Leadership and Management in Professional contexts

Part 1: Management Style
Description and feelings
This essay aims to reflect on my experience when working with a group of seven students tasked to critically analyse a case study and develop a group presentation. The Gibbs (1988) model of reflection will be used to discuss and analyse the lessons gained from my experience. At the start of our group meeting, a leader was selected and helped the group in planning and implementing the task. However, my experience with the group was marked with difficulties and challenges. In the first stages of our group formation, or the norming stage, we had difficulties meeting as a group due to differences in university schedule. During the meetings, some of the members chose not to participate while others were more demanding and tried to dominate the discussions. The leader tried to create some sense of order in our first meetings and demonstrated the authoritarian leadership style. Throughout our team meetings, some of the members were absent, while others who were present continued to depend on the more dominant members to accomplish the tasks. I was frustrated in the beginning of our meetings and felt that we could have been successful in our presentation if we managed to work more effectively. Our team presentation was not what I expected. I was disappointed with our overall team performance.

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Discussion and Analysis
Management is described as a process where leaders govern and make decision-making within an organisation (Bach and Ellis, 2011). This also involves planning of tasks, organising work, staffing, directing activities and controlling (Belbin, 2010). The main aim of management is for managers to influence or encourage team members to accomplish a task (Belbin, 2010). On reflection, my team leader demonstrated the authoritarian leadership style. This type of leadership is described as one where the leader provides the direction of the team and gives specific instructions and directives on how to achieve the team goal (Daly et al., 2015). An authoritarian leader also supervises the activities of the subordinates and strongly discourages members to validate or question his or her directives (Bach and Elllis, 2011). This type of leadership is appropriate in workplaces where there is a highly-structured setting with routine operations (Bishop, 2009). Autocratic leadership is also favourable for activities that are simple and of shorter duration (Marquis and Huston, 2012). On evaluation of my experience in the team, we had very little interaction and cohesion during the first few stages of the team working.
According to Tuckman’s model of team development, there are four stages of group formation (Clark et al., 2007). These include the following: forming, norming, storming and performing. Our lack of cohesion and difficulties in conducting team meetings may reflect the first stage of group formation, which is the establishing stage. In this this step, Clark et al. (2007) has explained that team members are still beginning to form their team roles and tend to be polite and diplomatic. At this stage, a team leader was chosen, who in turn reflected the authoritarian leadership style. Since most team members were reluctant to accept a task, our leader decided to assign team roles and ensured that each team member would attend the team meetings. The leader also supervised the entire group. On reflection, the authoritarian leadership style was appropriate in the first few stages of our team working since this ensured that tardiness and absenteeism were prevented (Belbin, 2010). Further, the authoritarian leadership style was also appropriate since our assigned task was not complex and was of shorter duration (Bishop, 2009). Our group leader was able to make follow-ups on our assigned task. However, as we progressed towards the second stage, which is the storming stage, conflicts soon arose.
There were members who tended to dominate the discussion and did not agree with our leader on our assigned team roles and how the case study should be presented. Although Goodman and Clemow (2010) argue that conflicts in teams are natural and may not always have a negative impact on the function and development of the team, in my experience, the conflicts had negative impact on our team development. Members who disagreed with our team leader on how the case study should be presented chose not to participate in our succeeding meeting and role-playing. Since the authoritarian leadership style was adopted, our team leader did not consider the team member’s suggestions. Morgan et al. (2015) reiterate that conflicts could help in the development of a team if each team member acknowledges the differences of the team members and learn to adjust to their individual roles. On reflection, most of my team members chose not to adjust to our individual differences. In turn, this created a discordant team, which also reflected on our final presentation. I felt that our presentation was chaotic and reflected poorly on our role as team members. On consideration, our team would have benefitted with the transformational leadership style. This type of leadership encourages members to actively participate in decision-making and is associated with achievement of goals and objectives (Bach and Ellis, 2010).
Conclusion
The authoritarian leadership style was not the most appropriate style in managing our team since this failed to encourage team members to participate in decision-making. This type of leadership is also not applicable in actual healthcare settings since patient-centred care is promoted and team working and participation highly encouraged.
Action Plan
When managing a team in the future, I will ensure that I am aware of my own team role. Conflicts should be used to develop and not destroy teams. I will also adopt a leadership style that allows teams members to actively participate in decision-making. Specifically, I will develop the transformational leadership style since this ensures that all members have opportunities to be actively involved and valued during achievement of a task (Bishop, 2009).
References:

