoffman can be contacted at dona.hoffman@advocatehealth.com.

A registered nurse of 24 years, I am currently the manager at Advocate Good Shepherd Hospital in Barrington, Illinois, responsible for the cardiac cath lab, the non-invasive cardiology department, and the interventional radiology department. Leading high-performing teams is invigorating and also demanding. I have seen, felt, and lived significant change during the past five years, and would like to share some insight on my struggles and successes during this period. In my current role, I have faced challenges such as addressing associate satisfaction scores of one percent, restructuring existing work teams, merging and downsizing work teams, and introducing cross-training. And yes, leading teams through difficult phases has been painful at times. Along with saying a daily prayer for me, for my team members, and for our patients, I have had to be positive and remain focused on the goals — many of which were outside my control to establish or modify. Although change is hard and does not occur overnight, I am proud to say that five years after I began this journey, I currently lead three teams with associate satisfaction scores of ninety-nine percent, patient satisfaction scores in the nineties, and staffing worked-hours that meet corporate established targets. Leadership is not a bed of roses, but the rewards of implementing effective leadership feel remarkable — especially upon reflection of how far you have come in light of where you were. I hope what I have experienced and learned can serve you in your journey. Please enjoy my thoughts and take freely from the lessons I have learned.

The art of leadership

The art of leadership goes much deeper than meeting the bottom line. Although leaders must meet budgets and address fiscal imperatives, the art of leadership is ultimately about positively impacting others, which in turn has the potential to positively impact health care outcomes. These beneficial outcomes ultimately change lives of the patients we serve for the better. Never before have we lived in a constant state of “how can we do it better” or “our finances depend on our outcomes”. How do we lead teams in this new, ultra-competitive, and demanding environment that requires constant change? We must manage these challenges through transformational leadership. As health care professionals, we may lead with a caring heart, but it is essential that we also lead with a clear, comprehensive, and global understanding of where we must be going. Transformational leadership, like the cultivation of a garden, requires motivation and inspiration to facilitate optimal growth and maturity. As leaders, we must have the ability to encourage our teams, appreciate laughter, be creative, and navigate change. Leading change depends on facilitating the will to change, as well as the willingness to be changed. As transformational leaders, we must be consistent, available, and mindful of each person’s attributes. We must focus our efforts to ensure unity and support our network, while being transparent with our results, goals, and vision. Success happens not because followers dutifully agree to go along but because leaders and followers learn from each other, come to a common understanding, and establish shared values.1

Authentic leadership is the “glue” needed to hold together a healthy work environment.2 One can encourage a team in a variety of ways, some of which require effort but very little time and minimal cost. The simplest actions by leaders, such as making rounds through the clinical area — smiling and appearing non-rushed — go light-years towards the goal of encouraging staff.3 If all your team members know you are not only present, but physically there behind them, it goes a long way to underpin staff morale. An email to an individual employee (or the entire team) thanking them for a job well done, or a brief thank-you note mailed to the home of an associate for going that extra step, conveys more than could ever be derived from a soon forgotten t-shirt, free lunch, or corporate logo pen set. Just have fun with it, but let it come from the heart. It is okay to show your team you care and are engaged in their success…in fact, it is essential! Lack of recognition leads to discontent, poor morale, reduced productivity and suboptimal care outcomes.4

Leading a business is stressful. Studies have shown that laughter can benefit both emotional wellness and physical well-being. The art of leadership requires a leader to relate effectively with his or her team. This doesn’t mean all interactions are business and require a boredom element, which most frequently leads to rolling eyes and dozing teams. From hosting an inexpensive potluck hot dog roast, to posting fun pictures of accomplishments, or serving Kool-Aid and cookies at staff gatherings, relating on a human level to those working the front line helps associates feel encouraged and welcomed. Introducing these types of opportunities to laugh and connect with one another infuses the human factor into the work environment. These moments convey that we are all in this together. As stated by one of my unit’s former patients, “The greater the relationship, the greater the understanding!” This not only applies to the patients we care for, but also to the teams we lead. I often say, “We must take care of our brothers and sisters before we take care of our cousins”, which my team understands to mean “no floating to other areas until the needs of the patients in our department are covered”. To me, this sounds much lighter than simply stating, “No floating”. Whenever possible, I strive to find a different way of saying no, other than just “no”.

