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Leadership Assignment: Case Analysis on Leading change in the general surgery unit.


Task: Prepare a leadership assignment critically discussing about the issues related to change management in the case study of Barbara Norris: Leading change in the general surgery unit.


According to the words of Roberts (2020) considered in the leadership assignment, a successful top and down process generally begins with the executives to clarify the desired results regarding the programs of leadership and change management. After the goal is known to be accepted and clear, the executives are able to identify any of the potential leaders of an organisation for engaging within the development of leadership along with the process of change management. Hence, the present study evaluates the importance of change management along with leadership highlighting the case study of Barbara Norris: Leading change in the general surgery unit.

In this case study, Barbara has been the nurse manager for a large General Surgery Unit (GSU) within the Eastern Massachusetts University Hospital (EMU). Barbarawas responsible to manage the staff along with budgeting and scheduling for the unit. The study mainly emphasizes on the situation of the case study where the unit has been short staffed consisting of higher stress levels along with lower morale of the employees. However, GSU has the lowest scores of employee satisfaction along with a higher rate of employee turnover within all the departments of EMU.

Key problems of the organisation

Barbara had 33 staff person involving 25 RNs including 8 patient-care assistants (PCA). Within the first month of Barbara’s joining, the nurse manager lost two RNs and prior 6 months of the joining, the RNs of unit three also left. However, due to the recently instituted hiring freeze within EMU, the nurse manager failed to fill up these vacancies. Due to the short staffed unit, the scores of patient satisfaction has also been average and declined steadily within the past few years. Nevertheless, GSU has been popular for its culture based on altercation; favouritism and blaming as well. This resulted in tensed relationships among the caregivers, both nurses as well as physicians functioning in the concerned units. Overtime was not found to offer because of the additional measures of cost cutting. If one of the nurses required a vacation or personal time, Barbara was not able to offer over time for the other staff for covering these absences rather had to depend on the RNs through the general float pool. Floaters were known not to be accustomed with the systems in the unit along with its care protocols and procedures as well and also had some negative effects upon quality of the staff dynamics for patient care.

After becoming the nurse manager of GSU, Barbara received requests from 29 staff members of the unit for one-on-one meeting and could not help but notice the culture of blaming and conflict within the Hospital. It was evidenced by the nurse manager that, besides helping the new staff, the senior nurses became highly critical along with complaining behind their backs. Most of the unit’s RNs were seen to be frustrated, consisting of the PCAs along with complaining about having inadequate training along with the skill sets. The PCAs were also found to not havecompleted reviews along with accurate record maintenance regarding annual staff performance, department-wise as well as on organizational basis. Barbara had viewed a regular and informal check in along with formal annual review to be the critical tools of management. However, from the personal experience of Barbara, the nurse manager knew the way to communicate and lead to a transparent system of review that had contributed towards the development and growth. Barbara decided to run within the off site for GSU staff, however, Barbara hoped for providing a forum for executing the discussion within the members of the unit however, the larger hope has been the off site that can inspire the beginning for turning around the unit.

Stakeholders affected with the problems
Barbara was found to have stood up in front of the staffs that have been on duty along with being able to attend the offsite. The nurse manager was found to ask each of the staff members to write two to three things that bothered them within the unit. Thus, the responses was then collected by Barbara where many things were identified such as lack in teamwork and collaboration, intergroup and interpersonal conflict,negative comments about the doctors who treated the staff like the order-takers as compared to caregivers along with the administrators who specially cared regarding the money rather than the care of the patient care; dissatisfaction, favouritism with the levels of staffing and procedures of performance review. Barbara was found to be blown away through the amount of negativity that was bargained for this respective exercise.

As stated by Bolden et al., (2019), many of the stakeholders were affected because of these problems. For instance, as observed by Barbara, Megan has been an affable and bright nurse who deeply cared for her patients where Megan was also found to receive many positive feedbacks through the patients along with the families.Megan was found to be upset with few of the senior nurses. Jennifer Goodwin had been working within the respective unit for over 10 years and had a stronger skill set along with being familiar with the new technologies and used to help the other people in the unit. Jennifer has been upset with the review process of the organisation. On the other hand, Louise Scribner had been working with EMU for over 30 years and delivered very good care for the patients, however, noted a resistance towards change. Louise had complained regarding the support that is asked by the younger nurses along with the PCAs.

Benefits and costs of their perspective helping in developing the solutions
Barbara considered certain solutions such as to conduct staff meetings along with hiring nurses along with taking of the money to hire a secretarial assistant. The choice was provided to the staff members. As per the views of Bolden (2020), this is how much money is composed by the Hospital, explained Barbara. The nurse manager offered to take a little bit of the nursing FTE along with hiring a secretarial assistant however little time of nursing can also be lost by the organisation however; this has been something with which work needs to be considered. Thus, the same thing can be done by Barbara while cutting down the resources explained by the nurse manager to the staff members.

Thus, at the end of the day, Barbara was found to know about setting the attainable and realistic goals for each of the things that has been listed. However, many questions were raised within the nurse manager like consulting with the director of the nurses; conducting regular meetings along with building a healthy culture in the unit. However, Barbara can institute a process of transparent and fair review. As put forward by Tang (2019), this might not consist of any influence for increasing the annual salary of the staff members. Nevertheless, other acknowledgements were also present that can be employed by the nurse manager, Barbara.

