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Review the five competencies of leadership (chapter 1). Describe in your post what your process is or will be to meet the competency of “leading yourself”.

DNP-803-Leadership in Organizations and Systems

 

Module 2: Discussion – Innovation, Competencies and Leadership.

 

1. Review the five competencies of leadership (chapter 1). Describe in your post what your process is or will be to meet the competency of “leading yourself”.  In addition, set a reasonable, small, self-care goal that you can accomplish every week for yourself for the next 7 weeks. Post your self-care goal on the discussion board thread this week. Please note: You will follow up with a progress report about meeting your self-care goal at week three and with a final post at the conclusion of the course. These self-care posts are part of your discussion board grade. 

 

2. Think about your role as a leader – either present or future role.  What activities or behaviors or activities could you demonstrate that reflect the seven characteristics (discussed in chapter 2) of the innovative leader?

 

3. Think about a change that is needed at your organization; Please use an idea not related to your scholarly project. Think about a needed change from a leadership perspective. How would you as the leader initiate this change/innovation  using the concepts of Complex Responsive Processes (CRP) (chapter 3)?

 

4.  Reflect on the values exercise. Did the value match up with how you make decisions, interact with others, and shape your decisions? Why or why not? How will this value influence you as a leader? 

 

1. Make your initial post by 23:59 EST Thursday of this first week.

 

2. Respond to your classmates’ posts by 23:59 EST Saturday. Follow up with your classmates on Sunday if needed.

 

STUDY MATERIALS

 

Additional Readings and Resources:

 

1. AUDIO: https://www.audible.com/pd/B07DJYBXNC?source_code=ASSOR150021921000V

 

2. Dare to Lead by Brene Brown.

 

3. Ellis, L. (2020). The Importance of Meta-Leadership During the COVID-19 Crisis. Harvard School of Public Health retrieved from   https://www.hsph.harvard.edu/ecpe/meta-leadership-during-covid-19-crisis

 

4. Divya, J.(2014). Love in a cup: Walla general hospital brings care to caregivers. Retrieved from  

 

https://gleanernow.com/news/2014/01/love-cup-walla-general-hospital-brings-care-caregivers

 

5. Jobs, S. (2010). Steve Jobs talks about managing people. YouTube. Retrieved from

 

Steve Jobs talks about managing people

 

 

6. Merrild, P. (2015). The biggest U.S. health care challenges are management challenges. Harvard Law Review. https://hbr.org/2015/02/the-biggest-u-s- health-care-challenges-are-management-challenges

 

PEER RESPONSES

 

Joy Oche

 

1.     Reflect on one of the four concepts presented in the reading in Chapter 4 of your textbook. The four concepts are:

 

               Organization as Conversation

 

               Working live: Improvisation

 

               Complex Relational Healthcare

 

               Complex Relational Being  

 

Choose  one concept above  and discuss the following:

 

What opportunities do you see in your organization for integrating this concept? What challenges might you face in adopting such a concept? What are some ways to overcome the challenges?

 

Working Live: Improvisation is one of my strengths according to the Clifton strengths assessment. This concept involves looking for patterns and reading cues to determine a course of action. Most organizations have scripts for scenarios such as de-escalating an angry client. What happens when the client is deaf? Or speaks a different language? Working live means improvising while still maintaining structure. It also means staying alert to situational cues and making practical judgment calls to address issues that arise in day-to-day working life. Some challenges that can be faced are the possibility of misreading a situation or running to the wrong conclusion. There are several reasons that explain a person’s actions such as cultural, religious, or personal values and beliefs. It is possible to mistake someone’s actions or reactions. This is where clarification can be used and rephrasing to make sure the right message is sent and understood as intended. Before assuming there’s an issue, get clarification, find out exactly where the communication breakdown occurred, find the parties involved, and what the current issues (if any) are. This will ensure resources are directed towards arriving at a meaningful solution.

 

2.      Discuss an intervention, care modality, etc. in your practice setting that is based on evidence but needs a change. Using the  evidence-innovation cybernetics model in your textbook as a guide (Figure 5.3 p.120) discuss the gaps (what is missing, what needs to be changed) in the areas of practice expertise, clinical values, and/ or culture of care.  As a leader how could you stimulate innovation to close these gaps to positively impact outcomes or changes?

