To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
develop a clear understanding of how ambiguity in organisational settings impacts management and leadership?
reduce ambiguity?
develop confidence in the identification and articulation of ambiguity in healthcare organisations?
acquire skills and knowledge in useful approaches to managing positions, directions and outcomes related to ambiguous circumstances and problems?
Introduction
Complexity is a feature of healthcare organisations. Irrespective of the role, size, processes and governance of these organisations, the internal and external environments in which they operate and the number of associated stakeholders represent significant challenges in managing clinical and social processes and outcomes, resources, workforces, decision-making and ethics. Within this complex framework, healthcare leaders need not only skills and strategies to manage their organisation, but also resources and personal competencies to lead individuals, groups and workforces.
Definitions
Ambiguity is defined as lack of certainty or dependability of meaning of communication, action or knowledge. It describes a situation in which information could be interpreted, construed or understood in more than one way. It is a natural aspect of the operations of healthcare facilities and the environments in which they engage with many stakeholders. Leading and managing health organisations requires awareness, understanding and focused action to ensure that ambiguous situations are managed for impact and usefulness to the health facility.
understand the place that interprofessional teams have in healthcare organisations?
analyse the enablers and barriers to leading interprofessional teams?
apply principles of successful leadership of interprofessional teams to enhance my teamwork skills?
work with the benefits and challenges associated with hybrid roles in leading interprofessional teams?
Introduction
Leadership is an elusive concept. Key authors cannot agree on the characteristics of leaders, but all agree that leadership is about relationships and evolves over time. For example, Rost and Barker (2000, p. 3) state that ‘leadership is an influence relationship among leaders and followers who intend real changes and outcomes that reflect a shared purpose’. Meanwhile, Landsdale (2002, p. 56) suggests that ‘effective leaders enable people to move in the same direction, toward the same destinations, at the same speed, but not because they have been forced to, but because they want to’. This raises the question of how we get people to want to go in the same direction and at the same pace. In the health services this is particularly challenging because of the multidisciplinary nature of the key stakeholders. It requires appropriate leadership of interprofessional teams.
The increased complexity of patient needs has driven the necessity of interprofessional teamwork in health services (Bridges, Davidson, Odegard, Maki & Tomkowiak, 2011 ). Consequently, the importance of such teams within a health context is increasingly being accepted (Bajnok, Puddester, MacDonald, Archibald & Kuhl, 2012). While working in interprofessional teams is challenging, it also has benefits. Healthcare professionals working in interprofessional teams have reported that the system produces greater patient satisfaction and outcomes, reduced healthcare costs and improved job satisfaction (Baggs & Schmitt, 1997 ; Clarke & Hassmiller, 2013 ; Hendel, Fish & Berger, 2007 ; Zwarenstein, Reeves & Perrier, 2005).
determine when to look for evidence to assist in decision-making?
source relevant evidence for my management practice and decision-making?
critically appraise evidence for its strengths, weaknesses and relevance to a particular health services management question?
apply relevant evidence to my management practice and decision-making?
find out more about evidence-based management?
Introduction
Building on the concepts of evidence-based medicine and evidence-based policy, the concept of evidence-based leadership and management suggests that leaders and managers find, evaluate and use the best available scientific evidence to inform their practice. An early definition of evidence-based management was ‘translating principles based on best evidence into organisational practices’ (Rousseau, 2006, p. 256). This chapter discusses when and how to look for evidence and outlines how to apply it to the leadership or management decision or situation at hand.
Use of evidence
While there are studies linking doctors who practise evidence-based medicine with better clinical outcomes (Pfeffer & Sutton, 2006), and despite the inherent logic of basing decisions on evidence, we could fi nd no studies linking evidence-based management with better organisational outcomes. In fact, there is a large body of research that suggests that managers have difficulty finding and applying evidence to their management practice generally (Hemsley-Brown & Sharp, 2003 ), and to healthcare leadership and management specifi cally (Finkler & Ward, 2003).
plan the change process and the human management component of the change?
develop my skills in leading organisational change?
Introduction
This chapter provides an introduction to the world of change management. Firstly, it sets out the case for change – why change management matters – then looks at the theories concerning individual and organisational change. Finally, the role of the professional change manager is discussed.
