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Chapter
Strategic Leadership in Nursing
Adelaide Maria AnsahOfei, TheresaBarnes
and YennutenPaarima
Abstract
Managing the complex healthcare facility in a lower middle-income country
(LMIC) such as Ghana can be challenging and demands management principles that
would enable the leader to be conscious of the significant role of the environment.
Nurses and midwives constitute majority of the health workforce, play pivotal role in
healthcare delivery, consuming most of the resources in managing patient care, and
promote the corporate image of the facility. Nurse leaders should exhibit practical
leadership skills that would enable effective utilization of the capabilities of staff to
achieve organizational goals and prominence in the environment. Long-term viabil-
ity and competitiveness of the healthcare system demands cost-effective strategies
using organizational competencies to take advantage of the opportunities within
the environment. Leadership, therefore, becomes essential by initiating a vision that
harnesses the potential of staff and stakeholders to this commitment. To withstand
time and change, strategic leadership principles such as setting high standards of
excellence, demonstrating exceptional performance, and constantly delivering value
are imminent. Strategic leadership in nursing ensures provision of leadership strate-
gies that would enhance effective teams and mitigate existing challenges confronting
the health system. The paper finds that nursing as a profession is incessantly evolving
and, hence, requires strong and dynamic leadership.
Keywords: strategic leadership, strategic management, relationship management,
nursing management, transformational leadership, laissez-faire, transactional
leadership, healthcare, leadership continuum, nursing administration
. Introduction
Managing the health needs of the populace in a lower middle-income country
(LMIC) such as Ghana is an enigma, due to the many challenges confronting the
health system, particularly, the varied professional groups, increased cost of deliver-
ing care, increased workload, and the continuous diminishing numbers of staff.
Being the largest group of healthcare professionals, nurses and midwives are pivotal
to these issues. Thus, nurse leaders are constantly searching for the “best” approach to
facilitate both staff and patients’ outcomes amid these challenges [1]. Encountering these
challenges and other related healthcare issues, nurse leaders should exhibit practical
leadership skills that would enable effective utilization of the capabilities of staff to
achieve organizational goals and prominence in their environment.
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To ensure the long-term viability and competitiveness of the healthcare system,
nurse leaders need a set of guiding principles or search for strategies cost-effectively
using organizational competencies taking advantage of the opportunities within the
environment whilst avoiding environmental threats. Leadership, therefore, becomes
very essential in this approach by initiating a vision that harnesses the potential of
staff and stakeholders to this commitment. For an organization to withstand time and
change, strategic leadership principles such as setting high standards of excellence,
demonstrating exceptional performance, and constantly delivering value.
The administration of nursing staff thus becomes crucial to any healthcare system
due to their numbers and essential roles [2]. The phrase "nursing administration"
is used to denote a broad range of nursing professionals who are well-versed in the
principles of effective leadership in the healthcare industry. It is the art and science of
planning, organizing, leading, coordinating, controlling, policy-making and moti-
vating human resources towards the achievement of organizational goals. Nursing
administration promotes commitment, cohesiveness, coherence, and direction to the
provision of nursing services by encouraging efficiency and comprehensiveness in
accomplishing the purposes and goals of nursing. Strategic leadership is sensitive to
taking advantage of the core competencies of nursing staff to deliver quality incom-
parable healthcare.
In today's healthcare market, nurse administrators can highly impact the need
for lower prices and better treatment that becomes a daily headline through leading
and dealing with a wide range of concerns, such as policy, administration, finances,
culture, and human resources. Nurse administrators are multi-faceted professionals
who establish objectives and strategies for the departments of nursing and maintain
organizational structure and culture to achieve the objectives by the maintenance of
stable staffing patterns, selecting and assigning nursing personnel and formulating
policies that are indispensable aspects of nursing administration. Additionally, they
maintain proper nursing records for clinical and administrative purposes as well as
constantly evaluate and improving nursing care of patients with the established nurs-
ing standard.
2. Principles of nursing administration
Nursing departments uphold the cooperate values and promote the image and
services of the healthcare system. Nursing staff are guided by the principles of
excellence in service, excellence in practice and excellence in leadership in promot-
ing competitive advantage within the confines of their immediate environment and
beyond. Patients, regardless of their circumstances, have intrinsic value and should be
treated with dignity and respect, according to the principles of excellence in service.
Patients' rights to privacy and confidentiality must always be respected in the pursuit
of high-quality comprehensive care that is affordable and based on cutting-edge
technology. Thus, every interaction with patients and their families should be marked
by empathy and consideration for the wellbeing of those being served.
