Skip Navigation LinksHome > July 2010 - Volume 41 - Issue 7 > Close the door on crisis management
Nursing Management:
doi: 10.1097/01.NUMA.0000384036.63293.c9
Department: Career Scope: South Central

Close the door on crisis management

Hudson, Kathleen MBA, MSN, RN

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Kathleen Hudson is a nursing faculty member at the University of Texas at Tyler in Tyler, Tex.

Healthcare environments can be cultures of reaction and crisis management due to the never-ending nature of responding to acute illness and emergencies. This reactionary type of culture also becomes embedded in management styles and organizational practices. Working within a reactive environment may leave you feeling like you're putting out fires—crisis after crisis—without control over your work. You may feel like you're inadequately dealing with situations and not supporting your staff, which can lead to chronic stress and burnout. At the end of the day, some managers disengage from their organizations and go through the motions without innovation or enthusiasm or leave the organization seeking something better.

Does this type of crisis culture exist at your workplace? Are things slightly out of control? If your environment and leadership practices appear to be reactive and crisis-based, here are some strategies to address these problems. Remember, working toward proactivity in leadership and organizational culture requires proactive infrastructure changes, behavior transformation, commitment, and time.

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What makes a proactive organizational culture?

First, consider what a proactive organizational culture looks and behaves like:

* Routines that work on a preplanned, preset, and organized time frame (such as accreditation requirements, budget planning, and quality improvement activities) are spread out reasonably during the calendar year.

* Information technology (IT) infrastructures are maintained for planning and data collection throughout the year. For example, managers document equipment replacement needs or other budget items as soon as they're identified.

* Routines are managed by project management thinking, software tools, and behaviors, allowing for designating clear accountabilities with preset time frames and streamlined coordination and personnel involvement.1 Staff members are strong problem solvers, providing an open forum for circulating potential solutions toward resolution. They're involved in and "own" best practice ideologies.

* The infrastructures that support these planned clinical modifications are adjusted proactively with adequate communication time. The personnel responsible for these areas exhibit accountability and ownership to ensure proactive methods can be maintained. Online access to relevant information is available and current.

* Everyone is kept informed in a proactive fashion about upcoming events for the month and year. These are posted as visual triggers on company desktops and notice boards for employees and the community.

* Service line care improvements are released every 6 months. These are evidence-based advances coordinated by service line care experts who are responsible for communication and outcomes related to service line improvements.2

* Clinical education is driven by local experts who are proactive and creative in their information delivery to staff. These experts keep up to date with any research that may soon impact care and disseminate resources and references for their clinical area. IT infrastructures are used for easy access, coordination, and communication of educational updates.

* The 1- to 3-year organizational strategic plan outcomes are clear, realistic, and supported by the stakeholders involved. Accountability for progress is maintained and respected, and status updates are available for personnel to review at any time online.

* IT supports dissemination and daily communication of important performance information, such as quality improvement data, targets, and outcomes, through desktop dashboards. Alerts provide prompts when variances are trending in the wrong direction.

* Patient and healthcare team member satisfaction is monitored and communicated through automated systems for efficiency.

* The attainment of set targets is rewarded in meaningful and fun ways.

* Enough equipment is available and well maintained so workflow isn't interrupted and work-arounds aren't created; this requires prompt staff reporting of malfunctions and a talented and committed maintenance staff.

* Everyone is committed to doing things right the first time. Personnel aren't satisfied with dysfunctional processes and won't tolerate noncontributory team members.

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What makes a proactive leader?

Next, consider the behaviors and thought processes used by proactive leaders. These include:

* Preplan activities using efficient modifications of project management to the level of detail required for the individual project. Support staff members are comfortable with project management concepts and motivated to provide support for their managers and directors.

* After a meeting, expect minutes within 24 hours, with a clear listing of requirements and expectations to be completed and reported on for the next meeting. Conduct meetings only when necessary and have the agenda items drive the meeting, not the clock.

