Leadership developments in nursing home settings

Leadership developments in
nursing home settings:
A person-centred
Situational Leadership
Core skills of a Situational Leader are diagnosis,
flexibility and partnering for performance
Not one style works in all situations
Four sets of leadership behaviours that result from
combining high and low supporting behaviours
(such as listening, providing feedback and
encouraging) with high and low directing
behaviours (‘task-related behaviours’ like
demonstrating, instructing and monitoring)
(Hersey & Blanchard, 1982)
“An approach to practice established through the
formation and fostering of therapeutic
relationships between all care providers, older
people and others significant to them in their lives.
It is underpinned by values of respect for persons,
individual right to self determination, mutual
respect and understanding. It is enabled by
cultures of empowerment that foster continuous
approaches to practice development”
(McCormack and McCance, 2010, p31)
The Person-Centred
Nursing Framework
Comprises four constructs:
1. Prerequisites which focus on the attributes of the
2. The care environment which focuses on the
context in which care is delivered
3. Person-centred processes which focus on
delivering care through a range of activities that
operationalise person-centred nursing
4. Expected outcomes which are the results of
effective person-centred nursing.
(McCormack and McCance, 2006, 2010)
Hypothesis 1
A situational leader enables the follower to articulate the
developmental level that makes it possible for them to function
effectively in the care environment
Hypothesis 2
The development of the follower, brought about by the
situational leader, enables the delivery of more effective
person-centred care.
Hypothesis 3
Improvement in the follower’s delivery of person-centred care
triggers a change in the leadership style of the situational
Study uses an action research approach
The interrelated cycles of action research that involve
planning, acting, observing and reflecting are shaped by the
study’s three actionable hypotheses.
Articulating the components of the
Leadership Programme
Nature of WCCAT is that it starts creating spirals -general action
Pin-point where my ‘leadership intervention’ will take place –
through - 1:1 facilitated critical reflection. coaching, individual
Moving from general observation sessions (looking at the
leaders changing practice) to observing the individual leader
(focusing on the leader’s behaviour)
Based on the observations - identification of the key components
that are derived from the S.L. framework which will be covered
with the individual leaders
At various points – reach Time 2 data –collect LPI’s and
interviews to see what’s happening in all of the cycles and
identify connections.
Action Cycles
Situational Leadership; Feedback from LPI
questionnaire & Articulating own leadership
style (both facilitator & leader)
Observation of practice: - Residents’ dining
experience; Getting up & settling down; daily
social activities
Follower articulates PCP & communicates
main concepts of PCP to team
Leader observes & and engages in critical
dialogue with follower
Action Cycles
Leader works on establishing quality of
communication between follower, individual
team members and overall team in general
Re-evaluates/diagnoses follower’s
developmental level and uses mainly
directing/coaching style to improve
Leader partners follower in her performance
e.g. establishing House Values with the team
Action Cycles
Leader decides with follower on a schedule of
regular meetings where critical dialogue and
reflection take place
Leader embarks on self-directed learning to
gain insight into more effective teamwork
Monthly Team meetings are established in
each House and these ‘feed’ into monthly
Leadership meetings which in turn ‘feed’ into
newly established Clinical governance
meetings: cyclical process
Components of Evolving Leadership Programme
Building team
Empowering the team
Clarifying House
Articulating PCP
Articulating own dev.
WCCAT Observations; LPI questionnaires; Interviews; Reflective field notes
Data Analysis
Actual WCCAT observations, reflective field notes
on leader interventions and map of cycles
Feedback from the LPI
Interview data analysed – framework linking it into
action plans for improving the quality of
care/practice and developing the person-centred
(Hsu & McCormack, 2006)
Data Analysis (continued)
Focus Group interview data analysed hermeneutic analysis/theme development &
metaphor construction in order to derive
overarching constructs that best represent the
views of key stakeholder
Outcomes Framework (McCormack & McCance
2010) to capture the person-centred outcomes
Thank you

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