Introduction
Medicine is not all, or even mostly, about money. Science, caring, professionalism, and even religious concerns regarding birth and death can be more important than dollars.
Around the world, healthcare institutions are encountering growing pressures from governments, investors and the general public. These institutions must simultaneously improve the health and well being of the public, cut costs and remain competitive. To achieve these goals, many healthcare institutions have implemented total quality management (TQM). Evidence from hospital-based studies, however, suggests that the success of TQM is constrained by inadequate information systems and poor application of information technology.
Change appears to be a driving force in society today and the American healthcare system is no exception. In addition to the need for change in today’s society, the importance of creativity in bringing about needed change must also be considered. An organization will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change.
According to some experts, the American Healthcare system is on the brink of failure. To support this assertion, experts point out signs of failure in the healthcare system. For one, Americans spend more than twice as much as Canadians on healthcare. And, there is a similar disparity between American and British spending. The Americans certainly don’t get their money’s worth, according to some experts. The US has roughly 43 million people with no insurance whatsoever, and among the rest, many are underinsured. That is, they have shrinking packages. This might be covered, but that won’t be covered. What’s more, experts argued that Americans are unhealthy. The life expectancy is shorter and infant mortality is higher. Childhood immunization rate is lower.
The United States is considered to have the highest healthcare costs per capita in the world. The healthcare industry faces a lot of challenges at present and which can be reflective of what lies ahead. These includes health care costs, the growing diversity of health populations and their expectations, government support for healthcare, the increasing use of technology and yet its poor application, the decreasing quality of healthcare education and the growing shortage of healthcare professionals especially the nurses among many others. There is also a challenge on the kind of leadership and management that is present in the healthcare profession.
Hospitals will be forced to shell out more on bioterrorism preparedness. Insurers will face rising demand for costly behavioral healthcare services. Vendors will have to scramble to supply new antibiotics. And physicians’ pleas for better Medicare payments may fall on deaf ears as Congress remains focused on homeland security.
Add to that the economic slowdown-which is leaving more Americans without health insurance and compelling states to squeeze their Medicaid budgets-and you have a perilous outlook for the coming year.
The American healthcare system is facing reform, which demands collaboration instead of competition, employment of a more diverse work force, and service to a larger number of uninsured individuals. This paper aims to look into the American healthcare system and the challenges that lie ahead by using the qualitative method of research.
Review of Related Literature
A number of external and internal forces cause health care systems to consider the need for change. The process in changing governance and management had three critical elements: establishment of a vision and guiding principles for the change, development of support, and implementation of change in governance and management. For the initial step in the change process, a clear and simple vision to focus the change was determined to be most important.
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For the healthcare professionals, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care.
In the succeeding paragraphs, the various challenges that the American healthcare system faces will be discussed.
Cost
Healthcare costs are skyrocketing. Most people are frustrated and angry about the state of affairs, and they want something done to rectify the problem. Added to the cacophony of complaints are claims by medical “experts” that the United States’ healthcare is sub-par and controlled by greedy doctors and pharmaceutical companies and that Americans definitely don’t get the healthcare that they pay for. If one asks most people what should be done about the problem, the answer usually involves government intervention as a solution–something along the lines of “the government ought to put a stop to runaway costs.
While the U.S. healthcare system is costly and does face challenges, the costs were largely brought on by government actions and agencies, not helped by them, and many problems attributed to our healthcare system–such as high infant mortality and short longevity–aren’t a reflection of bad healthcare. Those things have other causes. In fact, the United States has the best healthcare system in the world, despite its being hamstrung by government rules and regulations.
The assortment of components of health care cost increases are not independent but interact. But a main cause of the increased cost of medical care is clearly the growth of third-party payments, including private health insurance and various government programs, of which Medicare and Medicaid are the most important. Third-party payments affect all the other causes of health care cost increases. In majority of cases, payment for healthcare services and products are provided by a third-party. Many of working-age persons have their healthcare services and products paid for by their employer.