* Maintain an outcomes focus and ask outcome-directed questions.

* Expect resources to be available for prompt decision making. Data and reports should be structured to save time and be easily accessible.

* When responding to new situations, first use supportive, thoughtful, and information seeking behaviors; avoid emotional reactivity and negativity. Maintain a focus on the underlying issue, weighing the pros and cons of options toward the issue's resolution. Brainstorm and coordinate with people who generate innovative but practical solutions.

* Understand that complexity and conflict are fundamental components of healthcare. Seek the common ground first. Realistically consider the level of urgency, long-term impact, and effect on staff related to the various options available.

* Exhibit a keen understanding of interdependence within the healthcare team and demonstrate a willingness to quickly inform and consult.

* Demonstrate an appreciation and allowance for endpoints to be achieved in various ways, even when the idea source isn't your own.

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How to make proactivity the norm

Consider the following to make purposeful proactivity the new norm:

* Just say now. Consider the transition to proactive leadership as a process with both advances and setbacks. Start with talking about what part each team member will play in reaching best outcomes at all times.

* Determine with your main leadership group what proactivity looks like for your organization. What end results are desired in relation to preplanning? Discuss what types of values proactive managers consistently exhibit, and then determine how to operationalize these values.

* Hold brainstorming sessions and determine which management activities are truly value-added for your organization. Apply the zero-based concept to this exercise and be critical and objective. If an activity isn't contributing to the bottom line, patient safety and quality, regulation requirements, and patient and staff satisfaction, then it needs to cease. Compare what you're currently doing with what you really need to be doing. Make your key activities lean and keep the focus on results.

* Look at organization-wide workflow. Set an annual calendar and, in detail, plan budget cycles, next year's patient safety goals and regulation changes, service line activities, and implementation of IT advances. Plan new staff hires around student graduation times. Look for ways to balance activities through the year, and keep major changes away from holidays and key times when staff focus will be expectedly lessened. Also ensure your local area goals are consistent with your organization's strategic plan.

* Be on the lookout for red flags in your system. Identify infrastructure, personality, and process barriers. Look for common outcomes and shared goals, and work toward efficiencies. Consider the impact on productivity in addition to stakeholder relationships.3

* Collect data from all levels that identify obsolete paperwork or data screens, processes, policies, and expectations that are no longer contributing to outcomes. Identify what obstructs productivity and creates frustration. Eliminate all unnecessary workflow. Review this information at set intervals and quickly revise situations that are no longer productive. Ask all employees to make improvement recommendations that enhance their own productivity.

* Build into your infrastructure a reliable succession program for all levels of staff. Give staff the opportunity to move into the next role level by working alongside someone who currently holds the role. This can provide proactively prepared internal leaders.4

* Support for new leaders needs to be purposeful and sustained by supplying a mutually agreed upon mentor or group of mentors. On the job experience is an important component of learning to lead. Mistakes will occur and how these are responded to matters. Create a culture that welcomes learning and the sharing of lessons learned.5

* Start a database for documenting the management decision making of core problems, the interventions utilized, and the results. This will start a warehouse of practice-based evidence that may be used in future applications.6

* Examine the words used in your responses to daily situations. Do you use cause or blame terminology? Use preventive terms to remove the blame and closed silos within healthcare.7 When you change the language used, you change the culture.

* When dealing with personal behavior, first gain as much relevant information as possible and listen to various perspectives before you act. Expect brief, concise, accurate, and timely information from others. Avoid jumping in to solve problems based on limited information or anecdotal comments. Prompt decisions that aren't well thought out may negatively impact other departments and teams.

* Role model openness toward other perspectives. Trial and error is experience on the job. Collect and have available a resource of experienced colleagues who can be readily contacted to assist with providing guidance in challenging situations. Acknowledge errors and communicate corrective interventions.

