One of the most underrated ingredients to delivering significant performance improvement is the power of transformational leadership. Most hospitals today are under tremendous financial pressure. Dramatic improvements demand more than incremental change, yet most of us are incremental leaders. We know how to deliver small, step-wise gains, but the competitive and regulatory environment is demanding breakthrough gains.
Key ingredients for delivering more-than-incremental performance improvement are breakthrough thinking coupled with a culture of enthusiasm for radical change. To create these missing conditions, you need transformational leadership. But contrary to popular belief, many of the key attributes of transformational leadership can be learned through appropriate leadership initiatives.
ByVal Gokenbach, Administrative Director, Chief Nurse Executive, William Beaumont Hospital, Royal Oak, MI
The emergency department under discussion is a high-volume, Level 1-trauma center known for high turnover (58%) and poor staff and patient satisfaction scores. The leadership team decided to embark on a comprehensive journey to analyze root causes and define strategies to improve the work environment and quality of nursing care. A leadership assessment was undertaken as a first step, and identified a number of critical deficiencies:
Of the four, the first three were fundamental issues that would need to be addressed before much progress could be made. The fourth was in some ways an effect, which could be at least partially addressed by tackling the first three.
As a result of the assessment, a decision was made to initiate a leadership development program as the next step of the journey. This program was specifically designed to address the identified deficiencies.
The metaphor selected for the leadership team was Team of Eagles. The eagle was chosen for the image of strength, empowerment, leadership, and the ability to rise above and embrace challenge. The leadership team, through brainstorming and nominal group process, crafted a comprehensive list of core values and behaviors that supported those values. Following this, all team members signed a contract for commitment to the identified behaviors. This activity provided a foundation of joint understanding and commitment to the program.
An educational component was then designed to address the wide variability in leadership knowledge and experience. This consisted of a mandatory two-day seminar with a curriculum including leadership theory, team building, emotional intelligence, conflict management, generational diversity, communication, and several other areas. Particular attention was also paid to critical concepts of transformational leadership that would offer insight and suggest strategies to engage and empower both the leaders and staff. Instructional techniques included group sessions, brainstorming, personal assessments, and practice exercises.
Following this education phase, weekly leadership team meetings were conducted to develop on-going goals and objectives, assess the success of the program and maintain the vision of the team.
Response to the program was extremely positive. Discussion with staff demonstrated a general feeling that members of the leadership team were more supportive and interactive, provided increased feedback, and truly began to care about the staff. Problem solving became more proactive as evidenced by goal setting and anticipation of problems, while communication between all disciplines was reported as improved. Staff meetings became constructive and solution oriented rather than complaint sessions, and the general morale of the leadership team improved significantly.
Following this success in the leadership team, it was decided to include all staff charge nurses in the Team of Eagles program and to provide them the same educational opportunities and follow up. As a result, staff members reported increased consistency of practice among charge nurses and perception of improved support and fairness. Increased standardization clearly contributed to improved stability and consistency of processes, and staff and leaders began to work together to identify issues and actually improve processes.
Today the same department enjoys no staff vacancies and a waiting list of nurses interested in becoming staff members of the Team of Eagles. Turnover rates have dropped from 58% to 15% annually, and patient and staff satisfaction scores have improved dramatically. The Team of Eagles program has now begun to extend into other hospital departments with the same degree of success.
The Team of Eagles initiative by itself cannot claim all the credit for these improvements. Many subsequent changes, in areas from mentoring to scheduling, also had an impact. The Team of Eagles initiative, however, clearly provided the foundation of transformational leadership that was both a prerequisite for and driver of success in all the subsequent initiatives.