The nursing profession is viewed as both a science and an art, with the core values
of nurturing and care. The practice of nursing evolves around knowledge (science)
which is modelled in practice (art). Compassion and care are fundamental to the
profession's principal responsibility: in restoring and maintaining patients' health.
Patients' health needs are managed holistically by nurses and other healthcare team
members utilizing the models of nursing care. For instance, nurses monitor and
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evaluate nursing practice through auditing to improve patient-centered care and
health education. Continuing education, membership in a professional association,
and research are all ways in which nurses can ensure that clients' needs are met, and
nursing practice remains competitive.
Nurses, according to the principles of excellence in leadership, should foster a
progressive work environment that utilizes current technologies while exercising
fiscal prudence to enable the greatest possible standard of healthcare. The health
system should be a learning organization that engages research to enhance evidence-
based practice. The role of the nurse is to promote and facilitate group decision-
making. It is critical that nurses become sensitive to the unique requirements of each
patient and promote, commend, recognize, and encourage professional and personal
development to enhance the quality and differentiation of service. Suggestions and
criticisms should be considered as challenges for improvement and innovations thus,
giving room for flexibility and creativity. Equity, fairness and engagement should be
employed in all performance and personnel policies to promote confidence, compe-
tence and commitment.
Nursing administration through effective communication eliminates misconcep-
tions, misinterpretations and create shared vision, direction, and understanding
among staff. Subsequently, it is essential to establish effective control. Control is an
aspect of nursing administration that comprises of ongoing monitoring and evalu-
ation of the execution of the plan. Supportive supervision via standard-setting,
comparing performance with standards and making necessary corrections to ensure
achievement of organizational goals. Effective communication enhances control in
the nursing environment. Objectives are effectively communicated, roles and respon-
sibilities as well as resources are distributed to accomplish all activities without any
misunderstanding and confusion among staff.
3. Nuances of leadership and management
Leadership and management actions can be initiated with "the goal in mind,"
that is, outcomes that justify the existence of the organization[]. Nurse manag-
ers at all levels of the health system should strive to improve the well-being of the
patients. The nurse manager should integrate the department's vision to the hospi-
tal's strategic objectives or vision and focus time on activities that converge energy
to the results. Leaders must have the ability to motivate and inspire others to work
with a passion for common objectives[]. When it comes to leadership in health-
care, it is the capacity to get people to work together toward a common objective[,
6]. Good leaders must help others to overcome obstacles and achieve goals, even
when the situation is difficult. Hence, nursing leaders should create a workplace
climate that fosters good working conditions to enhance patient and staff outcomes.
Organizational goals can only be achieved through management's use of people and
available resources.
Management sets plans and budgets whereas leadership creates vision and strategy.
Managing practices involve planning, organizing, implementing, monitoring and
evaluation, whereas leading practices include scanning, focusing, aligning/mobiliz-
ing, and inspiring. Both tasks are accomplished in concert. Leaders in the nursing
profession utilize a wide range of leadership and management techniques. Strong
organizational capacity enhances healthcare services and long-term improvements in
people's health care through continuous implementation of the eight practices.
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Nurse managers should adhere to the eight leading and management practices to
become better leaders and managers. The practices can be employed in a wide variety
of scenarios to increase organizational performance and to maintain performance
over time. For operational strategies and reporting systems to reflect organizational
priorities, nurse managers should follow best management practices and adhere
to these guidelines. Being well-versed in the usage of management systems and
processes and being able to meet those expectations are two key characteristics of
successful nurse managers. Supportive supervision and monitoring and evaluation
mechanisms that provide timely, reliable information are significant in the provision
of feedback on performance.
To run the department effectively, nurse managers should be vigilant on the
provision of nursing services to ensure effectiveness (the right services), efficiency
(services are delivered in the right way), and consistently high quality to meet
patients’ satisfaction. Successful managers must accomplish these three objectives
first. During the planning phase, the nurse leader conducts a thorough investigation
of the environment to obtain relevant information. Strategies are then developed for
goal achievement through delegating responsibilities to team members while ensuring
that members are held accountable for timely completion of tasks and within budget.
Nurse leaders also ensure that the plan is implemented by putting systems in place
and assigning tasks to the right people, as well as monitoring and evaluating progress
to achieve the intended outcomes.
