The Decision Making Strategies of Modern Matrons

` The Decision Making Strategies of Modern Matrons ELAINE McNICHOL A thesis submitted in partial fulfillment of the requirements of the University of Northumbria at Newcastle for the degree of Professional Doctorate in Healthcare Research undertaken in an NHS Trust in the North of England September 2010 Contents Sections Content Page Number Contents list 2 Abstract 6 Chapter One Introduction 8 Introduction to the Role of the Modern Matron 8 study De-centralised Decision Making 11 Decision Making in Healthcare 12 Researcher Motivation 13 Focus and Aims of Study 14 Chapter Two Introduction 17 Literature Review Existing research on the role of the Modern Matron 19 Decision Making in healthcare 28 Decision making and leadership 32 Leadership Theory and Decision Making 33 De-centralised decision making 36 Power 39 Empowerment and decision making 47 Authority 48 Credibility 51 General Decision Making Literature 52 Heuristics 53 Decision making frameworks and models 57 Conscious Competence Learning Model 64 Reflection and decision making 65 2 Section Content Page Chapter Three Paradigm decision 69 Study Methods Phenomenology 70 Hermeneutic Circle 72 Study Design 76 Data Collection Method 79 Data Analysis 82 Analysis Framework 83 Chapter Four Introduction 97 Data Analysis Stage One Analysis – Emergent themes 99 Stage Two –Analysis - Emergent themes 104 Outcomes of stage 1 & 2 analysis 113 Final six themes from analysis 114 Chapter Five Question One – The Decision Making Approaches of 118 Findings Modern Matrons Question Two – Factors that help or hinder decision making 136 Key Findings 153 Chapter Six Decision Making Approaches 155 Discussion Factors that help or hinder MM decision making 173 Conclusions 202 Framework for Leadership and Management Decision 204 Making Appendices Appendix One Search Strategy 232 Appendix Two – Study Information Leaflet 235 Appendix Three – Consent Form 239 Appendix Four – Interview Schedule 240 3 Appendix Five – Schematic Account of Analysis Process 241 Appendix Six – Mind Maps and Field Notes for each 245 Modern Matron Appendix Seven – Final Themes and Supporting Transcript Data 273 Appendix Eight – Transcribed scenarios used in thesis 276 Appendix Nine – Modern Matron demographic 279 information List of Tables No. of Table Title Page 1 Areas contained in literature review 18 2 Defining de-centralised decision making 37 3 Framework of intuitive decision making 59 4 Framework of rational decision making 61 5 Emergent themes 99 6 Summary of themes circled by Modern Matrons 106 7 Notes from second interview with MM 1 110 8 Summary of theme descriptors 110 9 Range of decision making strategies identified by the Modern 122 Matrons 10 Mapping out decision making strategies 130 11 Application of a rational decision making framework to 160 uniform scenario 4 List of Figures No: Title Page No. 1 Cognitive Continuum Theory – six modes of practice 31 2 Position Power 42 3 Personal Power 44 4 Levels of authority 50 5 Conscious Competence Learning Model 64 6 Hermeneutic circle as a method of interpretation 73 7 Hermeneutic circle as a philosophy 74 8 Mind Map from Modern Matron 1 109 9 Conscious Competence model 168 10 Integrating cognitive continuum theory and conscious competence 170 model 11 Position and personal power 176 12 Understanding and awareness 200 13 Framework for leadership and management decision making 204 5 Abstract Modern Matrons are at the vanguard of both care delivery and the NHS reforms and have an important role in the modernisation of, and future delivery of healthcare. An important contextual feature of their role and a concept that has been widely embraced by the National Health Service, is that of decentralized decision making. Unlike clinical decision making which has been extensively studied, there is little in the healthcare literature regarding leadership and management decision making or the concept of decentralised decision making. In order to maximise the effectiveness of the Modern Matron role, it is important that we gain a thorough understanding of how they make leadership and management decisions, the reality of the term decentralized decision making for them and an insight into their abilities and needs in regards to this essential skill. This study explores how Modern Matrons take leadership and management decisions, with a particular focus on the strategies they use and the factors that help or hinder them. This is an interpretive case study that has adopted an inductive approach to elicit the lived experience of decision making of a group of Modern Matrons working within an acute NHS Hospital Trust. The data was generated through two sets of 1:1 semi- structured interviews. The emergent themes were presented back to the participants for comment and prioritization and to then describe in more depth what the themes meant to them. This process of co-construction facilitated an evolving understanding of the data between the researcher and the study participants. The findings of this study clearly show the importance of the