Health Insurance
Of the 285 million people in the United States, most have some form of private health insurance, usually through an employer. Government programs, mostly Medicare and Medicaid, cover 24 percent of the population, and about 25 million people, 9 percent of the population, purchase private insurance individually. That leaves about 44 million people, or 15 percent of the population, uninsured.
Payments from third-party increase the amount of medical services demanded by consumers by making them insensitive to the prices. This increased demand in turn allows the physicians to increase the supply of services rendered and to also increase their fees and earnings, attracting malpractice lawyers and tempting dissatisfied customers. Pharmaceutical companies and suppliers of medical technical equipment are encouraged to increase their research spending, their advertising, prices, and sales also at the same time. Even if pharmaceutical drugs are not covered in many insurance contracts, the fact that other medical costs are covered makes the consumer more willing to pay high prices for the medicines. These effects are made worse by tax subsidies for health insurance obtained through employers that lead to the purchase of insurance that is excessive in quantity and inaccurate in coverage.
Health insurance coverage is currently the primary means for access to medical services when unexpected medical crises arise and for everyday health concerns. The high costs of health insurance and medical services has led to reliance on (1) employer-provided health insurance coverage, and (2) federal- and state-funded Medicare and Medicaid programs.
Technological Advancements
Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians’ offices, not only laid the groundwork for the coming shift in the way health care was delivered, but also increased healthcare costs.
Technology standards like electronic information and other tools have significantly increased healthcare costs. Strongly associated with technological advances is also the issue of how quickly new treatments are made available to the general public. Although of course this is beneficial for the consumer, this would mean increased healthcare cost on their parts. Indeed all these advances have helped improve health care services for the consumers, but it also added extra payment or cost on their part. The choice should be the optimal combination of inputs to produce a specified level of output at the lowest cost.
Organizational innovation was complemented by an intellectual innovation, statistics. Clinic doctors began to count how many people were treated and how many got well. Numerical comparisons of outcomes began to replace doctors’ personal assessments. Determining which treatment was best previously depended mostly on the reputation and experience of the physicians who vouched for it, but now experiments and statistical observation were used.
Information systems and access to capital gave hospitals economies of scale and made them necessary adjuncts to medical practice. Although medicine has been actively practiced since ancient times, only fragmentary technological advances were made until the end of the industrial era.
Medical progress resulted more from planned effort and massive public investment than serendipitous discovery or any preordained mass of ideas. Rising incomes, falling mortality, and commercial organization were more than just contributing factors; they were central forces driving the demand that created medical technology.
Information technology can contribute significantly to quality improvements in healthcare institutions. There are difficulties associated with implementing information technologies, but they are not insurmountable. Suggestions are offered as to how managers can adopt information technology systems to improve the delivery of service to the consumer/patient.
Advances in medical care also made way for the provision of healthcare services to the financially less privileged. Hospitals began generating capital funds from paying patients who in the past had been treated at home. The importance of admitting privileges rose along with the criteria for receiving these privileges. Many physicians began making deals with the hospitals to admit their private patients. The hospitals in effect became the workshop for physicians where their private patients would pay the hospital charges and physician fees. In turn, this arrangement enabled both the physician and hospital to provide free care for the poor in the hospital dispensaries. Seriously ill poor patients were generally admitted to both municipal and private hospitals as “service cases,” where they were supervised by attending and cared for by students and house officers.
Implementing information systems in healthcare organizations poses a series of challenges. These include complexity, human acceptance of IT, data security, and data quality and standards. In light of these challenges, some argue that no other industry invests as little in IT as the healthcare industry. Most hospitals and physicians still rely on outmoded paper records organized by visual color codes, alphabet and number.
