Enhancing Leadership and Enhancing Leadership and Coalitions for Change Coalitions for Change Mitchell Clarke Mitchell Clarke RN, RMN, BSc, MA RN, RMN, BSc, MA Chief Nurse Officer Chief Nurse Officer Ministry of Health, Barbados Ministry of Health, Barbados Dori Taylor Sullivan Dori Taylor Sullivan PhD, NE PhD, NE - - BC, CNL, CPHQ BC, CNL, CPHQ Associate Dean for Academic Affairs Associate Dean for Academic Affairs Duke University School of Nursing Duke University School of Nursing
Transcript
Enhancing Leadership and Enhancing Leadership and Coalitions for ChangeCoalitions for Change
Ministry of Health, BarbadosMinistry of Health, Barbados
Dori Taylor Sullivan Dori Taylor Sullivan PhD, NEPhD, NE--BC, CNL, CPHQBC, CNL, CPHQAssociate Dean for Academic AffairsAssociate Dean for Academic AffairsDuke University School of NursingDuke University School of Nursing
Session ObjectivesSession Objectives
•• Identify components of nursing leadership to facilitate Identify components of nursing leadership to facilitate change, including coalitionschange, including coalitions
•• Explore strategies to enhance and build nursing Explore strategies to enhance and build nursing leadership in the Caribbean to address nonleadership in the Caribbean to address non--communicable diseases and the elderlycommunicable diseases and the elderly
•• Explore factors that facilitate or impede development of Explore factors that facilitate or impede development of nursing leadershipnursing leadership
•• Discuss principles of effective leadership in designing an Discuss principles of effective leadership in designing an evidenceevidence--based model/programs for prevention of based model/programs for prevention of cardiovascular and other chronic disease in the elderly ~ cardiovascular and other chronic disease in the elderly ~ and advocating for its adoption in policy and and advocating for its adoption in policy and implementationimplementation
INTRODUCTIONINTRODUCTION
•• The role of the leader in any The role of the leader in any organization, be it a hospital, an organization, be it a hospital, an insurance Company or a insurance Company or a supermarket, has changed by supermarket, has changed by leaps and bounds in the past few leaps and bounds in the past few years.years.
•• There are many changes and There are many changes and challenges that you are meeting challenges that you are meeting now that your predecessors did now that your predecessors did not experience. At the same time not experience. At the same time your staff is looking for effective your staff is looking for effective leadership.leadership.
•• What is leadership and what is What is leadership and what is change?change?
•• As you know there are many As you know there are many definitions for leadership.definitions for leadership.
LEADERSHIP AND CHANGELEADERSHIP AND CHANGE
•• Competencies, skills, knowledge, Competencies, skills, knowledge, experience and processes needed to experience and processes needed to positively influence, enable and empower positively influence, enable and empower followers to do extraordinary things in all followers to do extraordinary things in all circumstances and to perform at their circumstances and to perform at their personal and professional optimum to personal and professional optimum to benefit themselves, the group and the benefit themselves, the group and the organization; and I include the organization; and I include the Community.Community.
““Organization, Development and ChangeOrganization, Development and Change””(Waddell, Cummins & Warley, 2003)(Waddell, Cummins & Warley, 2003)
•• Management is doing things right while Management is doing things right while leadership is doing the right things. leadership is doing the right things.
•• Management is efficiency in climbing Management is efficiency in climbing the success ladder and leadership is the success ladder and leadership is ensuring that the success ladder is ensuring that the success ladder is placed against the correct wall.placed against the correct wall.
LEADERSHIP & MANAGEMENTLEADERSHIP & MANAGEMENT
•• Organizational Change is typically Organizational Change is typically conceptualized as moving from the conceptualized as moving from the status quo to a new, desired, status quo to a new, desired, configuration to better match the configuration to better match the environment. environment.
•• Change could be seen as a departure Change could be seen as a departure from the norm, or alternatively as from the norm, or alternatively as normal and simply a natural response normal and simply a natural response to environmental and internal to environmental and internal conditions.conditions.
•• Provide effective and applicable Provide effective and applicable leadership before, during and after leadership before, during and after change.change.