Definitions
For the purposes of this chapter, change is viewed from an organisational perspective. Organisational change is a systematic approach to reshaping organisations in line with their future goals, aims, vision and philosophy. By its very nature, organisational change needs to be actively managed to ensure the desired outcomes. Organisational change management requires the manager to take account of the range of internal and external forces that can augment, shape, hinder or derail organisational change. The internal forces can include organisational objectives, work standards, personnel, staff expertise and profit, while the external forces can include economic, technical, political, governmental and sociocultural factors, as well as the operating environment (Pathak, 2010). The manager should realise that any number of these internal and external forces may need to be actively managed simultaneously to ensure a successful outcome.
determine the leadership approach I might take in my organisation?
decide when I might need to change my leadership approach to a different style?
learn about how management theory has changed over time?
consider how best to develop my own leadership and management skills?
integrate knowledge of leadership and management theory to inform future practice?
Introduction
Effective leadership and management are crucial for healthcare services to meet the expectation to provide high-quality, accessible, affordable care that will result in improved health outcomes (Fehr, 2011) in the context of health reform. Healthcare professionals must understand the main theories of leadership and management and how these approaches translate into improving work practices in order to develop their own work capacity. This chapter presents leadership and management theories that healthcare professionals currently use to inform their practice.
Definitions
Definitions that locate the concepts of leadership and management in a healthcare context are important. The concept of leadership in healthcare receives attention from government, policy-makers, organisational managers, clinicians and researchers (Kean & Haycock-Stuart, 2011 ). To be effective, leadership must be appropriate for healthcare in its broadest sense and see issues addressed in a political, social, policy and economic context (Swearingen, 2009).
understand definitions, rationale, key concepts and public policy associated with stakeholder partnerships in healthcare settings?
identify stakeholder groups essential to quality health service delivery?
use the success factors associated with effective partnerships?
evaluate real-world situations, undertake a stakeholder analysis and recommend key points for stakeholder engagement?
reflect on the skills associated with developing, formalising and maintaining effective stakeholder partnerships?
Introduction
This chapter outlines how partnering with stakeholders is important for quality health service management and healthcare delivery, and highlights common patterns that drive partnership-based public policy. It also provides an introduction to concepts associated with partnering in health services, defining key terms and discussing the managerial skills or competencies required to engage with stakeholders and implement partnership-based policy. The interests of key stakeholders within the health sector are identified and discussed, and important steps are outlined for a manager undertaking a stakeholder analysis. Finally, the chapter explores the factors essential to successful partnerships and the competencies managers need to successfully develop and maintain stakeholder partnerships.
Definitions
The roots of contemporary whole-of-government and partnership-based public policies are evident in economic development theory dating back 25 years or more (Brownie, 2007). During the 1990s, a number of leading economic development theorists wrote of networked and associational approaches as being essential for local development and economic success (Cooke & Morgan, 1998; Morgan, 1997; Morgan & Nauwelaers, 1999). In 2001, the Organisation for Economic Co-operation and Development (2001) noted that governments across most of its member countries worked in partnerships involving the public, provider and not-for-profit sectors, plus partners from the wider community.
understand the key concepts associated with workplace cultures?
identify the impacts of positive and negative workplace cultures on the functioning of an organisation, particularly in the area of patient safety and quality?
identify different types of workplace cultures?
understand the impact a health manager or leader can make on the culture of an organisation or department?
build positive workplace cultures?
Introduction
Understanding, managing and building culture within a workplace are key responsibilities of leadership and management. This chapter outlines what workplace culture is, the impact of poor culture on an organisation and what managers can do to improve workplace culture.
Peter Drucker (as cited in Fernández-Aráoz, 2014 , para. 2) once famously said, ‘Culture eats strategy over breakfast’. This might seem implausible, because there is an expectation on healthcare managers to plan, set out, implement and then evaluate strategy. Drucker’s point is that unless there is a positive culture in a workplace, seeing a strategy move to successful implementation and adoption is very difficult, sometimes impossible.
Definitions
Workplace culture (also called organisational or corporate culture) has been well defined in the literature. Culture has often been described as the particular beliefs or values of an organisation that distinguish it from other similar organisations.
ensure my organisation has the key components of clinical governance?
make the connection between corporate governance and clinical governance?
explain responsive regulation?
develop skills to lead clinical governance in my organisation?
