“Leaders are people who are able to express themselves foulmouthed know who they are, what their strengths and weaknesses are, and how to fully deploy their strengths and compensate for their weaknesses. They also know what they want, why they want it, and how to communicate what they want to others in order to gain their cooperation and support. Finally they know how to achieve their goals” (Ingram, 2004). Leadership is a difficult task, by which a person impacts others to accomplish an objective.
While this is a challenging situation in any field, it is of extreme significance in the healthcare setting, here quality of service, trust, and ultimately people’s lives are dependent. In addition, leadership– whether it be positive or negative– will have a direct implication on staff interactions, continuous quality improvement, and risk management. Thus the ability to establish oneself as an effective leader involves a process of successfully employing characteristics such as communication, trust, guiding vision, knowledge, equity, and ethics.
The first characteristic a leader should apply is communication. Communication is the transmission of information and views from one person to another. The ability to communicate vision ranks among the key tasks of a leader, and all organizations depend on the existence of shared meaning and interpretations of reality to facilitate coordinated action (Leadership Advisory Commission, 2003). The act of communication begins with a thought within the intellect of the transmitter.
This idea is then conveyed to a recipient through actions or statements. The recipient then interprets these actions and statements into an abstract idea. Listening is the key to communication and the information is useless if it is not expressed in the right manner, making the ability to communicate a Lear and shared vision is an essential task of a leader. The combination of a compelling vision and effective communication skills inspires people to take action (Leadership Advisory Commission, 2003).
Trust is another component of effective leadership, and is built on consistency, dependability, and reliability. “If people are going to follow someone willingly, whether it be into battle or into the boardroom, they first want to assure themselves that the person is worthy of trust” (Leadership Advisory Commission, 2003). People may be enticed to a vision, persuaded by operating communication, but they must trust a leader o uphold their dedication to a system or a task.
Without the establishment of honesty and follow-up, it is impossible for a leader to maintain a functional level of commitment to an organization or project (Leadership Advisory Commission, 2003). Leaders must also be able to provide the members of their team with a guiding vision, a purpose for what they are doing and strength in adversity (Ingram, 2004). Their vision is a distinct view of the team’s intention and the implementation of well communicated objectives that connect to this vision.
Leaders need to express a “target that beckons”, and for an association to evolve the leader needs to think outside the box and break the mold (Leadership Advisory Commission, 2003). The leader needs to constantly have a clear view of the group’s purpose and develop mutually agreed upon and challenging goals that clearly relate to this vision (Leadership Advisory Commission, 2003). Another necessary component of leadership is knowledge, which includes acknowledgement of one’s own strengths and weaknesses.
An effective leader should be willing to take risks and recognize that errors are a chance for learning (Leadership Advisory Commission, 2003). Knowledge does not just refer to robber solving and clinical skills, but to possessing the ability to motivate oneself, accept responsibility and exhibiting emotional maturity (Leadership Advisory Commission, 2003). In the demonstration of all of these features, knowledge is constantly being attained on a personal level, and is also being relayed and encouraged to the members of the team.
In order for a leader to maintain cohesion and loyalty within an organization, they must employ the qualities of fairness and equality. Treating everyone without prejudice will decrease animosity amongst team members, and allow everyone to work at their best ability. A leader should be fair and open-minded to diversity especially in a world where individuals come from different cultural backgrounds, and have diverse religious backgrounds.
Leaders must be able accept these individuals for their positive attributes, as “diversity has proven valuable in all types of organizations in generating innovative ideas; broadening the appeal of the organization; expanding its network of donors and volunteers; and making it more open, flexible, and responsible” (Leadership Advisory Commission, 2003). Finally, leaders must maintain an ethical orientation if they re going to successfully lead their team.
Leaders are responsible for the ethical standards that govern the behavior of individuals in their organization, and they set the moral tone Recoveries & Brown, 2000). In addition, while organizations allow for a diverse range of evaluative rules and standards for people employed there, success is defined by adherence to an organization’s overriding ethic and effective leadership is inextricably tied to a concern for the nature of that ethic (Jerkewitz & Brown, 2000). Unfortunately, effective leadership in today’s healthcare setting is parallel to ineffective leadership.
Not all practitioners fit the mold of an effective leader, and although this continues to be a problem in healthcare, we as physician assistants have an obligation not only to our patients but to our colleagues as well. The impaired practitioner should not go unnoticed and it is our obligation to ensure that this doesn’t occur. Our responsibility as physician assistants is to protect patients and the public by identifying and assisting impaired colleagues who are unable to practice with reasonable skill and safety to patients.
