Exploring leadership effectiveness: nurses as clinical leaders in the NHS

Toward a universalistic behavioural model of perceived managerial and leadership effectiveness for the health services sector

Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive (effective) and four negative (ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature.

Approaches to leadership and managing change in the NHS

The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

The missing leaders: rediscovering the ward sister/charge nurse role

Purpose

– The aim of this paper is to examine the leadership role of the ward sister/charge nurse in the English National Health Service and demonstrate that its influence in maintaining standards of care has been undermined.

Design/methodology/approach

– This is achieved through a critical review of the relevant research and policy literature. Evidence relating to recent failures in the provision of nursing care is summarised to establish the nature of the problem. This is followed by an analysis of existing research concerned with the ward sister/manager role in the context of recent policy.

Findings

– The evidence demonstrating that the ward sister/charge nurse is one of the key determinants of quality care has been overlooked in recent years and this in part accounts for the quality failures that have occurred in NHS hospitals of late.

Practical implications

– Action is needed to place the ward sister/charge nurse at the heart of the hospital system. Systems of organisational and mutual support are needed to ensure that these ward-based leaders can reach their full potential as the guardians of care.

Originality/value

– The perspective offered in this paper illustrates how a solution to pressing organisational problem can be found through accessing the appropriate literature. Although the recommended action may not be “new” it is novel in the sense that it is based on rediscovering a role that already exists and can be supported to bring about change, rather than seeking wholesale complex change.