Bach, S. & Ellis, P. (2011) Leadership, Management and Team Working in Nursing. Exeter: Learning Matters.
Belbin, R. (2010) Management of teams: why they succeed or fall. London: Butterworth-Heinemann.
Bishop. V. (2009) Leadership for nursing and allied healthcare professionals. Open University Press: Milton Keynes.
Clark, P., Cott, C. & Drinka, T. (2007) ‘Theory and practice in interprofessional ethics: a framework for understanding ethical issues in health care teams’, Journal of Interprofessional Care, 21(6), pp. 591-603.
Daly, J., Speedy, S. & Jackson, D. (2015) Leadership and Nursing. Contemporary Perspectives. 2nd ed. Chatswood: Elsevier.
Gibbs, G. (1988) Learning by doing: A guide to teaching and learning methods, Oxford: Further Educational Unit, Oxford Polytechnic.
Goodman, B. & Clemow, R. (2010) Nursing and collaborative practice: A guide to interprofessional learning and working. Exeter: Learning Matters, Ltd.
Marquis. B. & Huston. C. (2012) Leadership and management tools for the new nurse. A case study approach. Lippincott: Philadelphia.
Morgan, S., Pullon, S. & McKinlaey, E. (2015) ‘Observation of interprofessional collaborative practice in primary care teams: An integrative literature review’, International Journal of Nursing Studies, doi: 10.1016/j.ijnurstu.2015 03.008 [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25862411 (Accessed: 15 May 2015).

Part 2: Leadership, Management and Change
Description and Feelings
In our team meetings, the concept of change management surfaced since our team leader struggled in influencing team members to assume different team roles. I also realised that I used to complete tasks individually and not as a team. Although I was not the team leader, I also have to learn how to reflect an appropriate leadership style that will be used in future team working. During our team meetings, I was frustrated since we were accomplishing little, but in the end, I felt that I have developed my ability to work in a team.
Discussion and Analysis
Change is described as a transition that involves movement from the present state of an organisation to a desired, future state (Marquis and Huston, 2012). Changes often occur in healthcare settings and require change management. During the role-play and team meetings, collaborative team working was encouraged to achieve the goals of the team. This represented a change in how I accomplish tasks. From completing assigned tasks individually, I have to learn how to complete tasks as a group. Apart from changes on how to complete tasks, there was also a suggested change on leadership style from authoritarian to the transformational leadership style. On evaluation, change management was necessary in our group since this could have addressed the factors that caused our poor performance and increased the factors that would lead to a successful group performance.
Practising change management is crucial since this would help prepare myself in my future role as a registered nurse and as a nurse leader. At least three theories have been proposed in managing change. These include the Plan, Do, Study, Act cycle (PDSA), Kotter’s Model and Lewin’s change model (Bach and Ellis, 2010; Appelbaum et al., 2012; Reed and Card, 2016). The PDSA cycle is often used in the NHS and allows nurse leaders and other healthcare practitioners to create a plan on how to implement a change while the ‘do’ stage constitutes the actual performance of the plan. In the third or ‘study’ phase, nurse leaders and team members analyse the performance and whether this needs to be enhanced or changed (Reed and Card, 2016). In the ‘act’ phase, the proposed changes in the action plan and performance are implemented. The entire process is then repeated until change has been integrated within an organisation. A critique of the PDSA is the difficulty in repeating this cycle, with Reed and Card (2016) noting that only 20% of healthcare groups using PDSA actually repeat the cycle. The applicability of the PDSA is limited with some healthcare settings not benefitting from this type of change management (Taylor et al., 2013).
Meanwhile, the Kotter Model of change adopts the top-down approach and is often used in corporate settings (Appelbaum et al., 2012). It is difficult to use this model of change in actual healthcare settings since the NHS encourages all team members and patients to actively participate in planning and implementation of a change initiative (NHS Leadership Academy, 2011). However, a reflection of my own group would show that the Kotter Model of change was demonstrated as our team leader exercised the authoritarian leadership style. The change came from the leader and trickled down to the team members. Finally, the Lewin’s model of change proposes three stages of change: unfreezing, change and refreezing (Gopee and Galloway, 2013). This model is often used in healthcare settings since it takes into account the factors that enable or deter change in actual practice. Force-field analysis is done and factors that enable change are increased while factors that deter change are reduced (Gopee and Galloway, 2013).
On reflection, employing this type of change management is crucial in my future role as a registered nurse leading a multidisciplinary team. In the NHS, it is recognised that there are several factors that deter or promote change in practise. For instance, the perception that a proposed change initiative only increases paperwork could deter the uptake of change in practice (Bach and Ellis, 2011). This perception is supported in literature with the Royal College of Nursing (2013) reporting that nurses spend an average of 2.5 million hours per week completing clerical tasks. Hence, I have to be aware of factors that deter or enable change. On reflection, the autocratic leadership style, coupled with the top-down approach to change did not lead to a successful performance of my group. The Lewin’s model of change would have been more appropriate in helping my team members accept their individual roles and in changing their own way of completing tasks. This model would have helped our team leader investigate the factors that lead to poor attendance to our team meetings and the team members’ refusal to resolve conflicts. 
Conclusion
Effective leadership and change management are crucial when implementing a change initiative and in completing group tasks. Using the Lewin’s model of change would have helped the team leader identify the factors that enable and deter change. Successful use of this model would lead to achievement of the goals of the team.
Action Plan
I will develop my leadership skills and abilities to carry out Lewin’s change model. I will find opportunities to practice change management skills in my own healthcare setting and report regularly to my mentor and colleagues on my progress. I will ask feedback from my mentor and colleagues if I have achieved leadership and change management skills.
References:

Appelbaum, S., Habashy, S., Malo, J. & Shafiz, H. (2012) ‘Back to the future: revisiting Kotter’s 1996 change model’, Journal of Management Development, 31(8), pp. 764-782.
Bach, S. & Ellis, P. (2011) Leadership, Management and Team Working in Nursing. Exeter: Learning Matters.
Gopee, N. & Galloway, J. (2013) Leadership and Management in Healthcare. 2nd ed. London: Sage.
Marquis. B. & Huston. C. (2012) Leadership and management tools for the new nurse. A case study approach. Lippincott: Philadelphia.
NHS Leadership Academy (2011) Clinical Leadership Competency Framework. Coventry: NHS Institute for Innovation and Improvement.
Reed, J. & Card, A. (2016) ‘The problem with Plan-do-study-act cycles’, British Medical Journal Quality and Safety, 25(3), pp. 147-152.
Royal College of Nursing (2013) Nurses spend 2.5 million hours a week on paperwork- RCN Survey [Online]. Available at: https://www2.rcn.org.uk/newsevents/press_releases/uk/cries_unheard_-_nurses_still_told_not_to_raise_concerns (Accessed: 10 May, 2017).
Taylor, M., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. & Reed, J. (2013) ‘Systematic review of the application of the plan-do-study-act method to improve quality in healthcare’, British Medical Journal Quality and Safety, doi: 10.1136/bmjqs-2013-001862.