This could include physical or mental illness, due to loss of motor skill, the aging process as well as excessive use or abuse of drugs, including alcohol (American Academy of Physician Assistants, 2000). The impaired colleague also includes one with an infectious disease, such as hepatitis, a physical disability or even inappropriate sexual behavior. In order for physician assistants or any healthcare practitioner to be able to provide quality care to their patients and to maintain a stable working environment with colleagues, one must be able to identify the “red flags” of ineffective leadership.
Some examples which are cause to be reported for reflections misconduct include practicing fraudulently, practicing with gross incompetence or gross negligence; practicing while impaired by alcohol, drugs, physical disability or mental disability; being convicted of a crime; filing a false report; guaranteeing that treatment will result in a cure; refusing to provide services because of race, creed, color or ethnicity; performing services not authorized by the patient; harassing, abusing or intimidating a patient; ordering excessive tests; and abandoning or neglecting a patient in need of immediate care (New York State Department of Health, 2002). All of these examples would have a negative effect on one’s ability to motivate and successfully gain the respect of team members, thus compromising the quality of care available to patients. Specific signs of impairment, which also contribute to ineffective leadership, include alcohol on the breath, difficulty processing information, failure to account properly for controlled substances and severe interpersonal difficulties. Other “red flags” of impairment include staggering, tardiness, tremor and unusually illegible handwriting. Being able to identify these signs is only half the battle.
Once any of these come into question, one must be able to approach the situation in a professional manner as well as know where and who to take the information to. An article in the Journal of the American Academy of Physician Assistants, included a review on the signs and events that might lead a physician assistant to suspect impairment as well as, suggestions on how one could address the problem (Paine, 1996): Joe, a PA and your partner in practice, has been repeatedly late to work at the hospital on Monday mornings. Several employees have complained to you that Joe has come to see patients with alcohol on his breath. You have observed Joey’s hands shaking, and he has been uncharacteristically curt with office staff lately. What should you do?
In order for someone to approach a situation like this, one must have the knowledge and competency to deal with it in a professional manner, as it is much easily overlooked. However, something as serious as this should never be ignored, since it not only jeopardizes the patients but the healthcare facility as well. So you must make every effort to identify the impaired colleague and assist them in obtaining help. Remember that almost all states offer intervention and retirement for impaired practitioners. You could start with an informal conversation with the impaired practitioner, who may or may not lead him/her to admit to their problem and want to seek help.
A way of going about this could be by saying, “I’m really worried about you. I’ve noticed some signs of impairment. What’s going on? ” Remember this approach may not always work and you may need to take it a step further (Paine, 1996). If that approach doesn’t work, you may need to seek higher help. This may include the chair of the physician well being committee. By addressing this omitted you are not only addressing the problem but it will be kept confidential and will include consultation and any other means of intervention necessary. It becomes an extremely urgent situation if a patient appears to be in danger because of the practitioner’s impairment.
In this type of situation, it must be addressed immediately to the chief of staff or the department chair to prevent any harm to the patient because your obligation to your patients is extremely important (Paine, 1996). Physician assistants also have an obligation to report any impaired colleagues to the state licensing board. All states have different rules and regulations regarding impairment disciplinary but for the most part they have all replaced harsh disciplinary approaches with rehabilitation provided that the patients were protected and unharmed. They must admit to the problem, participate in regular meetings, have random urine screening tests for drugs and be monitored by a local physician (Paine, 1996). If all this fails then the practitioner will be subject to a more harsh disciplinary action, including license revocation.
Being able to identify early signs of impairment in your colleagues becomes a err vital role in the physician assistant. This will prevent any harm to your patients and at the same time you will be protecting the health facility from any preventable lawsuits. This will also allow the impaired practitioner to seek for help for them before it becomes too late, but there is no denying that while one is taking the correct action, that it may still be difficult. A case described by Jim Van Rhea, MS, PA-C, involved a popular, general internist, Dry. X, who had been practicing for more then rays. He had developed a brain tumor, which required surgery to remove it.
The tumor and the surgery feet him with a number of disabilities, which included partial blindness and difficulty in writing due to weakness in his right arm. There were many incidents that led Physician Assistants to question his ability to practice medicine and provide effective supervision. These incidents included (Van Rhea, 2003): C] Dry. X was found talking to a family member as if they were the patient. O Dry. X repeatedly asked staff to read information in patient’s charts due to his poor vision. D Dry. X was unable to attend to night calls of critically ill patients due to his inability to drive. Due to this case many question came about.
