Marshall 0528 Mech.qxd 7/26/10 3:51 PM Page 1 Marshall TRANSFORMATIONAL LEADERSHIP IN NURSING Elaine Sorensen Marshall TR ANSFORMATI From Expert Clinician to Influential Leader TRANSFORMATIONAL Elaine Sorensen Marshall, PhD, RN he ultimate goal for Doctor of Nursing Practice (DNP) leaders is to develop skills LEADERSHIP that will support their ability to lead effectively through complex challenges— ON IN such as working within the constraints of tight budgets, initiating health care Tpolicy change to eliminate health disparities, and improving health care outcomes at all levels of care. AL This text is an invaluable instructional guide for nursing graduate students who are LEA developing the skills needed to fulfill this new and emerging role of clinical leadership. NURSING With this book, nurses can develop leadership skills that will ultimately transform health DERS care practice by incorporating innovative professional models of care. It provides critical information and practical tools to enhance leadership, drawing from the works of experts in business and health care leadership. This book is an important resource for DNP students, nurse practitioners, and current clinical leaders dealing with the challenges of health care HIP for the next generation. IN KEY TOPICS: NU • Cultivating the characteristics of a transformational leader: charisma, innovation, RS inspiration, intellect, and more • Developing the role of the DNP within complex organizational systems ING • Incorporating new care delivery, practice, and management models through leadership • Navigating power, politics, and policy: building the team, understanding economics and finance, and more From Expert Clinician to Influential Leader 11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com TRANSFORMATIONAL LEADERSHIP IN NURSING Elaine Sorensen Marshall, PhD, RN, is currently professor and Bulloch Healthcare Foundation Endowed Chair at the School of Nursing at Georgia Southern University. She served as dean of the College of Nursing at Brigham Young University and as a member of the Board of Trustees of Intermountain Healthcare in Utah. She has served in national elected and appointed leadership positions for the American Association of Colleges of Nursing (AACN), the American Association for the History of Nursing (AAHN), and the Western Institute of Nursing. She has published two books and more than 50 professional and public articles and book chapters. Her work has been noted by the New Professional Book Award from the National Council on Family Relations, the Lavinia Dock Award from the American Association for the History of Nursing, and the Jo Eleanor Elliott Leadership Award from the Western Institute of Nursing. TRANSFORMATIONAL LEADERSHIP IN NURSING From Expert Clinician to Influential Leader Elaine Sorensen Marshall, RN, PhD Copyright © 2011 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923; 978-750-8400; fax 978-646-8600; [email protected]; or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Margaret Zuccarini Project Editor: Peter Rocheleau Project Manager: Amor Nanas Cover Design: Mimi Flow Composition: The Manila Typesetting Company ISBN: 978-0-8261-0528-8 E-book ISBN: 978-0-8261-0529-5 10 11 12 13/ 5 4 3 2 1 The author and the publisher of this work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of pub- lication. Because medical science is continually advancing, our knowledge base continues to expand. There- fore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Transformational leadership in nursing : from expert clinician to influential leader/Elaine Sorensen Marshall. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-0528-8 — ISBN 978-0-8261-0529-5 (e-book) 1. Nurse administrators. 2. Leadership. I. Marshall, Elaine S. [DNLM: 1. Nurse Administrators. 2. Leadership. 3. Nursing, Supervisory. WY 105 T7723 2010] RT89.T733 2010 362.17’3068--dc22 2010026128 ______________________________________________________ Printed in the United States of America by Bang Printing The true professional is one Who does not obscure grace With illusions of technical prowess, The true professional is one Who strips away all illusions to reveal A reliable truth in which The human heart can rest. Margaret Wheatley Contents Foreword ix Preface xi Acknowledgments xiii PART I: BECOMING THE TRANSFORMATIONAL LEADER 1. Expert Clinician to Transformational Leader in a Complex Healthcare Organization 1 2. Characteristics of a Transformational Leader 27 3. Cultivating the Habits of a Transformational Leader 51 PART II: CONTEXTS FOR TRANSFORMATIONAL LEADERSHIP 4. Understanding Contexts for Transformational Leadership 79 5. Leading Among Leaders 101 6. Current Challenges in Health Care: The Role of the Leader 127 PART III: DESIGNING NEW CARE DELIVERY MODELS 7. Practice Design and Management 155 8. Culture and Practice Environments 181 PART IV: POWER, POLITICS, AND POLICY 9. Building the Team 201 10. Economics and Finance 225 11. Fluency in the System 245 Appendix: Classic Books for the Library of the Transformational Leader 263 Index 271 vii Foreword What would you do in the next three to five years if you absolutely know that you can- not fail? If you cannot answer that question spontaneously, you have probably let your dreams sit on the back burner for way too long. Throughout my career journey, I have had the privilege of assuming multiple leadership roles in healthcare systems, profes- sional organizations, and academia. In those roles as well as through reading the biog- raphies of many leaders who have made a phenomenal impact in the world, one of the most important things I have learned is that to be a transformational leader, you need to have a big dream or vision for what you want to accomplish and an ability to inspire that vision in others. Any successful initiative needs to begin with the end or dream in mind. However, there are far too many leaders who do not realize the importance of the team vision or dream and, instead, are overly focused on processes instead of outcomes. These types of extreme “process-driven” leaders have a challenging time keeping people mo- tivated, especially when the going gets tough. Although process is important, it should never be the main driving force in realizing a vision. When individuals are inspired with a common vision by a transformational leader, they are intrinsically motivated to accomplish that vision instead of satisfied with the status quo. Transformational leaders recognize that a clear consistent focus on the vision by the team and an ability to keep the dream bigger than any fears are a key ingredient to success, especially when the journey gets tough or “character-building.” However, having a dream and inspiring it in others is not enough by itself. Transformational lead- ers must believe in their abilities to accomplish their dreams and enhance that belief in others. They also must provide ongoing support and encouragement to others through- out the journey. Transformational leaders are innovators, positive deviants, and “movers and shak- ers.” They typically see things before others, use creative strategies to problem-solve challenges, and are not afraid to take risks in order to accomplish their dreams. These types of leaders also have the ability to anticipate and overcome barriers as well as mobilize resources and people to accomplish the vision. They are comfortable with un- certainty and thrive on change. Transformational leaders also have high integrity; their followers trust them, and they invest in the people on their team, especially through mentorship and encouragement. They strive for continuous quality improvement by using and generating evidence to inform best practice and organizational policies as well as use evidence to influence health policy. Finally and very importantly, trans- formational leaders persist through the “character-builders” until their dreams are realized in contrast to many individuals who give up on their dreams, right before they would have come to fruition. Transformational leaders go from one failure to the next with enthusiasm, knowing that they are one step closer to the realization of their dreams. ix x Foreword With so many daunting challenges in the current healthcare system,