On the other hand, the increasing use of IT in the healthcare systems also has drawbacks. Ensuring the integrity and confidentiality of patient-related data is a major requirement of healthcare information networking strategies. The availability of easy and rapid electronic transmission of patient information to various organizations at different locations increases the risk of violating confidentiality. Because of convenience and efficiency, staff may forget to consider the privacy implications. Rather than improving healthcare quality, IT could reduce patient satisfaction and the quality of care. Confidentiality is especially problematic in the management of suspected child abuse cases, psychiatric cases and for patients with AIDS.
Quality improvement data must be reliable and valid in order to measure performance and change within a healthcare system or to make comparisons with other organizations. The electronic transfer of health-related information inter-departmentally and, in particular, interorganizationally has been hampered by the slow development of standard clinical guide, lines and nomenclature. Even between different Blue Cross/Blue Shield health insurance groups organized at the state level in the U.S., there is little standardization of data elements. Electronic sharing of information is difficult. In some hospitals a 24-hour stay is classified as an inpatient episode while other hospitals classify it as outpatient care.
Diverse Population
The growing elderly population is largely the outcome of new technology, public health as well as medical technology, saving lives and postponing death. The introduction of Medicare and Medicaid in 1965 improved access to medical care for the poor and many of the elderly, contributing to life extension past age sixty-five.
This age group uses an uneven share of medical resources. In the elderly group, the social and personal requirements of residents who need some assistance with daily activities and health care are emphasized. Its an important distinction, in that the design of housing, services, activities, employee training, and such is truly customer-centered, or in other words, suited to their age group/population. At present there are many institutions or organizations that are specifically for the elder populations in the United States.
For Americans aged over 65 years and certain disabled persons, the federal government program Medicare pays for the majority of hospital and physician services consumed.
The growth in the number of elderly, coupled with the previously-mentioned large increases in the cost of health care, are making long-term care for the elderly populations very expensive. Although many of the most promising medical innovations will result in better health and longer life for the elderly populations, they will also increase–not decrease—healthcare costs and spending.
Health systems of different countries are struggling to improve the quality of care for an increasingly diverse population. This is very much true for the United States. For those with limited English proficiency and some who even do not know how to speak English, language barriers often result in reduced access to health care services, misdiagnoses, poor quality of care, and compromised medical treatment.
The lack of an interpreter could lead to misdiagnosis and negative health outcomes. The lack of an interpreter could also result in patients not complying with a prescribed treatment regimen. When a health care professional and a patient don’t share the same language, medical treatment can be compromised not to mention frustrating.
Government
Local government is a large portion of the overall health care safety net in the United States, providing direct-care services and funding such items as public hospitals, transportation, educational outreach, and housing subsidies.
As stated at the start of the paper, various government programs have contributed to the rising cost of health care in the US. The social awakening of the 1960s brought the introduction of Medicare and Medicaid as a means to give adequate healthcare to the poor. Its effect on the overall health care system in America was overwhelming. Americans belonging to the low-income brackets can enroll in a state-administered Medicaid program that pays for select healthcare services.
The role of the government in regulating health care providers will be limited to ensuring that providers and payers do not engage in anticompetitive practices and that the safety of consumers and patients is protected. This means that the government tries its best to reduce the healthcare costs at all levels for the consumer’s benefits.
As people go about their daily activities, trying to stay happy and healthy and save a few dollars, they are usually not aware of government intrusion. Suppose that a man gets a headache and goes to the drugstore for some aspirin. The man is making that choice individually, as a private citizen, and buying from a private company.
It seems so simple. Yet this simple transaction could not take place unless a government had already done many things to prepare for the welfare the man and the company. To begin with, government provides a medium of exchange (money) and maintains its value. Not only is the value of money determined by the government, so are the measurements of what the people would buy.
Another thing is that through government policing, a person can depend on the government to keep the local stores from selling to the public anything that could harm or even kill a person when ingested.
Consumer expectations
Almost all healthcare consumers would want to go to the “best” hospital in town, see their own doctor, and have access to the same new medicines. When one falls ill, gets a certain level of medical care, and tells the neighbor about it, the other’s expectations are raised accordingly. Each individual consumer shares a common need for health and a desire for the absence of illness through the demand for health care services and products. This in return affects the healthcare costs.
