Exploring senior nurses' experiences of leading organizational change

Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study

BACKGROUND

Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals.

METHODS

Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach.

RESULTS

Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability.

CONCLUSIONS

The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.

Evaluating the association of well-being strategies on line manager resilience

BACKGROUND

Line management tends to be associated with increased responsibility and accountability in the workplace and can be a challenging and high-pressured role. More resilient line managers are more likely to continue to perform despite work stressors.

AIMS

This study aimed to assess the association of various coping strategies and resources on resilience levels amongst line managers working within a corporate office-based environment.

METHODS

A questionnaire-based cross-sectional study was carried out over 4 weeks in 2020. The questionnaire probed demographic factors and the use of strategies and resources which may enhance resilience. Resilience was assessed using the Connor-Davidson Resilience Scale.

RESULTS

On regression analysis, resilience tended to increase with increasing years of line management. When each strategy/resource was considered separately and adjusted for the number of years of line management, exercise outside of work (B, 0.302; 95% confidence intervals [CIs], 0.109 to 0.495), hobbies/interests (B, 0.252; 95% CIs, 0.095 to 0.410) and socializing (B, 0.204; 95% CIs, 0.042 to 0.367) were all significant predictors of resilience.

CONCLUSIONS

The key coping strategies and resources that had the strongest association with resilience amongst office-based line managers were those that related to their personal lives, with exercise being of particular importance. This study highlights the importance of emphasizing work-life balance and lifestyle factors within workplace manager training and resilience programmes, as well as in the occupational health clinic. Additional support and health promotion for managers in their first few years of management responsibility may also be beneficial.

Impact of organisational change for leaders in mental health

PURPOSE

The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.

DESIGN/METHODOLOGY/APPROACH

Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard's framework.

FINDINGS

Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders' ability to focus on, and advance, the quality and safety agenda.

RESEARCH LIMITATIONS/IMPLICATIONS

Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.

PRACTICAL IMPLICATIONS

There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.

ORIGINALITY/VALUE

The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.

Outcomes of interventions for nurse leaders' well-being at work: A quantitative systematic review

AIMS

The aim of this study was to gather, assess and synthesize current research knowledge on interventions that aimed to improve nurse leaders' well-being at work.

BACKGROUND

The research evidence on interventions for nurse leaders' well-being at work has been sporadic and there are a lack of evidence-based recommendations for effective interventions that inform practice, future studies and education.

DESIGN

A quantitative systematic review, in accordance with the Cochrane Collaboration procedures and the reporting guidance in the PRISMA statement.

METHODS

CINAHL, Cochrane, EBSCO, PubMed, PsycInfo and Scopus databases were searched from 2009 - December 2016. The final data consisted of five studies, which were assessed with the Cochrane Risk of Bias Tool. The data were summarized narratively.

RESULTS

The interventions were mainly concerned with stress management and were targeted at individuals. Four of the five interventions examined produced statistically significant outcomes on well-being at work.

CONCLUSIONS

Stress management interventions that included mental exercises were the most successful. Interventions primarily reduced the stress experienced by participants, but the evidence on the stability of these outcomes was poor because of the short follow-up periods. The certainty of evidence was low, indicating that the use of these interventions among nurse leaders might be beneficial. Further studies are needed to provide more reliable recommendations for their use. As the performance of nurse leaders influences organizations, through interpersonal relationships, it is important to pay more attention in the future to the development of organization- and person-directed interventions and their combinations. A structural empowerment approach should also be considered.

Time and change in health care

Purpose

The purpose of this paper is to explore the dimensions of temporality that are rarely considered in the literature on leading change.

Design/methodology/approach

The analysis is informed by Adams’ (1995) social theory of time encompassing temporality, timing and tempo. This will illustrate the complexities of time as they relate to the individual, teams and organisation.

Findings

This paper demonstrates the multidimensional nature of time: temporality, timing and tempo, and how each of these can contribute to our understanding of the temporal nature and complexity of change within the health system. A framework to inform much-needed research in the area of time and change is presented.

Practical implications

Challenging assumptions that there is only one common time, that is clock time, can provide opportunities for further discussion and understanding of how various people view time and the influence this has on leading and participating in change in health care.

Originality/value

There is limited literature on the temporal dimensions of change at an organisational, team and individual level. The perspective offered in this paper presents the multidimensional nature of time and the influence this has on understanding the temporal nature of change and critically identifies some key areas for future research.