Introduction
The past two decades have seen the rise of clinical governance, firstly as a concept and ultimately as a system. Increased knowledge of the scope of iatrogenic harm to consumers coupled with public inquiries into poor care around the world has driven the development of governance of clinical care as a component of corporate governance. Despite this growing awareness and activity, various studies suggest we still do not have the processes in place for consistently safe, high-quality care for consumers. Compared with other high-risk industries, healthcare appears to have a high tolerance for ambiguity in processes, outcomes and roles (Spear & Schmidhofer, 2005). Accreditation, although now more focused on the quality of clinical care, is still seen as an administrative burden by many, with most health services subject to a rolling schedule of requirements and visits from a range of accreditation providers. It appears that the adverse event rate for overnight stay patients in public and private hospitals has plateaued at around 10 per cent (Australian Institute of Health and Welfare, 2013). These are not easy issues for governing bodies and executives to address within a funding environment focused more on efficiency than quality and safety (Balding, 2008).
understand when and why health service planning is required and initiated?
identify important stakeholders and consider how they may be engaged in health service planning?
develop critical thinking regarding the implications of various approaches and instruments used in health service planning?
improve my skills in effective health service planning?
Introduction
Matching available health resources to consumer needs is challenging. Governments and health bureaucracies with finite resources face increasing demands from their client populations, which often have complex health issues. No country has sufficient resources to meet every single health need of every citizen. Consequently, health service planning is important to maximise population health outcomes and ensure value for the available money.
Due to the inherent contradictions existing between the high demand for and the limited responsive supply capacity by health services, health service planning is often characterised by negotiation, lobbying and compromise among various interest groups. A consensus can best be achieved if stakeholders agree upon a set of core values and all involved in the process endorse principles and the procedures of planning.
Definitions
Health service planning may stem from the perspective of consumers (populationbased) or from the perspective of providers (institutional-based) (Eagar, Garrett & Lin, 2001). The ultimate choice between these two options often depends on who is responsible for performing the planning and the rationale.
ensure a plan for self-management that helps my integration into the workforce and facilitates lifelong learning?
motivate myself to strive for continual improvement through self-management?
set personal and professional goals for self-management?
plan to improve areas of intelligence that I have identified as not being as strong as needed?
find and work with a mentor?
Introduction
Nurses and allied health personnel are held in high esteem by the general public, a fact confirmed consistently by rankings of trust and reliability in both the United States (Swift, 2013) and Australia (Roy Morgan Research, 2014). People may approach student health workers for advice because of this inherent trust and recognition of their status. Throughout their careers health professionals help people manage their own health, and they can be more effective if they understand how to manage themselves. People have varying abilities, talents, life experiences, upbringings and opportunities that shape their lives. While self-management is a foundational philosophy of lifelong learning, it comes more naturally to some than to others.
Some of the literature discusses self-management from a management perspective (Markham & Markham, 1995 ); and theorists come from a variety of backgrounds, including organisational development, psychology and sociology. An added complexity is the interchangeability of some of the terms found in the literature (self-management, self-leadership, self-control, self-effi cacy, self-regulation and so on), so for the sake of clarity for this chapter, the terminology is restricted to facilitate understanding, acknowledging that others may have contradictory perspectives.
work with others in my organisation to develop an effective vision for the future?
increase my ability to identify and explore creative solutions to organisational issues?
foster creativity among the people I work with?
assist my organisation to become a learning organisation?
Introduction
The healthcare sector is continually confronted with the issue of how to manage with less. In response, health leaders and managers must explore and use new ways to face such challenges. Such issues ultimately affect the quality and safety, and the productivity and efficiency of the health services delivered. Within each organisation, the effectiveness of the leadership and culture impact squarely on the quality of patient care delivered. In order to effectively address such challenges, leaders have started to adopt new strategies and roles focusing on visioning and creativity.
Definitions
Creativity, or creative capital, is by far an organisation’s most important asset. It results from an effectively led and managed unit of creative thinkers and planners whose ideas can be transformed into valuable services and products (Florida & Goodnight, 2005). It is important to identify those factors which influence creativity within the organisation; Andriopolous (2001) identifies these as: organisational climate; leadership style; organisational culture, resources and skills; organisational structure; and organisational systems.
consider the importance and role of values in healthcare leadership?
ensure an organisational culture that is based on appropriate values?
develop my skills in values-based leadership strategies in my organisation?
