Editorial. Developing, implementing and sustaining nursing leadership and management capacity: practical implications for quality patient services

‘Nursing careers must respond to the profound changes taking place in the structure of health-care delivery and the need for nurses to exercise leadership to bring about change (Department of Health, CNO's Directorate 2006 2006, p. 3)’. Melanie Jasper in the first editorial for 2007 cited this quotation. There is no apology for repeating it in this editorial because it is profoundly relevant to: the theme of this edition which is, Strategic Patient Management Issues; current turbulent activities within health systems worldwide with nurses and nursing constantly exposed to a terrain of unchartered territories. Responding to the profound changes taking place and exercising the leadership necessary to bring about that change involve developing, implementing and sustaining nursing leadership and management capacity. Doing this has significant theoretical and practical implications for the quality of patient care, quality patient services and the economic viability of the organizations in which those care services are delivered. This message is reflected throughout the papers in this edition. This extended edition has 13 papers. It is about how nursing management and leadership impacts on strategic patient management issues. The editorial sets out by explaining what we mean by strategic patient management issues and patient services. We argue that if we accept that there is diversity of aspects that make up nurses’ lives at work, and which go beyond the overt aspects of the provision of care and that they impact on the quality of nurses’ lives, both at work and in their personal time, and contribute to the stability and maintenance of the workforce (Jasper 2007), then we must pay particular attention to the transformation processes involved when nurses and midwives deliver quality patient care and services. We recommend that the contents and activities of Box 1 (http://www.L4taids.com) act as a guide to nurses and health-care practitioners to provide and sustain quality patient care and services. The activities in Box 1 were already applied successfully within many health-care projects (N. Kennedy, unpublished results, Jumaa 2001, 2003, 2005, Alleyne 2002, Kennedy & Jumaa 2002, Alleyne & Jumaa 2005, Jumaa et al. 2005, Phillips 2005, Phillips et al. 2005). It is important to point out that this apparently simple diagram (Box 1) represents very complex nursing management and leadership activities from when THEIMM resources (Time; Human; Equipment/Estates/Energy; Information; Material and Money) are received or acquired for nursing and health-care services to how these are converted during the processes of providing care and services (capacity) to the expected level of satisfaction for the patient and the organization (professional and organizational capability). Alleyne and Jumaa (2005) have argued that effective implementation of change and sustaining the transformation processes for change requires providing the necessary resources for a given project – a process of real empowerment. The papers in this edition are therefore presented using an adapted framework of empowerment from Marchington et al. (1992)–the Empowerment Stairway. The Empowerment Stairway (I4C) consists of the use of information at various levels and depth of activities to give ‘ultimate’ control to all stakeholders for particular patient activities: information; communication; collaboration; codetermination and control. What then are strategic patient management issues and patient services? Strategic patient management issues as used in this editorial refer to developments inside or outside nursing and health-care organizations which by their very nature are likely to have an important impact on the ability of the nursing and health-care organizations to meet or determine its purposes and objectives for its patients. Examples of such strategic issues presented in this edition include: the relevance of mission statements in Flemish not-for-profit health-care organizations; Care-planning meetings with stroke survivors: nurses as moderators of the communication; Irish nurses’ and midwives’ understanding and experiences of empowerment; challenges in delivering safe patient care: a commentary on a quality improvement initiative; the need for nurses to have in service education to provide the best care for clients with chest drains; Computer-supported telephone nurse triage: an evaluation of medical quality and costs; a conceptual framework contributing to nursing administration and research; the Lead Cancer Nurse: an ill-defined role? Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services. Strategic patient management issues demand quality patient services. Quality patient services are about a holistic approach to managing patient care and patient services. A comprehensive approach to managing patient care and patient services is about providing the maximum satisfaction for patients, clients and service users as well as efficient utilization of available resources within the organization (see Box 2, Jumaa 2001). Reflecting on medical activities in the NHS during the First Way we observe that those who were predominantly key stakeholders during the First Way were doctors. During the Second Way control shifted to general managers. The Third Way is of particular interest. This is a period when nurses and nursing assumed more significant presence on the health arena in the NHS. This is evident from the formal title most senior and top nurses have at work – Director of Nursing and Quality, for example. This is a significant recognition for the profession to take a lead within a multi-professional context as the expert and adviser responsible for leading strategic quality issues within their organization. It is obvious from Box 2 that if focus now is expected to be shared between patient satisfaction and resources