 

I currently work at an outpatient clinic as a psychiatric nurse practitioner. The clinic relies on several diagnostic testing to be done to begin medication management for patient complaints. For instance, a patient needs to complete the GAD-7 assessment to justify a diagnosis of anxiety disorder and prescribe a medication. The practice has a required QB Check test for patients with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD). This test must be completed, despite the patients’ symptoms, prior to starting any medications. The same goes for an older adult with declining memory needing to complete a Mini Mental State Examination (MMSE) to assess for dementia. These patients are left without the required treatment if the testing cannot be completed. Using the Cybernetic evidence and innovation model, I can suggest and develop a behavior modification education plan for patients with mental health concerns who need some diagnostic testing. This will ensure that the patients get some resources to manage the symptoms they are experiencing without delay. Some patients never complete the required testing, while others wait for weeks to complete the testing due to cost or time restraints.

 

 As a hands-on provider, I see the gap between the practice and patient outcomes. To bridge the gap, I can work alongside the psychotherapist to develop behavior modification plans of care for the various psychiatric disorders that require testing. I can also collaborate with stakeholders to help them see the positive effect this will have on patient outcomes and patient satisfaction scores. This will prevent delays in managing patient symptoms while they schedule and complete the required diagnostic testing.

 

 

 

3. Post the results of your CliftonStrengths Assessment.  The assessment generates a report of your top five Themes/Strengths.  Post your top five Themes and discuss your thoughts about the results. Did the results surprise you?  Post the Ideas for Action for  two of your five themes. How will this knowledge of your Strengths and Ideas for Action enhance your leadership abilities? 

 

The Clifton strengths assessment revealed my top five strengths to be:

 

· Strategic

 

· Empathy

 

· Achiever

 

· Futuristic

 

· Connectedness

 

I was rather surprised to find out I was a strategic person, I always felt I was easy-going and took things as they presented. After reading the insights, I am inclined to agree with that strength because I am the one always finding cause and effect and solutions to manage situations both at home and at work. Empathy and connectedness were not too surprising as I have always been told that I am patient, kind and supportive. I have mixed feelings about the achiever’s strength. I am dedicated to things I set out to attain, but generally, I do not put pressure on those around me. I have high expectations for myself as an individual and would gladly support anyone on their journey through life, but I do not push others. I agree that I pay attention to the basis of things to ensure they are fundamentally right and generally I do not rush through things. I firmly believe that the saying that ‘anything worth doing, is worth doing right’.

 

    Being empathetic and strategic are great leadership strengths. It enables me to appreciate each team member’s unique strengths and struggles and still motivate and encourage them to participate in the team and organizational goals. Strategic leadership involves paying attention to the important things and being prepared for unexpected challenges. It also means I look for opportunities and solutions, rather than feel stuck with obstacles and quit. Being strategic and empathetic sets me up as a good leader that genuinely cares for the team members but is still focused enough to get the job done, by harnessing each member’s strengths.

 

References

 

Davidson, S. (2021). From organizations as machines to organizations as conversation: Making sense of Complexity in health care. In D. Weberg & S. Davidson (Eds.), Leadership for evidence-based innovation in nursing

 

       and health professions (2nd ed., pp. 80-95). Jones & Bartlett.

 

Porter-O’Grady, T. & Malloch, K. (2021). Evidence-based practice and the dynamic of innovation: A model for the advancing practice excellence. In D. Weberg & S. Davidson (Eds.), Leadership for evidence-based

 

       innovation in nursing and health professions (2nd ed., pp. 106-134). Jones & Bartlett.

 

Rath, T. (2007).  StrengthsFinder 2.0: Discover your strengths. Gallup Press.

 

Marla Schwarz

 

Yesterday Local: Aug 29 at 9:42am<br>Course: Aug 29 at 10:42am

 

1.     Complex Relational Healthcare           

 

     The concept of Complex Relational Healthcare (CRH) presents a range of opportunities and some challenges. As a clinical nurse practitioner in cardiology, I strongly rely on evidence-based practice (EBP), which is vital to CRH (Davidson, 2021). On the positive side, the CRH approach includes a holistic view of patient care, allowing me to consider a patient’s cardiac health and the interconnected aspects of their lives that influence well-being. This means I can provide more personalized treatments tailored to their unique circumstances. Collaborating within multidisciplinary teams becomes a great advantage. I can work alongside various team members such as the hospitalist, specialists, and nursing staff to offer comprehensive care that addresses all facets of a patient’s health, including their mental and social aspects.  

