Boundary Spanning Leadership in Response to the COVID-19 Pandemic: Experience of Nurse Leaders in a Large Integrated Long-term Health Care System.

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post-acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership-buffering, reflecting, connecting, mobilizing, weaving, and transforming-that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non-acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.

Hospital-Level Cardiovascular Management Practices in Kerala, India.

Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.

Developing Governance Structures in Health Care System Consolidation: A Framework for Nurse Leaders.

Given the acceleration and increasing complexity of integrative care models across health systems, the question how governance and management structure(s) should be operationalized and evolved to achieve peak system performance is paramount. In a recent evaluation of partnerships with the University of Kentucky HealthCare (UK HealthCare), the conceptualization of the integration management model was explored. It was recognized that nursing leadership, governance structure, and relationships are vital for successful movement and migration of appropriate care models. In this case, the evolving governance models and the forecasted impact on models of care delivery were carefully considered. This included the potential impact on nursing practice. As the model was developed, a conceptual framework was utilized to examine potential variant relationship arrangements and to provide organization to key constructs. Utilization of a blueprint to optimize decision making and provide a replicable approach was essential to management of the integration philosophy.

Gestión de recursos humanos por competencias / Human resources management based on competencies

Vivimos una época de cambios en los que las organizaciones sanitarias se enfrentan a nuevos retos. Entre ellos está el reconocer el talento que hay en ellas, para potenciarlo, desarrollarlo y retenerlo. La gestión de recursos humanos por competencias se perfila como una herramienta que contribuye a alcanzar este objetivo. Competencias desde su perspectiva de cualidad o genéricas: rasgos de personalidad, valores y motivaciones, que están profundamente arraigadas en la persona. Mediante la elaboración de un mapa de competencias para la organización y la identificación del perfil de competencias de los puestos, sobre todo los puestos clave, los empleados conocen qué se espera de ellos; posteriormente, a través de la evaluación de competencias, se detectan las necesidades de formación y aprendizaje y, una vez cubiertas, se consigue una mejor adecuación persona-puesto. Un puesto clave en las organizaciones sanitarias es el de jefa de unidad de enfermería, nexo de unión entre el equipo directivo y los profesionales; la forma en que se desempeñe va a repercutir en la calidad de los cuidados proporcionados y en la motivación de su equipo de trabajo. Así, la persona más adecuada para ocupar este puesto es aquella que, además de conocimientos, tiene habilidades, actitudes e intereses compatibles con su función. La gestión por competencias facilita la identificación tanto del potencial como de las necesidades de aprendizaje para desempeñar este puesto (AU)

We are living in a time with a lot of changes in which health organizations have more challenges to face. One of them is to recognize, strengthen, develop and retain the talent they have. Competency-based human resources management is emerging as a tool that contributes to achieve that aim. Competencies from the generic or characteristic perspective: personality traits, values and motivations, which are deeply rooted in the person. Through elaborating a competencies map for the organization, and identifying the job competencies profile, above all in key jobs, the employees know what it is going to expect from them. After, detect and cover the learning needs, it is possible to achieve better adjust between worker-job. The nursing unit manager is a key job because it is a link between management team and nursing team. The way that it is performed, it will have impact on the quality of care and its team motivation. So, the most adequate person who covers this job would have a part of knowledge, skills, attitudes and compatible interests with her job. Competency-based management helps identify both the potential and learning needs to performing this job (AU)

Boundary Spanning Leadership Practices for Population Health.

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. In this article, the authors discuss boundary spanning leadership practices for achieving the Triple Aim of simultaneously improving the health of populations, improving the patient experience, and reducing per-capita cost of health care. Drawing on experience with an existing population-focused heart failure clinic borne of an academic-practice partnership, the authors discuss boundary spanning leadership practices aimed at achieving the Triple Aim concept and its intended design.

Development of a hospital-based integrative healthcare program.

Public demand for complementary and alternative medicine (CAM) therapies, often referred to as integrative health (IH), continues to grow. Health systems are now pursing the integration of these therapies with conventional medical care. This article describes the development and evolution of 1 nursing-led model for the integration of CAM services in an inpatient setting and to provide lessons learned for nursing administrators or others interested in developing hospital-based IH programs.

Reflections on strategic nurse leadership.

This paper sets out some personal reflections by the Chief Nursing Officer for Wales on the challenges facing nurses and midwives as they undertake strategic leadership roles in NHS organisations. The paper looks at the national approach taken in Wales where behavioural competencies for executive nurse directors have been implemented. It considers the implications of the breadth of responsibilities executive nurse directors have and the importance of developing and supporting middle grade nurse managers and clinical directors. It concludes by looking at who is responsible for care within an organisation.

What is strategic management?

AIM: To discuss the theoretical concept of strategic management and explore its relevance for healthcare organisations and nursing management. BACKGROUND: Despite being a relatively new approach, the growth of strategic management within organisations has been consistently and increasingly promoted. However, comprehensive definitions are scarce and commonalities of interpretation are limited. METHOD: This paper presents an exploratory discussion of the construct of strategic management, drawing on the literature and questioning its relevance within health-care organisations. EVALUATION: Literature relating to strategic management across a number of fields was accessed, drawing primarily on meta-studies within management literature, to identify key concepts and attempt to present a consistent definition. The concept within health care is explored in relation to nursing management. CONCLUSIONS: Inconsistency in definitions and utilisation of key concepts within this management approach results in the term being loosely applied in health-care organisations without recourse to foundational principles and a deep understanding of the approach as a theory as opposed to an applied term. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are increasingly asked to adopt the 'next-best-thing' in managerial theories, yet caution needs to be taken in nurses agreeing to use systems that lack an evidence base in terms of both efficacy and relevance of context.

An integrated system's nursing shared governance model: a system chief nursing officer's synergistic vehicle for leading a complex health care system.

Seton Nursing reengineered previous models of care and leadership to accommodate rapid growth of its health care system from individual acute care sites to a health care system with consistent quality and standardization of like units across the system. Shared governance promotes collaboration with shared decision making and accountability; however, the role and methods of a system chief nursing officer to connect shared governance across a new system has not been previously described. A system chief nursing officer can significantly influence and guide the nursing strategic direction at all the health care system-related facilities by utilizing a single, systemwide nursing shared governance structure. Using this structure provides a venue to maximize the influence of a transformational leader and creates efficiencies in workforce development, resource management, best practice identification, and spread of initiatives and improvements to adapt to an ever-changing health care landscape. This is the story of one such system chief nursing officer.

Factors of human capital related to project success in health care work units.

AIM: To explore factors of human capital related to project success that employees expect from nurse managers. BACKGROUND: Human capital refers to those resources that managers working with projects possess, such as abilities, knowledge and qualities of character. METHOD: The data were collected by open interviews (n=14) with nurses, public health nurses and nurse managers working in primary health care and a hospital. Data analysis was carried out using qualitative content analysis. RESULTS: The main factors of human capital related to project success proved to be as follows: (1) management of enthusiastic project culture, (2) management of regeneration and (3) management of emotional intelligence. CONCLUSIONS: Future research is needed on the kind of means nurse managers use in human capital management in projects and how they see their possibilities in managing human capital. IMPLICATIONS FOR NURSING MANAGEMENT: Human capital management skills should be underlined as an important competence area when recruiting a nurse manager. The success of health care projects cannot be improved only through education or by training of nurse managers; in addition, projects need nurse managers who understand workplace spirituality and have high emotional intelligence.