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Building a successful partnership between management and clinical leadership: experience from New Zealand

Critique Aotearoa New Zealand, Wellington, Wellington, New Zealand
BMJ (online) (Impact Factor: 16.38). 04/2003; 326(7390):653-4. DOI: 10.1136/bmj.326.7390.653
Source: PubMed
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    • "According to the clinical nurses, matrons, rather than being the clear authority, were tied up with administrative, managerial and financial duties that distanced them from clinical practice – a view that illustrates the difference between management and leadership (Stanley 2006). Malcolm et al. (2003) recommended that clinical leaders remain focused on professional issues, quality and care rather than management. American studies of nursing leadership have tended to distinguish between so-called transactional and transformational leadership styles (Dixon 1999, Stordeur et al. 2001). "
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    ABSTRACT: The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses' leadership practice. The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses' navigate between nursing and leadership roles. An 11-month-long ethnographic study of 12 head nurses' work: five worked at a first line level and seven at a department level. At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by 'recognition games'. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role. Conclusions: Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices. Nursing leadership practises depend on leaders' negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity.
    Journal of Nursing Management 05/2011; 19(4):421-30. DOI:10.1111/j.1365-2834.2011.01212.x · 1.14 Impact Factor
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    ABSTRACT: This chapter explores the relationship between two components of our healthcare system: physicians, representing all providers of direct care, and hos- pital executives, referring to those with administrative responsibilities, regulatory obligations, and resource control. Currently, there is a wide gulf, or gap, represent- ing an adversarial interaction. Over the past 50 years, there have been dramatic, frankly, revolutionary, changes in the practice of medicine without corresponding or matching adjustments in the healthcare system. As a result, both physicians and healthcare executives are frustrated. The present adversarial tone between health- care executives and physicians adversely impacts healthcare outcomes. We discuss data showing differences between physicians and healthcare executives in education, background, work experience, and culture. However, the two share common core values: altruism, service, and love of a challenge. They also have common concerns about the future. We conclude that the real enemy is not the so-called other—physicians or healthcare executives—but our dysfunctional healthcare system. The common values and concerns shared by physicians and healthcare executives could provide the framework for successful communication leading to a bridge across the gap and a collaborative rather than confrontational relationship. Physicians could teach healthcare executives about clinical priorities, useful new technologies, and scientific methodology, including evidence-based decision making. Healthcare executives could educate physicians about management tools and techniques for planning, implementation, and assessment, especially systems thinking. To- gether as partners, healthcare executives and physicians could address many of the currently insoluble problems in healthcare.
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