Since consumers expect so much of healthcare, the healthcare providers are pushed to offering consumers a range of choices. Consumer expectations are fueling demand for health information that they can understand and services that they want. Consumers would want to know what their care options are and what health plans are available to them. By offering consumers a choice of healthcare services and plans, various healthcare organizations encourage the development of price competition among competitors. Price competition among healthcare providers could generate in a cost reduction of a range of healthcare services.
The empowerment of the consumer is perhaps the most exciting and potentially the most threatening of all the developments in healthcare. In a consumer-empowered marketplace, once dominant, name-brand players compete on a level playing field with those with a fresh approach and a strong customer focus. In a consumer-empowered marketplace, information flows freely, facilitating comparisons of quality, value, and price. In a consumer-empowered marketplace, there is less reliance on “experts” to make decisions because consumers have the information to participate actively in those decisions.
Deterioration of Healthcare Work Environments
The deterioration of healthcare work environments is a major problem of concern to the healthcare leaders or managers. It presents a challenge to the American healthcare system. A healthy work environment is necessary to bring about quality healthcare service to the population. An unhealthy work environment would create a devastating impact not only to the healthcare professionals and the clients but most importantly on the effectiveness of the entire healthcare system.
The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) Healthcare professionals are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Healthcare professionals, especially in the case of nurses are assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.
The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for healthcare leaders and the staff as well. For example, when each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – doctors, clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished.
State, federal, and local government accounted for almost half of all health spending in 2002. However, most “government” health care is actually third-party insurance payment to the highly regulated private health care industry composed of independent physicians, hospitals, nursing homes, and so on.
Since health care is one of the primary concerns of people, policies pertaining to healthcare were made to safeguard people from health problems. There are many different health care structures in different countries, like the employer based coverage or the universal coverage. There are more economic concerns when it comes to the universal coverage. In a universal coverage structure, the government gives health care to all the citizens.
Healthcare Education and Training
Skill acquisition is increasingly becoming the responsibility of the worker, although for healthcare professionals it is generally their professional body that determines the appropriateness of education and training. There is a growing acknowledgement of the importance of continuing professional development (CPD) in order that the individual can continue to refine skills and keep up to date with current evidence for practice. CPD must encompass, among many other things, technical skills and attitudes towards patients, staff and the general population.
The healthcare workforce is ageing, particularly in community nursing staff, and there is an increasing proportion of women in the workforce. The differing needs in terms of how training is delivered must be taken into account. Whereas in the past training has needed to cater for people in full-time employment, women frequently require more flexible arrangements, such as career breaks in which to raise a family.
While it is acknowledged that the education and training provided for the development of healthcare professionals is the responsibility of the individual and of the professional body, all education providers must share in the responsibility. That is, issues such as those relating to discrimination, stigma and social exclusion should have been raised within primary and secondary education and this should be clearly defined as part of the national curriculum. One might even suggest that these issues should be raised in pre-school education, and certainly all appropriate opportunities to include such discussions within adult learning environments should be taken.
Management
Management is necessary to make labor and capital productive and requires converting economic principles into rules of behavior that can be clearly communicated to employees, bosses, clients, and other partners. Management is not simple. In management it is people, not things, that have to be managed, and because decisions must be made under uncertainty, based on expectations, without ever really knowing the entire facts one would like to have, it makes it all the more complicated.
Methodology
For this proposal, the authors will employ a combination of qualitative methods. The qualitative methodology that was employed in this research is appropriate since it seeks to interpret or illuminate the actions and/or subjective experiences of the healthcare professionals regarding their experiences in the American healthcare system. This kind of research can utilize the qualitative method.
For the particular study, the participants will be various healthcare professionals from different parts of the country. Basically, how the participants will be selected is only a matter of random.
