Exploring the characteristics of women’s leadership in healthcare and healthcare education in the USA
I was awarded this scholarship on 16th December 2015. I found the RADA ‘Communication Skills, Personal Impact and Influence’ programme incredibly useful and my only regret is that I did not do this earlier in my career. The group worked effectively and I had the opportunity to rehearse some difficult situations at work. I then attended Westminster Experience day which I also found invaluable – both the feedback on presentation skills but also in terms of how the process works. This has been particularly important with the recent political changes within nurse education and, of course, on the wider political scene. I have been involved in a number of ‘political’ meetings relating to nursing and nurse education and I hope this day helped me to be more effective at these events.
I was invited to be a member of the panel at the Florence Nightingale day for students. This was an excellent day – the student engagement and knowledge was impressive and I would be delighted to help with such events in the future. I attended the ceremony at Westminster Abbey which was extremely moving and an excellent opportunity to catch up with previous scholars.
I have just attended the Women’s Leadership Forum at the Harvard Business School I chose a women only programme because, more recently in my career, I have become increasingly aware of the particular issues challenging women as leaders, particular in the healthcare sector. The programme was very good. There were sessions from excellent speakers including Frances Frei, Tesdal Neeley, Myra Hart, Iris Bohnet, Tom DeLong, Amy Cuddy and Jan Hammond. The sessions utilised the well-known Harvard case method and were extremely interactive and challenging. In addition we worked each morning in small groups or ‘Boards of Advisors’ meetings on a particular issue.
I learned a great deal from the programme, and I am still reflecting on this, but a key lesson was that in order to be a great organisation you need to decide what you will not be good at as the organisation cannot be excellent at everything – excellence is a trade-off and can be defined by what you do not do well. In order to do this it is important to assess what you customers (for us they are students and patients) really care about and need from you and to ask them what they think before deciding where to focus. Another area of learning from the programme reinforced a philosophy that I have long had in my career and that is to be prepared to take chances and pilot optimistic ways of doing things. The message was that, in order to try new initiatives, do something first and see if it works and then share the learning. If you always wait for permission and consensus too many people get involved and nothing happens. Furthermore, do not be concerned if someone else (above or below you) takes the credit as long as the improvement happens – make a vow to give up on taking the credit. In the same spirit, a subject that was discussed was the good leadership is about taking the blame for what goes wrong and giving credit for what goes right, making others better as a result of your presence – and ensuring that your influence and changes you initiate last after your absence – holding onto knowledge does not lead to sustainable improvements.
There were a number of sessions that related to change and the importance of recognising that, for change to happen, you need to get the indifferent people on board early as possible as their indifference can be contagious to the enthusiasts. Furthermore, the change process can feel slow in the middle of the implementation period so do not get demoralised.
The sessions on managing people were particularly good and a couple of key learning points were to acknowledge that staff members usually have had good intentions but do not always think about the impact of their actions. If you do not engage fully with people that you manage and have meaningful conversations about their performance, they can fear the worst and will feel negative connotations in the absence of feedback because it is easier to anchor on the negative. Therefore, managers should keep having conversations, even if they are uncomfortable.
A final useful point was that overworking rarely leads to excellent performance so stop giving credit for going above and beyond.
The focus of my project activity related to women, nursing and leadership and I therefore arranged to meet a number of leaders in nursing, healthcare and healthcare education. I had help from Jane Banaszak-Holl, Associate Dean of Academic Affairs, School of Public Health, University of Michigan and Julia Ball, Endowed Chair Neuroscience/Surgical Nursing and the previous Dean of the School of Nursing, University of South Carolina, Aiken and met nearly 40 individuals over a two week period. They worked within a range of healthcare settings including universities, acute adult hospitals, children’s hospitals, private sector organisations, not-for-profit and publicly funded organisations.
As with the rest of the programme, I am yet to fully appreciate all that I have learned but a key issue was that, in the USA, there is a better appreciation of the degree prepared nurse. The USA has had nursing associates for many years but is now moving away from this to having all degree qualified nurses because nurse leaders and CEOs in USA hospitals are convinced by the quality argument in relation to having degree qualified nurses. Another interesting fact was that the use of simulation was widespread instead of placements. However, there was a difference between the perceptions of the educators and the healthcare practitioners as to whether it was as useful as actual placement experience, with the educators believing it was and the practitioners less certain. A positive aspect of nurse education within the USA was that doctorates in nursing practice are much more common in the USA than PhDs and appear to be a good vehicle for improving care and enabling nurses to get doctorate qualifications. They are the seen as the educational standard for advanced nurse practitioners who are used much more across the USA and are much better paid. However, the variation across states in what nurses are allowed to do causes difficulties.
With respect to developing new nurse leaders, the head nurses I spoke to believed that understanding resources and finance is an essential part of preparation for new leaders. There seemed to be stronger mentorship systems and robust leadership development for succession planning. Lobbying skills were also seen as critical in the USA for nurses – but is more complex as it is required at city, state and national level.
With respect to the healthcare system an interesting issue was that healthcare practice is often dictated by the payment system and this prevents nurses and midwives being allowed to deliver more cost effective care as the doctors want to keep the income. The move to value based care is improving this situation. Overall I felt that we need to appreciate the healthcare system we have – it appears much fairer and better for all than the USA system.