 

     There are also challenges to navigating CRH. Increased time with each patient is needed to understand their complexities fully. Effective communication and coordination between applying EBP, patient involvement, and other team members is vital to ensure collaboration. For the social construction in CRH to be effective, a patient would need to disclose their personal information. Trust in healthcare providers is needed for this patient-centered approach. Life-long, continuous learning is needed to stay updated with EBP and address various aspects of patient health.  

 

    The best way to overcome challenges with the CRH concept is to focus on what is best for the patient. This is a motto I always focus on when conflict is present. In my organization, my care plan must be in collaboration with my attending cardiologist. If we disagree on a treatment plan, this could create a challenge with CRH. By reviewing EBP and honing in on what is best for the patient, agreement can be reached.  

 

     Another example of CHR is a recent patient whom I consulted with a diagnosis of acute pulmonary embolism. This patient was already on warfarin for a history of atrial fibrillation, but his international normalized ratio (INR) was subtherapeutic. This likely contributed to his development of pulmonary embolism. While warfarin may be less expensive than other direct oral anticoagulation, therapeutic levels and compliance is more complicated. The hematologist wanted to discharge this patient immediately on Eliquis, and I discovered the patient would not have been able to afford this medication. With help from social services, we were able to provide a coupon and assistance with insurance so that the patient would be able to afford his anticoagulation. Hopefully, using the CRH accompanying EBP and social considerations will keep this patient compliant and avoid further thromboembolic events. 

 

2.    Cybernetic Integration of Innovation and Evidence    

 

     I supervise cardiac stress tests as part of my role as a cardiology nurse practitioner and have historically advised patients to hold beta-blockers before stress testing. Literature and guidelines recommend that beta-blockers be held before stress testing so the heart rate is not blunted and the target heart rate can be met. However, most of this literature is old and needs to be updated (Koracevic et al., 2021). Based on evidence, the practice of holding beta-blockers before stress testing needs to change, and my medical director has called for this change. In addition, the current method of stopping beta-blockers suddenly might have some issues, like causing a rebound effect (Koracevic et al., 2021). The Cybernetic Evidence and Innovation Model can assist this systematic approach to change (Porter-O’Grady & Malloch, 2021). 

 

     Using knowledge creation and research of this change from multiple sources, including guidelines and experts, an analysis of data can be performed to understand the current impact of beta-blockers on stress testing (Porter-O’Grady & Malloch, 2021). The model encourages finding solutions within the existing process, informed by research and EBP, in addition to practice expertise. The decision-making process is guided by evidence, considering the outcomes of stress testing with and without discontinuing beta-blockers. The culture of care will need to be changed as nurses have practiced telling patients to hold their medication for years (Porter-O’Grady & Malloch, 2021). I suggest continuous monitoring of patients for who we do not hold beta-blockers with ongoing data collection of heart rates and outcomes. The model allows adjustments to be made based on both quantitative data and qualitative patient outcomes. Long-term evaluation can assess the sustained effectiveness of the modified change. This model provides a framework for not holding beta-blocker usage before stress testing, emphasizing evidence-based decision-making and patient-centered care (Porter-O’Grady & Malloch, 2021). 

 

3.   Strengths Assessment  

 

     The top five themes and strengths from my Strengths Assessment were deliverer, empathizer, catalyst, thinker, and philomath. These results are accurate and did not surprise me. As a deliverer, I enjoy finding success in problem-solving and teamwork roles. Being a clinical nurse practitioner allows for this. I feel terrible when promises are broken, so I do not use the word promise. Instead, I state I will do my best. I am an empathizer who is highly sensitive. This can be explained by the simple fact that I cry when I see others hurt or in distress in movies. Most recently, I tried to watch the film Unbroken and could not bear to see the main character suffering with time stranded at sea and at the Japanese prison camp. I also avoid the news.  Interestingly, I can put my work hat on and compartmentalize to put emotions aside when helping patients. As a catalyst, I enjoy motivating and inspiring others at work. Lastly, I enjoy life-long learning as a philomath. 