During this era of constant change and external demand to do things better and quicker, it is crucial as a leader to be open to embracing creativity and to encourage our team members to think outside of the box. As previously noted, leaders must be open to change and be willing to be changed. This is applicable for everyone on the entire health care team. What we did last year may no longer work today, and we have to be ready to accept that. As leaders, we must push the envelope and be prepared to accept failure on occasion. There’s nothing wrong with trialing a new process, re-evaluating current processes, re-tweaking revised procedures, and utilizing data to drive your team’s performance. Perhaps that new process needs to be tweaked, tweaked again, and then be tweaked a bit more. That’s all okay if in the end it’s all about impacting change and ensuring positive results. Cultural change may be needed when the environment of the company changes. Competition or new regulations may require a new organizational culture.5 

Benchmarking with like departments and similar facilities has become the expectation when it comes to improving performance. During the past few years, we evolved away from volume-driven metrics to value-based care. In today’s health care, we have uncontrollable external forces that impact our business model from every direction. Data and quality outcomes have become more important guideposts than ever before. As leaders, we must own the metric for our unit and facility, because we will be responsible for the financial impact when our scores are not what administration expects. 

Have you ever heard of the renter versus owner mentality? Renters are there to do the job and leave. They don’t follow through on demands and often push the blame off on others. Owners, however, truly care and are vested in the well-being of their clinical unit and facility. They ensure demands are met and they assume responsibility for their actions and the outcomes of their actions. Leaders must be “owners”, ensuring their teams own their actions, and take responsibility to get the entire team motivated to a similar mindset when it comes to knowing and owning their performance measures. Leaders must be transparent with what is working well, as well as with what is not working. They must have data to validate acceptable performance without pushing blame on the survey instrument or process. Standardized surveys such as HCAPS are the same for all institutions, regardless of size or geographical location. So why do some organizations perform better? Is it their process or is it the people working the process? When it comes to process change, failure to think of downstream impact when changing a process can lead to frustration, dissatisfaction, and failure. It is imperative when making a process change to think holistically and consider all downstream impacts. For example, the process or department may be a well-oiled machine, but if front-line associates are unhappy, lack training, do not feel valued, or are living in the renter role of coming to work clocking in and out, they need to be moved up or out of the organization. In this event, do not delay to have those crucial conversations, clearly state expectations, document interactions, and if necessary, involve your human resources department.

Networking with the leadership from another facility, whose performance is exceeding expectations, may generate some creative ways of altering your business approach. At the very minimum, it could lead to energetic brainstorming suggestions for future exploration. For those who do not have diverse experience or knowledge garnered through work engagement at various locations, networking with another facility can be your best asset. Creating external relationships, sharing ideas, and scheduling site visits to see and experience alternate processes can be a vital element to promote the embracing of change. Leaders must not omit front-line associates from participation in these activities. Encouraging a front-line associate to engage in a site visit may lead to vital dialogue on overcoming obstacles or barriers to improvement. A site visit is crucial, especially when you have departments with low turnover and tenured associates, as these environments tend to become mired in doing things as they always have been done. Engage your associates in the change process by having them lead group or team discussions. Hold staff accountable to participate in the change process; encourage them to engage and provide ongoing feedback about what is working or what could be improved, using data and evidence-based research as your carrot rather than as a stick.6

Consistency can be a challenge, and everyone has good and bad days. The associates we manage deserve a consistent leader, regardless of the type of day the leader is having. Understanding when it is not a good day to give performance reviews, and knowing when it’s best to avoid such engagements, is a leadership trait that must be learned and then hardwired. Whether you are president, director, or manager, the human factor remains an essential element of leadership. We all have a business to run, and we are all human with emotions and physical ailments. When you need those moments to cry, shut the door. When you need those moments to vent, call a peer. When you feel like you are going to explode, walk away. Our teams work hard and deserve a steady leader. In addition, teams are only as good as their leader, and leaders are only as good as the weakest link in their team. Having the ability to take a day off to unwind is healthy and is not only good for you, but also your team. The art of leadership doesn’t come easy and it can be physically draining. We must take care of our teams, but we must also take care of ourselves.