While management systems are fundamental for dependable operations, manage-
ment alone cannot ensure success. Nurse managers who implement new tools and
systems frequently achieve similar results, unless they successfully train others to use
them, change them regularly to suit client demands, and manage the organizational
framework in which they operate using innovative methods. Effective nurse managers
adapt to any volatile setting and inspire others to do the same. These adaptive abili-
ties enable individuals to succeed in the face of difficult circumstances and limited
resources. Nurse managers are well-informed about opportunities and dangers, and
their direction is transparent to nurses and other staff. Commitment ensues when
people and resources are focused on a common shared vision, and workgroups
delivered on the promises made by nurse managers. To lead effectively, nurse manag-
ers must direct their workgroup's attention toward attaining achievements that meet
the requirements and preferences of clients while also responding to the interests of
key stakeholders. With complete assistance, nurses who work on the front lines of
healthcare can learn to identify their barriers to service quality, begin improvements,
and give excellent service to their clients. To maintain support, the nurse manager
may also need to secure top management commitment. Below are the eight leading
and managing practices that nurse managers can practice:
• Scanning: identifying internal and external conditions that influence desired results
• Focusing: directing attention to priority challenges and actions
• Aligning and mobilizing: motivating internal and external stakeholders to sup-
port desired results
• Inspiring: creating commitment and a climate of continuous improvement
• Planning: preparing a set of activities, timeline, and accountabilities to meet goals
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• Organizing: developing structures, systems, and processes to support the plan of
action
• Implementing: carrying out and adapting the plan of action while coordinating
related activities
• Monitoring and evaluating: observing, examining, and assessing progress.
4. Leadership and strategy
Nurse managers have 2-h responsibility for managing nurses, nursing units, and
patients and serve as a bridge between the operational and management levels of the
facility []. They are responsible for creating a safe and healthy work environment for
the healthcare staff as well as ensuring that members of the multidisciplinary teams
continue to grow professionally and offer high-quality treatment, foster a supportive
and encouraging work environment []. The nurse manager position is significant
thus, requires effective and efficient leadership that is conceptual, technical, and
humane.
To understand strategic leadership, it is important to separate the two words,
leadership, and strategy. Leadership is a process whereby people are influenced by
an individual to work toward the attainment of a mutually agreed goal willingly and
enthusiastically [8]. On the other hand, management is defined as “the pursuit of
organizational goals efficiently and effectively by integrating the work of people
through planning, organizing, leading, and controlling the organization’s resources”
[9]. Strategy is a matter of doing things differently or doing the same things in a new
way, making a deliberate decision to do something different from your competitors,
and developing a system of operations that is distinct from those of competitors. To
cut costs and improve on-time performance, one needs a system that sets apart us
from the competition.
The nurse manager in maintaining her unique position in the healthcare facil-
ity needs both leadership and strategy to coordinate the affairs of colleagues and
stakeholders to uphold the values and integrity of the facility. Leadership is needed
for developing and sharing a sound vision whereas strategy is needed to achieve the
vision and position the facility within the environment with an incomparable com-
petitive advantage.
5. Strategic leadership defined
Strategic leadership is the ability to anticipate, imagine, maintain flexibility, and
empower others to accomplish strategic change as needed. Organizational develop-
ment, or the process of delivering leadership and inspiration, is what it's all about. The
multifunctional work requires managing via others, managing an entire organization
rather than a functional subdivision, coping with change, attracting, and managing
people (and intellectual) resources, and being able to actively influence others.
The art and science of strategic leadership go hand in hand. Having an open mind,
looking at things from a different perspective and being willing to consider the 'what
if possibilities,' as well as the bravery to analyze and weigh the various options, are
all part of the art of problem-solving. To be a strategic leader, one must have the
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confidence to make decisions, implement policies, and convince others to share your
vision and work together to accomplish it. Thus, focus your thoughts and take action
to bring your goal to fruition.
Strategic leadership, therefore, is the interaction of acting, thinking, and doing or
influencing the capability of leaders. Strategic leaders are in all levels of the organiza-
tion as individuals and teams. Nurse leaders are found in all levels of the health system
playing formidable roles for the achievement of organizational objectives. Thus, it is
essential to develop them to acquire this role orientation to become strategic leaders to
achieve organizational prominence.
6. Characteristics of strategic leadership
Strategic leaders' tasks and responsibilities include leading and managing change
and making use of the organization's unique resources to ensure the organization's
successful evolution. To be effective, a strategic leader must provide direction to the
organization in a way that everyone can comprehend and appreciate [10]. Long-term
and often major organizational changes are part of the work of strategic leaders, who
have a wide range of responsibilities. Strategic leadership is a learning process that
uses a combination of thinking, acting, and persuading skills to move an organization
in the direction of long-term success. In other words, strategic leaders are excellent
managers and leaders who are continually looking for ways to improve.