 

     Ideas for action as an empathizer include setting clear boundaries. The recommendation for relationships to help perverse emotional health was insightful to include the following:  

 

-Take a bit more time when replying to emails and messages, and don’t meet up with the other person as often. 

 

– Try not to have conversations too late in the evening, as this time of day tends to evoke more raw emotions.

 

– Be selective about who you choose to spend time with, and avoid people with toxic behaviours.

 

– Build a group of friends you can turn to and trust. Having people with whom to share your emotions freely is vital to self-care. (High5Test, 2023, para. 2)

 

     The thinker’s ideas of action listed improving my physical and emotional well-being and practicing putting thoughts into plain language. When thinkers are physically strong, they can perform better and manage their emotions. Putting thinkers in their deep thoughts and fancy words might intimidate others. So, it’s suggested that they practice explaining their ideas simply, making it easier for everyone to understand. Also, they enjoy friendly challenges to their ideas and finding like-minded friends for intellectual chats (High5Test, 2023).  

 

     I can use the information from the strength assessment to provide detailed introspection on my leadership style. I can reflect on my strengths to continue to build on them.  The action items will guide me in continuing to develop and encourage further leadership analysis with areas for improvement.  I look forward to working on setting clear boundaries as an empathizer and managing my emotions. 

 

References

 

Davidson, S. (2021). From organization as machine to organization as conversation: Making sense of complexity in health care. In D. Weberg & S. Davidson (Eds.),  Leadership for evidence-based innovation in nursing and health professions (2nd ed., pp. 77-102). Jones and Bartlett Learning.

 

High5Test. (2023).   High5Test: Your full profile.  https://test.high5test.com/profile

 

Koracevic, G., Micic, S., & Stojanovic, M. (2021). By discontinuing beta-blockers before an exercise test, We may precipitate a rebound phenomenon.   Current Vascular Pharmacology,  19(6), 624–633.  https://doi.org/10.2174/1570161119666210302152322

 

Porter-O’Grady, T. & Malloch, K. (2021). Evidence-based practice and the dynamic of innovation: A model for the advancing practice excellence. In D. Weberg & S. Davidson (Eds.),  Leadership for evidence-based innovation in nursing and health professions (2nd ed., pp. 105-140). Jones and Bartlett Learning.

 

Mikal Salew

 

Reflect on one of the four concepts presented in the reading in Chapter 4 of your textbook. What opportunities do you see in your organization for integrating this concept? What challenges might you face in adopting such a concept? What are some ways to overcome the challenges?

 

One of the four concepts  working live: improvisation refers to the ability of healthcare professionals or organizations to adjust, invent, and make decisions in real-time, often in unpredictable or rapidly changing situations. Observing and identifying the most suitable patterns, whether they involve stabilization or responding to emergencies, within a given situation constitutes a type of improvisational skill (Weberg & Davidson, 2021). In the healthcare context, improvisation involves adeptly addressing unanticipated challenges, using imaginative methods for solving problems, and making crucial decisions in the moment. The goal of improvisation is to be able access and use knowledge and situational responsiveness in real time to react to the emerging present moment (Weberg & Davidson, 2021).  

 

Within healthcare, effective communication stands as a vital element demanding continual adaptation to accommodate to patients’ requirements, needs and apprehensions. Essentially, it involves us connecting with the current moment and the gesture being expressed; while responding in a manner that generates meaningful significance for all parties engaged (Weberg & Davidson, 2021). Healthcare providers and organizations need to adapt their communication style and strategy according to the patient’s emotions, cultural background, level of knowledge and comprehension.

 

I currently work as a family nurse practitioner for Federally Qualified Health Center (FQHC). We provide comprehensive, primary healthcare services to underserved and vulnerable populations, regardless of their ability to pay to improve access to healthcare, promote preventive care, address health disparities, and improve overall well-being. Incorporating improvisation ideas into our healthcare setting brings several opportunities for enhanced patientcare, better communication among providers, and improved flexibility in a rapidly changing medical setting. Communication among providers and other clinicians is key to improve health of our patients and this is mostly accomplished due to the flexibility and adaptability of healthcare providers and clinicians. Flexibility and adaptability are key qualities for improvisation and the clinicians and healthcare providers must be willing to change gears and try new approaches when necessary.

