Developing nursing management and leadership capability in the workplace: does it work?

Abstract

This special editorial was going to have as its theme, ‘Work-based learning for leadership and management development’. What we have for this last issue in 2005, however, is a more inclusive theme, ‘Developing management and leadership capability in the workplace’. Management and leadership is perceived in this editorial in relation to its key purpose which is ‘to provide direction, gain commitment, facilitate change and achieve results through the efficient, creative and responsible deployment of people and other resources’ (UK's National Occupational Standards for Management and Leadership, 2005). Capability is used after Grant (1995), Christensen and Overdorf (2000) and Jumaa and Alleyne (2002). For Grant (1995), capability is the capacity for a team of resources to perform some task or activity. Resources, Grant (1995) concludes, are the sources of an organization's (my italics) capabilities and capabilities are the main sources of its competitive advantage. For our purpose competitive advantage should be seen as performance excellence. Christensen and Overdorf (2000), on developing capabilities, suggest that three factors affect an organization's capabilities, i.e. what it can and cannot do. These factors are: its resources, its processes and its values. In addition to Grant (1995), Christensen and Overdorf (2000), and from my research and development activities at Middlesex University and within the United Kingdom's National Health Service (NHS), I have added a third factor – climate (Jumaa 2001, Jumaa & Alleyne 2002). This review is structured as follows: first, a brief discussion about developing management and leadership capability through resources and capacity building; secondly, capability development, does it work? and thirdly the nine papers are reviewed under three key areas of capability development (Jumaa 2001). They are: the changing nature of knowing in the workplace; the changing nature of work and new approaches to understand and apply nursing and health care management and leadership work-based learning methodology to improve patient services. An important thread that runs through all efforts to develop management and leadership capability in the workplace is the urgent need to have, in the workplace, a structure to convert ‘tacit knowledge’ into ‘explicit knowledge’, an essential ingredient in the knowledge-creating processes. The grouping of the nine papers reviewed is not rigid but current allocation denotes the emphasis within the papers. But why is developing management and leadership capability in the workplace significant to the current and future activities of the nursing profession? Strategic nursing management and leadership cannot be studied, understood, critiqued and applied in isolation from the generic body of acceptable knowledge in strategic management. The uniqueness and credibility of nursing management and leadership capability will be judged on the extent to which the generic body of acceptable strategic management knowledge is employed to add value to nursing activities and improve the services and care offered to patients, clients and users. This is one of the main reasons why management and leadership capability in the workplace is significant to the current and future activities of the nursing profession. The significance of developing management and leadership capability in the workplace is not only an issue of concern to the nursing profession. It is also, generally, a national concern in the UK, and specifically a concern in the UK NHS. Research (Council for Excellence in Management and Leadership (CEML) 2002) has demonstrated that there are approximately 4.5 million managers in the UK, yet 36% of organizations stated that their managers are not proficient. One of the practical solutions the government has put in place in partnership with the Chartered Management Institute, the premier professional organization in the UK is the establishment of the Chartered Manager Scheme (Jumaa 2005a). Ivan Lewis MP, UK's Minister for Adult Skills, a keynote speaker at the launch of the Chartered Manager (CMgr), says: ‘There is compelling evidence of management skills shortages hampering business. Chartered Manager is a vital step towards maintaining up-to-the-minute skills in the workplace and tackling this longstanding issue. That is why CMgr is supported in the Government's Skills Strategy White Paper’. The CMgr award is the ‘Gold’ standard in Management and Leadership. It is about results and impact. It is ‘doers’ and ‘achievers’ who gain the CMgr status. As the first Nurse CMgr, the Chartered Manager Scheme is a process I recommend for all nurse managers and leaders, NHS and public sector managers who are confident to benchmark their workplace capability achievements; particularly as the professions (including the NHS) lag behind in management and leadership skills (CEML 2002). This research carried out by the CEML, set up by the government, was reported to be the most comprehensive study ever conducted into the supply of and demand for management and leadership capability in the UK (CEML 2002). The report stated that current management and business leadership development in the UK is ‘a dysfunctional system’, and that the UK's economic performance is being held back by a shortage of appropriate and practical leadership skills. Another report, ‘Leading change in the public sector: making the difference’ (CMI 2003) was sponsored by the Department for Education and Skills (DfES), Defence Leadership Centre, Improvement and Development Agency for Local Government, National College for School Leadership, The Metropolitan Police Service and The Training Group Defence Agency. According to the Chartered Management Institute (the Institute), it follows on from a major study into the nature of leadership in the UK organizations in 2001 by the Institute in association with the think-tank Demos, on behalf of the CEML. In that report, ‘Leadership: the challenge for all?’ (Horne and Jones 2001) the quality of leadership in the UK organizations did not receive high ratings and public sector organizations received the lowest ratings of all (Jumaa 2005b). After decades of underinvestment, the NHS has begun to turn itself around, with unprecedented increases in the money it can spend. As its budget has grown from ≤33 to ≤67.4 billion and rising, the average spending per head of population has gone up from ≤680 to ≤1345 (http://www.dh.gov.uk). Has this made a difference to the patient experience? The government believes so. This explains what is perceived as the goal of effective management and leadership in health care, in England, to make sure patients always come first by implementing and sustaining the current radical reforms and changes to the way the NHS works. The processes of developing management and leadership capability must, therefore, understand how the NHS works internally as well as externally, a view supported by Nigel Crisp, NHS Chief Executive: ‘We must lead change as well as manage it. We need leadership in setting out the vision and working with and through people to achieve it. We need excellent management in systematic and tested approaches to secure delivery and improvement (Department of Health 2002a, p. iv)’. Therefore, with so much billion pounds spent on the NHS, does developing management and leadership capability work generally and specifically in nursing? Making a case for evidence-based management and leadership capability at a glance, Jumaa and Alleyne (2002) showed and confirmed that their collaborative inquiry research studies supported Grant (1995), Christensen and Overdorf's (2000) assertions provided certain conditions are fulfilled. They suggest that when management and leadership resources interact with capacity effectively and efficiently, the outcome would be the desired outcomes of management and leadership capability (see Box 1). Resources are represented as Time, Human, Equipment/Estates, Information, Materials and Money (THEIMM; see Table 1), and capacity is presented as consisting of: process, values and climate. The climate necessary for effective management and leadership capability has been demonstrated (Jumaa 2003, Jumaa et al. 2005) and eloquently argued by Goleman (2000) as comprising: standards, responsibility, clarity, flexibility, rewards and commitment for work-based learning in the workplace. These statements further confirmed the importance of the need to have a thorough grasp of the real meaning and applications of resources and capabilities if nurses want effective management and leadership capability in nursing and in health care. There is further evidence that management and leadership capability works (Burgoyne et al. 2004). The key findings of this key research commissioned by the DfES* are: Management and leadership development (MLD) can and does, in the UK and elsewhere, enhance performance for economic and social benefit. It does not currently do so to its full potential, and there are therefore further performance gains to be had from improving it. This improvement can come as much or more from improving the ‘precision’ with which the MLD investment is made (by individuals, organizations and the state), than by increasing the scale of the investment – although the latter might usefully grow as confidence in performance benefit becomes more secure. This is because MLD contributes to performance in multiple rather than a single way, and what is effective varies very much with situation and context. Fitting the right approach to the specific context is the key. Management and leadership capability is located collectively in organizations, sectors and regions and initiatives to develop these, in addition to ones based on education, training and development to create individual capability are needed. Not all capability that exists at the individual level is fully used in collective organizational processes, for mixture of motivational, organizational and reward reasons. Future research should focus on improving understanding of what forms of MLD works best and in what situations. It also needs to be more coordinated. A recent and major research project also confirms that MLD works is from the Achieving Management Excellence Research Series 1996–2005. The Chair, of the Research Advisory Panel is Prof. Leo Murray, Companion of the Chartered Management Institute. The report is ‘Management Development Works: The Evidence’ (Mabey 2005). The report stated that ‘Given the huge national and corporate investment in developing management and leadership capability, questions about the effectiveness of such development activities are valid, necessary and urgent. Uniquely, this report provides key evidence of the links between investment and organizational performance over an 8-year period. This is a major study of MLD, which covers all activities that contribute towards improving the effectiveness and performance of managers and leaders, as defined by the survey respondents. There were 1000 respondents consisting of matched pairs of Human Resource (HR) managers and line managers drawn from 500 organizations. The survey was carried out using archive data collected in 1996, 2000 and then 2004. As such, it gives a distinctive insight into the changing patterns of MLD policy and practice in organizations of all sizes and sectors over 8 years. This study includes measures of impact, including organizational commitment, performance and productivity, and provides evidence showing how strategically driven MLD, implemented over time, makes a significant difference. These new findings are key in that they show: How sustained MLD can improve organizational performance. The need for MLD to be driven strategically if competitive advantages are to be realized through improved people management. Growing demand for development activities that improve people skills and change-management capabilities. The most effective forms of