Models and Their Role in Healthcare Assignment Papers.

Models and Their Role in Healthcare Assignment Papers.

Models and Their Role in Healthcare Assignment Papers.

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The study of healthcare is founded upon a few basic ideas like the cell or the concept of disease. Informatics is similarly built upon the concepts of data, models, systems and information. Unlike health, where the core ideas are usually grounded in observations of the physical world, these informatics concepts are abstract ideas. As a consequence, they can be difficult to grasp, and for those used to the study of healthcare, often seem detached from the physical realities of the clinical workplace .Models and Their Role in Healthcare Assignment Papers.

Models are abstractions of the real world .

What is a model and what does it do? Models are commonplace in our everyday lives. People are familiar with the idea of building model aeroplanes , or looking at a small-scale model of a building to imagine what it will look like when built. In health, models underlie all our clinical activities .Models and Their Role in Healthcare Assignment Papers.

Models actually serve two quite distinct purposes, and both of these are of interest . artificial heart is based upon two kinds of model. Firstly, the cardiovascular system has to be modelled, and secondly, a mechanical blueprint is used to model the way the heart will be constructed.Models and Their Role in Healthcare Assignment Papers.

When artefacts are created, it is assumed that they too will be used for a particular purpose. If the purpose changes, then a design becomes less effective. Thus, the physical design of the waiting room and treatment areas for a general practice clinic will assume a certain number of patients need to be seen during a day, and that certain kinds of therapy will be given. If the clinic was bought by radiologists, they would have to remodel the clinic’s design to incorporate imaging equipment, and to reflect a different throughput of patients .Models and Their Role in Healthcare Assignment Papers. we can consider a particular treatment of a disease written in a textbook to be a template for what should be done to any given patient. If that treatment was based upon assumptions about the incidence of diseases in a given population, then it may not work well if attempted in a different one. Treating infant diarrhoea in a developed nation is not the same task in underdeveloped nations where poorer resources, malnutrition, and different infecting organisms change the context of treatment. Before a model is used, one therefore has to be clear about what has actually been modelled. This is because, when models are created, the circumstances at the time have a strong influence on the final value of the model. Similarly, a set of rules and procedures might be developed in one hospital, and be spectacularly successful at improving the way it handles its cases.Models and Their Role in Healthcare Assignment Papers. One would have to be very cautious, given that these procedures implicitly model many aspects of that particular institution, before one imposed those procedures on other hospitals. Very small differences, for example in the level of resources, type of patients seen, or experience of the staff, may make what was successful in one context, unhelpful in another.Models and Their Role in Healthcare Assignment Papers.

More generally, any designed artefact, whether it is a car, a drug or a computer system, has to be designed with the world within which it will operate in mind. In other words, it has to contain in its design a model of the environment within which it will be used. These specifications constitute its design assumptions. Thus there is a connection between the process of model creation, the construction of artefacts based upon such models, and their eventual effectiveness in satisfying some purpose .Models and Their Role in Healthcare Assignment Papers.

Models are the basis of the way we learn about, and interact with, the physical world.Models and Their Role in Healthcare Assignment Papers.

Models can act either as copies of the world like maps, or as templates that serve as the blueprints for constructing physical objects, or processes.

Models that copy the world are abstractions of the real world:

Models are always less detailed than the real world they are drawn from.

Models ignore aspects of the world that are not considered essential. Thus abstraction imposes a point of view upon the observed world

Many models can be created of any given physical object, depending upon the level of detail and point of view selected.Models and Their Role in Healthcare Assignment Papers.

The similarity between models and the physical objects they represent degrades over time.

There is no such thing as a truly general-purpose model. There is no such thing as the most ‘correct’ model. Models are simply better or worse suited to accomplishing a particular task.

4. Models can be used as templates and be instantiated to create objects or processes that are used in the world.Models and Their Role in Healthcare Assignment Papers.

Templates are less detailed than the artefacts that are created from them.

An artefact is a distortion of the original template.

No two physical artefacts are similar even if they are instances of the same template.

The effect of an artefact may change while the original template stays the same.

The process of creating an instance has a variable outcome, and the impact of the instance of an artefact in the real world also varies. As a consequence, there is no such thing as a general purpose template. All we can have are templates or designs that are better or worse suited to our particular circumstances and task.Models and Their Role in Healthcare Assignment Papers.

5. The assumptions used in a model’s creation, whether implicit or explicit, define the limits of a model’s usefulness.

When models are created, they assume that they are to accomplish a particular purpose.

When models are created they assume a context of use. When objects or processes are built from a model, this context forms a set of design assumptions.

6. We should never forget that the map is not the territory and the blueprint is not the building

A 50-year-old woman with a past history diabetes and alcohol and IV drug abuse, presents with symptoms of abdominal pain and vomiting and is diagnosed as having “acute chronic pancreatitis.” Her amylase and lipase levels are normal. She is admitted and treated with IV fluids and analgesics. On hospital day 2 she begins having spiking fevers and antibiotics are administered. The next day, blood cultures are growing gram negative organisms.Models and Their Role in Healthcare Assignment Papers.

At this point, the service is clueless about the patient’s correct diagnosis. It only becomes evident the following day when (a) review of laboratory data over the past year shows that patient had four prior blood cultures, each positive with different gram negative organisms; (b) a nurse reports patient was “behaving suspiciously,” rummaging through the supply room where syringes were kept; and (c) a medical student looks up posthospital outpatient records from 4 months earlier and finds several notes stating that “the patient has probable Munchausen syndrome rather than pancreatitis.” Upon discovering these findings, the patient’s IVs are discontinued and sensitive, appropriate followup primary and psychiatric care are arranged.Models and Their Role in Healthcare Assignment Papers.

