EVERY NURSE A LEADER

Leaders Get Results! Jo Manion, PhD, RN, NEA-BC, FAAN IN THE FIRST COLUMN of this series, the topic was ‘‘Every Nurse a Leader.’’ No matter your position or your title, every perianesthesia nurse serves as a leader. This statement was based on the belief that leadership is the ability to influence others in a certain direction, to enhance another person’s capacity to act and perform in a way beneficial in the situation. Embedded within this definition is a strongly held belief that a key component of leadership is the ability of the individual to achieve results or execute actions that actually result in change. Things are made better or different. Too many times in our organizations, busyness is mistaken for getting results. If I am working hard, giving my all, putting in the hours, and am always busy, that’s enough. ‘‘Look how hard I’m working!’’ I might say. However, this column suggests that good intentions and a lot of effort are not enough. It is easy to be busy and fill the work hours; however, the true essence of effectiveness is whether there are desired results as an outcome of the busyness. The concept of execution also relates closely to one of the three essential attributes of an effective leader discussed in the last column. Proactivity is a leadership dimension that is future oriented and involves taking deliberate and intentional action based on that awareness. It is all about getting results. A proactive individual shows initiative and takes action to meet the challenges or solve the problems he or she faces. Proactive people scan the environment for opportunities; they are persistent and do not let barriers and challenges stop them from achieving the goals they are seeking to attain. When necessary, they find a way around a difficulty to maintain their momentum. And finally, the proactive individual changes his or her environment, actively dealing with problems rather than giving up. Jo Manion, PhD, RN, NEA-BC, FAAN, is the Owner and Senior Consultant, Manion & Associates, The Villages, FL. Conflict of interest: None to report. Address correspondence to Jo Manion, Manion & Associates, 873 Greenwich Place, The Villages, FL 32163; e-mail address: [email protected]. Ó 2014 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.08.002

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So, how do I attain results from the work I am doing? How can I increase my effectiveness as a leader? This column briefly explores five major concepts for getting the results you are seeking:     

Identify and prioritize the desired key results Evaluate outcomes continually Manage process effectively Capitalize on strengths Use appreciative leadership tools

Identify and Prioritize Key Results This first step requires disciplined awareness and the ability to identify the key results you are trying to obtain. With these key results clear in your mind, you can take deliberate action to attain them. With clarity, it is easier to remain focused on the overarching goal rather than getting caught up in the day-to-day crises that occur. Let’s say as a Postanesthesia Care Unit (PACU) charge nurse, you are a member of the leadership team for Perioperative Services. The leadership team has identified a key goal for the immediate future, that of creating stronger healthier relationships among the staff and thus improving the positive work culture. Holding this goal in your awareness can change the actions you may choose in a particular situation. For example, there is an interpersonal conflict quite actively brewing between a valued staff member and an anesthesiologist. You are very effective at deescalating conflict situations and you are respected deeply by both individuals. It would be relatively easy for you to intervene and handle the situation. And, in some instances, you may need to do so on a short-term basis. However, because you are aware of the overarching goal (building stronger relationships among the staff), you instead choose to coach the involved staff member in how to approach the physician and deal with the conflict herself. This is a much more difficult intervention and yet has the potential of leading to stronger interpersonal relationships between the two individuals in the future. It can also result in a stronger staff member, who does not need to rely on a supervisor to solve her interpersonal conflicts.

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EVERY NURSE A LEADER

Evaluate Outcomes Continually The ability to evaluate your outcomes honestly and realistically first requires that you are aware of the key results you are seeking. Accurate evaluation is impossible without this clarity. When you continually evaluate your results, you move beyond mere busyness to productivity and effectiveness. Good intentions behind your actions are simply not enough. In the previous example, you may intend to help and make the relationship between the anesthesiologist and the staff member better by personally intervening and attempting to deescalate the conflict yourself. And in fact, the situation may improve temporarily as tempers cool and civil behavior returns. However, there may remain an underlying resentment on the part of the two in conflict that you, the charge nurse, needed to get involved. And, neither conflicting party is going to feel particularly self-efficacious or self-empowered because you had to be involved. An unintended consequence of your intervention may actually be weaker working relationships in the department rather than stronger relationships (which is the goal). These coworkers may feel like they cannot resolve conflicts themselves but need to rely on you to intervene. Honestly evaluating outcomes requires a great deal of courage and self-reflection. It may be a period of time before the results actually reveal themselves to you. However, the alert leader continually scans the environment and connects the results obtained with the action he or she has taken. This is not easy, and there are a multitude of examples in our organizations and even our society where unintended consequences have been dramatic and quite harmful. For example, several years ago, during the massive restructuring and cost reduction craze in our hospitals, one CEO eliminated the infusion therapy team. He received kudos and compliments from the Board of Directors for the extensive cost savings obtained. Within a year, the number of central line infections and patient complaints had skyrocketed, with severe repercussions, including significant increased costs. Obviously, consequences were not well considered at the time of the original decision.

