Thoughts on TSL and Health Care – HC2

We’re the Health Angels!

This is the Health Angels first post! Who are the Health Angels you ask?  We are a dedicated group of health care professionals who are pursuing their passion in becoming strategic leaders in our fields.  The Health Angels name is actually a word play of one of the notorious motorcycle gang that is prominent in Canada and United States where members typically ride Harley-Davidson motorcycles (https://en.wikipedia.org/wiki/Hells_Angels).  But not to lose focus, we are the Health Angels, strategic leaders in health care!

Transformational Servant Leadership in Health Care

Transformational servant leadership (TSL), is a concept consisting of the ideologies of transformational leadership and servant leadership (Imbenzi, Williaume, & Page, 2013, para. 11).  The combination of these two concepts is strategic in nature to effectively engage followers to achieve the organizational purposes by attending to the needs to the followers (Imbenzi et al., 2013, para. 34).   When considering strategic leadership direction for health care, TSL greatly shifts the focus of a predominantly service-centric industry to learning-centric in order to focus the most important asset, which is the personal and intellectual property of the organization (Imbenzi et al., 2013, para. 38).  In other words, the paradoxical shift of the focus from patients (outward focus) to staff (inward focus) is a strategic way to increase staff engagement and improve health care for patients.

Health care professionals are overworked.  Speaking from personal experiences of working in Canada under a government-funded health care system, we have some of the most caring and dedicated staff members who decided to enter into the field because of their passion to serve and to help others.  However, the challenges with the Canadian universal health care system is the lack of accessibility and availability of care in a timely manner.  For example, recent studies have illustrated access to family physicians in Canada is becoming increasingly difficult due to physician shortages and increase rates of chronic illness (Ansell, Crispo, Simard, & Bjerre, 2017, p.2).  One of the results of this is patients turn to urgent care in the hospitals for non-urgent health issues which contribute to the long wait times.  CTV News Vancouver (2017) reported emergency room wait times are the worse in the province of British Columbia compared to other areas in Canada with about ninety percent of emergency visits were complete after 8.4 hours in the 2016-17 fiscal year (Miljure, B. and Mangione, K., 2017). Waiting for health care appointments can often impose a physical and emotional burden on individuals who are in pain or worried about serious health conditions.  However, the excessive wait times not only puts a burden on patients but to health care workers as well.  With patients lining for hours at hospitals, health care professionals are in extremely high demand, resulting in staff being overworked, missing necessary meal breaks and working in overtime shifts constantly.  Many professionals that talked to mentioned burn-out as one of the factors of job dissatisfaction.

Creating a culture of learning is the key.  In many organizations, including health care, there is a great disconnect with the people who are running the organization and the people who are in the front lines providing care to patients.  Achieving the enduring performance potential of the organization requires the hearts, minds, and hands of all to be engaged (Hughes, Beatty, & Dinwoodie, 2014, p. 41).  To create a culture of learning, the TSL utilizes strategic thinking and acknowledge it is a collective process that includes diverse perspectives from both inside and outside of the organization (Hughes et al., 2014, p. 54).  The result of engaging staff members in different levels and departments is the creation of new connections and relationships that would foster higher levels of motivation and morality (Imbenzi et al., 2013, para. 14).

Tools for TSL in Health Care

Approximately one month ago, my wife and I visited our elderly grandmother who was admitted to the hospital due to a kidney failure.  Grandma was sharing a room with three other patients who are also in care.  During this nighttime visit, two of the patients in the room require assistance and had called for help on numerous occasions but to no avail.  They groaned and call the alarm for help until eventually, a nurse came in.  The nurse was busy and her hands already full, running and hustling about.  The nurse told them they will have to wait as one of her colleague called in sick and unable to work.  She later added there were six other patients that are waiting for her assistance as well.  I felt bad for this nurse, who sighed and walked away, didn’t even bother to apologize or make an excuse.  Our health care professionals work tirelessly to care for those who are in need.  This question comes up often: who will care for those who care for us?

