Adapted from a presentation at the Saskatchewan Registered Nurses Association Nursing Leadership Conference, March 2012, Courage to Lead: Transforming Health Care. By Shauna Fenwick, Leads Learning Founding Partner.
“In a democratic society and in a profession, leadership functions belong to each of us. Leaving leadership to an elite few is not an option”. (Fugate Woods, 2003).
“The times do not allow anyone the luxury of waiting around for others to lead”. (Matthew Fox, n.d.)
These 2 quotes are central to addressing what many call the leadership crisis in health care. In our fast paced, task focused and fiscally constrained health system, where there are multiple causes for outcomes, and causes that are often only knowable in retrospect, where there’s more than one right answer to most questions, we need leadership everywhere. We need leaders in formal positions who can create innovative policies and build collaborative networks across a variety of communities (agencies, professions, geography, users and providers). We also need leaders who work at the point of service delivery, leaders who can see the impact of decisions and possibilities for new ways of acting.
The LEADS framework can help you take leadership action no matter where you are in the system. You can start leading now in 3 easy steps:
- Decide to lead.
- Focus your leadership using the LEADS framework (see examples below).
- Find a buddy.
1. Decide to Lead
Given the pace and demands of your work today, you need to make a conscious decision to lead, to be intentional in how you approach the many jobs that come your way every day.
What was your last working day like? Were you driven by a long list of tasks to complete, asked to respond to an unceasing rapid fire of demands? Did you go from meeting to meeting with no time to think or prepare for the next meeting or do the work from the last meeting? In all of that essential busyness, how many times did you stop and ask yourself how you were going to lead in the moment of any of those activities? Some of you may already be doing this. Imagine the impact if everyone in health care, no matter their work or position, set out to consciously lead in the midst of their busy work. Imagine the collective energy and synergy of small, random, conscious acts of leadership every day.
What is calling for leadership in your workplace?
2. Focus your leadership using LEADS
The LEADS framework has 5 major domains. Each domain has 4 capabilities. That means there are 20 possibilities for types of leadership action. None of us can work on 20 things at once. Once you’ve answered the question about what’s calling for leadership in your work, scan the 20 capabilities and pick 1 or 2 that you think will contribute to addressing the issue. I’m explicit about “contribute” as I don’t expect you to “fix” the issue, just contribute to its resolution. Once you’ve chosen 2 capabilities, think about actions you can take next week to lead from that stance. Here are some examples.
Front line leadership
A front line hospital nurse that I worked with said that the main issue calling for leadership in her workplace was the grumpiness of the staff. The mood is understandable: they had the usual problems of rising workload, staffing challenges and pressure from other departments for faster admission, discharge and flow-through. Their manager was off site and was only able to visit the unit once, maybe twice a week, so was unable to do much to address some of the immediate morale issues.
This nurse decided that 2 LEADS capabilities would help address the mood on the unit: Contributing to the creation of a healthy environment (in the Engage Others domain) and Purposefully build partnerships (in the Develops Coalitions domain). She felt that she could do things herself to build a more positive social climate on her unit, by attending to the relationships among staff and making sure that there were positive human connections among them, in the midst of all the work demands.
She also felt that building partnerships was key, as many other people came onto the unit who experienced the grumpiness first hand. She started by stopping and recognizing the physios, OTs, RTs, doctors, porters, and other non-unit personnel by name and welcoming them to the unit. She organized an appreciation day for everyone who had work of any type on the unit, and persuaded her manager to spring some money for a cake. In her own way, she was using 2 LEADS capabilities to make a difference on her unit.
Middle manager leadership
Middle management can be one of the most difficult places to be in a health care organization. You get information from the top, the side and the bottom. You know firsthand the impact of policy and strategic decisions made in the executive suite (or maybe even in the Minister’s office). You also have to make sure there are enough qualified hands on deck to do the work. One middle manager I know was responsible for several units located at different sites. With the last round of regionalization, these units actually came from previously different organizations and considered themselves unique and distinct from the larger organization.
This manager felt that the leadership being called for in his department was for better relationships across the different units and sites. He chose the capabilities of Building teams (Engage Others domain) and Communicate effectively (also in the Engage Others domain). His focus was to create a sense of common purpose among all units in his portfolio. He called a meeting with staff from all areas, and worked with them to formulate a vision for their service and a shared purpose statement. During this one-day meeting, they also got to know one another as individuals, and crafted a set of agreements about how they wanted to work together on common issues.
The second leadership capability that this manager wanted to address was his ability to listen to staff. He felt that he was constantly rushing, and seemed to be more in a “telling” mode than a listening mode. He shifted his approach to unit visits by creating an open 20 minute coffee break with staff every time he came to the unit. This took some logistical attention to have his visits coincide with times that staff could take a break, but over several weeks, the pattern of talking over coffee became the norm for his visits. He learned a lot by asking people what was foremost on their minds, and simply listening.
Executive leadership
One leadership team I worked with decided that they wanted to be very clear and transparent that leadership needs to be a visible component of their strategic planning. Yes, they realized, implementing the strategic plan required leadership, but never before had they explicitly stated the leadership capabilities that would be necessary to achieve their plan. While all 20 capabilities were important, the executive team strategically focused on keeping Customer service (Develops Coalitions), Strategically aligning decisions with the organization’s values (Achieve Results), Encouraging and Supporting innovation (Systems Transformation), Purposeful partnerships (Develops Coalitions) and excellent communication (Engage Others) in the forefront. Each strategic plan is checked against these 5 leadership capabilities to ensure that the organization is focused and that the actions of leaders are coordinated.
Personal leadership
I use the Lead Self domain as a reflective tool to review my actions on a regular basis. How did I show up as a leader today or this week? How did I demonstrate my values of making a difference, honesty and learning? How did I manage myself in tight quarters – was I reactive, or thoughtful and collaborative? How did I develop myself this week?
3. Find a buddy
Both leadership and learning are social acts. While we might read a book on our own, or attend a class, it’s in dialogue with others and in trying out new behaviours in the workplace that we make sense of theory. Evidence shows that having a learning buddy can both accelerate and deepen your learning. I hear many leaders say that they never talk about leadership, and that once they do they often find that it taps into their passion for being in health care– to work with others to achieve a positive outcome. Find a buddy / friend / confidante / mentor with whom you can talk about your leadership, where you can discover together what leadership means to you and how you can take steps in your workplace to contribute to addressing the issues calling for your leadership.
The beauty of the framework is that it is adaptable to the practical nature of many of us who work in health care. For any issue you are facing, choose a couple of capabilities that you think might help you organize your thinking and your action, and start now.
Fugate Woods, N. (2003). Leadership – Not just for a few! Policy, Politics, & Nursing Practice. 4(4), 255-256.
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