 

A fundamental challenge within our healthcare organization involves leaders’ difficulty in swiftly adapting, innovating, and making real-time decisions. Consequently, this situation has resulted in miscommunication between the leaders and healthcare providers. Rational leaders exercise practical judgment to differentiate between scenarios requiring stability and reliability assurance from those demanding novelty and creative emergence and take appropriate actions based on this distinction (Weberg & Davidson, 2021). Leaders must then take appropriate actions based on these distinctions. Successfully implementing this concept requires the active involvement of leaders, staff healthcare providers and clinicians in the decision-making process, acknowledging the necessity to adapt certain choices based on patient requirements and circumstances. However, this attempt has been met with difficulties due to the historical lack of inclusion of staff healthcare providers in decision-making.

 

This has been quite challenging as staff healthcare providers have not been included in the decision-making and current leaders have not been very open to the idea of staff healthcare providers being part of the decision-making process. To navigate this challenge, enhancing communication channels between leaders and staff healthcare providers is crucial. By incorporating healthcare providers into the decision-making processes that directly affect patient well-being; we can adopt clear, efficient communication and flexibility between leaders and healthcare clinicians. Effective communication serves as the foundation of support in the swiftly changing healthcare environment, facilitating the dynamic adaptation, evolution, and real-time decision-making essential to the healthcare environment.

 

Discuss an intervention, care modality, etc. in your practice setting that is based on evidence but needs a change. Using the  evidence-innovation cybernetics model in your textbook as a guide (Figure 5.3 p.120) discuss the gaps (what is missing, what needs to be changed) in the areas of practice expertise, clinical values, and/ or culture of care. As a leader, how could you stimulate innovation to close these gaps to positively impact outcomes or changes?

 

A cybernetic model illustrates how the elements and components within it integrate and interface, highlighting their interrelationships, interactions, and self-feedback loops that collectively give rise to the model’s dynamic (cybernetic) character (Weberg & Davidson, 2021). Our healthcare organization has encountered a significant challenge in patient care, specifically in effectively addressing chronic pain management. Previously, a provider handled pain management cases exclusively. However, following the departure of this provider, the responsibility of overseeing these patients and their pain management has fallen to the remaining providers. As primary care providers, our inclination is to utilize a blend of non-opioid pain management strategies along with nerve blocks to effectively address and alleviate pain in these patients. This has led to some challenges with management, as most of the providers did not feel comfortable with continuation of opioids. Primary care providers (PCPs) face unique challenges in managing complex patients who struggle with pain, addiction, or both (Sokol et al., 2021). 

 

In the past, primary care providers held the belief that treating chronic pain could be accomplished using pain medications, often relying on high doses of opioids (Sokol et al., 2021). However, their understanding of the extent and frequency of potential risks was limited. Over time, it has become clear that relying solely on opioids for chronic pain management does not offer a solution to the underlying issue; instead, it can contribute to a heightened risk of developing a substance use disorder (Sokol et al., 2021). This evolving understanding has prompted a shift in the approach of managing chronic pain.

 

Our attempt has been to transform the care culture by moving away from opioid-centric pain treatment. Our approach involves utilizing non-opioid methods in combination with essential therapies. It has been established those comprehensive strategies, encompassing a spectrum of therapeutic choices such as pharmacological interventions and non-pharmacological approaches like cognitive behavioral and physical/rehabilitation therapies, yield the most favorable outcomes in addressing chronic pain (Sokol et al., 2021).

 

In a leadership role, adopting a culture of collaborative decision-making that places importance on clinicians’ insights holds great significance. Engaging them in conversations regarding the incorporation of evidence-based practice techniques and proactively addressing any reservations they may possess can greatly improve the quality of patient care. Furthermore, coordinating dialogues and presentations that highlight the research substantiating the evidence-based use of non-opioid pain management approaches can play an essential role in reshaping clinical perspectives to align with evidence-based practices.

 

3. Post the results of your CliftonStrengths Assessment. The assessment generates a report of your top five Themes/Strengths. Post your top five Themes and discuss your thoughts about the results. Did the results surprise you?  Post the Ideas for Action for  two of your fiveThemes. How will this knowledge of your Strengths and Ideas for Action enhance your leadership abilities? 