When leading multiple departments in various buildings, time is precious and can easily evaporate. You still have to take time to show your reports the way. Ensure your team knows you are available. Extend your open-door policy by inviting staff to schedule a time that works for both of you. Round on the unit daily to ensure the front line is aware of your presence. Simple acts such as keeping the office door open and lights off signals to my team I am on-site and in a meeting. Meeting early morning or late afternoon may be best for both parties and your division, so do whatever is necessary and be flexible. 

Ensure your team members are being utilized to their fullest potential, and continually look for ways to strengthen their abilities or skills. Although everyone has an expected performance level, the attributes of each team member are unique, and each individual adds a specialty to your team if you cultivate their potential.7 Utilize your staff’s skills and talents, encourage their involvement in unit activities, and support and reassure them in times of unrest or uncertainty. Each person on the team must feel valued. If you want to identify what is not working well, just stop for a moment and quietly look around the room in a detached manner. It is highly likely that you will be able to identify at least one element that could be improved. However, approach these opportunities from the viewpoint of appreciative inquiry and focus on the majority that is working well, not the two percent related to complaints.8 So far in my career, the best advice given to me was from my current vice president of nursing, who said, “Surround yourself with genius, compared to those who won’t belly up to the table, and your life will be easier”.9 

Finally, unity within a team is visibly apparent, and it goes beyond just being cohesive or connecting.10 Success for the organization comes when the entire team has unity, clearly understands its vision and goals, and is supported to work at their fullest potential. A unified team can survive the most drastic of changes. Creating and maintaining team unity is not easy. Like growing vegetables in a garden, which requires water, cultivation, and weeding, a unified team requires time to develop, leader investment, and repetition in modeling and role modeling. Leaders must continually cultivate the team and weed out those who cause disunity by managing them up or out of the organization. 

In conclusion, never underestimate the power of your influence as a leader. The patients we serve and our front-line team members depend on and deserve our very best, each and every day. Make the most of what you have by focusing on what’s working and then work to hardwire it. Focus your attention on your team as a whole, but celebrate the strength that each member of the team brings to the group. Engage your team in results-oriented efforts, and ensure they engage their fellow team members with the same desire and energy. Change is hard and results are not often quickly visible. Be patient and be driven by your progress. Focus on what’s working, and work to fix what isn’t. Learn to aim for immediate results, but be willing to accept delayed gratification. That’s what separates artful leaders from those that are just going through the motions of leading! 

References

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  2. Shirey MR. Authentic leaders creating healthy work environments for nursing practice. Am J Crit Care. 2006 May; 15(3): 256-267.
  3. Powell C. It Worked For Me: In Life and Leadership. New York, NY:  Harper Collins; 2014.
  4. American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2005. Available online at http://www.aacn.org/wd/hwe/docs/execsum.pdf. Accessed February 13, 2015.
  5. Schein EH. Organizational Culture and Leadership. Hoboken, New Jersey: John Wiley & Sons; 1992.
  6. Thompson PA. Creating leaders for the future. Am J Nurs. 2009 Nov; 109(11 Suppl): 50-52. doi: 10.1097/01.NAJ.0000362023.70375.77.
  7. Bricker J, Dombrowicki C. Creating a top-performing cath lab team: the importance of communication. Cath Lab Digest 2009; 17(8): 8-9.
  8. Hammond SA. The Thin Book of Appreciative Inquiry. 3rd ed. Blend, OR: Thin Book Publishing Company; 2013.
  9. M. Araujo. Personal communication, February 14, 2014.
  10. Maxwell JC. Everyone Communicates, Few Connect. Nashville, TN: Thomas Nelson, Inc.; 2010.

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