Strategic leadership is a continuous process and a cycle. ‘It is not enough just to
‘think,’ ‘plan,’ and ‘reflect’, people expect to see things happen. This cycle involves (1)
assessing where we are. The nurse leader conducts environmental analysis in the facil-
ity, or department to know where they are. The environmental analysis involves both
internal and external analysis. The internal analysis includes identifying the strengths
and capabilities of staff, resources, vision, mission, policies, objectives, activities
accomplished previously, etc. The weakness of the organization should also be identi-
fied such as staff and resource inefficiencies, etc. the external analysis will help you
to identify the opportunities and threats within the environment. The data gathered
from this analysis will then be analyzed. (2) Understanding where we are and want
to be – Mission, vision. The nurse leader analyses all the data gathered in step (1) to
understand the current situation. () Learning how to get there —Planning and using
strategies that will continue to define us. This involves critical analysis of the data
gathered, studying other successful organizations, and using benchmarks to develop
plans and strategies. Again, organization of resources as well as alignment and mobi-
lization of staff. () Making journey—Implementing tactics. Implementation starts
with monitoring and evaluation together with inspiration. The nurse leader monitors
all activities being implemented to ensure the right things are done or take correc-
tive actions where necessary. Nurses are inspired throughout the process to maintain
the momentum of implementation thus, encouraging creativity and innovation to
enhance core competencies. () Checking progress—Current performance. The nurse
leader continuously checks all the activities been accomplished to sustain enthusiasm
by motivation through acknowledgement and praise. Thus, the strategic organization
is all about continually becoming. Strategic leadership involves discovery more than
determination and is not reserved for those at the top only.
Essential for nurse managers are the provision of direction, application of strategic
thinking for policymaking, a clear plan of action, balance long and short-term goals;
develop ownership; build partnerships; leading by example and a succession plan for
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the future of the organization. This creates a balance between short-term and long-
term goals, strategic leadership in oneself and others, making words into action (mak-
ing the journey), monitoring the progress, and changing course if necessary are all
significant for nurse managers. They need to be able to think, act, and have an impact.
A nurse manager's strategic strategy is nothing more than that. The judgments and
choices that an organization makes when they implement or fail to implement the
plan constitute a real strategy.
Everyone, not only the CEO or nurse leader, has a role to play in strategic leader-
ship. A collection of processes cannot adequately describe this never-ending cycle of
personal, group, and organizational growth. It aims at helping senior executives and
future leaders build and maintain a focus on the 'essential few' factors that have been
determined to be most critical to the long-term success and competitiveness of the
organization. All these aspects are necessary for organizations to be long-term win-
ners in the face of change and uncertainty and to continually give value to all of their
main stakeholders—including society—no matter how challenging the environment.
The 'roadmap' is the executive blueprint for moving the organization to the next level
of performance and competitiveness. These important performance components
should be included.
To be effective, a strategic leader must have transformative powers, act morally
and politically when appropriate, prioritize the relationship between the organiza-
tion and its environment, and possess strong managerial skills. Successful strategic
leaders, according to Cousins [11], have specific cognitive and conceptual abilities.
According to him, they are analytical, creative thinkers who can thrive in a dynamic
and complicated environment because of their analytical, creative, innovative,
reflective, and proactive thinking abilities [11]. As a healthcare organization, nursing
necessitates leaders who possess these traits to achieve and maintain a competitive
edge.
7. Components of strategic leadership
When it comes to effective strategic leadership, there are five key components:
(1) Creating an inspiring mission statement and sharing it with colleagues, (2)
Developing high-level cognitive activity because developing strategies is hard mental
work, () Gathering multiple inputs, that is strategy formulation which is democratic,
() Anticipating and creating a future that involves the invention of a new world, and
() Revolutionary thinking and action to get things accomplished.
The critical performance components of strategic leadership include the (1)
Organization’s Business Model which must be designed and driven by the leadership
team, who must focus relentlessly on ‘doing the right things for the business – not just
‘doing things right’. (2) Organizational culture, particularly, the values or beliefs can
either be the greatest enabler or inhibitor of organizational performance. () An orga-
nization’s core shared purpose which becomes the ‘anchor’ that keeps the organization
from ‘drifting’ into danger in the sea of turbulence. () Renewal that is the seamless
integration of adaptability, innovation, and continuous learning, which is the secret
ingredient that sustains the organization’s ‘vitality’, its ‘relevance’ through time so its
‘business model’ never becomes outmoded. () Organization’s vision, which is the
destination the organization wants to reach. The organization is on a journey, and it
is the responsibility of the leader to ensure that it ends up at the desired destination.