A postscript to this admission: 3 months later, the patient was again readmitted to the same hospital for “pancreatitis” and an unusual “massive leg abscess.” The physicians caring for her were unaware of her past diagnoses and never suspected or discovered the likely etiology of her abscess (self-induced from unsterile injection

The magnet hospital model is an international design to provide optimal framework for nursing care and future research. The model is composed of transformational leadership, empirical outcomes, exemplary professional practice, structural empowerment, and new knowledge combined with innovations and improvements. Hospitals that participate in the model and were awarded the title are constantly looking to improve and expand. They strive to provide expert care globally.Models and Their Role in Healthcare Assignment Papers. Scheduling and staffing are done in a way to keep nurses from burning out. The lower the burnout rate the higher the rate of satisfaction and overall health of patients. When nurses are not burnt out they work optimally and want to work with their patients and that creates …show more content…
The magnet hospital model is an international design to provide optimal framework for nursing care and future research. The model is composed of transformational leadership, empirical outcomes, exemplary professional practice, structural empowerment, and new knowledge combined with innovations and improvements. Models and Their Role in Healthcare Assignment Papers. Hospitals that participate in the model and were awarded the title are constantly looking to improve and expand. They strive to provide expert care globally. Scheduling and staffing are done in a way to keep nurses from burning out. The lower the burnout rate the higher the rate of satisfaction and overall health of patients. When nurses are not burnt out they work optimally and want to work with their patients and that creates better outcomes for their patients.
The steps in the nursing process relate to evidence based practice in many ways. During the diagnostic, and assessment steps of the nursing process important clinical questions are considered and the critical review of existing knowledge is completed. Evidence based practice also begins with identification of the problem and knowing the clinical problem by asking questions, in relation to the nursing process.Models and Their Role in Healthcare Assignment Papers.

Abstract: In many areas of the developed world, contemporary hospital care is confronted by workforce challenges, changing consumer expectations and demands, fiscal constraints, increasing demands for access to care, a mandate to improve patient centered care, and issues concerned with levels of quality and safety of health care. Effective governance is crucial to efforts to maximize effective management of care in the hospital setting. Emerging from this complex literature is the role of leadership in the clinical setting. Models and Their Role in Healthcare Assignment Papers. The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and in various government reports. Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to achieving and sustaining improvements to care quality and patient safety. In this discursive paper, we discuss clinical leadership in health care, consider published definitions of clinical leadership, synthesize the literature to describe the characteristics, qualities, or attributes required to be an effective clinical leader, consider clinical leadership in relation to hospital care, and discuss the facilitators and barriers to effective clinical leadership in the hospital sector. Despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Future strategies should aim to address these barriers so as to enhance the quality of clinical leadership in hospital care.Models and Their Role in Healthcare Assignment Papers.

Keywords: management, hospital care, barriers, leadership, clinical leadership, discursive paper

Introduction

Globally, health care systems in the developed world continue to struggle with escalating demands for services and escalating costs. Service design inefficiencies, including outmoded models of care contribute to unsustainable funding demands.1 An example is the continuing practice in many settings to look to hospital emergency departments to provide what are essentially, primary health care services. While some progress and reforms have been achieved, numerous experts point to the need for further system change if services are to be affordable and appropriate in the future.2 They note that

[…] further change is still needed, despite years of progress in the quality of health care around the world. Models and Their Role in Healthcare Assignment Papers. This transformation will require leadership – and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles. Clinicians not only make frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery.2

Effective clinical leadership has been linked to a wide range of functions. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system.2–4 Though most people are provided with health care within the community setting, hospital care continues to garner the bulk of funding and attract considerable attention in relation to care quality and related concerns. Models and Their Role in Healthcare Assignment Papers. Indeed, hospitals are very costly and diverse environments that vary in size and complexity, determined in part by their overall role and function within the larger health care system. The services provided by individual hospitals are determined and driven by a number of mechanisms, including government policy, population demographics, and the politics and power of service providers.5

However, regardless of the differences, the clinical areas of the hospital are critical to all health care organizations, given that it is at this level where consumers principally engage with the hospital system.Models and Their Role in Healthcare Assignment Papers. It is at this point where consumers are recipients of hospital care and where they witness and experience how the system functions, observing the strengths and inefficiencies of the health care system and conflict and collegiality between and among groups of health professionals. It is also at this point that clinicians, defined as any frontline health care professionals, have opportunities to fulfill leadership roles. For consumers of health care to achieve optimal health outcomes and experience optimal hospital care, many believe effective clinical leadership is essential.Models and Their Role in Healthcare Assignment Papers.

In this paper, we discuss clinical leadership in contemporary health care, definitional issues in clinical leadership, roles of hospitals in contemporary health care, preparation for clinical leadership roles, and the facilitators and barriers to effective clinical leadership in the hospital sector.Models and Their Role in Healthcare Assignment Papers.