 

My results for CliftonStrength assessment were: Empathy, discipline, responsibility, focus and consistency. I have taken this assessment previously for graduate school and the results were very similar. The results did not surprise me as I can relate with most of the themes. Below are the themes in more detail:  

 

Empathy: You possess the ability to perceive the emotions coming from those in your environment; their feelings resonate within you, creating a sense of shared emotional experience (Rath & Buckingham, 2007). This intuitive connection allows you to adopt their viewpoints and perceive the world through their eyes.

 

Discipline: You find satisfaction in establishing and following to routines, finding comfort in predictability (Rath & Buckingham, 2007). Your desire for setting elevated standards drives you to work with unwavering dedication, and you naturally bring organization to your surroundings.

 

Responsibility: The theme of responsibility compels you to assume psychological ownership for every commitment you make (Rath & Buckingham, 2007). Regardless of the scale, you develop a deep emotional attachment to seeing things through to completion.

 

Focus: You possess the ability to focus intently on a task, sidestepping potential distractions. With an ability for establishing well-defined objectives, you actively pursue and strive to achieve your goals (Rath & Buckingham, 2007).

 

Consistency: You hold the concept of balance in high regard, being acutely conscious of the necessity to treat individuals equally, regardless of their life circumstances (Rath & Buckingham, 2007). Your intention is to avoid any excessive bias in favor of any particular person, striving consistently for impartiality and consistency. Your skill lies in creating systematic procedures and setting standards (Rath & Buckingham, 2007).

 

Post the Ideas for Action for  two of your five Themes. How will this knowledge of your Strengths and Ideas for Action enhance your leadership abilities? 

 

Empathy: is a complex psychological phenomenon that incorporates the comprehension and quality with the emotions, thoughts, and viewpoints of others. Empathy is often defined as the feeling that a person image themselves in another’s situation and “putting himself in the other’s shoes” (Jia-Ru et al., 2022). Empathy grasps the emotional state, thoughts, and experience and is very important in building relationships, supporting cooperation and developing emotional connection. Empathy is an aspect of personality that plays an important role in interpersonal relationships and promoting communication skills (Jia-Ru et al., 2022).

 

· Embracing empathy will enhance my leadership skills by adopting stronger connections, building emotional ties among individuals, and demonstrating a genuine understanding and concern for the emotions and experiences of others.

 

· Empathy will further improve my leadership skills by allowing me to improve communication, allowing me the ability to authentically listen and understand the underlying message someone expresses, exceeding simple verbal expression.

 

  Responsibility: the concept of responsibility urges you to take on psychological ownership for each commitment you accept. Responsibility within the healthcare system involves the commitments and tasks that individuals and organizations hold. These obligations aim to safeguard the health and safety of patients while also promoting the smooth and proficient operation of the entire healthcare system.

 

· As a nurse practitioner preparing for a leadership role, I have the responsibility to provide safe, competent and ethical care to my patients. Additionally, as a future leader, I am accountable for developing collaboration among stakeholders to optimize results for both patients and the healthcare system. This involves following ethical standards, embracing optimal approaches, and continuously improving the quality of patient care.

 

· As a future leader, responsibility will uphold me to improve healthcare access to vulnerable underserved population to reduce health disparities and improve health of patients.

 

 

 

References

 

Davidson, S. (2021). From organization as machine to organization as conversation: Making sense of complexity in health care. In Weberg & Davidsons (Eds.), Leadership for evidence-based innovation in nursing and health professions (2nd ed., pp.77-102).

 

Jia-Ru, J., Yan-Xue, Z., & Wen-Nv, H. (2022). Empathy ability of nursing students: A systematic review and meta-analysis.  Medicine,  101(32), e30017.  https://doi.org/10.1097/MD.0000000000030017Links to an external site.

 

Porter-O’Grady, T. & Malloch, K. (2021). Evidence-based practice and the dynamic of innovation: A model for the advancing practice excellence. In Weberg & Davidsons (Eds.), Leadership for evidence-based innovation in nursing and health professions (2nd ed., pp.105-138).

 

Rath, T., & Buckingham, M. (2007).  StrengthsFinder 2.0. Gallup Press.

 

Sokol, R. G., Pines, R., & Chew, A. (2021). Multidisciplinary Approach for Managing Complex Pain and Addiction in Primary Care: A Qualitative Study.  Annals of family medicine,  19(3), 224–231.  https://doi.org/10.1370/afm.2648Links to an external site.