Before the study will be conducted, an approval to perform the study will be obtained from the ethics committee. The researchers will employ an interview method of data collection in two forms: (1) a questionnaire which will be sent by mail or email (2) a narrative interview through the telephone.
Every participant in the study will be interviewed in the same manner and the data will all be collected in the same way. The timing of when the interviews will take place will also be within one timeframe – e.g. within a span of two weeks. The reason for this is because discrepancies in time could significantly affect the data collected.
Data Analysis
Data analysis employed in the study will be carried out in steps. Every data form (audiotape-recorded or written and transcribed) will be carefully read in order to have an idea of the whole results concept. The text will then be read again and divided into meaningful units as the researchers see fit. Data will be condensed and formed into four syntheses which will be integrated to form the structure of the challenges of the American healthcare system.
Summary, Conclusion and Recommendations
Most early leaders in healthcare management had a vision that stressed the primacy of patient care. The aim of management is to put the interest of the patient first, regardless of race, creed, or ability to pay, and to seek complete health rather than just to cure the ailment at hand. This is a critical moral commitment to the same core value as the caring professions. Any philosophy that puts management values contrary to the caring professions will be corrosively destructive.
Management must establish organizational goals or standards for both the administrative and clinical processes. Managers must begin with a focus on outcomes. The decision of what outcomes to measure determines the type of data that need to be collected and maintained.
For example, outcomes related to administrative activities suggest that the degree of cost efficiency obtained is an important outcome. This means that data on expenditures and revenues by appropriate subcategories need to be available. The development of clinical standards for quality patient care and patient satisfaction outcomes also determine the type of data that should be maintained in the clinical information system.
Managers should plan, coordinate and implement information technologies that can improve quality and efficiency in all processes. For example, an organization should provide on-line medical records and other clinical information at multiple sites, such as laboratory results and imaging.
Measures to evaluate the outcomes of the various processes must be developed. These have implications for the type of data that need to be collected and the design of databases and records. The issue of data quality is particularly crucial because the resulting information is used to make vital decisions. Data entry of patient information must be free of transcription errors. Data must be maintained in order to provide longitudinal performance measures for the various clinical and administrative processes and develop a clear track record against the quality standards that have been set.
If a quality improvement team uses poor data to report outcomes, this provides an excuse for some personnel in the organization to criticize and remain peripheral to the quality improvement process. This is another reason why involvement of all parties is crucial.
Clinicians must be involved in establishing the standards of practice, performance levels and types of data required in their particular areas of expertise. The system can then be instructed to build an appropriate database that can be used to compare actual outcomes with the standards.
Health care settings utilize different management theories. Group theories exist where groups seem effective in the management process. No single team member has any statutory authority over the others, but in the event of irreconcilable disagreements, issues should be referred to an authority. There is a collaborative process in managing health care concerns.
Management needs strong leadership. Effective leadership style is an integral part of creating an environment that nurtures the development of a well managed health care setting. Leadership is defined as a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.
Employees sometimes feel bored and disinterested in their work which calls for the need to motivate them. One big factor in motivating employees is through cash incentives. But, contrary to popular perception, motivation is more internal. The management is responsible for creating an environment in which people can motivate themselves. And this can be done without relying on merit increases, incentives and bonuses.
That is an important concept to understand because few health care setting have had opportunities to promote people internally; many have withheld equity adjustments and even annual merit pool increases because the bottom line has been squeezed so tightly. In this climate, it is important for managers to focus on the top non-monetary motivating factors: open communication, recognition, career development plan and the ability to make a difference at work.
More companies adhere to the philosophy of minimal communication rather than “open book” management. In other words, senior management often assumes that the less the employees know, the better. Even if the senior management adheres to this closed communication style, it is important to practice open book management with the staff. Knowledge is power, and the Internet and library make for free resources of invaluable information.
Sometimes, situations call for a time to shift the responsibility for leadership away from management and toward the employees. One way to do this is to allow each of the employees to run a weekly staff meeting–its structure, delineation of responsibilities to others and follow-up. Placing future leaders into management development roles is probably the most important benefit that management has to offer the people. In addition, management should keep an eye out for other ways to give the employees more responsibility to test their leadership skills. Respect and recognition are two proven ways to retain employees.