The essence of servant leadership is putting others first.  Attending to the needs of others first will allow them to produce their best by meeting their personal needs and supporting them in the workplace (Imbenzi et al., 2013, para. 39).  A TSL need to engage our health care workers first and address their concerns.  When staff members are given the opportunity to be heard and recognized, they feel valued and honoured to be a part of something bigger than themselves.  In addition, staff members will focus on generating solutions to a problem rather than complaining or waiting to be told what to do (Lepsinger, 2010, Bridge 3: Employee involvement in decision making).

Visioning collectively is an important process for an organization that is servant leadership focused.  Many organizations have an established vision which provides direction and purpose of its existence.  However, often the vision is created at the higher leadership level and seldom consulting with the front line staff.  Allowing health care workers from all levels to participate in the vision-setting process allows an opportunity for people to share personal versions of aspirations for the organization to create ownership of the organization’s vision (Hughes et al., 2014, p. 76).

Making common sense with transparent communications is vital in creating a culture of trust.  TSL is to help others in the organization make common sense of the world around them, the challenges they collectively face, and how they will face them together (Hughes et al., 2014, p. 84).  Developing a shared understanding is important in terms of being transparent because people often rely on implicit knowledge and fill start to fill in the gaps when information is not known.  Unarticulated knowledge can cause people to feel unclear and even more disconnected to the organization (Hughes et al., 2014, p. 85).  This is less likely to happen when people share a common understanding of their vision and strategy for the organization.

“Staying above the line” is a reframing mindset, focused on creating a culture of learning and being curious.  Appreciative inquiry is one method of staying above the line, where the goal is to encourage others to focus on working collaboratively in solving problems versus finding faults.  A TSL who is focused on creating a culture of curiosity and learning will result in better collaboration, creativity, innovation, and connection.

Critical Thinking

In 2012, all health authorities in British Columbia faced a budget cut mandated by the federal government.  In the efforts of reducing the overtime costs and excessive sick-time, many health authorities went through a dramatic change in health care worker’s scheduling.  The result of this change led to many dissatisfied workers having to work shift times that are unfavourable to their lives.  Many committed individuals felt this schedule change was unnecessary and they provided various alternative strategies that would help fulfil the budget mandate without having taken this step.  In subsequent surveys that were conducted of the staff in Vancouver Coastal Health indicated job satisfaction and engagement is at an all-time low, with much to do with this imposed change.

There is no money.  With various constraints and mandates from higher levels of government, a TSL must utilize critical thinking in order to continue to support our health care workers.  When monetary incentives are out of the question, the TSL will need to utilize critical thinking and consider alternative means to motivate staff members such as providing additional learning and development opportunities.

Health care and governments are rigid.  Unlike organizations from private sectors and businesses, many health care organizations and government groups are stuck doing things the same way for many years.  Another way where critical thinking is essential in health care is for the TSL to consider the current landscape and how to best deliver care to the public.  The needs of the public shifts with culture.  Consider the accessibility of technology and internet connectedness, creative thinking can provide new strategic direction in how people can access care without waiting at the emergency room for non-urgent medical attention.

 

References

Ansell, D., Crispo, J. A. G., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times for primary care appointments: a systematic review. BMC Health Services Research, 17(1), 295. https://ezproxy.student.twu.ca:2420/10.1186/s12913-017-2219-y

Hughes, R. L., Beatty, Collarelli-Beatty, K., & Dinwoodie, D. L. (2014). Becoming a strategic leader: Your role in your organization’s enduring success. San Francisco, CA: Jossey-Bass.

Imbenzi, G., Williaume, D. & Page, D. (2013). Transformational servant leadership. Unpublished manuscript, Master of Arts in Leadership. Trinity Western University: Langley, Canada.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Franciso, CA: Jossey-Bass.

Miljure, B. and Mangione, K. (2017, November 30).  B.C. emergency wait times worse than most in Canada: report. CTV News Vancouver. Retrieved from https://bc.ctvnews.ca/b-c-emergency-wait-times-worse-than-most-in-canada-report-1.3701287