 

Ingrid LaRrett

 

· Reflect on one of the four concepts presented in the reading in  Chapter  4 of your textbook. The four concepts are: Organization as Conversation, Working live: Improvisation, Complex Relational Healthcare, Complex Relational Being. Choose one concept above  and discuss the following: What opportunities do you see in your organization for integrating this concept? What challenges might you face in adopting such a concept? What are some ways to overcome the challenges? 

 

Working live: Improvisation. This is the concept of being able to be present in the moment rather than planning, analyzing, and being structured. It’s a skill that many people do not possess but it is an invaluable characteristic for a good leader. One must be able to present and adapt to what may occur as it occurs. We must use our expertise, judgement, and reflexes to take on whatever may arise (Weberg & Davidson, 2021). An example that comes to mind is when a patient declines at work and we must use our intuition and knowledge to react in that moment rather than panic or freeze because it breaks the plan or routine of the shift. Nixon (2014) explains that improvisation in the workplace facilitates many things, including “provoking competence”. It allows the group to improvise, share ideas, and brainstorm to allow for growth of ideas and increase competency of ideas without a structured plan or goal (Nixon, 2014). This is a great concept to utilize within the workplace. I feel like we do a good job utilizing this currently by allowing staff to meet, brainstorm, share ideas, work in comfortable environments (outside of the office), and encourage others to think outside the box and be adaptable to change. There are changes in healthcare daily, so we are taught that we must improvise and adapt so we do not get overwhelmed. One challenge I can identify is excessive patient messaging to providers and staff. Coming in to 50 or more messages is overwhelming and causes some staff to panic and often “freeze”. This slows productivity and contributes to high turnover rates and burnout. To overcome this challenge, leaders encouraged improvisation during a meeting. Staff shared their ideas, and we trialed those ideas in various settings to allow for adaptation. Staff members now have the same workload but have their own way of handling things to allow them to improvise, adapt, change, and handle situations without a standardized plan or regimen. This has resulted in happier, healthier, more well-rounded staff, as well as increased productivity and respect for leadership.

 

2.      Discuss an intervention, care modality, etc. in your practice setting that is based on evidence but needs a change. Using the  evidence-innovation cybernetics model in your textbook as a guide (Figure 5.3 p.120) discuss the gaps (what is missing, what needs to be changed) in the areas of practice expertise, clinical values, and/ or culture of care.  As a leader how could you stimulate innovation to close these gaps to positively impact outcomes or changes?

 

In relation to the evidence- innovation cybernetics model, there are many gaps in this practice that need addressed: Using GAD and PHQ9 to assess in primary care settings. There are gaps in knowledge creation and research. We are becoming more diligent about asking every patient, every visit, about suicide, self-harm, and domestic violence because research has shown that early assessment and intervention improves patient outcomes. Research has shown that when a patient is asked directly about depression, anxiety, domestic abuse, and suicide, they are more likely to be honest and ask for help than when they aren’t asked at all (Rukundo et. al., 2022). That is why primary care offices have incorporated the use of screening tools such as PHQ9 and GAD7 to assess risk and severity, often at every visit. There are gaps in the research because this is fairly new practice, so it has been hard to determine if these screeners are effective at intake. There are also gaps in practice expertise. While we are educating staff on providing and scoring these screeners, we are not providing enough education about further assessment, referral need, treatment, or training them on importance of these needs. The utilization of these tools doesn’t seem to provide accurate information in many settings, especially primary care. Patients tend to blow off the questionnaires if that is not the reason they are seeking care. They answer everything as 0 and then we get inaccurate information, but we also don’t follow up on these scores and ask again during our assessments. As a leader my first step would be to utilize the research and evidence we have at present to address the gaps in practice expertise and clinical values. I would strive to educate every staff member on how to utilize these tools, the significant evidence and research behind these tools, as well as work to make these a cultural norm for the staff. I would provide education quarterly on suicide prevention since research is every changing in this field. I would also encourage and normalize staff having conversations with patients surrounding depression, anxiety, domestic violence, and suicide. These are difficult topics, and many are not comfortable talking about them. Normalizing these conversations is essential to address the clinical values gap (Weberg, 2021).

