Question

Reflecting on readings from this week discuss (2) healthcare trends and their impact on quality of care and nursing leadership? How have these trends impacted your current clinical practice?

Answer 1

Nowadays, both evidence-based medicine and nursing are widely recognized as the tools for establishing effective healthcare organizations of high productivity and quality of care. Management and leadership of healthcare professionals is critical for strengthening quality and integration of care. Leadership has been defined as the relationship between the individual/s who lead and those who take the choice to follow, while it refers to the behaviour of directing and coordinating the activities of a team or group of people towards a common goal [1,2]. There are many identified styles of leadership, while six types appear to be more common: transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership. Transformational leadership style is characterized by creating relationships and motivation among staff members. Transformational leaders typically have the ability to inspire confidence, staff respect and they communicate loyalty through a shared vision, resulting in increased productivity, strengthen employee morale, and job satisfaction [3,4]. In transactional leadership the leader acts as a manager of change, making exchanges with employees that lead to an improvement in production [3]. An autocratic leadership style is considered ideal in emergencies situation as the leader makes all decisions without taking into account the opinion of staff. Moreover, mistakes are not tolerated within the blame put on individuals. In contrary, the laissez-faire leadership style involves a leader who does not make decisions, staff acts without direction or supervision but there is a hands-off approach resulting in rare changes [4]. Task-oriented leadership style involves planning of work activities, clarification of roles within a team or a group of people, objectives set as well as the continuing monitoring and performance of processes. Lastly, relationship-oriented leadership style incorporates support, development and recognition [5].

Quality of care is a vital element for achieving high productivity levels within healthcare organizations, and is defined as the degree to which the probability of achieving the expected health outcomes is increased and in line with updated professional knowledge and skills within health services [6]. The Institute of Medicine OM has described six characteristics of high-quality care that must be: (1) safe, (2) effective, (3) reliable, (4) patient-centred, (5) efficient, and (6) equitable. Measuring health outcomes is a core component of assessing quality of care. Quality measures are: structure, process, outcome, and patient satisfaction [6]. According to the National Quality Measures Clearing House (USA), a clinical outcome refers to the health state of a patient resulting from healthcare. Measures on patient outcomes and satisfaction constitute: shorter patient length of stay, hospital mortality level, health care-associated infections, failure to rescue ratio, restraint use, medication errors, inadequate pain management, pressure ulcers rate, patient fall rate, falls with injury, medical errors, and urinary tract infections [7].

There are numerous publications recognizing leadership style as a key element for quality of healthcare. Effective leadership is among the most critical components that lead an organization to effective and successful outcomes. Significant positive associations between effective styles of leadership and high levels of patient satisfaction and reduction of adverse effects have been reported [8]. Furthermore, several studies have stressed the importance of leadership style for quality of healthcare provision in nursing homes [9]. Transformational leadership is strongly related to the implementation of effective management that establishes a culture of patient safety [10]. In addition, the literature stresses that empowering leadership is related to patient outcomes by promoting greater nursing expertise through increased staff stability, and reduced turnout [11]. Effective leadership has an indirect impact on reducing mortality rates, by inspiring, retaining and supporting experienced staff. Although there are many published studies that indicate the importance of leadership, few of these studies have attempted to correlate a certain leadership style with patient outcomes and healthcare quality indicators.

Therefore, the aim of this review was to identify the association between leadership styles with healthcare quality measures.

2. Materials and Methods

This systematic review was designed and conducted in line with the published guidelines for reporting systematic reviews and meta-analyses [12]. Systematic review of the existing literature on leadership style and quality of healthcare provision was performed. The main review question was: “Which is the relationship between styles of leadership in healthcare settings and quality of care?” A systematic, comprehensive bibliographic search was carried out in the National Library of Medicine (Medline) and EMBASE databases for the time period between 2004–2015 in the PubMed interface. Search terms used were chosen from the USNML Institutes of Health list of Medical Subject Headings (MeSH) for 2015. The included MeSH terms were: “Nurse Administrators”; “Nurse Executives”; “Physician Executives”; “Leaders”; “Leadership”; “Managers”; “Management style”; “Leadership style”; “Organizational style”; “Organizational culture/climate”; “Leadership Effectiveness”; “Quality of healthcare”; “Patient outcome Assessment”; “Quality indicators, Healthcare”; “Healthcare quality, Access and Evaluation”; and “Quality Assurance, Healthcare”. References used by each identified study were also checked and included in the study according to the eligibility criteria.

Five major inclusion criteria were adopted:

Papers published in peer-reviewed journal

Papers written in the English language

Papers published from 2004 to 2015 (focus on more recent knowledge)

Human epidemiological studies

Studies used a quantitative methodology reporting the leadership style and healthcare quality measures

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