utilization this presents urgent and continuous significant external and internal pressures for nursing, nurses and health-care practitioners in the NHS. The situation is the same globally. These pressures include, for example: externally an ageing population with increasing demands for nursing and health-care services; internally an acute but growing workforce nursing shortages resulting in a limited supply of nursing and health-care services. These paradoxical pressures are driving nurses and will continue to push the nursing profession and the health-care industry to seek alternative and revolutionary interventions to provide health-care services that negotiate the difficult divide of patient satisfaction and resources utilization. A modified Empowerment Stairway integrated within the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model (Jumaa 2005) is an example of such an alternative and revolutionary suite of interventions (see Figure 1). Patient involvement through an empowering information process. The 13 papers in this edition are presented as examples of how nurses in the UK, Finland, Sweden, Belgium, Republic of Ireland, Canada and Australia are aspiring to empower patients and staff to lead others and manage the discontinuous changes they face as nurses and health-care practitioners. The papers fall, perhaps not overtly in some cases, into the five areas of the modified Empowerment Stairway (Jumaa 2001). They are classified into an area we believe reflects the dominant message in the paper: information for all stakeholders for specific goals (developing patient management issues); communication with all stakeholders for explicit roles (developing patient management issues); consultation with key stakeholders for clear processes on which direction to follow (how to implement patient management issues); codetermination with key stakeholders on clear processes of options for quality service (how to implement patient management issues); control shared with all stakeholders through a process of open relationships (implement and sustain patient management issues) (Jumaa 2005). Information and communication are collapsed into one area representing activities necessary for specific goals and the explicit roles required when nurses develop patient management services. There are six papers in this section all, in their different ways, extolling the importance of information and communication as basic essentials for efficient and effective patient management processes. Dominique Vandijck, Sebastian Desmidt, and Marc Buelens are sensitive to the fact that health care is a rapidly evolving industry in which organizations have to deal constantly with changing conditions, increasing costs, fluctuating demand for services, fundamental management problems and new challenges. This paper explored how in order to achieve the highest possible performance level, managers are continuously searching for tools to foster organizational efficiency and effectiveness. The role of Mission Statement as a valuable tool to improve organizational performance and to increase the level of employee satisfaction and motivation is the focus of this paper. The findings of this study suggest that the mission statement is an effective tool for managers but not for non-managerial organizational members. As reviewers we are at odds with this finding as it contradicts the purpose of mission statements. Readers are invited to take part in this debate. Daniela Lehwaldt and Fiona Timmins writing about the best care for clients with chest drains conclude that the results of their study confirmed common findings in the literature that while nurses were often competent with practical skills, they might lack understanding of the underpinning principles of care. Nurse Managers, they suggest, need to lead the development of appropriate evidence-based clinical guidelines and protocols and existing policies need review to establish comprehensive guidelines that cover the wide-ranging activities and implications for nursing practice. This suggestion by Lehwaldt and Timmins assume that such a capability resides with nurse managers. This assumption could be challenged on the grounds the role of the nurse managers have been found to be focused on day-to-day operational difficulties and that this mitigates against their involvement in strategic development or policy formulation in a meaningful way (Crossant 2003). The next paper submits that the Lead Cancer Nurse role is complex and often ill-defined. The authors compared it with the roles of Nurse Consultant and Advanced Nurse Practitioner. Fiona Vas and Sheila Small suggest that there is a need for further research to monitor and evaluate new senior nurses’ roles and to demonstrate their effectiveness and focus less on the expedient establishment of new roles and instead be more proactive in identifying the factors which policy makers and managers need to address in order to ensure the sustainability of posts such as these. The distinctive role of information management for efficient and effective patient management is the concern of Junttilla et al. Their findings are that successful implementation of a Nursing Management Information System requires systematic data quality checks. They based the need for this approach on the pressures of a rapidly changing health-care environment. A health-care environment with continuous need to contain health-care-related costs, to increase productivity, reduce patient stays and to maintain or improve quality of care. This situation has created new challenges for nursing leaders and requires appropriate, accurate and timely data for decision-making. Reallocation of resources, redefinition of tasks and responsibilities and new care delivery models has to be planned and executed. Junttilla et al. recommend a Data warehouse approach to combat these pressures. Currie and Watterson reflected on the challenges in delivering safe patient care. Safety culture is about improving