Foster, Rhonda R. EdD, MPH, MS, RN, NEA-BC
Your organization's executive leadership and board of trustees have completed the strategic plan. The plan incorporates strategies that focus on improving patient care, providing services that promote health, and lowering and controlling operational cost. These priorities have been established, aligned, and integrated into the nursing strategic plan. Now what? Execute? No. Identify nurse managers who have real change leader skills? Yes!
The importance of nurse managers
The execution of strategy (or plan) and alignment must occur at the service, division, and department/unit levels, and, often, at the individual level. Whether it's called a strategy, a goal, or simply an improvement effort, any initiative you drive to significantly move your team or organization forward will fall into one of two categories: stroke of the pen and those requiring behavioral change.1
Stroke of the pen strategies are said to be those that you can authorize, mandate, or order to be completed. Behavioral change strategies are different; they require the ability to get people to do something differently than they've done it before. As healthcare organizations struggle to find ways to survive in an uncertain, constantly changing, and competitive environment, it's of paramount importance to identify leaders, strategies, and goals that will set your organization apart in the industry.2
The individuals who are primarily important to organizational change are nurse managers because they're closest to the individuals who will undergo the most behavioral change and they're in the practice environment that will potentially undergo the change. There are two principle things a leader can influence when it comes to producing results: strategy and the ability to execute that strategy.1
Nurse managers as real change leaders
The most difficult aspect of major change has little to do with getting the right concept, core process redesign, or even a team at the top. It lies in changing the people system—the skills and behaviors of hundreds of employees down the line.3 The skills required to execute strategy and lead change from the middle of the organization are consistent with those of a real change leader—individuals who possess a different skill set than traditional managers. These individuals lead initiatives that influence dozens to hundreds of others to perform differently—and better—by applying multiple leadership and change approaches.3 The key to changing performance capability in dozens of dynamic companies is a new breed of manager and professional in the middle.3
A vision that can't be translated into action is of no benefit. These nurse managers understand the vision and are able to articulate how it will be realized to their staff, crafting the story using language and ideas that will resonate. Essentially, they inspire and motivate the staff to follow and trust in the vision that was first articulated by the executive leadership team.
Our nurse managers must be able to assess internal capacity for change by first identifying a cadre of change leaders. This increases the unit's and nurse managers' capacity for change. In essence, they gather ambassadors for change to drive the initiatives. Additionally, they must be stakeholder focused, considering multiple stakeholder needs in the changing environment, as well as what the stakeholders might desire.
Real change leaders have a proclivity to collaborate. Their natural inclination is to bring individuals together to develop strategy, solve problems, brainstorm, and, most of all, celebrate. They realize that the most creative solutions are identified when multiple stakeholders are together with the same vision and goal. They're committed to the healthcare system, the organization, their department/unit or group, and individuals. A genuine commitment inspires the commitment of others. Real change leaders share a seemingly inexhaustible and visible commitment to a better way.3 They believe that the future of the company is dependent on the change—particularly their part in it—being successfully executed.
A real change leader understands data and values the importance of metrics, measurement, and outcomes. It's important to know what goals are to be achieved; for the employee, it's important to know how close the team is to achieving the goal. This confirms that the behavioral changes are making a difference. It's also imperative that our nurse managers have the ability to understand barriers to success, identify problems and appropriate interventions, articulate the results, and communicate findings in a manner that staff members understand and can embrace. The key to engagement is a big, visible, continually updated scoreboard that's compelling to the players.1
Real change leaders are courageous and willing to take action. This includes, but isn't limited to, having the ability, courage, and commitment to the organization to be honest in sharing information that may not be popular or viewed favorably. By not speaking, it can negatively affect the organization's performance. This can be handled sensitively, not in a manner that's obstructionist or disrespectful, but in a manner that's objective, truthful, and facilitates the achievement of the goal. The best change leaders are seldom arrogant or egocentric. However, they do develop higher levels of confidence that enable them to speak out when it matters much more readily than their counterparts.3
Real change leaders are also cognizant of the emotional element in leading change. Empathetic leaders reveal three distinct types of empathy: cognitive empathy, which is the ability to understand another person's perspective; emotional empathy, which is the ability to feel what someone else feels; and empathetic concern, which is the ability to sense what another person needs from you.4 The leader's ability to explain himself or herself in meaningful ways and think about feelings rather than feel them directly is a skill essential to getting the best performance from direct reports.4 Empathetic leaders are fair-minded, sensitive to helping others succeed, and intent on enabling the performance of others as well as their own.3
Cultivating real change leaders
We must identify middle and frontline managers who are real change leaders in our organizations and systems. Without this, there can be no lasting change in employee performance.3 These are our “go to” nurse managers who love challenging assignments and think beyond the unit or department. They understand the organizational implications of decisions and actions, have established relationships across the organization and system, and value stakeholder involvement. In fact, this is the way these nurse managers commonly practice, consistently displaying emotional maturity when handling difficult issues and people.
It's equally as important to cultivate real change leaders as it is to identify them in your organization. Therefore, consider challenging these nurse managers with important projects. Provide projects that allow them to demonstrate skills and for you to determine the areas where they may need to be mentored. Identify key meetings and/or conferences for them to attend. These conferences should have a broader and more global focus to enable the real change leader to continue thinking about the system, the organization, the department, and the individual. Another approach to cultivate and nurture these managers is to provide routine feedback and acknowledge and reward success immediately. Overall, you want to continually encourage and build leaders with nontraditional mindsets.
Lasting change awaits
Real change leaders have a spirit of inquiry. They don't believe that they have all of the answers, but they've developed an ability to ask questions that serve as the key to unlock ideas and thoughts, which leads to innovation and creativity. We trust and depend on the clinical knowledge and sound management ability of our nurse managers; however, as we navigate today's healthcare environment, we recognize that different skills and abilities are needed to execute strategy and balance performance outcomes, and the individuals who produce those outcomes. We must identify nurse managers with these skills and provide support, guidance, and mentoring to those who have a desire to develop and learn.
1. McChesney C, Covey S, Huling J. The 4 Disciplines of Execution: Achieving Your Wildly Important Goals. New York, NY: Free Press; 2012.
2. Hughes-Rease M, Foster R. Transformational and transactional leadership. In: Gullatte M, ed. Nursing Management Principles and Practice. 2nd ed. Pittsburgh, PA: Oncology Nursing Society Publishing; 2011.
3. Katzenbach JR. Real Change Leaders: How You Can Create Growth and High Performance at Your Company. New York, NY: Three Rivers Press; 1996.