development are those connected directly to managers’ experiences in the workplace. The belief that ‘leaders are born and not made’ has finally been eclipsed by the importance of job experience (Mabey 2005, p. 1). Developing management and leadership capability in nursing and in health care is and should be the sole concern of this journal. All the authors in this issue and many more from past editions of this international journal are demonstrating varying degrees of how MLD contributes or could contribute to nursing and health care performance in multiple rather than a single way. These papers also show that what is effective varies very much with situation and context. Continuous efforts are being made to fit the right approach to the specific context in the workplace. The nine papers reviewed are presented under three key areas of capability development (Jumaa 2001). They are: the changing nature of knowing in the workplace, the changing nature of work and new approaches to understand and apply nursing and health care management and leadership work-based learning methodology to improve patient services. Two papers explore new ways of perceiving professional clinical activities to improve and sustain continuous quality service to patients. They focus on the very significant issues of producing high quality student nurses and their socialization to provide quality services for patients. Nursing practice, we are reminded, plays an important role in transferring nursing knowledge to student nurses. The clinical setting provides unequalled opportunities for students to develop the theoretical knowledge and practical skills that are necessary to become competent and capable (fully qualified) nurses. The implications for the development of student nurse's clinical practice capability in these two papers are significant. The setting up of the structure to convert tacit knowledge into explicit knowledge, an essential ingredient in the knowledge-creating processes is mandatory. There is also the requirement for qualified practitioners involved in the student nurse's socialization processes to collaboratively create the right climate for professional growth (see Box 1). Ming-Tien Tsai and Ling-Long Tsai explored the uncharted territory of prior knowledge interaction effect on student's performance and its influence on nursing students when evaluating the knowledge transfer success factors. They concluded that students with prior knowledge were more independent than students without prior nursing knowledge. These students also preferred self-directed learning over students without prior knowledge. Students who did not have prior knowledge were eager to take every opportunity to gain experience and more readily adopted new knowledge. What is significant from this study is that the student nurse's clinical practice capability could be gainfully developed with or without their prior knowledge. This is confirmed by agreements from both groups of students studied on 12 critical success factors (CSFs) necessary for student nurse's effective socialization. These CSFs include that: ‘nursing students are cautious and respect for life; hospitals require nursing students to qualify with nursing knowledge; nursing students ask questions without hesitation’, for example. Marian Willmer's paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology (ICT) capability development in student nurses. The paper reminds us that the profession of nursing, like many others, is facing the increasing usage of information technology in day-to-day operations. The processes of admissions and discharges of patients, for example, have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the NHS and using computers as one way to assist in achieving greater effectiveness. If the future of the profession and the quality of its future practitioners depend on current student nurses, their socialization process is of significant importance. Nurse education therefore needed to reflect this need and support trainee nurses to acquire ICT skills. The paper concludes that there is a significant gap in the literature in this area. It proposed a practical conceptual framework to fully analyse, develop and implement sustained ICT capability in student nurses to meet the demands of the changing nature of work. I do not intend to list the vast range of the government's White Papers, in the UK, which has radically altered the organizing, management and leadership typology of the UK NHS. Reference to these White Papers is cited in the papers by Janice Phillips and Marian Willmer. The challenge facing nurse managers and leaders working within and outside of the new NHS is to develop the capability to understand how to organize work in more imaginative and flexible ways that fit with today's lifestyles. Looking back on over 30 years of working within and with the NHS and applying the legal, organizational, occupational and personal factors decision approach (the L.O.O.P Factors decision framework, Jumaa 2001) as points of reference, I appreciate the immense positive growth within the NHS since the 2000s, and I am very proud and I celebrate the significant contributions of nursing and nurses to these achievements. ‘While there has been a great improvement in communication between NHS staff and their patients there is still much to be done to ensure that patients understand the information they are given and can influence decisions’. The growing case for improvements within the new NHS is supported by both patients who use the service and the staff who provide these services. Healthcare Commission chief executive Anna Walker said: ‘More than 200 000 people have told us what it is like to work in the NHS. Many said they were generally satisfied with their jobs, but further analysis of the results show that some groups of staff are more likely to experience violence and bullying, have a poorer work-life balance and report higher levels of work-related stress and injury’ (Jumaa 2005a, Ch 3; see