(6) Principles of engagement which cover how the organization presents itself to
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society including such topics as corporate governance, corporate social responsibil-
ity, sustainability or environmental programs, ethical practices and more. Over time
these principles define and either strengthen or weaken the organization’s image and
even the strength of the brand. They cannot be minimized or trivialized. () Investing
in the growth of the organization's human resources. When an organization aligns
itself around a goal or vision, it can harness all of the organization's resources to
achieve that goal. For the achievement of the vision, it is necessary to include the fol-
lowing elements: critical success factors, performance drivers, key business objectives
(KBOs), and the strategies that assist in achieving these KBOs, all of which must be
implemented perfectly to achieve the desired outcomes.
(8) Creation and delivery of value to all key stakeholders including society.
Values are defined as any of the tangible or intangible benefits that the customer
or stakeholder perceives he or she receives from you and would not realize from
any other provider. As such it represents an immediate source of differentiation
and is also the foundation for building and maintaining exceptional stakeholder
relationships. (9) Agility and resiliency; agility involves identifying, assessing, and
acting on opportunities (or threats) faster and better than competition. Resiliency
involves recovering from problem situations better and faster than a competitor –
minimizing the potential ‘cost of lost opportunity’. (10) Relationship mastery; this
is the capability to build and maintain exceptional and secure relationships with all
key stakeholder groups including customers. In times of market turbulence noth-
ing contributes more to the organization’s stability than well-defined and secure
relationships with key stakeholders. (11) Competitiveness and growth; the ultimate
outcome which is driven by the above. There must be also a sensing system or
strategic information architecture to support all the above components including a
hyper-decision-making capability.
8. Strategic leadership process
The healthcare industry has expanded its understanding of the significance and
impact of strong leadership [12]. The healthcare system's complexity necessitates the
skills of a capable leader who can bring together medical and clinical practice while
also recognizing the needs of patients and establishing a wide range of health services
[1]. The primary goal of the healthcare sector is to provide preventive, rehabilitative,
and palliative care to a community [1]. The strategic leadership process has four
stages: competence, vision, communication, and service.
Step 1—The capacity to meet a specific demand, an honest appraisal of one's
skills, shortcomings, goals, and motivating factors, the development of a competency
that others respect, and the competency must be recognized by the organization,
are all components of competence. Developing exceptional competence requires
10–18years, and early development of core competence should be prioritized through
investment.
Step 2—To guide the organization in the right direction and create a vision that
serves as a guidepost. This creates a motivational focus, giving employees a specific
goal to work toward. The following are characteristics of a vision: To be imaginable is
to have a vision of the future. Long-term interest appeals to stakeholders are desirable.
Clear: able to serve as a compass for making decisions. Adaptable: allowing for a wide
range of reactions and allowing for individual initiative. The term "communicable"
refers to the ability to communicate effectively within five minutes.
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Step —Included in the list of questions to inquire about the effectiveness of
communication is: The vision statement will be communicated to whom? What are
all the possible means of communication? We must consider how we can best convey
the organization's long-term strategy to our stakeholders. What are the best means
of contacting you in the future? What measures can be used to assess whether or
not the vision statement is known and understood by the target audience? A vision
statement without proper communication is like hosting a party without sending out
invitations.
Step —Empathy, healing, listening, awareness, foresight, persuasion, steward-
ship, dedication to the growth of people, developing community, and conceptualizing
are among the 10 characteristics of servant leaders highlighted by Spears [1]. The
leader-follower relationship should be built on open and reciprocal exchanges of
information. Being able to listen and be open to what others have to say is a learned
skill. Through good listening, servant leaders recognize and validate the thoughts of
their subordinates. Servant leaders that are empathic show that they truly understand
the thoughts and feelings of their subordinates. It's all about the help a servant leader
gives their followers to overcome their own personal struggles. Servants who are
aware of their social, physical, and political surroundings are better able to respond
to the needs of their organizations. Persuasion is the ability to communicate in a way
that persuades others to change their minds. Focus on the person's capacity to be a
visionary for the organization by providing a rich sense of objectives and direction.
Servant leadership requires foresight and accountability, while stewardship requires
accountability for one's leadership role. For those who want to learn more about
servant leadership, these ten traits are an excellent starting point.
9. Relationship management
To complete all four elements of the Strategic Leadership Process, managing
relationships is essential. As a strategic leader, you need to manage your connections
with your colleagues, executives, and employees effectively. Listening and effective
talking are two abilities that can help manage relationships.
Being a nurse administrator or leader necessitates a high level of listening skills.
(1) Ignoring is a form of listening in which the listener does not pay attention to what
the speaker is saying. (2) "Pretend listening" refers to the practice of paying scant
attention to a speaker while doing other things. () Selective listening usually occurs
in a group setting where one tunes in and out depending on the interest of the verbal
cues. () Attentive listening is focusing on the speaker and not allowing external
noise or potential distractions to interfere with the messages being conveyed. ()
Empathic listening is the most successful kind of listening because it allows you to
put yourself in the other person's shoes and fully comprehend what they are trying to
say. Strategic leadership in the healthcare industry necessitates that the nurse leader
is well-versed in all these types of listening styles to effectively engage colleagues and
build trust.