safety attitudes in people, but it is also about good safety management established by organizations with a holistic, whole of community, whole of life approach. Good safety culture implies a constant assessment of the safety significance of events and issues so that the appropriate level of attention can be given. Establishing and developing positive attitudes towards safety culture in a community is cost-effective. Currie and Watterson discovered that the challenges identified by the majority of nurses they spoke to could be described as located at: the blunt end of care; institutional context; work environment; and the management and organization of care. This section concludes with Corbally et al. writing about Irish nurses’ and midwives’ understanding and experiences of empowerment. They suggest that although elements of power and control seem to be common features, how empowerment is conceptualized within each of these perspectives varies. They conclude that empowerment is a complex concept and its meaning is contextually determined. Marklund et al. observe that changes in the health-care system during the 1990s have led to longer waiting lists for appointments, expensive visits to doctors and an increasing demand for medical advice from patients at the point of entry to the health-care system. Therefore, people hesitate before using the health-care system and called up a health-care professional, often a nurse, before deciding to see a doctor. Their study describes an example of a telephone nurse triage (TNT) model based on scientific evidence-based guidelines and protocols developed, implemented and maintained by doctors and nurses using their expert knowledge. They conclude that the telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health-care system. The delivery of health care is affected by increasingly complex social, political and economic factors. In addition, the challenges of hospital closures and mergers and human resource shortages have brought to light inefficiencies within health-care systems. These are observations by Biron and colleagues. They present a conceptual framework for nursing administration and research that links patient health-care needs, nursing resources and the nursing care processes to the context of the health-care system, and the social, political and cultural environments of care. This conceptual framework, they argued, provides nurse administrators and researchers a framework for situating knowledge that is currently available, identifying the relationships between health-care needs, nursing resources, processes of care and outcomes at all levels critical to informed decision-making in a changing health-care system. It is predicted that using such a framework would assist to firmly establish nursing, the world's largest group of health-care providers, in a unique position to establish a scientific basis for improving the global care of individuals and families in the 21st century. One of the requirements needed by nurses to establish a scientific basis for improving the global care of individuals and families in the 21st century would be to examine and understand the association between hospital structural and organizational factors and patient perceptions of individualized care. This is the focus of the paper by Suhonen and colleagues. They propose that instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse–patient interactions to facilitate individualized care. They conclude that what is needed is considerable investment in staffing, education and organizational development to establish individualized care. Marian Willmer in her paper writes about how patient management issues could be sustained by ensuring that student nurses develop Information and Communications Technology (ICT) skills. She suggests how evidence based nursing leadership and management interventions could facilitate the effective use of ICT by student nurses for efficient and effective patient management. Running Care-planning meetings with stroke survivors with nurses as moderators of the communication is the next paper by B. Hedberg, A. Cederborg and M. Johanson. They argued that how the patients participate in this process is, thus, dependent on how they are able to contribute but also on how they are involved by the other participants. They conclude that the education of health- and social-care professionals need to increase and highlight the practice in how to involve patients in participation of care and treatment planning. G. Hubbard and P. Munro's Frail older people's experiences and use of health and social care services is the penultimate paper in this edition and the last in this section. The area of focus in this paper, an ageing population with increasing demands for nursing and health-care services, is significant to the nursing profession. The conclusion from this study is that the same people who are targeted by care services are reluctant to engage with them. Care providers need to adopt older people's priorities to provide them with responsive patient-centred care. The last paper in this edition and the only one in this section epitomises how we could all engage in conducting research with and not on our ‘subjects’. Alleyne and Jumaa report on research using an action research approach which utilized all the steps on the modified empowerment stairway (see Figure 1). This collaborative inquiry within a case study was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The inquiry conducted over a period of two-and-a-half years used evidence based management and leadership interventions to assist the participants to develop ‘actionable knowledge’. They conclude that using group clinical supervision with an executive co-coaching approach for the implementation and sustaining quality service demand that ‘good nursing’ is accepted as being synonymous with ‘good management’. This, they argue is the future of ‘new nursing’.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.