http://www.healthcarecommission.org.uk for more details). Enhancing the strategic learning of individual nurses and other health care practitioners as well as promoting NHS organizational capability could only become a reality within an appropriately supportive environment. The papers by Fiona Timmins and Honor Nicholl, Leigh Ann Farmer and Tracy Williamson are disciplined and deliberate attempts to assist in the development of management and leadership organizational capability. Fiona Timmins and Honor Nicholl's study detailed how continuing professional education is fast becoming a source of significant stress, as opposed to an enjoyable professional growth. The price paid by these nurses, although not necessarily in monetary terms, is high. There is a ‘personal killing’ involved in dedicating time to personal studies. Many nurses report that this kill is a source of stress, resulting directly from work/study and work/home balance, getting time off work to attend, as well as the academic requirements of the programme. This has obvious implications for quality patient care, supporting student nurse's education and developing the capability needed for performance excellence. Fiona Timmins and Honor Nicholl suggest that managers and educators have a responsibility to support these motivated nurses in their personal endeavours. Leigh Ann Farmer believes that technological enhancements have allowed the health care arena to expand and improve its capabilities, including the delivery of health care and the information exchange among patients, providers and workers. Traditional leadership styles, Leigh Ann Farmer suggests must be modified to respond to the needs of telecommuters. Situational leadership, it is argued, gives structured guidance to the nursing leader when managing and leading change. Tracey Williamson's paper could seat comfortably in the next grouping of the nine papers in this issue. It is here because, while the paper employs new approaches to understanding and applying nursing and health care management work-based learning methodology to improve patient services, its main focus is the use of the Shared governance processes to replace traditional hierarchies. The study used an action research approach, which has been found to have great utility at optimizing work-based learning. Nurse Managers, Williamson concludes, need to develop their coaching and facilitating skills and recognize there is no quick fix for developing clinical leaders. Implications from this changing nature of work style include the need to support learners in identifying and implementing changes arising from work-based learning activities, the significant resource implications and the need to optimize the organizational climate if work-based learning approaches to leadership and management development are to succeed. It is my opinion from the analysis and evaluation of the new NHS (Jumaa 2005a) that developing management and leadership capability within the new NHS requires a ‘balanced scorecard’ approach focussing on: financial perspectives, customers/patients/clients perspectives, internal conversion process perspectives, and innovation and learning growth perspectives (Kaplan & Norton 1996). The four final papers in this issue have adopted varying degrees of the new approaches to understanding and applying nursing and health care management work-based learning methodology to improve patient services. Teija Korhonen and Johanna Lammintakanen write about web-based learning as an important instrument, both for obtaining skill-based organizational outcomes and for facilitating organizational learning within organizations. Jacqueline A. Leigh, Calbert H. Douglas, Kath Lee and Mary R. Douglas adapted the generic European Foundation for Quality Management (EFQM) model to a specific case of the preceptorship programme. Caroline Mulcahy and Linda Betts used a participatory action research framework was to achieve and sustain a cultural change process. Janice Phillips used a strategic nursing management and leadership performance implementation model for managing information, knowledge and communication for results within nursing and health care services. Teija Korhonen and Johanna Lammintakanen observed that little is known about nurse managers experiences on web-based learning, even though nurse managers have a crucial role in promoting the professional development of their staff. Nurse managers in this study found web-based education to be a suitable and modern method of learning. On the basis of their experience they found multiple ways to utilize web-based learning environments in health care. Information technology skills, equipment, support and time were considered essential in web-based learning. Additionally, they found that their own experience might lead to more widespread implementation of web-based learning in health care settings. Information technology skills of nurse managers and staff need to be developed in order to use information technology effectively. In order to learn in a web-based environment, everyone needs the opportunity and access to required resources. Ming-Tien Tsai, Ling-Long Tsai and Marian Willmer emphasized, in their papers, the role of prior knowledge, CSFs and the development of ICT capability during the socialization period of student nurses. Jacqueline A. Leigh et al. continued with this trend but concentrate on the professional development of the newly qualified nurses through the adaptation of the generic EFQM model to a specific case of a preceptorship programme. The modern NHS puts strong emphasis on quality and safety, with a focus on the efficient delivery of high quality responsive services. Following introduction of the special preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptors self-reporting increased levels of confidence. For the first time within the organization, the contribution of a targeted education programme to the achievement of corporate objectives and improvement of patient outcomes were demonstrated. Utilization