Part 3: Leadership, Management and Decision Making
Description and Feelings
In our group work, our team leader did not make a decision to identify the factors that deterred participants from resolving conflicts and adjusting to team roles. There was also no decision to reflect on why team members were reluctant to accept the assigned tasks and the reasons for poor attendance to the team meetings. I felt that these non-decisions heavily influenced our team performance. As a group, we made the erroneous conclusion that our team leader can handle all the required tasks. This group conclusion might have also contributed to our failed group presentation. During our meetings, I was anxious and apprehensive that we were not accomplishing our tasks with the given time frame.  
Discussion and Analysis
The indecision to identify factors that deterred the group from participating in meetings and accepting tasks had a negative impact on our team performance. The ability to make decisions is crucial when completing tasks as a student nurse and in preparation for my role as a registered nurse or a nurse leader. Marriner-Tomey (2009) has argued that decision-making is crucial in healthcare organisations and within teams. In actual healthcare settings, decisions are made constantly and range from decision on whether to admit a patient to decisions on which interventions to use for a specific healthcare condition. These decisions are influenced by legislations, policies, leadership styles and the practice of patient-centred care (NHS Leadership Academy, 2011). On analysis, it is crucial to make decisions within groups. However, it is cautioned that collective decisions might reflect ‘groupthink’ and lead to failure instead of success (Marriner-Tomey, 2009). The theory of groupthink is described as faulty decision made by a group that represents deterioration in reality testing, mental efficiency and moral judgment (Wilcox, 2010). Groups who demonstrate groupthink often do so without realising the impact of their decisions on other groups and in the process, ignore alternatives or actions (Cooke and Young, 2002). It is important to note that groupthink often occurs when members have similar background, when rules for decision-making are not clear and when members do not consider the opinions of others (Wilcox, 2010). In my experience, we were not able to make a decision or demonstrate groupthink despite the similarities of our background. I felt that our lack of cohesion prevented us from also making faulty decisions, which are common when a team ‘groupthinks’.
An analysis of our group revealed that we were not able to examine the power relations within the group. Power relations could have an impact on who make the decisions and whether these decisions are followed (Bach and Ellis, 2010). Power is described according to who has the formal authority to make decisions for the group and according to who has access to resources (McDonald et al., 2012). Power is also described according to who has less ability to control ideas (McDonald et al., 2012).  In teams, there may be power imbalance especially when professional systems, social and cultural factors reinforce these imbalances (Martin-Rodriguez et al., 2005). This power imbalance may be more evident in hospital settings where medical dominance is seen. For example, medical doctors have traditionally retained their independence and professional autonomy and status when collaborating with other groups of healthcare workers (Hudson, 2002). This may create power imbalance as doctors tend to have more power in decision-making compared to the rest of the group. This is in contrast with what is often seen in community healthcare settings where each member of a healthcare team tends to share power and make decisions according to what is best for the patient (Hudson, 2002).
Meanwhile, Weir-Hughes (2011) asserts that in order for a therapeutic relationship to develop, there is a need to consider the power relationships between healthcare practitioners and patients. It is suggested that power may be used negatively (i.e. through coercion and force) or positively (i.e. through encouragement and empowerment).  On analysis, my ability to understand power relations through my experiences in team working will be essential when caring for actual patients. In our team, power was used negatively since our team leader had to force our team members to accept assignments. However, I realised that in actual settings, it is important to encourage and empower patients and my colleagues to improve patient care. It has been shown that patient empowerment tends to improve the quality of care and patient outcomes (Sullivan and Garland, 2010). On analysis, there was power imbalance in our group since the team leader made all the decisions and the top-down approach to change was followed.
Conclusion
Making decisions is crucial in team working and when caring for patients. However, the ability to make decisions would depend on one’s power. Those with more access to resources and power have greater ability to influence decisions. In healthcare settings, it is crucial to use power positively and empower patients and other members of the healthcare team to make decisions. Positive use of power is also important in preventing ‘groupthink’, a phenomenon that tends to result to negative consequences for the group.
Action Plan
When faced with a similar situation in the future, I will ensure that I actively participate in decision-making. However, I need to empower others and myself to make good decisions. Empowerment is necessary to prevent power imbalance. I will continue to engage in training on how to practice effective leadership and management skills in order to empower others to actively engage in decision-making.
References:

Bach, S. & Ellis, P. (2011) Leadership, Management and Team Working in Nursing. Exeter: Learning Matters.
Cooke, M. & Young A. (2002) Managing and Implementing Decisions in Healthcare. London: Healthcare Balliere Tindall/RCN.
Marriner-Tomey (2009) Guide to Nursing Management and Leadership. St. Louis: Mosby Elsevier.
Martin-Rodriguez, L., Beaulieu, M., D’Amour, D. & Ferrada-Videla, M. (2005) ‘The determinants of successful collaboration: a review of theoretical and empirical studies’, Journal of International Care, 19(2), pp. 132-147.
McDonald, J., Jayasuriya, R. & Harris, M. (2012) ‘The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus’, BMC Health Services Research, 12(63). Doi: 10.1186/1472-6963-12-63.
NHS Leadership Academy (2011) Clinical Leadership Competency Framework. Coventry: NHS Institute for Innovation and Improvement.
Sullivan E., Garland G. (2010)  Practical Leadership and Management in Nursing. Pearson Education, Harlow.
Wilcox, C. (2010) Groupthink: An impediment to success. USA: Xlibris Corporation.