•• Knowledge, skills, strategies and Knowledge, skills, strategies and experience are essentialexperience are essential
•• Connect with your followers on an Connect with your followers on an emotional levelemotional level
•• Acting as a stabilizing factor to keep Acting as a stabilizing factor to keep your organizations and followers well your organizations and followers well focusedfocused
•• Be cognizant that change touches your Be cognizant that change touches your staff/followers on a variety of levels staff/followers on a variety of levels e.g. emotional, personal, spiritual and e.g. emotional, personal, spiritual and financial. financial.
FACTORS THAT MAY INFLUENCE A FACTORS THAT MAY INFLUENCE A PERSONPERSON’’S REACTION TO CHANGES REACTION TO CHANGE
•• Be resilient and work with change Be resilient and work with change rather than against itrather than against it
•• Receptive to new ideas and ways of Receptive to new ideas and ways of doing thingsdoing things
LEADERS CAN FACILITATE CHANGELEADERS CAN FACILITATE CHANGE
•• Think creatively Think creatively
•• Resist falling back to the old, Resist falling back to the old, traditional ways of doing thingstraditional ways of doing things
•• You must not be overwhelmed by You must not be overwhelmed by pressure which adds to the pressure pressure which adds to the pressure of changeof change
•• Balance your daily life and business, as Balance your daily life and business, as a result to >a result to >
•• Focus on the job and change at handFocus on the job and change at hand
•• Be more open, flexible and empathetic Be more open, flexible and empathetic to staffto staff
•• Leaders must be able to regard Leaders must be able to regard setbacks as challenges rather than setbacks as challenges rather than problemsproblems
•• Flexibility in the area of problem Flexibility in the area of problem solvingsolving
•• Consider different approaches and Consider different approaches and scenarios before making decisionsscenarios before making decisions
•• Communication must be honest, Communication must be honest, open, direct, comprehensive, and open, direct, comprehensive, and factualfactual
•• Participation and involvementParticipation and involvement•• Facilitation, guidance and supportFacilitation, guidance and support•• Negotiation and coNegotiation and co--operationoperation
STRATEGIESSTRATEGIES
•• Effective planningEffective planning•• Understanding (process and people)Understanding (process and people)•• Rewards for effective changeRewards for effective change•• Education and empowermentEducation and empowerment•• Utilization of positive peopleUtilization of positive people•• Role modelingRole modeling•• Provision of resources for changeProvision of resources for change
•• CeremoniesCeremonies
•• In summary your role as a leader is In summary your role as a leader is critical to the facilitation of change in critical to the facilitation of change in organizations and communities. organizations and communities. Outcomes will be dependent on your Outcomes will be dependent on your leadership and what strategies you leadership and what strategies you adopt.adopt.
A Primer on CoalitionsA Primer on Coalitions
•• ““A temporary alliance of distinct parties, persons A temporary alliance of distinct parties, persons or states [organizations] for joint actionor states [organizations] for joint action””(Webster(Webster’’s Dictionary)s Dictionary)
•• ““A community coalition is a group that involves A community coalition is a group that involves multiple sectors of the community, and comes multiple sectors of the community, and comes together to address community needs and solve together to address community needs and solve community problemscommunity problems”” (Berkowitz & Wolff, (Berkowitz & Wolff, 2000)2000)
Coalitions offer:Coalitions offer:
•• Strength and power in numbers leading to a Strength and power in numbers leading to a wider reachwider reach
•• Added credibility to the health community with a Added credibility to the health community with a coordinated plan, united front, and consistent coordinated plan, united front, and consistent messagemessage
•• Public perception of tangible, broad community Public perception of tangible, broad community supportsupport
•• Media attention and public profile for Media attention and public profile for organizations which they may not otherwise organizations which they may not otherwise achieveachieve
•• Increased access to policy makersIncreased access to policy makers
•• Networking and partnership opportunitiesNetworking and partnership opportunities•• Economies of scale and costEconomies of scale and cost--efficiencyefficiency•• Division of labor and reduced duplicationDivision of labor and reduced duplication•• The exciting feeling of belonging to something The exciting feeling of belonging to something
greater than the sum of its partsgreater than the sum of its parts
•• Process vs Process vs actionaction coalitiocoalitionsns……
Disadvantages to CoalitionsDisadvantages to Coalitions
•• Conflict is inevitable due to a Conflict is inevitable due to a variety of strengths/weaknesses, variety of strengths/weaknesses, personalities, etc.personalities, etc.