Keys to the effective conversation are (1) Candor: setting up an agenda with
one’s feelings, beliefs, or ideas. That is the act of being open and honest or frank.
Conversations with colleagues should be straightforward and sensitive to their senti-
ments. (2) Clarity: verbal and non-verbal exchange of wants and needs should be the
same and specific. () Commitment: agreement on next steps. Nurse leaders should
learn to agree with colleagues on the next steps to adopt and be committed to them.
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0. Effective strategic leadership
Nursing as a profession is incessantly evolving hence requires strong and dynamic
leadership. The complex and dynamic nature of the nursing environment requires
nurse executives to leverage the basic tenants of strategic leadership to promote
nursing performance and service delivery [1]. It's all about developing a feeling of
purpose and direction, which are crucial enablers for interacting with key internal
and external aspects in the organization's environment [16]. Strategic leadership,
according to Nwachukwu and Vu [1], is based on the ability of a leader to think
strategically and see the future to improve the efficiency of the business. Strategic
leadership is not only about having unique qualities that allow for the acquisition and
learning of new knowledge and ideas but also having an adaptive capacity to effec-
tively respond to the dynamism and complexity of the external environment. Hence,
strategic leaders may respond to a changing environment by constantly and tacti-
cally adjusting their organization. The presence of strategic leadership is not enough
to promote organizational effectiveness as other antecedents can be at play [16].
Effective strategic leadership is a crucial aspect of organizational effectiveness and
has been associated with numerous organizational outcomes [18]. Effective strategic
leadership can identify the moderation and mediating factors such as the internal
and external environmental dynamics, taking advantage of the opportunities and
overcoming the threats [19]. Organizational strategic flexibility and sustainability are
facilitated by the strategic leadership. This means that a nursing organization's long-
term strategic planning hinges on its leadership, in which leaders adopt a common
vision of what the organization will become [12].
To be an effective strategic leader, an organization should first determine its
long-term goals, strike a balance between internal and external controls, efficiently
manage its resources, maintain an effective organizational culture, and focus on ethi-
cal standards.
. Choosing a course of action. Involves defining a long-term goal and a strategy for
achieving goals. For the next 3–5years, strategic direction is articulated in terms
of the opportunities and dangers that exist. All organizations need to have a
strong foundation of beliefs and a clear vision of what the future holds.
. Organizational controls that are well-balanced. Strategic and financial controls
must be developed and used eectively by strategic leaders. Controls define the
parameters by which strategies are to be implemented and the actions that must
be performed to change those strategies once they have been implemented. Fi-
nancial and strategic controls must be balanced to succeed. For strategic execu-
tives, the Balance scorecard framework is a way to check that they have created
both financial and strategic controls to measure organizational performance
Premise is that when financial controls are prioritized above strategic controls,
organizations put their future performance at risk. Organizations can use diverse
views to aain higher levels of performance when strategic and financial controls
are properly balanced. Financial perspective criteria involve cash flow, return on
equity and return on assets. Customer perspectives criteria consist of the assess-
ment of the ability to anticipate customers’ needs, the eectiveness of customer
service practices, the percentage of repeat business, and the quality of commu-
nication with customers. Internal business processes perspective criteria include
improvements in innovation ability, improvements in employee morale and
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changes in turnover rates. Learning and growth perspective criteria also include
improvements in innovation ability, the number of new products compared to
computers and increases in employees’ skills.
. Eectively managing the organization’s resource portfolio. is includes financial,
organizational (competencies and capabilities) and human capital. Organiza-
tions’ resources must be managed in a way that is consistent and supportive of
the strategy. ey also must be allocated as eciently and eectively as possible
so that each area of the firm has what it needs for strategy implementation. e
changing strategy will likely call for the reallocation of resources and the move-
ment of people and other resources from one area to another. Financial resources
are managed through the budgeting and resource allocation process. Core compe-
tencies and competitive capabilities should be developed in a strategy supportive
fashion. Organizations should build their strategy around things they are good at
doing and/or become good at doing things that are supportive of strategy. A firm’s
human capital, which refers to knowledge and skills of a firm’s entire workforce,
should also fit its strategy. is can be accomplished by hiring people that fit the
organization and its strategy, and an eective training and development program.
Investments should be made to acquire and develop the firm’s human capital.
4. Sustaining an eective organizational culture. is complex mix of basic beliefs,
ideas and symbols that are shared throughout the organization, particularly
among the employees, have a significant impact on the way business is done.