interplay between individual and organisational characteristics in regard to a Modern Matron’s approach to leadership and management decision making. Specifically a Modern Matron’s level and range of power bases, the authority that they hold and the credibility with which they are viewed are essential pre-cursors to the range of decision making strategies that they can then employ. These factors are then strengthened or weakened by the level of 6 active reflection engaged in by the Modern Matron and the structures and processes an organisation puts in place to support both the role of the Modern Matron and the establishment of a culture of empowerment and decentralised decision making A framework of decision making is proposed that could be used to underpin a structured approach to developing and informing both a Modern Matron’s and an organisation’s understanding of what factors and strategies support effective decentralised decision making. 7 Chapter One - Introduction to The Study Introduction This study examines the leadership and management decision making behavior of Modern Matrons (MM) within one acute hospital trust in the north of England. The role of the MM is relatively new and was introduced in 2000 within a short time frame and a political framework that was looking in part to address public confidence in the National Health Service (NHS) (Scott et al.,2005,22). This was in conjunction with a professional drive for leadership development and a combined political and professional emphasis on de-centralised decision making. Central to the success of both of these drivers is the leadership and management decision making knowledge and skill of MMs. Whilst there have been national initiatives to foster a culture of de-centralised decision making and to develop nurses’ leadership skills, none of these initiatives have explicitly addressed the theory and practice of decision making. These constituent themes set the focus of this study. This chapter provides a preliminary introduction into the key literature and emerging themes that under-pinned the development of the research question, including: the role of the MM; de-centralised decision making; decision making in healthcare and my motivation for undertaking the study. It culminates with an explanation of why this insight is required and how this study will add something new to the existing body of research. 1.1 The role of the Modern Matron The notion of a MM first became formalised in the NHS Plan (Department of Health 2000), where the government clearly stated its intentions to introduce "a strong clinical leader with clear authority at ward level" (para 9.21). Nurses appointed to MM posts were to be: Respected professionals and experienced clinical managers People who took a pride in the NHS People who had a reputation for setting and delivering high standards of care 8 People who had the skills to enable them to lead by example and motivate and empower others They were to be "given authority to resolve clinical issues, such as discharge delays and environmental problems such as poor cleanliness"(para 9.21). Alongside this they would "be in control of the necessary resources to sort out the fundamentals of care, backed up by appropriate administrative support"(para 9.21). Ten key responsibilities were identified as being core to the MM role: 1. Leading by example 2. Making sure patients get quality care 3. Ensuring staffing is appropriate to patient need 4. Empowering nurses to take on a wider range of clinical tasks 5. Improving hospital cleanliness 6. Ensuring patients nutritional needs are met 7. Improving wards for patients 8. Making sure patients are treated with respect 9. Preventing hospital-acquired infection 10. Resolving problems for patients and their relatives by building closer relationships To help facilitate the above, the government produced a Health Service Circular (HSC 2001/010 p.2) which set out "the principles to which NHS organisations should attend to when establishing matron posts." It identified a number of strategies required to introduce the role successfully. In particular, that the "personal, professional responsibility and accountability [of MMs] is matched by organisational structures and arrangements that support and enable them to exercise the authority they need to do this effectively" (HSC 2001/010 p.4). This circular recognises the importance of a robust infrastructure to enable MMs to provide strong leadership, be a positive interface between the patients and enable prompt and appropriate decision making to facilitate 9 high quality care. The circular does not, however, describe what some of those organisational structures and arrangements might look like. It could be argued that it was implicit given the wider healthcare context and emphasis on de-centralised decision making and empowerment. However, it might have been useful to have re-stated those arrangements that the government would have considered to be a priority. Evaluation of the role of the MM is inevitably in its infancy due to the newness of the role itself.

Load more