•• Requires time on consensus Requires time on consensus buildingbuilding
•• Have to spend time Have to spend time ““sellingselling””advocacy coalitions to advocacy coalitions to organizations and othersorganizations and others
•• Coalition management can Coalition management can become cumbersome become cumbersome –– need a need a convenor with resources to convenor with resources to promote information sharing and promote information sharing and action planning among membersaction planning among members
Selected World Approaches to Selected World Approaches to Health PromotionHealth Promotion
•• WHO Ottowa Charter of 1986WHO Ottowa Charter of 1986–– Strengthen infrastructure for Strengthen infrastructure for
ProProLead Lead Health Promotion TrainingHealth Promotion Training•• The aim of ProThe aim of ProLead Lead is to develop a critical mass is to develop a critical mass
of of leadersleaders in health promotion, applying their in health promotion, applying their knowledge and skills, focusing on their own local knowledge and skills, focusing on their own local conditions, developing projects attuned to local conditions, developing projects attuned to local needs but with an understanding of global needs but with an understanding of global driving forces, and having the skills with which driving forces, and having the skills with which to implement these projects.to implement these projects.
ProProLead Conceptual FrameworkLead Conceptual Framework•• Health promotion CAPACITY Health promotion CAPACITY
MAPPINGMAPPING•• Health promotion Health promotion
What explains community coalition effectiveness: What explains community coalition effectiveness: a review of literature a review of literature (Zakocs & Edwards, 2006)(Zakocs & Edwards, 2006)
•• Published articles 1980Published articles 1980--2004 > 1168 > 145 complete 2004 > 1168 > 145 complete articles with 26 meeting selection criteria for coalition articles with 26 meeting selection criteria for coalition factors and effectivenessfactors and effectiveness
•• 26 studies > yielded 6 coalition building factors 26 studies > yielded 6 coalition building factors associated with effectiveness in 5 or more studiesassociated with effectiveness in 5 or more studies
•• An engaged relationship between leaders An engaged relationship between leaders and followers that enhances individual and and followers that enhances individual and system outcomessystem outcomes…… based on:based on:
•• Managing organizational trust through Managing organizational trust through intellectual intellectual stimulationstimulation of followersof followers
•• Providing a credible Providing a credible visionvision for the system and inspiring for the system and inspiring othersothers
•• Building and maintaining Building and maintaining organizational trustorganizational trust•• Having Having selfself--esteemesteem and building selfand building self--
esteem in othersesteem in others
Complexity Science and Complexity Science and Organizational ConceptsOrganizational Concepts•• World/organizations comprised of complex adaptive World/organizations comprised of complex adaptive
systems (CAS) that are nonsystems (CAS) that are non--linear and capable of selflinear and capable of self--organizationorganization
•• CASs are embedded in other CASs thus relationships and CASs are embedded in other CASs thus relationships and connectedness are criticalconnectedness are critical
•• CASs are everCASs are ever--changing and adaptable > therefore, changing and adaptable > therefore, unpredictable and uncontrollableunpredictable and uncontrollable
•• Yet from this apparent disorder patterns emerge that are Yet from this apparent disorder patterns emerge that are governed by simple rulesgoverned by simple rules
Comparing Comparing Traditional vs Traditional vs Contemporary Contemporary View of View of OrganizationsOrganizations
Information Information Downward, Downward, formal upward formal upward info plansinfo plans
Open, loose, Open, loose, diversediverse
Role of LeaderRole of Leader Decision MakerDecision Maker Sense MakerSense Maker
StructureStructure HierarchicalHierarchical Semiautonomous Semiautonomous work groupswork groups
Adapted from Barker, Adapted from Barker, Sullivan & Emery, 2006Sullivan & Emery, 2006
The most The most effective leaders effective leaders combine combine traditional and traditional and contemporary contemporary organizational organizational perspectives and perspectives and strategies to strategies to achieve the achieve the vision for their vision for their organizationsorganizations……
•• Foster inclusive process to Foster inclusive process to develop a develop a ““good enoughgood enough””visionvision
•• Use language that creates Use language that creates excitement and purpose:excitement and purpose:
•• Provide comprehensive Provide comprehensive healthcare to elderly with healthcare to elderly with cardiovascular disease cardiovascular disease vsvsUse latest research to create Use latest research to create a network of services that a network of services that enhance health and wellenhance health and well--being of elders with being of elders with cardiovascular disease cardiovascular disease
•• Consider communications within and outside of Consider communications within and outside of groupgroup
•• Use marketing techniques like focus groups to Use marketing techniques like focus groups to test the test the ““message receivedmessage received””
•• Incorporate multiIncorporate multi--modal communication modal communication techniques in all messages (see next slide)techniques in all messages (see next slide)
MultiMulti--Modal CommunicationsModal Communications•• Communication Preferences Communication Preferences (Relationship Styles Grid, Murphy, (Relationship Styles Grid, Murphy,
1996, p.66)1996, p.66)–– Rational relators: analytical, factual, technicalRational relators: analytical, factual, technical–– Functional relators Functional relators –– planners, organizers, controlledplanners, organizers, controlled–– Intuitive relators Intuitive relators –– conceptual, visionary, creativeconceptual, visionary, creative–– Personal Personal –– sensitive, subjective, verbalsensitive, subjective, verbalRecommend including elements of all styles in messages Recommend including elements of all styles in messages
•• Communication Methods/ToneCommunication Methods/Tone–– Print, electronic, videoPrint, electronic, video–– In person: individual, small group, large groupIn person: individual, small group, large group–– Formal/informal ~ Scripted/spontaneousFormal/informal ~ Scripted/spontaneous–– And many other dimensionsAnd many other dimensions……
Group/Team Group/Team Activities and ProceduresActivities and Procedures
•• Groups vs TeamsGroups vs Teams•• Explicit articulation of how Explicit articulation of how
team will operate > ground team will operate > ground rules reflecting shared rules reflecting shared values, communication, values, communication, decision making, action decision making, action steps, evaluationsteps, evaluation
•• Teambuilding activities that Teambuilding activities that also create progress toward also create progress toward the vision or goalthe vision or goal
Policy Change LeversPolicy Change Levers•• Achieve some good Achieve some good ––
believe right thing to dobelieve right thing to do•• Save money or better Save money or better
results with same dollarsresults with same dollars•• Trade for support of Trade for support of
influence in futureinfluence in future•• Respond to pressure Respond to pressure
considering strength of considering strength of those in favor vs opposingthose in favor vs opposing
Change StrategiesChange Strategies•• Head Head –– intellectual, dataintellectual, data•• Heart Heart –– values, beliefsvalues, beliefs•• Hands Hands –– strength, leversstrength, levers•• Combination based on Combination based on
stakeholder analysisstakeholder analysis•• Consider variety of Consider variety of
communication communication strategies to match strategies to match stakeholder preferencesstakeholder preferences
Stakeholders and CommunicationsStakeholders and Communications
•• Identify various groups and anticipate Identify various groups and anticipate their position and prioritiestheir position and priorities
•• Develop plans to address their needs and Develop plans to address their needs and concerns if important stakeholdersconcerns if important stakeholders
•• Design communication and relationship Design communication and relationship building activities to promote supportbuilding activities to promote support
•• If in agreement, discuss what actions the If in agreement, discuss what actions the group could enact to move the agendagroup could enact to move the agenda
Change StrategiesChange StrategiesTraditional & ContemporaryTraditional & Contemporary•• Develop a change plan that Develop a change plan that
includes structure for who, includes structure for who, when, where, what, why when, where, what, why and howand how
•• Focus on connecting and Focus on connecting and building relationships building relationships among many elements among many elements
•• Consider several small Consider several small actions to move in desired actions to move in desired directions and evaluatedirections and evaluate
Being a LEADER of LeadersBeing a LEADER of Leaders
•• Considering transformational leadership Considering transformational leadership and complexity concepts, how might and complexity concepts, how might leader behaviors need to change to be leader behaviors need to change to be most effective when leading leaders???most effective when leading leaders???
