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Exploring CNL/Engineer Courageous Follower Behaviors
Sandra W. Kuntz, PhD, PHCNS-BC William J. Schell, PhD, PE WIN April 19, 2013
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Purpose Compare roles of clinical nurse leaders and engineer project managers. Explore challenges related to change identified by nurses and engineers in middle leadership roles Discuss the challenges and flexibility necessary to both lead and serve as courageous followers.
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Background: Support for IPE
Institute of Medicine [IOM] Core Competency (Work on Interdisciplinary/Interprofessional Teams) Health professions education: A bridge to quality. (2003) Keeping patient’s safe: Transforming the work environment for nurses. (2004). Building a better delivery system: A new engineering/health care partnership. (2005) Future of nursing: Leading change, advancing health. (2011). (Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.) AACN Quality and Education for Nurses (QSEN) competencies (teamwork and collaboration) Interprofessional Education Collaborative [IPEC]
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IPEC Core Competencies for Interprofessional Collaborative Practice--Domains
Values/Ethics for Interprofessional Practice Roles and Responsibilities Interprofessional Communication Teams and Teamwork
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IPEC Core Competencies Model http://www. aacn. nche
Patient & Family Centered Interprofessional Teamwork and Team-based Practice Interprofessional Communication Practices Values/Ethics for Interprofessional Practice Roles and Responsibilities for Collaborative Practice Community and Population-Oriented
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Method Multi-step study--- Case study content analysis (N = 26)
Meta-analysis of the engineering literature Theory--- Kotter’s eight stages of change Chaleff’s courageous follower model
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John Kotter’s Eight Stage Process of Creating Major Change (p. 21)
Create a sense of urgency Pull together the guiding team Develop the change vision and strategy Communicate for understanding and buy in Empower others to act Produce short term wins Don’t let up Create a new culture Kotter, J. (1996). Leading change. Boston, MA: Harvard Business School Press.
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Results Nurse Case Study Themes
Challenge Themes # of Cases (N = 26) % Macro-mandated change 19 73 Ineffective communication/confusion 15 57 Caught in the middle 7 27 Need for change rationale/evidence 6 23 Take creative action 5 Resistance/sabotage Trust/distrust 4 Lack of incentives 2
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Ira Chaleff What are the characteristics of a courageous follower?
Assume Responsibility Serve Challenge Participate in Transformation Take Moral Action *************************************** Speak to the Hierarchy Listen to Followers Chaleff, I. (2009). The courageous follower: Standing up to and for our leaders (3rd ed.). San Francisco, CA: Berrett-Koehler Publishers.
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“Followers and leaders both orbit around a common purpose; followers do not orbit around the leader.” (Chaleff, p. 13) Purpose
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Results Nurse Middle Leadership Behaviors
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Results: Comparison Characteristic Nurse Engineer Focus Patient-care
System process improvement Ethics Social justice oriented Product stability/cost effective Epistemologies & Vocabularies Human functioning; caring Mechanical operations; analytical Change & Resistance Same themes/different weighting Tools Complex care processes Systems engineering processes Outcomes Safety, quality Efficiency, quality Middle Leadership Similar challenges Metaphor of the Tango
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Conclusion Similar change challenges
Key differences: Failure of ISyE application Professional interaction (Gemba walk) Cultural exchange (Process Enneagram) Nurse Follower Behavior: Strong evidence of courage to assume responsibility and serve; less indication of courage to challenge, transform, or take moral action
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Acknowledgements & References
MSU College of Nursing CNL graduate students ( ) for their managing change case contributions. CNL Team (Winters, Claudio, Kinion, Kuntz, Hill, Luparell, Nichols, Schell, Sobek, Torma) For references:
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