Transformational Leadership: "Vision"-ary Direction
By Ann-Marie Peckham
Home care and hospice are at a crossroads. ACOs and other initiatives related to health care reform are on a roll! CMS is setting forth new regulations, and our industry is feeling the heat. Just the other day, I was at work and heard a revealing comment: “we feel lost and not sure what our vision is at this point.” So leading the way to a strong sense of identity is a very relevant challenge!
For the past 13 years, we have taken care to strike a balance between clinical and financial management of patients. Our “value,” too, requires some attention and definition. No clinician or team wants the value of their intervention questioned. Yet our front-line managers must do just that. How well do our front-line managers dispel the inferences that come from questioning value? I would say that the answer lies in how well prepared our managers are to be leaders.
Our home care leaders must attempt to balance declining reimbursement; perhaps some issues related to adequate staffing, recruitment, and retention; regulatory requirements; and increasing complexity in technology while maintaining efficient, quality-focused service.
I go to work every day practicing to be “underwhelmed.” Like other health care administrators, I face a glut of disturbing facts. The U.S. spends more on health care than any other industrialized country. Yet we see the doctor far less often, hospital visits for chronic conditions are common, and outcomes aren’t as good. Most disturbingly, Americans do not live as long despite our higher spending on health care. Implicit in these facts is the notion that the high cost correlates mostly to in-patient costs, which ordinarily implies hope for post-acute settings. That said, another implicit truth is that “value” in general has become questionable (health data reported by the Organization for Economic Co-operation and Development, OECD, in 2013).
So has there ever been a better time to have our “vision” checked? Recent events prompted me to take a look at my agency’s published vision, then the one published by the ACOs we are currently working with, as well as the vision that appears in the ACA. I found it interesting to note that my agency’s 15-year-old vision includes many terms and concepts that correlate with those I found in the more recent visions of the ACOs and ACA. They are as follows: leader … innovative health care services … quality care; top quality … timely … coordinated … thoughtful; lower the rate of growth of cost … high-quality service and care … putting patients first; and increase the quality while lowering the cost … reduce cost and improve care outcomes by shifting toward quality over quantity. So I feel confident going back to my curious co-worker and saying that higher quality, lower cost, and improved outcomes (as defined by metrics) make up our quest and “vision.” When we question our “value,” these will be the defining imperatives.
Is attaining them easier said than done? There is a sense of uncertainty and turmoil, if not due to the internal environment of the workplace then definitely due to the external environment we live and work in. Reassuring our employees requires “transformational leaders” who are flexible and adaptive. Such leaders create environments of shared responsibility and inspire new ways of thinking.
There are four components to transformational leadership: idealized influence, inspirational motivation, intellectual stimulation, and individual consideration. This sounds like a lot of theory to cut through as we balance complex demands in unstable environments. “Idealized influence” builds confidence and trust by reinforcing a sense of mission and vision. Inspirational motivation is communicating high expectations to employees and encouraging them to share the organization’s vision. Intellectual stimulation is influencing staff to think in new ways, reframe problems, and realize that “how we did it” no longer applies. Finally, individualized consideration is expressing appreciation when the mission and related goals are accomplished.
Direct managers can play an important role in empowering staff. They can hold team meetings where staff members have opportunities to voice their opinions, collectively set goals, and come up with strategies to deliver more effective care aligned with the organization’s vision and mission. This input counts because success in the workplace often depends upon a leader’s ability to make positive changes and inspire other to higher levels of achievement. Transformational leaders do that and it starts with redefining (if need be) and committing to the vision. And today, it is important that we ensure the vision is in sync with the vision of health care reform. The ACA strives for higher quality, lower cost, and optimal outcomes. Our “value” is in having the skill set and competencies that will align the organization with that vision.
Ann-Marie Peckham RN, MSN, MBA, has been with the VNA of Cape Cod since 1986 and currently works as chief clinical officer overseeing home care and hospice operations. Ann-Marie is also a nurse educator and instructs on health care ethics for the University of Phoenix. She was appointed a member of the board of registration in nursing for Massachusetts in 2011 and holds the seat representing health care administration for the board.