The world today is changing and being affected by advances in technology, and communication, as well as changes in the political, economic, demographic, and social environment. These changes also affect the delivery of health care services as well as changing of patient’s expectation toward health care system. Traditional task- orientated, routine and habitual nursing management style is no longer able to meet the ever changing health care system. Therefore, it is crucial for present health care worker especially Assistant Medical Officers (AMO’s) to integrate leadership in health care management to meet the needs of contemporary professional practice and consumers’ requirements and expectations (Sofarelli & Brown, 1998). The changing of mindset from bureaucratic management to effective leadership becomes more popular and acceptable in the health care system in Malaysia.
I am Assistant Medical Officer (AMO’s) who is currently working in Out Patient Department in one of the government hospitals in the central region of Malaysia. My department caters to about thousand patients daily. Patients come to the department with several problems. Therefore it is essential for all staff especially AMO’s should endeavor to equip themselves with current knowledge and skills.
I was appointed by my Head of Department to become a committee member in the training as well as an instructor at my department level. My task is to train and facilitate my department’s staff to update and upgrade their knowledge and skills. As an Instructor, I have to facilitate personnel and professional development that encourage reflections, identifying gaps in knowledge and skills also providing structured feedback to enable the all staff more so newly posted staff develop and expand their practice safely and confidently to improve standard of care. Instructors also do play role of leaders by generating student motivation and providing support, and influence staff by using their practice area as practical arena conducive to learning objective. By effectively managing this aspect of a classroom’s culture, it can increase both student and teacher motivation and indirectly impact learning gains. According to Orton (1981), the role of ward manager is not only do they have control of management of the area, but also serve as role model for nursing practice. The leadership style and personality of the ward manager are important determinants of an effective learning environment.
In this paper I will explore the leadership theories and management in which influence staff toward lifelong learning and their own professional development and I also shall use these ideas into my clinical practice. I shall also draw conclusions and recommendations for future practice.
Marquis and Huston (2003) stated leadership is a process of empowering belief, moving, persuading and influencing others toward a goal mostly without any force or threat. Leadership also can define as an interactive process directed toward mutual goal achievements between leader and followers. Leadership emphasizes goal achievement and change, occurs in any setting and is not tied to a specific organization (Manfredi, 1994). Meanwhile, McNay (1998) offers a triangular model of leadership, consisting of three elements; inspiration, organizations and education. Leadership based on education to change the way people think where it will be creating dynamic environment and culture for learning. These situations encourage and foster lifelong learning and own professional development.
Management is defined as the action to plan, organize, direct and control staff (Marriner-Tomey, 1996). Whereas, Quinn (2000) stated that management is essence of rationality. Managers plan, organize, and solve problems. Managers have been described as those people in organizations who honor stability and control, they tend to be task-oriented and are comfortable with that which is rational, quantitative and logical (Rodriguez 1995). Managers often possess positions of authority with the legitimate source of power that accompanies the position through which they delegate and control situations and outcomes (Kouzes & Posner 1987). They are often concerned with short-term goals and objectives and spend much of their time controlling situations by interpreting and enforcing policy and procedures and maintaining the structure of the hierarchical rule of the organization. Concern for the people they manage tends to become subordinated to organizational goals (Covey 1992).
Managers use and hold the power and authority to organize, delegate and control situation through the position justify by the organization. Managers are more task-oriented. They work on assigned goal, control, enforce and maintain policy and procedure through hierarchical rule of the organization (Sofarelli & Brown, 1998). There are differential between leadership and management. Management is about “doing things right”. This contrasts markedly with leadership: effective leaders produce “constructive or adaptive change to help people and firms to grow, they establish direction, align people and motivate them Leadership is about “doing the right thing”.
Leaders are open for change, value and concern about people in their group; whereas managers focus at obtaining the best beneficial outcome for the organization (Sofarelli & Brown, 1998). Managers ensure goal achieve efficiently, leaders focus on the effectiveness of the process and the impact on participants (Marriner-Tomey, 1996; Spitzer- Lehmann, 1994).
Burns (1978) stated there are two types of leaders in management. The traditional manager, concerned with day-to-day operations, was termed a transactional leader, the manager on the other hand, who is committed, has a vision, and able to empower others with vision wad termed a transformational leader.
Transformational leadership is a style which is ideally suited to the present climate of change because it actively embraces and encourages innovation and change. A transformational nursing leader will provide the skill for the profession to stretch its boundaries and innovative in the way in which problem are viewed and solve.
Transformational leader are able to create synergistic environments that enhance change. Change occurs because the transformational leader’s futuristic focus values creativity and innovation. The transformational leader also values organization culture and values strongly, perpetuating these same values and behavior in their staff (Wolf, Boland & Aukerman, 1994).