Manage Process Effectively Leaders seeking results in our complex health care organizations must manage process effectively. Jim

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Collins, in his monograph ‘‘From Good to Great for the Social Sector,’’ points out that leadership in the social sector organizations is very different than that in the business sector. In the business sector, executives are more likely to simply make decisions and expect other people to implement them. In the social sector organizations such as in health care, influencing others to behave in desired ways is much more complex. It requires healthy interpersonal relationships, communicating for shared meaning, and building and creating strong alliances. Managing processes is a key skill for the social sector leader because so few decisions are individual decisions, most require input and involvement from key stakeholders so there is a strong commitment to support and carry out the decision. Managing process effectively is somewhat rare in our organizations. All you have to do is review your committee memberships and ask yourself ‘‘How often do we meet and what are the results of our meetings?’’ Organizational committees are a key area where there is a lot of busyness and few real results. Because of this, most of us respond to committee assignments with a feeling that this is going to be a waste of time! An effective leader uses group time wisely and has the skills to facilitate the process and work of the group. People do not just meet for the sake of getting together. The facilitator understands the principles of managing a group and leading it to the desired outcomes. Of course, this includes typical meeting mechanics or logistics (e.g., developing an agenda, obtaining an appropriate room, sending prework material out ahead of time), but it also includes the ability to manage the interpersonal aspects of the group meeting to ensure that the environment is safe and comfortable and all voices and opinions are heard and explored. To effectively manage process, the leader also needs to recognize and respect the process involved. For example, developing a good team does not just happen because we say that we are a team. There is a developmental process involved, and a wise leader understands that process. Nor can one easily or quickly build a solid relationship with staff when a crisis looms. The key elements of a healthy relationship, trust, respect, support, and honest, open communication, need to be in place long before the crisis appears. Developing

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relationships and teams, problem solving, and process improvement are just a few examples where there is organizational failure because of a general disrespect for process. Leaders who effectively manage processes also understand that there are always ways to improve their processes and looking for incremental improvement is a way of life for them. Never satisfied with being ‘‘good,’’ they continually strive to become the best. One of the leader’s roles is to question the process in place and ask: ‘‘Is this the best we can do?’’

Capitalize on Strengths Getting results is easier when there is a focus on strengths rather than deficiencies. Conchie and Rath, in ‘‘Strengths-Based Leadership,’’ report on research conducted by the Gallup organization. Their research found that when an organization’s leadership focused on the strengths of people, approximately 73% of employees reported being engaged compared with only 9% engaged when leadership focused on deficiencies. Exemplary leaders know themselves and their strengths well and call on them when the situation is right. But good leaders do not just stop there, they also recognize and find ways to use the strengths of the people with whom they work. People are happiest when using their strengths in the workplace. They tend to be more effective and passionate about the work. It may seem a simple matter to know your strengths, but the truth is that not all of us accurately recognize our strengths. We may not recognize them as a strength that is important in the workplace, such as the strength of gratitude or gratitude. Or we may discount them, believing the strength is nothing special. Courage is an example of a strength often minimized or discounted. Yet, any of us who has watched a colleague speak up honestly in the face of authority or another person’s criticism has an appreciation for this character trait and recognizes that not everyone has the strength of courage. Assessment tools that give you feedback on your strengths are invaluable. You may not receive any surprises in the results, but you may think about your strengths differently in the future. Looking for ways to use your strengths in your workplace

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and valuing those strengths can lead to increased contentment and better results. And sometimes we just do not have the skills needed or the strengths for a particular job. When we are clear about what our strengths are, we will find job opportunities that capitalize on those and where both we and others appreciate them. While you can work on furthering developing the strengths you have, try developing complementary strengths. The development of complementary strengths is likely to increase your effectiveness exponentially rather than the smaller incremental improvements you see when you work harder on your strengths. Years ago football players during the training season took ballet lessons. This did not necessarily help their speed on the field or their ability to pass the ball. However, it did improve their balance and agility, both very necessary complementary skills for a pro football player. So in the same way, if you have the strength of courage and a strong sense of purpose, you might want to work on increasing your assertiveness. As a complementary strength, this gives you increased comfort in and ability to speak up, be focused on your purpose (or the purpose of your team or organization), but to do it in a way that others will be willing hear your message.