Introduction
As Mahatma Gandhi once said, ‘Your beliefs become your thoughts, your thoughts become your words, your words become your actions, your actions become your habits, your habits become your values, your values become your destiny’. Values permeate every aspect of our lives, shaping individual actions and giving meaning, direction and scope to our work environments and organisational cultures. Defining positive behaviours and identifying unprofessional, disrespectful or negative behaviours, values permeate and define every aspect of our work and personal lives. Values also have an emotional component: when we act in accordance with our values, we experience positive emotions; conversely, when we act against our values or are placed in situations that compromise our values, we experience negative emotions. It is this emotional component that drives us to seek values alignment in our personal and professional lives.
In healthcare, values-based leadership is particularly important. Patients seek our care often at the most vulnerable time in their lives. In their vulnerability, they must trust us to provide competent and compassionate care.
use assets, liabilities, equity, revenues and expenses in the financial management of a service, department or organisation?
develop an appropriate budget and cashflow?
enhance my organisation’s financial position through a casemix classification and funding system?
use variance analysis to improve the performance of my service, department or organisation?
Introduction
The financial management of healthcare organisations is a key management responsibility for both public and private facilities. While this responsibility has always been important, it is becoming increasingly more so, with the rising costs of healthcare provision due to advances in technology, chronic disease and ageing populations. The responsible use and management of scarce healthcare resources requires knowledge and information. The accounting process provides the necessary information to develop and monitor a budget. However, it is the financial management of the budget and associated activity levels that provide the necessary framework to ensure budget integrity and financial governance.
Financial accounting is mainly concerned with the transactions of accounting, with the systematic recording of the fi nancial events of the organisation. The main accounting groups are listed below:
Assets are items of value owned or controlled by an organisation, such as cash, inventories or land.
Liabilities are amounts owed by an organisation to external parties, such as loans or wages owing.
Equity is the funds invested in the organisation by its owner, either as capital investment or as retained earnings.
Revenues (or income) are the flows of resources into an organisation from government, grants, sales or services performed.
Expenses are outflows of resources from the organisation to purchase goods or services, or carry out its general operations.
apply the principles of quality improvement in a healthcare setting?
describe the key differences between a traditional hierarchical management approach and the quality improvement approach?
use the eight main characteristics of the quality improvement approach to facilitate change in my organisation?
ensure I structure my quality improvement change processes to engage the clinicians?
determine the data needed to embark on a quality improvement process?
Introduction
Quality improvement has a specific history and tradition, a particular approach and a repertoire of techniques that have been repeatedly shown to be effective in delivering sustainable improvements in healthcare delivery (Chassin & O’Kane, 2010; Kurth, 2013; Shewhart, 1980; Warrier & McGillen, 2011). Along with a description of each of these characteristics, this chapter provides readers with a series of techniques associated with them, establishing a quality improvement framework within which problems can be best addressed.
Definitions
Despite the fact that it is in widespread use, there is no definitive account of what constitutes quality improvement. The language of quality improvement, however, is used widely in healthcare settings around the world. Many people use the term as a vague generalisation for ‘trying to make things better’, but this chapter argues that it is a specific term of art and science.
apply project management in health and community services?
recognise the fundamentals and important concepts in project management?
appreciate project-planning life cycles and major characteristics of projects?
improve my skills in project management?
measure project success?
Introduction
In the face of rapid change as a response to increasing health needs and financial constraints, healthcare systems and organisations are pressured to adopt innovative and effective tools to manage service delivery. Since its inception in the architectural, engineering and building sectors in the early 1900s, project management has become a systematic management tool with techniques to bring people and resources together for a single purpose (Cleland & Gareis, 2006). Its popularity in health and community services has significantly increased in the last decade. Project management has been widely used as an effective management tool to implement change, trialling new service models, developing new programs and technologies, and improving organisational structure and care processes (Dwyer, Liang, Thiessen & Martini, 2013). The inclusion of project management as one of the core competencies for health service managers, public health practitioners and those who may need to be involved in health-related projects in some way further proves its importance in health and community service provision. This chapter assists readers to develop understanding of projects and project management, how projects should be planned and implemented, ways of ensuring and measuring project success and, more importantly, how to use project management as a tool to achieve intended outcomes and generate new knowledge for future learning.