It sets the stage for the organization's strategy-making and implementation.
Employees' behavior is also regulated by this method. Organizational culture is
made up of a wide range of factors, including its origins. Once established, an or-
ganization's culture tends to survive because it hires people who share its values,
socializes its employees, and systematically indoctrinates them with the culture's
norms and practices. e retelling of organizational folklore and ceremonies
honoring personnel who exhibit cultural values. Cultural standards should be
rewarded. e robustness of a company's culture can vary depending on how
deeply it is ingrained in everyday operations and customs. A company's culture
should reflect its strategy to help it become more strategically competitive and
generate above-average returns. As dicult as it may be to change a company's
culture, with the right strategic leadership, it may be done.
. Emphasizing ethical practices. Controlling employees' judgment and behavior
can be achieved through the application of ethical practices. When it comes to
making decisions, they should be a key element of the culture of the firm. It is
critical for strategic leaders to set and convey ethics-related goals; continually
revise and disseminate the organization's code of conduct; create an acceptable
work environment; and utilize reward systems to recognize and promote ethical
behavior. Ethical practices can be used to ensure that people are acting in a mor-
ally correct manner.
. Developing policies and procedures. People's behavior is governed by policies
and procedures, which are sets of wrien and unwrien norms and styles of
conduct. e standardization of work practices and the specification of the opti-
mal methods for completing tasks can boost productivity. Provide direction from
the top-down on how specific tasks should be completed. As a result of their
Nursing
2
eorts, important strategic actions are carried out consistently. e kinds and
numbers of policies and procedures employed by various kinds of organizations
vary widely. ere must be a good synergy between an organization's policies and
procedures and its overall strategy.
7. Developing reward systems. Eective plan execution can only be achieved
through employee commitment if they get incentives. Behavioral control can
be achieved in part through the use of rewards. ose who achieve their goals
should be rewarded abundantly, and those who don't achieve their goals should
not be rewarded. Strategy-based incentives and monetary compensation should
be used to motivate employees to improve eciency and find ways to save mon-
ey. Distinguishers should recognize and reward those who are creative. Conse-
quently, organizations must reward and encourage their employees in ways that
complement the strategy and implementation of the business plan.
. Strategic leadership and strategic management process
The strategic management process can only succeed if it is led by an effective
strategic leader. Vision and mission are shaped by the strategic leadership of the
organization, and the development and implementation of strategies are facilitated by
the leadership of the organization.
Leadership plays a key role in terms of enforcing organizational strategies. Strategic
leaders in an organization work with the strategic vision by formulating strategies,
implementing, and evaluating those strategies to achieve the strategic goal [20]. This
process is described as the strategic management process. Strategic management is a
rapidly developing field of study that has emerged in response to increasing environ-
mental diversities [21]. Strategic management seeks to manage all resources to create
and sustain a competitive advantage for a successful future. The focus is to view the
organization as a whole and examine the firm’s performance attempting to explain why
others perform better under similar chaotic conditions. Strategic management empha-
sizes on decision making, which is a characteristic feature. These strategic decisions are
long term and focus on the future of the organization. The distinguishing characteris-
tics of strategic management are its emphasis on strategic decision-making with three
key attributes: rare, consequential, and directive [22].
2. Strategic leadership models
All the leadership styles are significant in strategic leadership, particularly when to
use each of the styles to realize its usefulness. However, transformational, laissez-faire
and transactional leadership are the models used in bringing about strategic leader-
ship. Knowing which styles to use as a nurse leader is important when dealing with
a complex work environment such as the hospital where varied accomplished health
professionals converge to manage the patient.
2. Transformational leadership
Transformational leadership devotes attention to charismatic and emotional
elements of leadership which emphasize intrinsic inspiration and follower growth.
3
Strategic Leadership in Nursing
DOI: http://dx.doi.org/10.5772/intechopen.104512
This aligns with the needs of today’s workforce, who needs inspiration and empower-
ment to succeed. Working with teams to identify what changes are needed, building
a shared vision to guide the change, and then implementing those changes together
with dedicated members of the group are all steps in leadership. By changing roles
and responsibilities, leaders motivate their teams to put the interests of the organiza-
tion ahead of their own. It is a process that affects and transforms individuals under
transformational leadership. Leaders can also have a unique and reflecting effect on
their subordinates and subordinates. The values, norms, ethics, feelings, and long-
term objectives of transformational leadership are at the heart of this approach. It
also requires assessing the motivations of followers, meeting their needs, and treating
them as individuals... Transactional leaders are responsible for the day-to-day opera-
tions of the company, whereas transformational leaders are responsible for bringing
in new ideas and implementing them.