 

3. Post the results of your CliftonStrengths Assessment.  The assessment generates a report of your top five Themes/Strengths.  Post your top five Themes and discuss your thoughts about the results. Did the results surprise you?  Post the Ideas for Action for  two of your fiveThemes. How will this knowledge of your Strengths and Ideas for Action enhance your leadership abilities? 

 

My top five themes from the assessment were consistency, adaptability, harmony, restorative, and deliberative.  I am not surprised by these results. They seem to fit my personality and leadership style well. I feel like I have a good balance between these strengths and that gives me a good edge for being a people person, as well as an effective leader. The adaptability and deliberative strengths are somewhat countering of each other but work well when balanced. I’m able to be adaptable, do well with change, and not be easily bothered by alterations in structure but I also like things to be done in an organized, planned, efficient manner. Rath (2007) explains how important it is to know your strengths so you can achieve your potential. He refers to the saying “you can be anything you want to be” but suggests this is not quite accurate. He indicates that you can be whatever you are capable of being, based on who you are and what your strengths are. (Rath, 2007). A good leader is aware of both their strengths and weaknesses and works to play on strengths to perform well. I will use the ideas of action daily to be a more effective leader. One thing I plan to utilize is playing to my strengths rather than trying to use characteristics and behaviors that are my weakness. This will allow me to perform my best and show consistency in my leadership style.

 

Ideas of Action: Adaptability-

 

· Be the person that others know they can count on to be calm and comforting when things are difficult, and others are distressed by conflict.

 

· Steer clear of rigid, structured roles. This will increase distress and self-conflict.

 

· Help others realize they can handle change without panicking.

 

· Maintain boundaries for self and don’t allow others to take advantage of your adaptability. It can be easy for others to utilize this to their benefit. When, where, what they need, rather than what is best for you or others.

 

· Use this trait as a strength and look for roles that utilize this strength. For example: ER role, rapid response nurse, roles where you are expected to think on your feet and stay calm.

 

· Be prepared for unanticipated events such as spontaneous travel or on-call roles. Text calls this “fine tuning responsiveness” (Rath, 2007, p. 47)

 

· Outsource planning roles to those with strengths in planning, goal settings, strategy.

 

· Distinguish your strengths of adaptability and calmness from that of apathy or not caring. Make sure others understand this difference in you.

 

· If you are involved in structured activity, avoid burnout or boredom by using creative techniques to add variety to the activity.

 

· Use this strength to support and calm others.

 

· Be aware of behaviors that worked in the past and use them in the future to help others.

 

Deliberative-

 

· Find work and leadership roles that play to this strength.

 

· Use this characteristic to help others facilitate good decision making. Be a resource to others.

 

· Be diligent and deliberate in decision making. Be open and communicate your decision-making process.

 

· You are trustworthy because you take time to consider consequences and make sound decisions. Utilize this trait when handling difficult or sensitive situations.

 

· Trust your judgment and instincts.

 

· Utilize pros and cons when making decisions. Share these with others to increase understanding and so there is no question that the situation is being handled rationally.

 

· Be deliberate and cautious in the personal information you share with others. Divulge information slowly and build relationships that are valuable.

 

· Work with people whose strengths include “command, self-assurance, or activator” (Rath, 2007, p. 87)

 

· Educate and encourage others to take time and consideration when deciding rather than jumping right in.

 

· Allow yourself time to weigh choices and make a good, thoughtful decision (Rath, 2007).

 

 References

 

Nixon, N. [TEDx Talks]. (2014, March 28).  The new workshop of the world. 7 rules for improvising at work [Video]. YouTube. https://www.youtube.com/watch?v=UTS95OchFOE

 

Rath, T. (2007) StrengthsFinder 2.0: Discover your strengths. Gallup Press

 

Rukundo, G. Z., Wakida, E. K., Maling, S., Kaggwa, M. M., Sserumaga, B. M., Atim, L. M., Atuhaire, C. D., & Obua, C. (2022). Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda.  BMC Psychiatry,  22(1), 1–11. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1186/s12888-022-04244-z

 

Weberg, D. R., & Davidson, S. (2021).  Leadership for evidence-based innovation in Nursing and Health Professions (2nd ed.). Jones & Bartlett Learning.

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