Clinical leadership in contemporary health care

The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and various government reports.6–8 Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to improving quality and safety.9 As one Australian example, a key priority nursing recommendation of the Garling Report was that Nurse Unit Manager (NUM) positions be reviewed and significantly redesigned “to enable the NUM to undertake clinical leadership in the supervision of patients […] to ensure that for at least 70% of the NUM’s time is applied to clinical duties.”8 The remaining time could be spent on administrative and management tasks.Models and Their Role in Healthcare Assignment Papers. In the more recent Francis report7 from the UK, a recommendation was made for similarly positioned ward nurse managers to be more involved in clinical leadership in their ward areas. In the United States, clinical leadership has also been identified as a key driver of health service performance, with the Committee on Quality of Healthcare suggesting considerable improvements in quality can only be achieved by actively engaging clinicians and patients in the reform process.10

However, leadership in health care is often very complex, and some authors claim it faces unique contextual challenges. For example, Schyve5 claims aspects of governance are sui generis in health care, noting

healthcare organizations also have a rather unique characteristic. That is, the chief executive is not the only part of the organization’s leadership that is directly accountable to the governing body. In healthcare, because of the unique professional and legal role of licensed independent practitioners within the organization, the organized licensed independent practitioners – in hospitals, the medical staff – are also directly accountable to the governing body for the care provided.Models and Their Role in Healthcare Assignment Papers. So the governing body has the overall responsibility for the quality and safety of care, and has an oversight role in integrating the responsibilities and work of its medical staff, chief executive, and other senior managers into a system that that achieves the goals of safe, high-quality care, financial sustainability, community service, and ethical behaviour. This is also the reason that all three leadership groups – the governing body, chief executive and senior managers, and leaders of medical staff – must collaborate if these goals are to be achieved (Schyve 2009:35).5

While nursing is not specifically named in the above quote, we believe nursing to be implicit and integral to leadership in hospitals. There is recognition of the challenges associated with health care governance, evidenced by significant investment internationally in building systems for leadership development in health care.5,11 For example, the UK advanced leadership programs have been instituted and run for clinical leaders since 2001 by the National Health System Leadership Centre,12 and there are some similar innovations in other countries (see, for example, Ferguson et al13). Models and Their Role in Healthcare Assignment Papers. This points to the realization that the cost and consequences of poor clinical leadership greatly outweigh the costs and potential benefits of provision of formal programs to enhance clinical leadership capacity ideally in a multidisciplinary health care team context.12

Indeed, across the health care sector, evidence exists of the need for clinical leadership to optimize care delivery. In addition to challenges associated with resources and demand, episodes of poor patient outcomes, cultures of poor care, and a range of workplace difficulties have been associated with poor clinical leadership,8,9,14 and these concerns have provided the impetus to examine clinical leadership more closely.Models and Their Role in Healthcare Assignment Papers.

Definitional issues in clinical leadership

Within the health care system, it has been acknowledged that clinical leadership is not the exclusive domain of any particular professional group.15 Rather, all members of the health care team are identified as potential leaders.16 Like “leadership,” the concept of clinical leadership can be defined in a range of ways; and while a standard definition of clinical leadership providing absolute agreement on meaning is not crucial to progress and is likely to prove difficult,17 it is useful to consider the various ways clinical leadership is conceptualized and presented in the literature. While effective clinical leadership has been offered up as a way of ensuring optimal care and overcoming the problems of the clinical workplace, a standard definition of what defines effective clinical leadership remains elusive.15,18 Indeed, in some ways it is easier to consider what constitutes poor or ineffective clinical leadership.Models and Their Role in Healthcare Assignment Papers.

A secondary analysis of studies exploring organizational wrongdoing in hospitals highlighted the nature of ineffectual leadership in the clinical environment. The focus of the analysis was on clinical nurse leader responses to nurses raising concerns. Three forms of avoidant leadership were identified:Models and Their Role in Healthcare Assignment Papers.

placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant.14

These forms of leadership failure were all associated with negative organizational outcomes. Similarly, McKee et al employed interviews, surveys, and ethnographic case studies to assess the state of quality practice in the National Health Service (NHS); they report that one of the most important insurances against failures such as those seen in the Mid-Staffordshire NHS Trust Foundation is active and engaged leaders at all levels in the system.14,19

Despite the definitional uncertainty, a number of writers have sought to describe the characteristics, qualities, or attributes required to be an effective clinical leader.Models and Their Role in Healthcare Assignment Papers. Synthesis of the literature suggests clinical leadership may be framed variously – as situational, as skill driven, as value driven, as vision driven, as collective, co-produced, involving exchange relationships, and as boundary spanning (see Table 1). Effective clinical leaders have been characterized as having advocacy skills and the ability to affect change.20,21 As well, effective clinical leaders have been linked to facilitating and maintaining healthier workplaces,22,23 by driving cultural change among all health professionals in the workplace.24 To achieve these positive outcomes, clinical leaders need to be seen as credible – that is, be recognized by colleagues as having clinical competence18,25–27 and have the skills and capacity to effectively support and communicate with members of multidisciplinary clinical teams.18,25 Taking an individual perspective, effective clinical leaders require personal qualities that reflect positive attitudes toward their own profession, have the courage and capacity to challenge the status quo, effectively address care quality issues, and engage in reflective practice.18,14 Pepin et al found that clinical competence, the capacity to lead a team, and being prepared to challenge the status quo were necessary skills for clinical leaders in one Canadian study.28 In an Australian study, findings indicated that student nurses want clinical leadership attributes from their clinical preceptors to include being supportive, approachable, and motivating, while being effective communicators.29 Table 1 summarizes the characteristics of clinical leadership and the attributes of clinical leaders distilled from the literature.Models and Their Role in Healthcare Assignment Papers.

Table 1 The characteristics of clinical leadership and the attributes of clinical leaders
Notes: Table distilled from: Clark 2012;31 De Casterle et al 2008;47 Edmonton 2009;11 McKeon et al 2009;73 Stanley 2012;32 Patrick et al 2011;34 McKee et al 2013.19

Despite acknowledging the lack of a standard definition of clinical leadership, the authors in one literature review identified common themes:Models and Their Role in Healthcare Assignment Papers.

