Leadership, Supervision and Discipline in Health Care Organizations :Leadership, Supervision and Discipline in Health Care Organizations •Luvella Anderson •Richard Hudgens •Jonie Starling •Jennell Wilcox November 1, 2009 “Hometown Hospital”


Issue: Leadership Committed to Safety :Issue: Leadership Committed to Safety Leadership is a critical function in promoting high quality, safe health care. In health care organizations, leadership is provided by the governing body, the chief executive and senior managers, and the leaders of the clinical staff. When a sentinel event (serious adverse event) occurs in a health care organization, inadequate or ineffective leadership is often one of the contributing factors. In fact, inadequate leadership was a contributing factor in 50 percent of the sentinel events reported to The Joint Commission in 2006. Research shows that leadership makes a major difference in the quality and safety of patient care. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_43.htm#1


Importance: :Importance: Sentinel Events are a direct result of: Ineffective leadership Inadequate leadership Inadequate communication Inadequate communication between care providers or between care providers and patients/families is consistently the main root cause of sentinel events. Other leading root causes include incorrect assessment of a patient’s physical or behavioral condition and inadequate leadership, orientation or training. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_43.htm#1 http://www.jointcommissionreport.org/pdf/JC_2007_Annual_Report.pdf


Ways to Improve Safety: :Ways to Improve Safety: Improve Clinical Environment Retrain Staff Awareness of Surroundings Accountability Follow Guidelines Put Safety First


Mission: :Mission: “Hometown Hospital is committed to providing quality health care to our community members. We commit ourselves to create an environment that promotes teamwork and a caring attitude to extend the utmost respect and courtesy to our patients. We further dedicate ourselves to clinical excellence and patient safety to not only meet, but exceed, the needs and expectations of those we serve.”


How mission is impacted by issue: :How mission is impacted by issue: When safety mistakes are made due to lack of leadership or supervision, the mission of Hometown Hospital is not upheld. When safety is an issue at Hometown Hospital, we are not providing quality health care to our patients as promised. There is a lack of a caring attitude for patients, putting them at risk. There is no dedication to clinical excellence and patient safety as the mission promises. Safety issues do not allow us to meet or exceed the expectations of our patients.


Contingency Theory :Contingency Theory Links the situation with the leader’s behavior and with the follower’s attitude Contains two applications: Contingency Model Situation leadership theory Vandeveer and Menefee, 2010


Contingency Model: :Contingency Model: Links the concept of task and relationship. Contains three elements: position power -- the degree to which a leader’s position enables the leader to ensure compliance task structure -- the degree of clarity for goal accomplishment leader-member relations -- the nature of the relationship between the leader and the members Vandeveer and Menefee, 2010


Situational Leadership® theory: :Situational Leadership® theory: focuses on the follower. follower’s ability and his willingness to accomplish a task are the central leadership issues that guide the behavior of a leader. proposes that a leader’s style is flexible and may be adjusted to fit the situation. Vandeveer and Menefee, 2010


Expectancy theory: :Expectancy theory: A motivational theory that explains the mental process of making a choice. Montana and Charnov, 2008


Helps motivate employees when they believe: :Helps motivate employees when they believe: increasing effort will yield better job performance increased job performance will lead to positive reinforcement, such as an increase in salary or benefits. these predicted rewards are valued by the employee in question. Montana and Charnov, 2008


Slide 12:Leadership: Supervision: process of “creating structural change wherein the values, vision, and ethics of individuals are integrated into the culture of a community as a means of achieving sustainable change”(Braveman, 2006, p. 84) “the ability to influence others” (Vandeveer & Menefee, 2010, p. 122) defined as “the control and direction of the work of one or more employees in a manner that promotes improved performance and a higher quality outcome”(Braveman, 2006, p. 142)


Best solution: Positive discipline :Best solution: Positive discipline referred to by Grote (2006) as “Discipline Without Punishment” begins by, “recognizing that the overall objective of the enterprise’s discipline system should properly be the development of well-disciplined individuals who are committed to the organization, its mission, its values, and its vision;” and, “results in the first element of Discipline Without Punishment; Positive Contacts, the recognition of good performance.”(Grote, 2006, p. 29)


Positive discipline Cont. :Positive discipline Cont. Motivates employees to act in any desired way. Contingency, Expectancy, Situation leadership theory's all have better results with positive reinforcement. Team members get a sense of pride in their job when rewarded for good behavior.


Conclusion: :Conclusion: Leadership and Supervision is most effective to an organization because it’s the key function that hold an organization together. It keeps order and control over the department and staff. In the expectancy theory leadership and supervision use steps to motivate the effects of the ones performance, rewards of the performance, and the need to be satisfied by a reward. Some example of this theory experience the need to improve clinical environment, re-establish guidelines for safety of the organization, and refocus the members ability to think and address health issues.


Slide 16:In the Contingency model leadership and supervision was defined as a links to a situations with the concept of task and relationship which follows with three key elements: position power, task structure, and leader-member relations. Each of these elements describes a format that speaks about each task or issue and shows how a leader such respond or react.


Slide 17: The experience used from this model displays roles and situations that ensure supervision of the organization stays on track under the direction of the leader and discipline reinforces an environment of followership. Leadership is the key to the survival of the organization. Without effective leadership, there is no motivation to achieve the goals of the organization which reduces the chances of its success.


Final analysis: :Final analysis: In order for leadership and supervision to become more effective, each aspect of this team or department must be on board to help make any changes that will support the process of improving ways for positive discipline within management and team-efficacy, whereas “creating structural change wherein the values, vision, and ethics of individuals are integrated into the culture of a community as a means of achieving sustainable change.” (Braveman, 2006, p. 84). Working together as a team allows minimal supervision and allows leadership to focus on other issue and conflicts within the organization.


References: :References: Braveman, B. (2006). Leading and Managing Occupational Therapy Services: An Evidence-based Approach. Philadelphia: F.A. Davis Company. Grote, R. (2006). Discipline Without Punishment, :The Proven Strategy That Turns Problem Employees Into Superior Performers. (2nd ed.). New York: AMACOM Books. Montana, Patrick J; Charnov, Bruce H, Management – 4th edition; (2008) – Barron's Educational Series, Inc. ISBN 978-0-7641-3931-4 The Joint Commission:  Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2007. Sentinel Event Root Cause and Trend Data section, pages 45-48.  The Joint Commission: Leadership committed to safety . The Joint Commission. Issue 43. Retrieved October 23, 2009, from http://www.jointcommission.org/SentinelEvents Situational Leadership® is the registered trademark of the Center for Leadership Studies, Inc. www.situational.com Vandeveer, R.C. & Menefee M.L. (2010). Human Behavior In Organizations. (2nd ed.). Upper Saddle River: Pearson Education.