* Build proactive thinking teams. Getting the right people who demonstrate good judgment onto your teams is fundamental.8 Evaluate the productivity of various organizational teams and their ability to adjust while learning along the way. Are all team members contributing in a manner that best produces the highest quality output and innovation? Are some teams creating organizational problems or barriers? What changes need to be made in membership, meeting format, and agenda? Consider the group's productivity, not individual's. Reshuffle, reskill, or remove members as needed. Focus on high quality, efficient output, creating a nontolerance for mediocrity. Evaluate team performance at set intervals by evaluating outcomes.

* Develop and use an insider-outsider perspective.9 This involves pairing employees who have an intimate working knowledge of the interdependencies of the organization with open and informed outsider perspectives. Look at how errors are avoided during care provision in addition to care advances.

* Consider all aspects of your service line(s). Efficient and productive services will attract and maintain high-quality medical staff and community support. Market the strengths of each service line as new innovations are adapted to keep them visible as progressive and competent.

* Avoid relying on formal authority and micromanagement. Lead others by assisting them to think about how things are organized and the appropriate level of preparation for normal daily operations. Focus on leading and not controlling or directing. Leadership comes from credibility, not formal authority.5 Qualities that contribute to credibility are commitment to doing the right thing, being visible and participatory, empowering others, and efficiently completing projects.

* Consider lifestyles and balance for all staff. The ability to be rested and refreshed is priceless in providing motivation and commitment. Well-rested personnel have a reserve of emotional balance to avoid negative and emotionally based reactionary decisions.

* Develop and refine your stress management skills to minimize feeling pressured, overwhelmed, and disorganized. A state of fundamental leadership is one in which you enter moments of greatness that complement a proactive leadership style.10 Characteristics include being results centered, internally directed with clear core values, focused on others for the collective good, and externally open to allow yourself to be receptive to things you aren't comfortable doing. These skills can provide a foundation for the transition from being a reactive to a proactive leader.

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Throw away crisis management!

Learning to proactively lead in an environment that reacts is challenging. These strategies may assist you to start the transition toward creating a culture of proactivity and calm by implementing modifications to infrastructure, behavior, and values. Purposeful reflection about how you respond and conduct your daily decision making is an important starting point in styling yourself as a proactive leader. Redesign your healthcare culture for more coordination and proactivity, yet maintain a flexibility to respond to shifts in major trends. Throw away crisis management and be part of the paradigm shift toward proactivity by creating a rewarding culture and leadership style.

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REFERENCES

1. Sunindijo RY, Hadikusumo BHW, Ogunlana S. Emotional intelligence and leadership styles in construction project management. J Manage Engineer. 2007;23(4):166–170.

2. Moore K. Rapid response teams: a proactive critical care approach. J Contin Educ Nurs. 2008;39(11):488–489.

3. Porter-O'Grady T, Malloch K. Quantum Leadership: A Resource for Health Care Innovation. Boston, MA: Jones and Bartlett Publishers; 2007.

4. Sinnott DJ. Leadership turnover: the health care crisis nobody talks about. Trustee. 2008;61(7):29,32.

5. Hill LA. Becoming the boss. Harv Bus Rev. 2007;85(1):48–56,122.

6. Warye K. The infection challenge. Proactive hospitals realize the value of prevention. Mod Healthc. 2008;38(24):38.

7. Kerfoot KM. From blaming to proactively changing the future: the leader's safety challenge. Nurs Econ. 2008;26(4):280–281.

8. Tichy NM, Bennis WG. Making judgment calls. The ultimate act of leadership. Harv Bus Rev. 2007;85(10):94–102,165.

9. Bower JL. Solve the succession crisis by growing inside-outside leaders. Harv Bus Rev. 2007;85(11):90–96,153.

10. Quinn RE. Moments of greatness: Entering the fundamental state of leadership. Harv Bus Rev. 2005;83(7):74–83,191.

© 2010 by Lippincott Williams & Wilkins, Inc.

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