[…] the ability to influence peers to act and enable clinical performance; provide peers with support and motivation; play a role in enacting organizational strategic direction; challenge processes; and to possess the ability to drive and implement the vision of delivering safety in healthcare.30

Many articles assert that clinical leadership is leadership provided by clinicians often recognized as clinical leaders. Indeed, an important driver of the move toward models of clinical leadership is the notion that clinical leaders “are the custodians of the processes and micro-systems of health care.”31 Stanley has contributed a summary of seven clinical leadership characteristics which includes factors such as expertise, direct involvement in patient care, high level interpersonal and motivational skills, commitment to high quality practice, and empowerment of others.32 In contrast to managerial leadership, which operates through hierarchical superior–subordinate organizational relationships, clinical leadership has a collegiate orientation and a focus upon the patient or service interface.11 While some clinical leaders may hold positions of positional authority, primarily the influence of clinical leaders stems from characteristics such as clinical credibility and the capacity for collaboration. Models and Their Role in Healthcare Assignment Papers. While transformational leadership positions the leader as a charismatic shaper of followers,33 clinical leadership is more patient centered and emphasizes collective and collaborative behaviors.19,32,34

It is apparent that the “theory” of clinical leadership is in an early stage of development, and like leadership in general, in health there is very limited empirical support for specific approaches to enacting effective models. Edmonstone notes following the implementation of numerous clinical leadership programs in the UK the little research undertaken has largely focused on program evaluation, rather than the nature or outcomes of clinical leadership.35 As the body of evidence continues to develop, some definitional clarity may be achieved.Models and Their Role in Healthcare Assignment Papers.

Role of hospitals in contemporary health care

Globally, hospitals are under increased strain and scrutiny. Increased demands and fiscal pressures have increased the pressures on all health professionals as well as clinical and non-clinical staff. Hospitals, once seen as representing “health care,” are now recognized as dangerous places, particularly where the most vulnerable, such as children and older people, are exposed to the risk and actual adverse clinical events. A number of nationally and internationally influential reports6–8 have resulted in changes in visibility, scrutiny, and accountability in relation to hospital care. This scrutiny has increased the emphasis on the role of health professionals, including nurses, in monitoring standards, developing and evaluating better ways of working as well as advocating for patients and their families; and led to a substantial momentum in the quality and safety agenda, including the promotion of various strategies such as promoting evidence-based practice.Models and Their Role in Healthcare Assignment Papers.

In the hospital sector, the demands placed upon leaders have become more complex, and the need for different forms of leadership is increasingly evident. Models and Their Role in Healthcare Assignment Papers. To derive cost efficiency and improve productivity, there has been intense reorganization. Coupled with these reforms has been increasing attention upon improving safety and quality, with programs instituted to move attention beyond singular patient–clinician interpretations of safety toward addressing organizational systems and issues of culture.36 Arising from these reforms has been growing recognition that many assumptions of common leadership models are not well suited to delivering change at the point-of-care delivery or to assuring increased clinician and patient engagement in decision making.3 Accordingly, there have been calls for a transition to a new phase of hospital leadership, one that places the clinical frontline and clinicians as crucial to leadership within organizations.13,37 This transformational shift in the conceptualization of leadership has seen debate move from managerial, senior leader, or singular leader interpretations of leadership to a focus upon clinical leaders and clinical leadership.Models and Their Role in Healthcare Assignment Papers. In part, this shift has been in response to growing recognition that while designated leaders in positions of formal authority within hospitals play a key role in administration and espousing values and mission, such leaders are limited in their capacity to reshape fundamental features of clinical practice or ensure change at the frontline.11

There is considerable evidence to suggest nurses may experience dissatisfaction with the working environment in hospitals,38 with poor work environments impacting negatively on the delivery of clinical care and patient outcomes.39 In seeking to understand this dissatisfaction, work engagement among nurses and other health professionals has been explored from the perspective of burnout and emotional exhaustion40–42 with work engagement conceptualized as a positive emotional state in which employees are emotionally connected to the work roles.43 While such studies have examined engagement with work from an emotional perspective, engagement can also be understood as a broader concept that includes an employee’s relationship with their professional role and the broader organization.44 This broader view on employee engagement ties in with the concept of organizational citizenship behavior, which captures discretionary behaviors that are not formally rewarded within the organization that help others, or are displays of organizational loyalty or civic virtue.45

The thrust of much recent attention upon attaining reform in hospitals through clinical leadership has positioned clinical leadership as a vehicle for improving clinician engagement in not only their own work, but also the care delivery microsystems in which they operate.Models and Their Role in Healthcare Assignment Papers. This type of work engagement requires forms of citizenship behaviors that are focused upon improving clinical systems and practices. For individual clinicians, broader engagement within the organization with systems and processes requires the capacity for citizenship behaviors that are clinically focused and motivated, both at the level of one’s own work and also the broader network of relationships and systems. Models and Their Role in Healthcare Assignment Papers. These forms of “clinical citizenship behaviors” require a fair and just work culture in which individuals can openly identify issues and work together toward solutions.45

Importantly, given that clinicians may not necessarily be employees of the hospital in which they work but self-regulated and independent professionals who operate with a level of independence from typical employer–employee relationships, and who may have lower levels of commitment to the institution, understanding clinician engagement beyond the level of engagement with one’s own work, toward engagement with the broader clinical quality and safety agenda within the organization has important implications for the success of clinical leadership agendas.46 A small sample study of head nurses in a large academic hospital47 reported the development of clinical leaders improved the quality of the nursing work environment through enhanced communication, increased responsibility and empowerment, improved patient-centered communication, improved clarity and structure, and improved interdisciplinary collaboration.Models and Their Role in Healthcare Assignment Papers.