Part 4: Reflection on Development of Skill
Description and Feelings
I participated in a second group activity where I was chosen as the leader. In the second group, I was able to practice leadership skills such as effective communication, motivation, change management and integrity. During one of our discussions, I assigned a group member to search for evidence-based interventions for a specific healthcare condition. Following some research, my team member decided to use the case of a real patient to explain the interventions. However, she identified the name of the patient and the context of her care, including the names of the nurses who were involved in her care. I talked to my colleague privately after our discussion and informed her of the NMC (2015) code of conduct on patient autonomy and the need to observe the privacy of the patient. I asked her to use a pseudonym instead when discussing the case of a patient. My colleague accepted my suggestion and protected the identity of the patient during succeeding discussions. On reflection, I felt that my decision to inform my colleague on how to discuss patient care was based on the ethics principles of patient autonomy.
Discussion and Analysis
From my participation in teams/groups throughout the module, I was able to develop effective communication skills. Specifically, I learned how to listen and show compassion to my colleagues and my patients during placement when they converse with me. Kourkouta and Papathanasiou (2014) have emphasised that effective communication skills is crucial in healthcare settings and when working in teams. These communication skills include recognising both verbal and non-verbal messages (Johnston, 2013). Patients who feel that their nurses are listening intently tend to report higher patient satisfaction with the care they receive (Kourkouta and Papathanasiou, 2014). Effective communication skills are also necessary in resolving conflicts in teams and understanding the perspectives of others (Craig and Moore, 2015). In nursing teams or when working with patients, it is recognised that conflicts in ideas also occur. Hence, the ability to communicate effectively and resolve conflicts will be necessary in preparing myself in my future role as a registered nurse (Craig and Moore, 2015).
Apart from effective communication, I also learned how to motivate my fellow team members. Motivation is crucial in team working since this would help team members to complete tasks. In my experience with my first group, team motivation was not practiced. In contrast, my second team was able to use motivation to help team members accept and carry out tasks. I realised that the main difference was the support that my team members received in the succeeding group. Craig and Moore (2015) state that team support is critical in team working since the absence of support could create dissatisfaction and loss of motivation. In addition to the skills on motivation, I also saw the importance of change management in our team. In my first group, change management was not practised. Managing change is critical in healthcare practice. Thorpe (2015) has stated that planned change, which is described as purposeful, requires collaborative effort and the presence of a change agent. The NMC (2015) has emphasised that nurses must deliver quality care that is based on evidence, suggesting that nurses have to continually update their skills and practice. This also means that changes in practice have to be made. However, in practice, implementing change is challenging. It is suggested that almost 70% of change projects do not succeed (Mitchell, 2013).
In my experience with the group, I also realised the necessity of recognising factors that influence or deter change. Mitchell (2013) suggests that advances in science, shortages of the nursing workforce, an ageing population, the need to increase patient satisfaction and rising cost of treatment all influence change. Inappropriate leadership, poor communication and under-motivated staff also deter the uptake of change in practice (O’Neal and Manley, 2007). In my future practice, I have to identify factors that promote change in practice. On reflection, I was not able to promote change in our first group. I could have assisted the team leader in my first group in analysing the factors that deter my colleagues from accepting their assigned tasks.
Integrity was also practiced in the succeeding groups that I was involved in. Specifically, power was not misused as all team members in these groups had equal chances to participate in decision-making. In addition, the team leader and group members exercised honesty and transparency in the decisions made. Finally, ethics in decision-making was observed. For instance, all personal information of patients discussed during case studies was not mentioned and patient autonomy was observed. The NMC (2015) has reiterated the importance of protecting the privacy and autonomy of the patients.
Conclusion
Practising effective leadership skills and ethical decision-making are important when working as teams and in providing quality care to the patients. Inability to work effectively could result to poor performance, which in turn could affect the quality of care that my future patients will receive. Developing these leadership skills early in my undergraduate years would help prepare me in my role as a registered nurse.
Action Plan
As part of my action plan, I will continue to engage in training on how to develop effective communication skills. Specifically, I will refine my skills on how to show empathy when listening to my patients and colleagues. The ability to demonstrate empathy is crucial since this would help my patients feel that they matter to the team (Fowler, 2015).
References:

Craig. M. & Moore. A. (2015) ‘Providing support for teams in difficulty’, Nursing Times. 111(16), pp. 21 – 23.
Fowler. J. (2015) ‘What makes a good leader?’, British Journal of Nursing, 24(11), pp. 598 – 599.
Johnston, B. (2013) ‘Patient satisfaction and its discontents’, Journal of the American Medical Association, 173(22), pp. 2025-2026.
Kourkouta, L. & Papathanasiou, I. (2014) ‘Communication in nursing practice’, Materia Socio Medica, 26(1), pp. 65-67.
Mitchell, G. (2013) ‘Selecting the best theory to implementing planned change’, Nursing Management, 20(1), pp. 32-37.
Nursing and Midwifery Council (NMC, 2015) The Code: Professional Standards of practice and behaviour for nurses and midwives [Online]. Available from: http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf (Accessed: 12 May, 2015).
O’Neal, H. & Manley, K. (2007) ‘Action planning: making change happen in clinical practice’, Nursing Standard, 21(35), pp. 35-39.
Thorpe. R. (2015) ‘Planning a change project in mental health nursing’, Nursing Standard, 30(1), pp. 38 – 44.