The key in retaining employees is to allow all of them a chance to reach their career goals at the health care organization. People are much more inclined to feel like they’re making a positive contribution to the organization if they’re in a learning curve. The health care organization could do this by providing seminars for further learning. The employees should also be given time and allowed to reflect on their careers as well as to reinvent themselves in light of your organization’s changing needs.
There are three main routes to improve performance in the health care setting: (1) prevention, (2) appropriateness of services, and (3) coordination of services. Formal organization and trained management will be essential to all three.
Improving the skills of healthcare managers depends on how six problems are solved. First is to achieve the vision of healthcare as a commitment to the worth of individuals and communities. This goal of providing healthcare that is “safe, effective, patient-centered, timely, efficient, and equitable” demands a new level of management performance. To reach it, management must expand use of quantitative comparison to “best in class” and benchmarking on access, satisfaction, quality, and cost. The transition requires financial support for the development of managerial technology.
The second is to strengthen the recognition of managers’ contribution to the health enterprise. The funding system must reward responsive provider organizations and individuals and encourage others to follow that success .
The third is to attract a fair share of the leading intellectual talent in each cohort, and promote healthcare management as a rewarding professional endeavor. A program to promote healthcare management, expand scholarships, support mentoring and encouragement for young managers, and expand opportunities for under-represented minorities and women will attract talented young people to the field.
The fourth is to develop a formal education program that recognizes both the unique needs of healthcare and the learned skills of management. Organizations should begin specifying learning outcomes, prioritize them in terms of practice needs, and measure learning.
The fifth is to expand and improve continuing professional education. Education beyond the entry degree must be systematically improved by an alliance of large healthcare buyers, provider associations, consulting houses, professional organizations, and universities. An accreditation mechanism should insist on outcomes learning assessment and should coordinate learning opportunities with entry education. Health care organizations should help the management with specific learning goals that are reviewed yearly and a subsidized plan for fulfillment.
Lastly, there is a need to identify health care managers of exceptional potential. There is also a need to develop their skills for the most-senior leadership roles. Few will rise to the most-demanding posts in the largest healthcare organizations. They need a training facility that rivals the best of the large public companies. To attain this, there needs to be collaboration among organizations affecting the health care sector. This would include the government, educational institutions, private insurance companies and the people among others.
Healthcare management can be realistically described as an arena where the need is pressing, the risks are high, the complexity is great, and the monetary rewards are relatively low. A series of conditions are necessary to stimulate change in healthcare and to support managers leading that change.
The critical requirements are (1) broader understanding of goals and the potential. Quantitative comparison, comparison to “best in class,” and benchmarking on the dimensions of success–access, quality, and cost–will improve the governance ability to set goals and the management ability to translate these to achievable targets. (2) Support for the development of information systems, communication devices, and training systems. (3) Revisions to the funding system that reward responsive provider organizations and individuals and encourage others to follow that success. As in the for-profit sector, capital should flow to organizations that meet social goals. The uniformity of funding hampers innovation, reinforces the status quo, promotes individualism rather than teamwork among caregivers, and, in recent years, has left even the best-performing organizations short of capital.
A number of actions should be taken to engender support for change. First, a facilitator should be retained to work within the setting for the analysis and modification of the governance. As part of that process the facilitator will have meetings with all the corporate and institutional boards to discuss changes in the health care organization and to obtain input on the process. Additional feedback from the facilitator will be obtained through a written survey and selective one-on-one interviews with key board members, management, and medical staff leaders. Questions should be designed to solicit views on the need for a change and the issues and concerns that had to be dealt with in effecting governance or management modifications.
The feedback from the survey as well as input obtained from a board retreat will allow the top officials to make better plans for communications and other change management interventions. Data from the surveys will be used as illustrations to validate the problems and the overall need for change within the healthcare setting.
