Transforming negative work cultures: a practical strategy

A healthcare case study of team learner style and change management

Purpose

The purpose of this paper is to explore the learner styles of a healthcare institution transition team and its respective members within a change management context. In particular we focus on the role of learner style in the success of change efforts within a team setting.

Design/methodology/approach

This paper presents a case study that employs a questionnaire survey, non‐participant observation, and semi‐structured interviews as part of a larger study of healthcare change management.

Findings

Findings suggest that a mix of learning styles is ideal for successful healthcare change management. Specifically, this limited study suggests a learner ratio that favors convergers and assimilators over divergers and accommodators may be the most effective staffing strategy for change leadership teams in a healthcare environment.

Originality/value

Managing change in healthcare has been researched from a process perspective but few studies examine the individual team members' learner styles and the impact of these learning styles over time. Implications for human resources and change implementation are discussed.

Transforming work place relationships through shared decision making

AIM

Using Donabedian's Structure-Process-Outcomes (SPO) paradigm, this study explored the SPO linkages related to nurse-nurse leader shared decision making around workload issues, such as safe staffing assignments.

BACKGROUND

Shared decision making represents nurses' control over practice, which is associated with positive nurse outcomes, such as job satisfaction. This study is based upon four project sites where nurse-led project teams addressed workload issues.

METHODS

Participatory action research was used, with the authors acting as participant observers. Four sites were case ordered and analysed: least successful to most successful outcomes. Cross-case matrices were constructed to identify SPO linkages. Data included observation field notes, interviews and focus groups.

RESULTS

Operations leaders with formal access to empowerment structures, such as information and resources, were the critical link to successful outcomes. Sites with conflict that blocked team-operations leader relationships were unable to engage in effective, sustainable decision making.

CONCLUSIONS

Effective work relationships among teams consisting of staff and front-line leaders contributed to successful outcomes, but team-operations leader relationships made the biggest difference.

IMPLICATIONS FOR NURSING MANAGEMENT

Formal access to power through leadership is critical for building and sustaining processes that promote and sustain nurses' control over practice.

Authentic Leaders Creating Healthy Work Environments for Nursing Practice

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment.

In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the “glue” needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed.

A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment

OBJECTIVES

The overall aim of this comprehensive systematic review was to identify the best available evidence on the effect of team characteristics, processes, structure and composition within the context of collaborative practice among nursing teams that create a healthy work environment.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of Medline and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified keywords and index terms was then undertaken.

METHODOLOGICAL QUALITY

Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.

RESULTS

The papers included in the review included nine experimental or quasi-experimental studies, 11 descriptive studies and four qualitative studies. A variety of different team structures such as interdisciplinary teams, primary nursing, team nursing, multidisciplinary models of care delivery and the use of a Partner in Patient Care model were investigated. Team characteristics should include accountability, commitment, enthusiasm and motivation. Social support within a team from a supervisor or colleague increased satisfaction levels of staff.

CONCLUSION

The results of the review lead to the development of a number of recommendations for practice that could assist with creating a health work environment.

Understanding the workplace culture of a special care nursery

AIM

This paper presents findings from the first phase of a research study focusing on implementation and evaluation of emancipatory practice development strategies.

BACKGROUND

Understanding the culture of practice is essential to undertaking effective developments in practice. Culture is a dominant feature of discussions about modernizing health care, yet few studies have been undertaken that systematically evaluate the development of effective practice cultures.

METHOD

The study intervention is that of emancipatory practice development with an integrated evaluation approach based on Realistic Evaluation. The aim of Realistic Evaluation is to evaluate relationships between Context (setting), Mechanism (process characteristics) and Outcome (arising from the context-mechanism configuration). This first phase of the study focuses on uncovering the context (in particular the culture) of the Special Care Nursery in order to evaluate the emancipatory practice development processes and outcomes. Data collection methods included survey, participant observation and interview. Cognitive mapping, constant comparative method and coding were used to analyse the data. Findings. Four key categories were identified: Teamwork, Learning in Practice, Inevitability of Change and Family-Centred Care and collectively these formed a central category of Core Values and Beliefs. A number of themes were identified in each category, and reflected tensions that existed between differing values and beliefs within the culture of the unit.

CONCLUSION

Understanding values and beliefs is an important part of understanding a workplace culture. Whilst survey methods are capable of outlining espoused workplace characteristics, observation of staff interactions and perceptions gives an understanding of culture as a living entity manifested through interpersonal relationships. Attempts at changing workplace cultures should start from the clarification of values held among staff in that culture.

Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American nurses

This study describes how the potential sources of errors and error prevention in operating room (OR) teams are experienced by Finnish, American and British nurses. The data were collected by interviews and analysed using a qualitative content analysis. Results consisted of categories demanding teamwork practice, shared responsibility in teams and organized teamwork. The demanding practice category included fear of errors, turnover in teams, overtime work and emotional distress as potential factors leading to errors in OR teamwork. Shared responsibility emphasized how the familiar teams, safety control and formal documentation of errors prevented errors. At the organizational level, the prevention of errors required scheduling of work, good management, competency and a reasonable physical environment. In order to improve safety in OR teams, recognition should be given to the balance of error-making and learning from them. More effective ways in reporting incidents should be adopted and overall reporting systems should be developed in Finnish OR teams.

Dual or dueling culture and commitment: The impact of a tri-hospital merger

OBJECTIVES

This article addresses differences in RNs' commitment to their employing hospital versus the umbrella corporate organization, and the role of organizational culture during a tri-hospital merger. This study is the first to investigate the construct of dual commitment in healthcare organizations.

BACKGROUND

Fiscal restraints, decreasing reimbursement, and increasing competition have made organizational mergers and acquisitions prevalent. As corporate culture changes, organizational variables previously related to organizational commitment may no longer apply.

METHODS

RNs employed on general nursing units at 3 hospitals involved in a merger process completed 2 versions of Mowday's Organizational Commitment Questionnaire. Commitment to hospital and corporate system were examined. Semi-structured interviews, participant observation, and analysis of company documents assessed the organizational culture changes that have occurred.

RESULTS

Thirty-one percent of the nurses returned completed questionnaires; 9 were interviewed. RNs from the acquiring hospital demonstrated a significantly stronger commitment to the corporate system than the nurses from the acquired hospitals. The RNs at all 3 hospitals showed significantly greater commitment to their own particular hospital than to the umbrella corporate system.

CONCLUSIONS

Moderate level of commitment reflected uncertainty of job status, work overload, and feelings of unappreciation. These attitudes prevent nurses from exerting efforts on behalf of the organization.