Recommendations and solutions
The way solutions can help in mitigating the problems

For providing all the patients with the best possible care, the nurses within the roles of leadership must maintain the principles of collaboration and teamwork as well. This can provide the nurses and the staff members to function in an effective manner within the inter-professional and nursing team while fostering the mutual respect and shared decision making process through open communication. This can help in achieving quality care for the patient as well. However, for arranging a collaborative teamwork, certain measures need to be practiced which are mentioned below:

Establishment of team goals
As evidenced by Oreg and Berson (2019), common healthcare goals need to be established by the concerned nurse manager such as improving the care of the patient; decreasing waste and shortening the response time. This can help the team members to be focused on the objective that can, in turn, help in creating the unity of the team.

Assigning roles
Nurses are found to interact with many professionals of healthcare both within their team and other teams as well. This makes understanding the roles of individual teams to be a crucial aspect for achieving collaboration.

Allowing open communication
Nurses should develop listening skills as they tend to interact with many people. As opined by Fleming and Millar (2019), the people working alongside the nurses should also consist of their suggestions; individual feedback and questions as well.

Thus, this can help Barbara to handle the conflict with care and communicate in an effective way within the concerned Hospital. However, dealing with the situation through different skills of communication can also help in improving the intergroup and interpersonal conflict. There are certain strategies that should be undertaken by the nurse manager for mitigating this type of conflict situation which are mentioned below:

Identify the issue
Whenever an issue takes place, it should be identified and the perception needs to be checked for the problem as well. Other people should also be allowed to explain their concern. As per the views of Barrow and Toney-Butler (2019), this is mainly concerned with focusing on the events and the behaviour rather than the personalities.

Transparent communication
This requires honesty along with providing supportive and constructive feedback. The conflict needs to be handled sooner rather than later. Others should also be invited for talking about the situation within the undisturbed location.

Thus, all these represent that communication within the healthcare providers can be affected through the human factors like interpersonal relationships. Varying the relationships of team members can lead to varying collaborative behaviour that affects the safety outcomes of the patients through a change in the team communication. On the other hand, performance appraisal is known to be a process for recognising the performance of the staff within a respective period of time. As stated by Outram and Parkin (2020), this process involves assessing the needs along with setting goals as well as establishing objectives and progress with the evaluation of performance.

For the present context, to implement an improved appraisal system within the concerned hospital, Barbara is required to define clear objectives and aims of the organisation to the staff members along with the implementation of a fairly simple documentation. However, a pre-appraisal questionnaire needs to be filled by the nurses which can help in demonstrating their self-awareness along with the establishment of their basis of communication.

Potential weaknesses
As per the above recommendations, there are potential impacts or rather weaknesses that can also be faced by the concerned Hospital while implementing these strategies and policies. For instance, teamwork can lead to some negatives such as conflicts within the staff members; missing deadlines; reduction of flexibility and poor communication as well. The employees, consisting of stronger personalities, tend to dominate the staff over a discussion which eventually affects the morale of the team. As the senior nurses of the respective hospital are found to treat the new staff s as order takers, then this can be possible within the concerned environment. On the other hand, as opposed by Freer and Robertson (2020), interpersonal relationships within nursing can also lead to an increase in the obligations and can also prevent developing any other relationships. Nevertheless, appraisals can also result in overestimating the abilities of the nurses which can lead to a negative atmosphere while the beliefs of the managers and actual abilities tend to be different. Thus, the existing pre-appraisal questionnaire can be altered for leading to an open dialogue during this appraisal. For instance, within the present situation, some of the senior nurses have been found not to follow the targets along with the action plans which eventually resulted in several inconsistencies and devalued the aims and the process as well. According to Faupel and Süß (2019), this suggests that feedback is an important part for the appraisal process for achieving the outcomes along with assessing the performance.

As stated in the above study, it has evaluated the significance of leadership within change management emphasizing on the case study of Barbara Norris: Leading change in the general surgery unit within the Eastern Massachusetts University Hospital (EMU). The problems faced by the staff of the organisations have been highlighted along with appropriate recommendations.

Barrow, J. M., & Toney-Butler, T. J. (2019). Change management. Bolden, R. (2020). Guest blog: Richard Bolden, Professor of Leadership and Management and Director of the Bristol Leadership and Change Centre. Notes. Bolden, R., Adelaine, A., Warren, S., Gulati, A., Conley, H., & Jarvis, C. (2020). Inclusion: The DNA of leadership and change.

Faupel, S., &Süß, S. (2019).The effect of transformational leadership on employees during organizational change–An empirical analysis. Journal of Change Management, 19(3), 145-166.

Fleming, K., & Millar, C. (2019). Leadership capacity in an era of change: the new-normal leader. Journal of Organizational Change Management.

Freer, A. S., & Robertson, P. J. (2020). Organizational spiritual maturity: a goal of positive leaders and direction for change.Leadership assignment In New Horizons in Positive Leadership and Change (pp. 103-125).Springer, Cham.

Oreg, S., &Berson, Y. (2019). Leaders’ impact on organizational change: Bridging theoretical and methodological chasms. Academy of Management Annals, 13(1), 272-307.

Outram, S., &Parkin, D. (2020). A tailored undertaking: the challenge of context and culture for developing transformational leadership and change agency. Delivering Educational Change in Higher Education: A Transformative Approach for Leaders and Practitioners.

Roberts, G. (2020). Servant Leadership and Change: A Review of the Literature. In New Horizons in Positive Leadership and Change (pp. 33-64).Springer, Cham.

Tang, K. N. (2019). Change management. In Leadership and Change Management (pp. 47-55). Springer, Singapore.


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