Hospitals are complex socio-political entities, and the ability for engagement and leadership among clinicians can be hampered by power dynamics, disciplinary boundaries, and competing discourses within the organization. Models and Their Role in Healthcare Assignment Papers. The tension inherent between clinical and administrative discourses is evidenced in the findings from the evaluation of clinical directorate structures in Australian hospitals, with close to two thirds of medical and nursing staff surveyed reporting the primary outcome of such structures was increased organizational politics.48 At the same time as there have been growing calls for clinical leadership, there is evidence from Australia that reform and restructure within hospitals has resulted in a loss of nursing management roles and functions.49 Despite a policy agenda to foster clinical leadership, there are reports that managerial imperatives can instead primarily focus upon fiscal efficiency or organizational political imperatives, with various factors colluding to silence concerns of clinicians.Models and Their Role in Healthcare Assignment Papers.

Edmonstone11 cautions that without structural and cultural change within institutions, the move toward clinical leadership can result in devolution of responsibility to clinicians who are unprepared and under resourced for these roles.Models and Their Role in Healthcare Assignment Papers. Evidence emerging from the NHS suggests particular value in leadership coalitions between managers and clinicians.19 Further, strong clinician representation at Board level has been reported to make a difference to clinical engagement.35

Preparation for clinical leadership roles

There is also a concern that many health professionals may not be well prepared to understand the nature of leadership, or take on leadership roles because of the lack of content on leadership in undergraduate course curricula.50 These deficiencies have been recognized by professional organizations and health service providers, especially in light of wide-ranging inquiries into the quality of health services in a number of countries.6,7,8 As a result, there have been efforts made to overcome these deficiencies in the preparation of health professionals. As Gagliano et al comment, there is some evidence that health service provider groups are attempting to address issues pertaining to leadership issues through design and implementation of leadership development programs.51

In the UK, a Medical Leadership Competency Framework (MLCF) has been developed and embraced by professional medical bodies, regulatory authorities, and educational providers.31 Similarly, a Clinical Leadership Competency Framework has been developed from the MLCF for use across all regulated nonmedical clinical professions, with the aim to include competencies into undergraduate, postgraduate, and continuing professional education.52 Ellis et al note that even with the establishment of these frameworks and an acceptance of them as the “gold standard for developmental activities”53 for clinical leadership, other programs in the UK in the literature report an apprentice-style program targeting doctors in training and providing them with experiential learning opportunities with senior medical officers.54 Also,Leeson and Millar describe a leadership program for allied health professionals and nurses working in community and hospital settings in the UK that aims to build individual leadership capacity.55 Such programs running alongside a national approach in some ways epitomizes the complexity of clinical leadership in health care.Models and Their Role in Healthcare Assignment Papers.

Other countries have developed education and professional development programs in clinical leadership for doctors, nurses, and allied health professionals working in their respective health systems. Some of these programs have similar features to UK NHS leadership frameworks and associated strategies.Models and Their Role in Healthcare Assignment Papers. For example, in New Zealand medical schools are working to provide leadership training in their undergraduate medical curriculum.56 In Australia, training programs are available to hospital medical registrars in teaching hospitals.57 Opportunities for allied health professionals to engage in clinical leadership development programs offer similar opportunities for capacity building in leadership, especially in postgraduate training.58,59

Globally, the International Council of Nurses identifies leadership as one of the major considerations underpinning their activities and has established a Global Nursing Leadership Institute as a vehicle for these activities.60 In addition to this global approach, local initiatives to enhance clinical leadership have been developed and implemented in a number of countries.Models and Their Role in Healthcare Assignment Papers. Interestingly, while many countries have taken a relatively widespread approach to clinical leadership development, in Australia, New South Wales Health’s response to the Garling report has been the “Take the Lead,” a program developed specifically for NUMs to enhance their clinical leadership skills through professional development activities.61 However, it must be noted that while effective clinical leadership is identified as a key issue to be addressed, and despite a number of strategies designed to enhance clinical leadership, to date there are a lack of studies that show improvements in patient outcomes or outcomes for the health workforce as a result of these strategies. And, as Moscrop comments, “questions persist about what leadership means in medicine”.62

Facilitators and barriers to achieving effective hospital-based clinical leadership

Clinical leadership, if it is to be evident and successful, requires broader clinician engagement and forms of citizenship behaviors within the clinical context that mediate the realization of this form of leadership.Models and Their Role in Healthcare Assignment Papers. Much has been written in the organizational and health care literature about employee work engagement and the benefits derived through promoting work engagement.5,19 Similarly, organizational citizenship behavior is well rehearsed in the literature. Considerable evidence confirms positive associations between constructs such as job satisfaction, work performance, improved productivity, and engaged employees.5 Organizational citizenship behavior has been defined as work-related behaviors that are discretionary, not related to the formal reward systems, and which promote the effective functioning of the organization.Models and Their Role in Healthcare Assignment Papers. The types of behaviors commonly seen to form organizational citizenship behavior include altruism, courtesy, conscientiousness, and civic virtue,63 including acts such as helping those with a heavier workload, giving of one’s time to help others, not taking long lunch breaks, and completing tasks on time.64 The focus of attention on work engagement and citizenship behaviors, both within and outside of the health care literature, has largely been upon the general construct of work engagement or disengagement with attention to work roles and tasks.46 The turn toward clinical leadership requires attention to different facets of work engagement and citizenship behaviors, in particular the nature of clinical citizenship behavior as opposed to generic forms of these behaviors.Models and Their Role in Healthcare Assignment Papers.

Despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Such barriers are noted extensively in the literature and can include lack of incentives, lack of confidence, clinician cynicism, poor communication, poor preparation for leadership roles, curriculum deficiencies at undergraduate level in medicine and health professional courses, experience as participants in poorly constructed clinical leadership programs, inadequate resourcing of development programs, poor leadership, lack of vision and commitment at the higher levels, perceptions of leadership as “other” and not core to a clinical practice role, poor interdisciplinary relationships, role conflict, and at times rejection of the “leader” role as unacceptable impost, resistance to change, and poor team work.2,12,50,65–67,69–71

Edmonstone35 cautions that the emphasis upon competency-based leader development has done little to foster effective clinical leadership in the UK, despite its potential usefulness, and informative and summative evaluation of leader development. Although considerable discussion has occurred on the need for clinical leadership, and large scale pubic inquiries evidence the considerable patient harm that has occurred in the absence of such leadership,7,8 there continues to be a major disconnect between clinicians and managers, and clinical and bureaucratic imperatives. The debate over who is best positioned to lead service delivery and the place of clinicians in governance continues.Models and Their Role in Healthcare Assignment Papers.

Conclusion

Effective clinical leadership is associated with optimal hospital performance. It is allied to a wide range of hospital functions and is an integral component of the health care system. Developing clinical leadership skills among hospital nurses and other health professionals is of critical importance. However, despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Future strategies should aim to address these barriers so as to enhance the quality of clinical leadership in hospital care. As the focus on hospital performance intensifies, leadership to increase efficiencies and improve quality will be of increasing importance.Models and Their Role in Healthcare Assignment Papers.

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. Models and Their Role in Healthcare Assignment Papers. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.Models and Their Role in Healthcare Assignment Papers.

Keywords: Teamwork, Health organization, Quality care, Effective team, Communication
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Introduction
An effective teamwork is now globally recognized as an essential tool for constructing a more effective and patient-centred health care delivery system. Identifying best practices through rigorous research, which can provide data on optimal processes for team-based care, is subject to identification of the core elements of this system.Models and Their Role in Healthcare Assignment Papers. Once the underlying principles and core values are agreed and shared, researchers will be able to more easily compare team-based care models and commissioners will be able to promote effective practices [1]. Therefore, a number of designated health professional bodies worldwide have come out with recent statements to define teams and their roles and the characteristics of a successful team [1–4]. They elaborated on essential values and principles of a team based health care, to share a common ground on this very hot topic. These have all been highlighted in this article. The potential challenges, and practical tips on how to successfully approach the task, have also been explored and included alongside proposed implementation strategies.Models and Their Role in Healthcare Assignment Papers.

Definitions, Importance and Evolution
The nature of a team is varied and complex. Though many patients may think that the most effective team is the multidisciplinary team, however, teams may be drawn from a single professional group.

Definitions
A team can be defined as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common and valued goal/objective/mission, who have been assigned specific roles or functions to perform and who have a limited lifespan of membership [2].Models and Their Role in Healthcare Assignment Papers.

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient – to accomplish shared goals within and across settings to achieve coordinated, high-quality care [5]. The incorporation of sharing responsibilities with accountability between team members in health care systems offers great benefit.Models and Their Role in Healthcare Assignment Papers. However, in practice, shared responsibility without high-quality teamwork can result in immediate risks for patients. For example, poor communication between health-care professionals, patients and their caregivers, has emerged as a common reason for patients taking legal action against health-care providers [2]. Medical errors, “near misses” and other adverse events may also occur due to inadequacy of communication among team members even in a well coherent team [6–10]. Moreover, lack of purposeful team care can also lead to unnecessary waste [11]. Therefore, identification of best practices may help avoiding some of these dangers, and may help to control costs [12,13].Models and Their Role in Healthcare Assignment Papers.

An effective team is a one where the team members, including the patients, communicate with each other, as well as merging their observations, expertise and decision-making responsibilities to optimize patients’ care [2]. Understanding the culture of the workplace and its impact on team dynamics and functioning will make a team member a good team player.Models and Their Role in Healthcare Assignment Papers.

Importance
Nowadays, patients are rarely looked after by just one health professional. In the context of a complex healthcare system, an effective teamwork is essential for patient safety as it minimizes adverse events caused by miscommunication with others caring for the patient, and misunderstandings of roles and responsibilities [2]. Patients are undoubtedly interested in their own care and must be part of the communication process too; their early and throughout involvement has been also shown to minimise errors and potential adverse events [2].Models and Their Role in Healthcare Assignment Papers.

The evolution of patient care
One all-knowing physician, or a private nurse living in the community in the “good old days” cared for people, and either was very easy to approach when needed at any time of the day [1]. Health care has changed enormously since then with more rapid pace in the last 20 years. It is now seen as undesirable in health care to practice in isolation and may even put the patient at risk [14,15]. The complexity of modern health care, which is evolving rapidly acts as a driving force behind the transition of health care practitioners’ from being soloists to members of teams who share a common aim [1].Models and Their Role in Healthcare Assignment Papers.

Today, as both clinicians and patients integrate new technologies into their management process, the overall rapidity of change in health care systems will continue to accelerate. The U.S. National Guideline Clearinghouse has listed over 2,700 clinical practice guidelines now, and, each year, the results of more than 25,000 new clinical trials are published [16].Models and Their Role in Healthcare Assignment Papers. No single practitioner can handle, absorb and use all this information, and the need for specific knowledge in specialized areas of care by different team members has become a necessity. Now, more than ever, there is an obligation to strive for perfection in the science and practice of inter-professional team-based health care [1]. Each clinician relies upon information and action from other team members. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented [1].Models and Their Role in Healthcare Assignment Papers.

