Political leadership in action

The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

Background

The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature.

Methods

The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services.

Results

Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes.

Conclusion

There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06272-z.

Effects of nursing power and organizational trust on nurse's responsiveness and orientation to patient needs

Aim

To assess the relationship among perceived nursing group power, organizational trust and patient orientation and identify patient orientation predictors.

Background

Nurses and nursing organizations should use all resources to give care.

Methods

Survey data were collected from 193 nurses at six acute care hospitals in South Korea. Characteristics of hospitals and nurses were analysed using t tests, one-way ANOVAs and regression models.

Results

The means for perceived nursing group power, organizational trust and patient orientation were 3.71 (SD± 0.58), 3.22 (SD± 0.83) and 3.94 (SD± 0.53), respectively. Multiple regression analysis revealed that 40% of the variance in patient orientation was explained by perceived nursing group power, organizational trust and work experience.

Conclusion

Hospitals should increase nursing group power and improve organizational trust to enhance patient orientation. Hospital executives and nurse managers should work to enhance nursing group power and positive perceptions of organizational trust, which could contribute to patient orientation.

Exemplary professional practice through nurse peer review

The development and execution of a nurse peer review program to evaluate nursing practice associated with significant adverse events has resulted in systemic changes. Descriptive analyses were conducted for 23 peer-reviewed cases involving 41 RNs and 2 advanced practice nurses from 14 specialties over a 4-year period. Thematic analysis revealed four common event categories: assessment and monitoring, team communication, skin integrity, and vascular access. This approach demonstrates the impact of professional nurse accountability for improving the quality of care and may serve as an exemplar for professional practice.

Nursing shaping and influencing health and social care policy

AIM

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.

BACKGROUND

The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.

METHODS

This paper critically reviews recent UK and USA literature and policy with relevance to nursing.

RESULTS

Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.

CONCLUSIONS

Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.

IMPLICATIONS FOR NURSING MANAGEMENT

All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

The glass ceiling in Irish healthcare: a nursing perspective

PURPOSE

The purpose of this study is to describe and explore from the perspectives of top-level nurses holding the formal position of director of nursing their perceptions and interpretations of their experiences in the Irish healthcare system.

DESIGN/METHODOLOGY/APPROACH

This paper presents some findings from a nation-wide study, which is qualitative in approach using grounded theory methodology. Semi-structured interviews were conducted with 50 directors of nursing representing general and psychiatric nursing.

FINDINGS

The study in this paper was conducted in the context of a changing healthcare system, which emphasises the flattening of organisational pyramids. However, this study's findings indicate that, while structures might be changing, behaviours remain unaltered. In particular, the medicine nursing power base remains unchanged, while the power shift between nursing and general management continues to widen in favour of general management.

RESEARCH LIMITATIONS/IMPLICATIONS

Research in this paper shows that directors of nursing who chose to participate in this study may have different perceptions of experiences from those who chose not to participate.

ORIGINALITY/VALUE

In the paper the reality is neither medicine nor general management, individually or collectively, are going to share or devolve power and influence to nursing. This study's findings indicate that nursing needs to confront this power imbalance. Nursing needs to take the first steps towards shattering the glass ceiling by really examining its own behaviours, in maintaining the status quo, in the traditional balance of power.