As changing in Medical Science concept, approach, practice and trend due to advances in technology and communication, a transformational leader’s futuristic focus or visionary leadership is important for my clinical practice.
Tyrrell (1994) identifies “visioning” as a mark of the transformational leader, stating that “nurses at all levels are expected to demonstrate leadership in setting direction for nursing practice, and that visionary leadership allows nurses to create a picture of an ideal future.
In sharing this vision, the transformational leader empowers staff to find common ground and a sense of connection. Leaders empower and influence their followers to achieve a goal by communication through open discussion and negotiation without using any power and authority. Transformational leadership is an empowering leadership style and one which is highly suited to the profession of nursing, characterized as it is as being caring and highly ethical (Biordi, 1993).
In the other perspective, Heinzen et al. (1996) describe vision as a personal attribute, and all agree that in order to align the followers and the organization with their vision the leader must possess powerful communication skills. Meanwhile, according to Grohar (1992) to be good leader a person must have basic understanding of communication process which consists of a sender a message and receiver.
Every staff must be motivated for lifelong Learning and own profesional development. According to Cohen (2004) leadership is the best tactic that one can use to motivate others and renew interest in others in attaining goals that are for the good for all. The leaders must have to provide staff development programmed and in service training to keep the staff advance information. For example, staff can go for conference, seminars, courses or continuing education programmed in ethic, which can provide the AMO’s to clarify their legal rights and responsibilities. As discussed in Quinn (1998), continues professional development is a process of lifelong learning aim at meeting client needs and improving health outcomes by systematic improvement and the increase of knowledge, upgrading skills to more advance.
Since an instructor is a role model, it is important for the instructor to be accepted and trusted by the people whom he trains. Skills of persuading and to influence others are important in order to gain confidence and to become to follows. Bennis (1990), state trust is essential in the transformational process. Organizations cannot empower without trust and it is essential that if employees are to align themselves with the goal of the organization that they have built a trusting relationship with leader in order to share the vision. The important to be trusted and accepted by staff and student is to get cooperation. Bass (1998) has defined leadership as terms of specific trait of personality, a set of behaviors, a differentiated role, as the exercise of influence or persuasion, as the art of inducing compliance or getting cooperation, as the emerging effects of interaction (process), as a power relationship, or as a combination of elements.
The World of Medical Science is keep changing, the technology and the evolution of disease pattern, occurrence and distribution constrain present healthcare workers especially AMO’s to update and upgrade their knowledge and skill simultaneously with changing of current concept and practice. Therefore lifelong learning and own professional development is essential.
The Transformational Leadership is the style of leadership that is best suited to the present climate of change, not least because it actively embraces and encourages innovation and change. To change the situation is not an easy job. The leader must quench the remnants of historical influences and balance the complex issues of revenues and profit with the delicate issues of human relation with focus on staffs need and patient care (Dixon 1999). Therefore, the leader is suggested to apply transformational leadership style to manage the complexities of the current health service, they must also foster key competencies and pursue training and development to enhance effective transformational leadership performance. Transformational leader must be motivated, visionary, balanced, self-aware and confident of breaking existing professional boundaries to develop a multidisciplinary team approach to patient care.
In the other perspective, this paper has discussed the need of motivation among staffs, is an aspect in leadership management. Leadership is the ability to influence other to perform and work toward the achievement of a goal. The transformational leader strives to empower others and to motivate followers by articulating his vision and behaving as agent of change. Transformational leadership can be anyone in the organization, regardless of the position held. The function of management is the skills of director of the practice setting to facilitate the mission, goals and work of organization.
In the other perspective, a good leader always motivate his staffs how to delegate his work to the subordinates during his absence in order the organization can function well and smoothly. Hasten and Washburn (1994) define delegation as transferring to a competent individual authority to perform a selected in selected situation. Delegation is high level implementation skills to delegate they must be aware of the client’s need. As a leader, he must be honest for himself and others in whatever situation. The main purpose of delegation is promoting motivation and job enrichment and the personal growth for staff as well as for professional growth of the manager.
Every new staff must be motivated for life learning and own professional development. The leaders must provide staff development programs and in service training to keep a continuous professional development.
For the recommendation I will suggests that every staffs working in healthcare services must be motivated to upgrade skill, knowledge and developed self leadership and move from rigid hierarchical structure and role, as well as changing in current practice due to advances in technology and communication. The leader must emphasize to the subordinates on how to achieve quality of care and provide health care to patient through one seamless s to go care that continuity of care. Effective communication between leaders, subordinates and student, will bring success to organization in the aspect of health care delivering systems. Therefore student and staff must actively involves in continuous medical education for competency, skills and knowledge. The last and not least the leader must encourage his staff to go for continuous development programs and inculcate lifelong learning culture.