The Development and Characteristics of a Successful Health Care Team
Different types of teams can be identified in health care systems [2]:

Core teams
These are directly involved in caring for the patient.Models and Their Role in Healthcare Assignment Papers.

They usually consist of team leaders and members who are direct-care providers such as nurses, dentists, pharmacists, doctors, assistants…etc. They also include case managers.

Coordinating teams
The group responsible for operational management, coordinating functions and resource management for core teams.

Contingency teams
Formed to deal with emergencies or specific events (e.g. cardiac-arrest teams, disaster-response teams,. etc).

Ancillary teams/services
The group supports services that facilitate patient care such as cleaners or domestic staff.

Support services and administration
Those who provide indirect, task-specific services in a health-care facility support services. It includes secretaries and the executive leadership of a unit or facility. This team has 24-hour accountability for the overall functioning of the organization. In order for any team to form and develop in a way that makes it coherent, effective and strong enough to face future challenges, research have shown that it usually passes through the following stages [2]:Models and Their Role in Healthcare Assignment Papers.

Forming: Typically characterized by ambiguity and confusion. Team members may be unclear about tasks at this stage. They have not yet chosen to work together and may communicate in a superficial and impersonal manner.

Storming: A difficult stage when there may be conflict between team members and some rebellion against the assigned tasks. Team members may get frustrated here when do not progress well in the tasks.Models and Their Role in Healthcare Assignment Papers.

Norming: Open communication between team members is established and the team starts to confront the task at hand. Generally accepted procedures and communication patterns are established.

Performing: The team focuses all of its attention on achieving the goals. The team is now close and supportive, open and trusting, resourceful and effective.Models and Their Role in Healthcare Assignment Papers.

After being formed and continue to develop, Healthcare teams interact dynamically and have the common goal of delivering health services to patients. In order to succeed, the team members need to share certain characteristics, which include [2]:

Possess specialized knowledge and skills and often function under high-workload conditions.Models and Their Role in Healthcare Assignment Papers.

Know their role and the roles of others in the team(s) and interact with one another to achieve a common goal.

Act as a collective unit, as a result of the interdependency of the tasks performed by team members.Models and Their Role in Healthcare Assignment Papers.

Possess specialised and complementary knowledge and skills.

Take decisions.

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Values, Principles and Benefits
The values needed in an effective team member harmonize with the core competency domain of “Values/Ethics” put forward in the meeting sponsored by Inter-professional Education Collaborative (IPEC)entitled “Team-Based Competencies”.The following are five personal values that characterize the most effective members of high-functioning teams in health care [1]:

Honesty: A high value is put on effective communication within the team, including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continuous development and for maintaining the mutual trust, which is prerequisite for a high-functioning team.Models and Their Role in Healthcare Assignment Papers.

Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems inconvenient. Such discipline allows teams to develop and stick to their standards and protocols even as they seek ways to improve.Models and Their Role in Healthcare Assignment Papers.

Creativity: Team members are excited and motivated to tackle emerging problems creatively. They see even errors and some unanticipated bad outcomes as potential opportunities for improvement.Models and Their Role in Healthcare Assignment Papers.

Humility: Team members do not believe that one type of training or perspective is uniformly superior to the training of others, though they recognize differences in training. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy.

Curiosity: Team members are dedicated to reflecting upon the lessons they learned in their daily activities and using this reflective experience in continuous professional development and the functioning of the team.Models and Their Role in Healthcare Assignment Papers.

Principles of Team-Based Health Care
There are many models to describe effective teamwork. Historically, these have come from other industries, such as the aviation’s crew resource management (CRM) [2]. The principles that characterize a successful team based health care include [1]:

Shared goals: The team, including the patient and, where appropriate, family members or other support persons, generate a common and clearly defined purpose that includes collective interests and demonstrates shared ownership.Models and Their Role in Healthcare Assignment Papers.

Clear roles: There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team to take advantage of division of labour, thereby accomplishing more than the sum of its parts. Mutual trust and respect: Team members earn each other’s trust, creating strong norms of reciprocity and greater opportunities for shared achievement. They respect and appreciate the role of each other. They also respect each other’s talents and beliefs, in addition to their professional contributions. Effective teams also accept and encourage a diversity of opinions among members.Models and Their Role in Healthcare Assignment Papers.

Effective communication: This is crucial for the teamwork success. The team prioritizes and continuously refines its communication skills. It has consistent and accessible channels for complete communication, and used by all team members across all settings.

Measurable processes and outcomes: Reliable and timely feedback on successes and failures should be agreed and implemented by the team. These are used to track and improve performance immediately and put strategies for the future.Models and Their Role in Healthcare Assignment Papers.

Leadership: Effective team leaders facilitate, coach and coordinate the activities of other team members. Effective leadership is a key characteristic of an effective team.

Benefits of effective teamwork
Effective teams can improve care at the level of the organization, the team itself as a whole, the individual team member and the patient (Table 1) [2]:Models and Their Role in Healthcare Assignment Papers.

Table 1
The benefits of effective teamwork

Organizational benefits Team benefits Patient benefits Benefits to team members
Reduced time and costs of hospitalization Improved coordination of care Enhanced satisfaction with care Enhanced job satisfaction
Reduction in unexpected admissions Efficient use of health-care services Acceptance of treatment Greater role clarity
Services are better accessible to patients Enhanced communication and professional diversity Improved health outcomes and quality of care Reduced medical errors Enhanced well-being
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Challenges to Effective Teamwork
Several barriers exist to establishing and maintaining effective teamwork in health care [2]:

Changing roles
In many health-care teams, there is considerable change and overlap in the roles played by different health-care professionals. These changing roles can present challenges to teams, in terms of acknowledgement and role allocation.Models and Their Role in Healthcare Assignment Papers.