Cultural Context for Cultural Context for Leadership BehaviorsLeadership Behaviors
•• Which leader behaviors will Which leader behaviors will be most effective in this be most effective in this situation/context?situation/context?
•• Do not make the mistake of Do not make the mistake of assuming that evidence/ assuming that evidence/ data alone will win the daydata alone will win the day
•• Consider preservation of Consider preservation of long term relationships long term relationships while moving toward goalswhile moving toward goals
In SummaryIn Summary……•• There is substantial agreement about There is substantial agreement about
leadership skills required for health leadership skills required for health promotion change coalitions ~ attention to promotion change coalitions ~ attention to assessing and enhancing these skills assessing and enhancing these skills critical for success!critical for success!
•• An evidenceAn evidence--based approach to policy based approach to policy change is powerful but not alone sufficient change is powerful but not alone sufficient to assure support and implementation.to assure support and implementation.
Reference ListReference List
•• Barker A, Sullivan DT & Emery M. (2006). Barker A, Sullivan DT & Emery M. (2006). Leadership Competencies for Clinical Leadership Competencies for Clinical Managers: The Renaissance of Transformational Leadership.Managers: The Renaissance of Transformational Leadership. Sudbury, MA, Jones & Sudbury, MA, Jones & BartlettBartlett
•• Barrett L, Plotnikoff R, Raine K & Anderson D. (2005). DevelopBarrett L, Plotnikoff R, Raine K & Anderson D. (2005). Development of measures of ment of measures of organizational leadership for health promotion. organizational leadership for health promotion. Health Education and BehaviorHealth Education and Behavior, , 32(2), 19532(2), 195--207207
•• Forsythe J. (1997). Forsythe J. (1997). A Guide to Coalition BuildingA Guide to Coalition Building. Retrieved 8/31/08 from . Retrieved 8/31/08 from http://www.cypresscon.com/coalition.htmlhttp://www.cypresscon.com/coalition.html
•• Murphy E. (1996). Murphy E. (1996). Leadership IQLeadership IQ. New York, John Wiley & Sons. New York, John Wiley & Sons•• Nelson L. (2003). A case study in organisational change: implicNelson L. (2003). A case study in organisational change: implications for theory. ations for theory.
The Learning Organisation, 10 (1), 18The Learning Organisation, 10 (1), 18--3030•• ProProLead Health Promotion Leadership Training. Lead Health Promotion Leadership Training. Retrieved 8/31/08 from Retrieved 8/31/08 from
http://www.prolead.orghttp://www.prolead.org•• Healthy Urbanization: Guidelines for ActionHealthy Urbanization: Guidelines for Action. WHO Centre for Health Development. . WHO Centre for Health Development.
Retrieved 8/31/08 from Retrieved 8/31/08 from http://www.who.or.jp/http://www.who.or.jp/•• Spangler B. (2003). Spangler B. (2003). Coalition BuildingCoalition Building. Retrieved from . Retrieved from
ThompsonThompson•• Wolff T. (2001). Community coalition buildingWolff T. (2001). Community coalition building--contemporary practice and research: contemporary practice and research:
Introduction. Introduction. American Journal of Community PsychologyAmerican Journal of Community Psychology, 29(2), 165, 29(2), 165--172172•• Zakocs RC & Edwards EM. (2006). What explains community Zakocs RC & Edwards EM. (2006). What explains community
coalition effect? coalition effect? American Journal of Preventive Medicine,American Journal of Preventive Medicine,30(4), 35130(4), 351--6161
Questions to Guide Further Questions to Guide Further Discussions on LeadershipDiscussions on Leadership1.1. What do we know about change What do we know about change –– in in
general and when considering health general and when considering health policy makers and regulators?policy makers and regulators?
2.2. What leader behaviors are most effective What leader behaviors are most effective when trying to lead a group of leaders?when trying to lead a group of leaders?
3.3. Why are stakeholder analyses and comWhy are stakeholder analyses and com--munication plans essential for success?munication plans essential for success?