of the framework has also identified areas of practice that need to change. This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for the development of nursing capability. Caroline Mulcahy and Linda Betts worked in an organization faced with the following questions. What actions would you take when you have an increasing demand on your services with bed numbers in excess of 100% occupancy on many occasions? How would you manage the resulting increased stress, absence of teamwork and low morale? What CSFs are going to galvanize your team to action as your Unit's efficacy deteriorates, your status low and many areas of dysfunction are evident in your services? The initial and most significant challenge was to achieve effective partnership between medical and nursing staff within the Unit and at all levels of the Neonatal Team, which would also be supported by the nursing union, the Australian Nurses Federation (ANF). A participatory action research framework was used to achieve and sustain this cultural change process. A key part of the process was the use of an external facilitator, within a Focus group, who continued to be actively involved in the project. This enabled the learning to be continually feedback to staff in the Unit, being owned by facilitator and the staff, rather than the knowledge being taken outside the staff group. The facilitator became an active participant and the knowledge gained was used to plan, implement, monitor and measure change. This paper celebrates how the Neonatal Unit, at The Royal Women's Hospital in Melbourne developed the capability needed to successfully managed and led these challenging situations. Janice Phillips in this final paper posed the question: are we still overlooking a critical and key area which is fundamental in achieving and delivering cost-effective quality health care – the area of information management within health care today? This question was prompted by changes in politics, government legislation and reforms of the NHS. These changes have created a need to equip managers with the necessary tools and skills to be able to lead and manage effectively. This paper, set within the context of a specialist forensic learning disability setting, examines the purpose, role and function of information and information management within health care today. A strategic nursing management and leadership performance implementation model, the CLINLAP model was used for this research and development project. The paper concluded that sustained quality information could be embedded in nursing practice at Yelday Lodge or elsewhere by evaluating and discussing the different information management approaches within the practice area through the use of structured management and leadership interventions. Throughout my working life as a line manager within the clinical environment, as a senior education manager and director, as a MLD programme director at Middlesex University, as a residential school tutor with the Open University Business School† and as a MLD consultant with the Centre for Business and Social Progress (CBSP), my belief has grown that management development interventions, properly focussed and appropriately delivered within a systematic framework, will definitely make a significant difference to the performance of individuals and organizations. Others and I, within nursing and health care, have demonstrated that management and leadership capability could be developed and that MLD works (Alleyne 2002, Alleyne & Jumaa 2005, Jasper & Jumaa 2005, Phillips et al. 2005). A thread that runs through all efforts to develop management and leadership capability in the workplace is the urgent need to have a structure to convert ‘tacit knowledge’ into ‘explicit knowledge’, an essential ingredient in the knowledge-creating processes. Most people know more than they can tell. This is particularly true of nursing and nurses. A significant amount of a nurse's personal and professional knowledge is grounded in experience that it cannot be expressed in its fullness in a written form. This form of knowledge is described as ‘tacit knowledge’. I have observed, in the last 30 years of working for and within the NHS and the higher education sector, in the UK that this is one of the major weaknesses of nursing and nurses. This precious asset of nursing knowledge is bound up in the nursing processes, activities and efforts that produced it. It is a procedural knowledge that guides our behaviour but also not readily available for introspection. Tacit knowledge is intimately related to action and relevant to the attainment of goals that nurses value. Unfortunately, while tacit knowledge is the primary basis for both effective nursing managerial and leadership actions, paradoxically, it is also responsible for the deterioration of nursing managerial and leadership actions. This is because according to Argyris (1993), management and leadership capability need both knowledge (‘tacit and explicit’) and skill. The efficacy of nursing's tacit knowledge depends on its being acquired and then being effectively used. To use nursing knowledge effectively demands that it is converted to explicit knowledge through the processes described by Nonaka (1991), which drives a virtuous cycle of continuous innovation of ‘combination’ (explicit), ‘internalization’ (tacit), ‘socialization’ (tacit) to ‘externalization’ (explicit). I dedicate this Guest Editorial to my friend and mentor, Prof. (Dr) Justus Akinsanya, the first African to become a Professor of Nursing in the United Kingdom. He passed away on the 11th of August 2005. He was a truly knowledgeable professor, a prolific writer and one who continuously convert his vast tacit knowledge into explicit knowledge for the benefit of others. Sun re o$ May your soul rest in perfect peace. Amen. My gratitude and appreciation to my wife and children for their support and encouragement for me to complete this guest editorial despite the devastating effect that Justus's death is having on me.