Changing settings
Some changes in the nature of health care such as increased delivery of care for chronic conditions require the development of new teams and the modification of existing teams.

Health-care hierarchies
The strongly hierarchical structure of health care can be counterproductive to well-functioning and effective teams where all members’ views are considered.Models and Their Role in Healthcare Assignment Papers.

Individualistic nature of health care
Many health-care professions, such as nursing, dentistry and medicine, are based on the autonomous one-to-one relationship between the health care provider and patient. While this relationship remains a core value, it is challenged by many concepts of teamwork and shared care.Models and Their Role in Healthcare Assignment Papers.

Instability of teams
Some health-care teams are transitory in nature, coming together for a specific task or event (e.g. Trauma team).

Failing teamwork leads to accidents
Reviews of high-profile incidents have identified three main types of teamwork failings, namely, unclear definition of roles, lack of explicit coordination and other miscommunication.Models and Their Role in Healthcare Assignment Papers.

Resolving disagreement and conflict
The ability to resolve conflict or disagreement in the team is crucial to successful teamwork. This can be especially challenging for junior members of the team or in teams that are highly hierarchical in nature.

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Practical Tips
How to apply teamwork principles?
Here are some tips to help health care teams to head towards successful achievements, which include:

A life example of a strategic plan.Models and Their Role in Healthcare Assignment Papers.

Practical tips for health care team members.

Monitoring progress through patients’ satisfaction.

Practical strategic approach
“The context for health care and support is changing. Most significantly, with people living longer, we have a greater number of older patients and people to support, many with multiple and complex needs, and with higher expectations of what health, care and support can and should deliver.Models and Their Role in Healthcare Assignment Papers. Delivering health and care support and services involves us working with people in a new partnership, offering and engaging with people in making choices about their health and care, and supporting ‘no decision about me without me” [3]. These are statements made by the senior NHS nurses, Midwifery staff and other health related professionals in the UK who have engaged a wide range of professionals and patients in assessing satisfactions and suggestions of these team members in quality of delivered care. Accordingly, they put a strategy to meet the rapidly progressing demands on the service. The purpose of the engagement was two-fold. Firstly, they wanted to get wider views on 6Cs: care, compassion, competence, communication, courage and commitment.Models and Their Role in Healthcare Assignment Papers. They wanted to test whether these would resonate with staff and patients and form a common language of their vision. Secondly, they wanted to test responses to six areas of action that (underpinned by the 6Cs of value and behaviour) which will enable ongoing improvements in care and services for all patients and service users [3]. The strategy addressed equality issues under the Equality Act 2010, considering it from the point of view of both the people receiving care and those giving it. The six areas of action that were supposed to deliver their vision included [3]:Models and Their Role in Healthcare Assignment Papers.

Action area one: Helping people to stay independent, maximise well-being and improving health outcomes.

Action area two: Working with people to provide a positive experience of care.

Action area three: Delivering high quality care and measuring the impact.Models and Their Role in Healthcare Assignment Papers.

Action area four: Building and strengthening leadership.

Action area five: Ensuring we have the right staff, with the right skills, in the right place.Models and Their Role in Healthcare Assignment Papers.

Action area six: Supporting positive staff experience.

Practical tips for health-care professionals [2]
Always introduce yourself to the team

Clarify your role

Use objective (not subjective) language

Learn and use people’s names

Be assertive when required

Read back/close the communication loop

State the obvious to avoid assumptions

Ask questions, check and clarify

Delegate tasks to specific people, not to the air

If something doesn’t make sense, find out the other person’s perspective

Always do a team briefing before starting a team activity and a debrief afterwards

When in conflict, concentrate on “what” is right for the patient, not “who” is right/wrong?

And remember: “Teamwork doesn’t just happen”. It requires [2]:

– An understanding of the characteristics of successful teams
– Knowledge of how teams function and of ways to maintain effective teams.Models and Their Role in Healthcare Assignment Papers.
Patient satisfaction
A sensitive indicator for a successful health delivered teamwork is Patient satisfaction, which requires:

C.P.R.

C: Compassionate Communication

P: Patient information/Pain management

R: Response

For a high patient satisfaction, the delivery of the following is critical [4]:

Communicate to the patient who you are, what you do and who are the members of the team.Models and Their Role in Healthcare Assignment Papers.

Inform the patient daily what their plan is for the day and set expectations – write on the whiteboard so they can see it and revise as they need.Models and Their Role in Healthcare Assignment Papers.

Inform the patient and family if they have any questions, concerns to call – you are there to help.

Encourage the patient to communicate how they are doing in managing their pain – their comfort is vital!

Include the patient – tell them what you are doing in the room, even the simple things like adjusting IV’s or taking a vital sign. The more you communicate about what you are doing, the more comfortable they will be with asking questions.Models and Their Role in Healthcare Assignment Papers.

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Conclusion
The ambition of delivering quality patient care is subject to high performance through patient focused teams. However, we need to close a gap between traditional practices and the new attitudes required from an effective team to achieve such a great ambition. Therefore, health care organizations should aim at providing exceptional patient care by adopting wide team based culture in which certain values and principles are shared and transparently communicated among team members including patients who should be placed in the heart of the care.Models and Their Role in Healthcare Assignment Papers.

 

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