Second, change agents or champions will then be identified. This would provide core support to bring about the change needed by the health care organization.
Managers often fail because they lack skills, which they might have learned under more systematic dissemination of management practice. Major concepts, such as total quality management, are subject to widespread distortion; it is little wonder that many implementations fail. Less-publicized improvements simply are not widely recognized. The innovations of the twenty-first century are likely to be sophisticated structures and processes, which managers must study before they can implement.
The tools of health care management includes continuous quality improvement, “balanced scorecard” measures of performance throughout the organization, empowerment of workers, new approaches to collaboration across traditional lines, improved use of outsourcing, supply chain management, and strategic partnerships with outside organizations – all these constitute a revolution in management practice.
Willingness to accept change, focus on customers, and reliance on data have replaced old attitudes of inflexibility, introspection, and personal authority. This is the transition that supported the 1990s’ economic boom, and this is the transition that the healthcare industry is struggling to make. Faced with a rapidly changing healthcare environment, there is often a need to change how health care providers practice medicine. Yet change is difficult, and the process needs strong management.
The lack of leadership skills is one major factor. In order to solve this problem, focus should be given to the nursing leaders and managers. Leadership training programs should be offered and nursing managers and leaders should be required to attend. These managers and leaders in turn should perform their responsibilities of teaching and guiding the rest of the staff in promoting a healthy work environment.
With the particular problem concerning the deterioration of the work environment, a change is needed. This change would include on a large scale the leadership and management styles within the work environment. Aside from that, there should also be empowerment for all the parties involved in the work environment. Healthcare organizations must empower their staff to deliver patient-focused care. Empowerment is defined as “moving decision making down to the lowest level where competent decisions can be made”.
This kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that healthcare staff be prepared to accept and effectively use expanded decision-making responsibilities. To start changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.
Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered healthcare staff, defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.”
The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment .
The professional accountabilities of the empowered healthcare professional includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, healthcare professionals need mentoring, education, awareness of political activism opportunities, and networking skills.
In order to achieve all these, shared leadership should be employed. In the field of nursing, shared leadership supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment. As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration.
Shared leadership is a collaborative team process in which team members share key leadership roles. Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients.
Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other.
Aside from shared leadership, the transformational leadership theory can be employed to help face the challenges ahead. The transformational healthcare leader typically inspires followers to do more than originally expected. Transformational leadership theories predict followers’ emotional attachment to the leader and emotional and motivational arousal of followers as a consequence of the leader’s behavior. Transformational leaders broaden and elevate the interests of followers, generate awareness and acceptance among the followers of the purposes and mission of the group and motivate followers to go beyond their self-interests for the good of the group.
The demands of the health care environment have brought about changes that have not always contributed to positive work environments, and healthcare professionals have been concerned about the impact this has had on patient care and the entire healthcare quality in general. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations.
To address all these issues, healthcare professionals need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses.
Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of healthcare workers. Simply put, collaborative work relationships should be actively enhanced and promoted in order to create a positive work environment.
In an increasingly technological healthcare world, it is therefore apparent that in order to respond to the ever-changing and increasing diversity of skills required to participate effectively in a highly technological healthcare system, mechanisms for continuing skills acquisition are a necessity. Yet it is not solely technical skills that are required. It is becoming increasingly important for healthcare staff to provide more holistic care which requires staff from differing professions to work effectively within a multidisciplinary team. These teams may be ward, acute care or primary care based, and may also require working across areas and with other voluntary and statutory organizations.
It is increasingly recognized that formal preparation is necessary for healthcare staff so as to ensure true teamwork. We are moving away from the traditional, didactic teaching methods (e.g. lectures) to more student-centered enquiry or problem-based learning methods. These alternative approaches not only develop problem-solving skills and enhance critical thinking, but they may also provide a forum for the frank discussion of issues relating to deviance, difference and dilemmas in healthcare.
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