Between principle and compromise: We are all meat in someone else's sandwich

Clinical leadership and workforce management are high profile topics in many recent healthcare journals and frequently the focus of discussion in this sectors dynamic environment. Emergency physicians, like their cousins in other medical specialties, are required to work collaboratively within an increasingly complex system in order to optimise the clinical outcomes of their patients. This article presents a reflective analysis using a fictional character, Ulysses, who encounters traps and potholes in his journey to clinical leadership and management enlightenment.     

Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies

Aim To illuminate ways that avoidant leadership can be enacted in contemporary clinical settings. Background Avoidance is identified in relation to laissez-faire leadership and passive avoidant leadership. However, the nature and characteristics of avoidance and how it can be enacted in a clinical environment are not detailed. Methods This paper applied secondary analysis to data from two qualitative studies. Results We have identified three forms of avoidant leader response: placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant. Conclusions Through secondary analysis of two existing sets of data, we have shed new light on avoidant leaderships and how it can be enacted in contemporary clinical settings. Further work needs to be undertaken to better understand this leadership style. Implications for nursing management We recommend that organizations ensure that all nurse leaders are aware of how best to respond to concerns of wrongdoing and that mechanisms are created to ensure timely feedback is provided about the actions taken.     

Time for change in community nursing? A critique of the implementation of the Review of Nursing in the Community across NHS Scotland

Aim Current literature underpinning change is examined and a critique offered of the implementation of the role of the generic Community Health Nurse in Scotland, from a leadership and cultural perspective. Background In November 2006, Government strategy outlined a new service model for community nursing to be implemented in four demonstration sites across Scotland. Almost two-thirds of community nurses were not supportive of the model. There was belief this generic role would not meet the health needs of patients and carers. Evaluation Evidence supporting the model is presented and the implementation process evaluated from leadership and cultural perspectives. The literature is examined to offer explanations as to why implementation was unsuccessful. Conclusions Transformational and transactional leadership at all levels of the organization are required to make change happen. Evidence supporting change provides an impetus for change. The culture of an organization should be recognized and harnessed during the change process. Effective facilitation will empower staff to make change happen. Implications for Nursing Management Engagement with staff is vital, at the beginning of the change process. The concept of ‘nearby’ leadership offers an enabling style of leadership at an individual and group level which will enable effective change.     

The importance of leadership style and psychosocial work environment to staff‐assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross‐sectional survey design was used and a total of 469 questionnaires were distributed (March–April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.