Use Appreciative Leadership Tools Leaders with the ability to execute and obtain results often use positive affirmative approaches and techniques. Having an arsenal of tools to draw from is helpful in today’s complex health care organization. Traditional problem-solving approaches and newer process improvement strategies can be appropriate in some instances. However, having only these tools to rely on will reduce the leader’s effectiveness. Using evidence-based approaches is a must in today’s world. Rather than continuing to do things based on belief or out-of-date teaching, today’s health care leader needs to be comfortable using research and tools, such as systematic review to base decisions and approaches on the latest evidence. Systematic review is covered elsewhere in this issue and is a tool for gathering and synthesizing the latest findings on the particular topic you are exploring. Leading staff members through this process is a powerful way to demonstrate a

EVERY NURSE A LEADER

respect for examining the latest evidence and using it to guide our decision making. Two additional approaches for dealing with issues in the workplace that are based on positivity rather than negativity are polarity management and appreciative inquiry. The first of these, polarity management was first popularized by Barry Johnson who believes that some of the issues creating problems for us in our workplaces are polarities to be managed rather than problems to be solved. Most problems have a solution, and once you find it, the problem goes away. Polarities, on the other hand, are situations where there is no either/or answer, simply polar opposites. And if the pendulum swings too far to one side, there will be issues as a result of this. For example, in perioperative services, there has long been the tension between whether staff in the operating room (OR) should be highly specialized in a particular skill or whether each staff member should be a generalist and prepared to cover for any surgery. When everyone is highly specialized, responsibilities like taking surgical call becomes a problem because when on call, the individual may be asked to work on a case for which they do not feel prepared. On the other end of the continuum, with the increased complexity of surgical procedures today, having only generalists working in the OR is clearly not an acceptable answer. Thus, the answer must lie somewhere in-between. Part of polarity management is recognizing that there is no solution with an either/or answer and that strategies must be developed that keep the polarity in balance. Clarifying the opposite sides of a polarity is a process aimed at more fully understanding the issue to enable selection of useful strategies to deal with the situation. Effective polarity management treats opposition as useful because it increases understanding of the issue. Appreciative inquiry is another positive approach that has become popularized in recent years. It is both an attitude toward the issue and specific action research methodology. It begins with the belief that something is already working right, in the team, department, or organization. The trick is to find it, study it, and learn why it is working right. The question studied is fateful and will determine your success with this approach.

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If there are problems with consistent performance in patient handoffs to another department, this can be explored through appreciative inquiry. Instead of listing all the problems that occur with the patient handoff, instead find an example where everything went beautifully. Spend time exploring all the things that went right, and from this develop, the protocol for patient handoffs. This creates a process based on success rather than on simply correcting problems occurring. Leaders are not just busy, they get results. Good intentions and hard work are fine, but there need to be desired outcomes for either to really matter. Consider these five concepts in examining your own leadership practice. 1. What are the key results you are seeking to obtain? What are the overarching goals for the department that requiring your focus and attention? What definitive steps have you taken to achieve these key results within the last 48 hours? 2. Are you getting the results you need on a regular basis? Is there anywhere when you have been surprised by unwelcomed results or unintended consequences that did not support your intention? How often do you reflect on your actions and their outcomes? 3. How comfortable are you with managing processes in your department? Are you skilled at facilitating group work? Are the groups of which you are a part obtaining substantial results of which you are proud? 4. What are your top five strengths and how do you use them in the workplace? Are there complementary strengths you could develop? When was the last time you deliberately looked for and recognized the strengths in someone else? 5. Are you comfortable learning new approaches or do you prefer to stick to the ‘‘tried and true’’? Have you ever used appreciative inquiry, polarity management, or systematic review? How could you begin? Good leadership does not just happen; it requires deliberate and intentional action. And, really exceptional leaders are always focusing on their results.