These questions included whether the Pas who were providing care to his patients were practicing medicine without adequate supervision. The answer is yes, because Dry. X was felt to be incompetent because he lacked the ability to supervise the Pas at the level the Pas and state law required. Another question that was brought about was whether or not the Pa should report the incompetent physician and if they should continue to care for his patients. As practicing physician assistants we always have an obligation to protect the quality of life or our patients and to make sure no harm is done. In doing so, we have a responsibility to avoid abandonment of our patients, and to care for the patient to the best of our ability.
As far as the incompetent physician, it is our responsibility not to become intimidated or overwhelmed by the situation, thus ignoring the incompetent practitioner is not an option. It is our obligation to report any incompetence to the medical peer review committee, and to document the instances that have occurred, thereby minimizing the overall negative effects of an ineffective leader. As we have seen thus far, not all leaders are charismatic, and not everyone in supervisory role is automatically an effective leader. If effective leaders are able to manage meaning in their organization and inspiring employees, this will result in the organization reaching its goal i. E. Improved healthcare services, increased institutional reputation, and an overall positive working environment.
Conversely, ineffective leadership, along with the “red flags” described earlier also has some key characteristics described as micromanagement, dictatorial practices and ineffective delegation to team members, and day-to-day interactions that disembowel and hurt people (Pathways). This results in poor oral, an increase in staff turnover, the delivery of poor service, an increase in employee stress, poor employee/employer communications, a decrease in productivity, a lack of company trust and employee resistance to change. Nevertheless, it is by providing clear guidelines and fostering a positive and supportive work environment, that leaders are able to inspire their employees to lead and have far greater effects in today’s healthcare settings. In professional healthcare settings, leadership has a direct effect on issues such as continuous quality improvement and risk management.
Continuous quality improvement valuates the institutional infrastructure, systems, outcomes and improvement systems and is measured by an outside agency, the Joint Commission on Accreditation of Healthcare Organizations (COACH) (Labor, 2004). Thus, quality management in healthcare settings satisfies several goals of healthcare professionals who want to remain self-regulating and self-improving. It requires a sense of responsibility and focus, looking beyond immediate results, and appreciating the interrelationship between continuous quality improvement and quality management as the process of continually identifying and solving robbers, and utilizing characteristics of effective leadership to ensure that this vision is understood among team members (Labor, 2004).
Today, quality management exists in almost every type of healthcare organization and effective leaders who practice quality management emphasize cost control, teamwork, provider flexibility, interdependence, demonstrated competence, a focus on primary care, and outcomes measured by patient participation and satisfaction with care-all hallmarks of PA practice (Defecation, 1997). Within healthcare systems quality management (CM) programs have several features in common namely, CM is problem seeking. Problems are identified and prioritize by means of staff meetings, committees, patient interviews and surgeries, etc. As a clinician, you should expect a review of performance by and of the organization. As a professional participating in CM, you can develop skills in analyzing and solving organizational problems (Defecation, 1997). CM verifies and formulates problems.
Quality is evaluated by measuring the individual’s and the organization’s conformance to standards. In addition, CM resolves problems. Measurable, attainable objectives are set within specified time frames, establishing solutions o deficient performance and inadequate systems. Improvements are developed in ways that will benefit patients, clinicians, the organization, and society (Defecation, 1997). Quality management also reassesses and documents the resolution of problems. Some problems are resolved immediately, other require ongoing review, i. E. Patient satisfaction surveys, implementing and monitoring safety measures to reduce risk factors.
Reducing risk factors plays the greatest role in minimizing risk management issues in that one is actively seeking to minimize adverse patient outcomes, and maintaining a consistent and impotent method of collecting and reporting all incidences (Labor, 2004). Another strength of quality management is that it involves the greatest number of individuals possible. All members of the team must be completely oriented to their responsibilities and participate in the process of continuous quality improvement, thus success is seldom obtained when CM is the idea of an individual or a segment of the organization (Defecation, 1997). For healthcare organizations to succeed, everyone must understand that quality must be a value and a philosophy of every encounter, service, and job.
Through the ministration and continuous process of developing one’s skills as an effective leader, not only can services improve, but a trickle-down effect will take place, as staff morale increases, increasing the quality of patient care, increasing esteem within the community, and overall forming a powerful institution, that is constantly looking inward. Those leaders who are effective in the healthcare setting are those who successfully manage ongoing quality management programs will lead in a way that rallies their team members to the causes. Ineffective leadership will negatively impact on both employee and consumer attestation and will negatively influence meeting the goals of the organization.