Maintaining Standard of Care with Reduced Resources through

Maintaining Standard of Care with Reduced Resources through Transformational Leadership #607 2009 ANCC National Magnet Conference™ Friday, October 2, 2009 10: 15 – 11: 15 am Julee Bolg, MS, MBA, RN, NE-BC Robert Wood Johnson Executive Nurse Fellow Danny van Leeuwen, MPH, RN, CPHQ Children’s Hospital Boston, MA Nursing at Children’s Hospital Boston

Guiding Question How can you use Transformational Leadership to maximize your leadership abilities? Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

OBJECTIVES 1. Recognize and articulate the key components of Transformational Leadership. 2. Understand how Transformational Leadership can contribute to the successful management of changing resources while maintaining standard of care. Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

History • Burns 1978 used Transformational Leadership to describe political leaders – “Leaders and followers make each other advance to a higher level of morale and motivation” – Transformational v. Transactional • Bass (1985) – The extent to which a leader is transformational, is measured first, in terms of influence on the followers – The leader transform and motivate followers by charisma, intellectual arousal and individual consideration. Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Definitions A leadership style focused on effecting revolutionary change in organizations through a commitment to the organization’s vision (Sullivan & Decker, 2001) Transformational leaders have the ability to clearly articulate a vision of the future… They are the myth-makers, the storytellers They capture our imagination with the vivid descriptions of the wonderful future we will build together (Trofino, 1992) Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Reduced Resources • Turbulent Times – Financial Hardship – Fundamental Changes in Healthcare – Risks and Opportunities • Leadership in Permanent Crisis – Emergency Phase • Apply current mechanisms to stabilize and buy time – Adaptive Phase • Understand • Experiment • Innovate Nursing at Children’s Hospital Boston

Children’s Hospital Network Tertiary & Quaternary Care Children’s Hospital Physicians at Beverly Hospital Primary Care Network PPOC, HVMA, Urban CHC, etc. CHILDREN’S HOSPITAL NETWORK Provides primary, secondary & some tertiary care Martha Eliot Health Center + Urban Health Network Centers Children’s Hospital Physicians at Caritas Good Samaritan Hospital Children’s Hospital Physicians at Winchester Hospital Children’s Hospital Physicians at Caritas Norwood Hospital Children’s Hospital Boston at Peabody Children’s Hospital Boston at Lexington Children’s Hospital Boston at Waltham Outpatient specialty centers owned by CHB Urban Center managed by CHB Nursing at Children’s Hospital Boston Children’s Hospital Physicians at South Shore Hospital Services may include emergency medicine, inpatient, newborn medicine and other pediatric services

Case Study • • CNO Vision Linking Satellites to Mothership Building New Model Hospital within Hospital Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

CNO Vision Leadership Strategy Satellite Strategy • Decentralized • Flexible • Partnerships with other leaders • Develop staff • Establish context • Perceived as part of the solution • Onsite nursing leadership • Partner with Chief Administrative Officer • Sit at table with mothership nursing leadership • Maintain brand & standard of care Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Linking Satellites to Mothership • • • Lexington and Peabody History Leadership Challenge Staff and Physician Buy-in Enhanced Resources Success Measures Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Building New Model • Waltham History • Leveraging Resources and Expertise • Building in flexibility for shifting volumes and acuity • Physician Leadership Group • Code Team Development Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Hospital within a Hospital • • Key strategic initiative Partnering with a community hospital Leveraging combined resources Administrative, medical, and nursing leadership collaboration • Specialty standards within a community hospital Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Why Satellites? • • • Value Add Shop Creative New Models of Care Flexibility in Response to Healthcare Reform Academic Specialties to Community Patient and Family Satisfaction Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Transformational Leadership Journey Who - All Leaders including Nurse Managers Experience - Can Be Learned Map/Guideposts – Recognizes Success Pace – Variable, Work in Progress Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

The Making of Transformational Leaders • Self-knowledge – Search for opportunities to change/ grow – Develop professionally • Strategic Vision – Share uplifting vision – Commit • Interpersonal and Communication Effectiveness – – – Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved. Join and engage Inform & share power Update and give feedback continuously

The Making of Transformational Leaders • Inspire and Lead Change – Individualize projects – Clarify responsibility & accountability – Involve team – Celebrate achievements • Take Risks / Be Creative – Experiment – Trust Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Elements of Trust • Commitment • Familiarity • Integrity • Consistency • Communication Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Recognizing Success-Quantitative • • Nurse Sensitive Measures (NDNQI) Employee Retention/Satisfaction Patient Satisfaction Magnet Designation Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Recognizing Success-Qualitative • • • Effective use of Chain of Command Professional Advancement Ownership at Unit Level Fewer Crises Magnet Designation Nursing at Children’s Hospital Boston

Conclusion • This works for us! • We feel prepared • Tell us about your experience Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Resources • • Bass, B. M. (1985). Leadership and performance beyond expectation. New York: Free Press Burns, J. M. (1978). Leadership. N. Y. : Harper and Row Publishers. Christenson, C. , Grossman, J. , Hwang, J. (2008). The Innovators Prescription: A Disruptive Solution for Healthcare. Mc. Graw Hill; 1 st edition. Mc. Guire, E. and Kennerly, S. (2006). Nurse Managers as Transformational and Transactional Leaders. Nursing Economics, July-August; Vol. 24 (pp. 179 -185) Sullivan, E. J. and Decker, P. J. (2001). Effective Leadership and Management in Nursing (5 th Ed. ). Upper Saddle River, NJ: Prentice Hall. Trofino, J. (1992). Transformational Leadership. Nurs Adm Q Fall; 17(1) viviii. Winning in Turbulence—Memo to CEO Series (July 2009). Harvard Business Idea. Cast RSS Feed. Leadership in a (Permanent) Crisis. Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.

Julee Bolg, MS, MBA, RN, NE-BC Robert Wood Johnson Executive Nurse Fellow Children’s Hospital Boston julee. bolg@childrens. harvard. edu (781) 216 -2288 Danny van Leeuwen, RN, MPH, CPHQ Children’s Hospital Boston daniel. vanleeuwen@childrens. harvard. edu (857) 218 -4617 Nursing at Children’s Hospital Boston © Children’s Hospital Boston, . All rights reserved.