According to Bass [2], transformational leadership is defined by the impact it
has on the people it serves. Transformational leaders, according to Bass, inspire their
people to trust, respect and admire them. Transformational leadership is judged
mostly on the impact the leader has on his or her subordinates. Transformational
leaders inspire loyalty, adoration, and respect in their followers because of the leader's
willingness to go above and beyond the call of duty. Due to the transformational lead-
er's ability to foster a sense of personal value in his or her followers, these results can
be achieved. They provide adherents with a compelling mission and vision, as well as
a sense of self-worth. It is via academic stimulation, idealized influence (charisma),
and personal consideration that followers are transformed and motivated to action.
Additionally, the leader encourages his or her subordinates to cultivate inventive and
unique approaches to question the status quo and modify the environment to achieve
success. Because leadership is a continuum from transformational to transactional to
laissez-faire, Bass argued that leaders can simultaneously demonstrate both transfor-
mative and non-transformative leadership attributes.
2.2 Laissez-faire
Laissez-faire leadership style is when a leader does not provide leadership that
allows followers to look after themselves. Subordinates end up with freedom in
deciding which policies and methods to adopt. The leader develops the structure
of the work and provides adequate resources for work and helps upon requests by
coaching or answering questions or supplying information. However, the leader does
not participate in workshop discussions or group tasks. The leader again does not
provide comments on followers’ performance unless specifically requested. As a result
of this, employees may become dissatisfied and fail to meet the goals they had set for
themselves.
Negative repercussions are commonly linked to leadership, particularly in terms
of follower satisfaction or leader effectiveness [2]. Female leaders are more likely
to be transformational leaders, whereas male leaders are more likely to be laissez-
faire leaders [2]. Those that have a proven track record of excellence or matured
employees are most suited for this type of leadership. Using this strategy, more
experienced employees become self-sufficient, productive, and impactful. As a result,
the approach encourages team members to be creative and original, which in turn aids
in the advancement of their careers. Members see a laissez-faire attitude as a vote of
confidence in their talents, which gives them more room to grow into self-assured,
devoted, competent, and successful individuals.
Nursing
4
2.3 Transactional theory
The transactional leader directs attention to the use of conditional responses such
as rewards and punishments to acquire compliance from followers. Transactional
leaders attain goals by seeking to uphold the status quo, not aiming for advancement,
whereas transformational leaders endeavor to transform the future by inspiring the
followers. Transactional leadership styles result in increased job satisfaction as well
as leader job performance. The leader gets the job done with no commitment from
the followers. Because of its emphasis on short-term goals, transactional leadership is
more like a management style than a true leadership one. Despite these drawbacks, it
can be a useful tool in other settings, such as in the workplace.
As depicted in Figure , leadership is viewed as a continuum, ranging from
transformational leadership, through transactional leadership to laissez-faire leader-
ship. This implies while leaders may have a specific style this may not be fixed, as
there are points/situations when leaders’ styles may depict traits of the other two.
Transformational leaders bring a lot of energy and enthusiasm to the workplace,
change and new ideas to management, thus more is achieved. Transactional leaders
maintain the status quo and ensure goals are achieved through the routine accom-
plishment of roles and responsibilities with normal energy, whereas laissez-faire lead-
ers normally lack energy and ideas and bring lethargy to the workplace killing at time
enthusiasms. Nurse leaders, in being strategic ought to acknowledge this continuum,
understand the peculiarities of a particular situation and know and practicalize the
best-fitting approach.
3. Conclusion
The complex and dynamic nature of the nursing environment requires nurse
executives to leverage the basic tenants of strategic leadership to promote nursing
performance and service delivery. Leadership plays a key role in terms of making and
enforcing organizational strategies. Leadership capabilities and strategies are essen-
tial for optimizing team-based nursing and patient outcomes. A visionary leadership
approach motivates teamwork and seeks to reach the highest levels of performance
possible within the boundaries of nursing practice.
Many studies support the transformational method since it encourages employees
to work creatively, exhibit dedication, and meet expectations. Some research sug-
gests combining the three styles in management because each situation necessitates
a distinct style. Transformational and laissez-faire methods encourage employees'
independence and creativity. When a leader wants to develop new practices and
implement them quickly, transactional approach works best.
Figure 1.
Leadership continuum.
Strategic Leadership in Nursing
DOI: http://dx.doi.org/10.5772/intechopen.104512
5
Author details
Adelaide Maria AnsahOfei*, TheresaBarnes and YennutenPaarima
Department of Research, Education, and Administration, School of Nursing
and Midwifery, University of Ghana, Ghana
*Address all correspondence to: adelaideofei@gmail.com
© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Nursing
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