Leadership for Intellectual Disability Service

Motivating Change and Improvement

Fintan Sheerin, Elizabeth A. Curtis, Fintan Sheerin, Elizabeth A. Curtis

• Publisher: Productivity Press
• Year: 2019
• Print ISBN:
  9780815390848
• eBook ISBN:
  9781351172387
• Topic: Social Sciences
• Subtopic: Business General
• Index: Social Sciences

People with intellectual disability often experience challenges in their lives. These may be due to difficulties in social adaptation, but may also be related to a reality of disempowerment whereby they have little role in the decisions central to their lives or in the provision of health, educational and social services. This book argues for alternative and innovative approaches to leadership in intellectual disability service provision. It does this in the light of service scandals including Winterborne View (UK), Oswald D. Heck (USA), Áras Attracta (Ireland) and many others. This book also explores the failed leadership issues underpinning such debacles and then examines how the context for intellectual disability service provision has changed. The authors propose alternative models for service leadership that are contiguous with the changed landscape, emphasizing participatory models of leadership and ending with exemplary vignettes outlining situations where such innovative change is happening.

II

Leadership for Improving and Energising

Chapter 3

Distributed Leadership – An Alternative Approach for Intellectual Disability?

Elizabeth A. Curtis

Contents

Chapter Topics

Introduction

Importance of Leadership in Health and Social Care

Why Distributed Leadership and What Is it?

Theoretical Origins of Distributed Leadership

Overview of Distributed Leadership

Leadership Practice

Distributing Leadership – Who and How?

Distributed Leadership in Nursing and Healthcare

Distributed Leadership in Practice: Some Suggestions

Conclusion

Key Concepts Discussed

Key Readings on Distributed Leadership

Examples of Studies about Distributed Leadership in Healthcare

Websites

References

Chapter Topics

• Significance of leadership in health and social care
• An alternative approach to leadership: less leaderism and more participation
• Genesis of distributed leadership (DL)
• Leadership for contemporary nursing and healthcare
• A tentative guide for initiating DL in nursing practice

Introduction

Leadership has generated interest among people for a long time and much has been written about it too. This interest and fascination with the topic may in part be due to its enigmatic nature and partly because at some point of our lives most of us will be affected by it (Yukl, 1998, 2013). Furthermore, the topic of leadership and its research is of concern because it can inform us not only about who we are as individuals but also about who we are as members of a group and wider society (Curtis and Cullen, 2017). To stress the importance of leadership further, Hughes et al. (2006: 19) remind us in the first chapter of their book Leadership: Enhancing the Lessons of Experience that “leadership is everyone’s business and everyone’s responsibility”. Leadership however, is not always an easy process and this was eloquently expressed by Warren Bennis when writing about the challenges of leadership. He stated “In the best of times, we tend to forget how urgent the study of leadership is. But leadership always matters, and it has never mattered more than it does now” (Bennis, 2007: 2). Leadership is also critical when teams or organisational systems are undergoing change. This is especially relevant within the context of nursing and intellectual disability services given that in recent years several deficiencies in care have been reported both nationally and internationally (Northway, 2017; Áras Attracta Swinford Review Group, 2016).

This chapter suggests DL as an alternative approach to leadership and puts forward a tentative guide for supporting organisational change and development within intellectual disability services. The chapter does not offer a comprehensive account of DL. Rather, its intention is to introduce nurses and other care staff to the concept and draw attention to key considerations that might be useful for creating an environment where DL could be used as a driver for supporting care and changes in intellectual disability. The chapter begins by reminding the reader about the importance of leadership in health and social care and then explains how DL has been conceptualised and defined in the literature. Next, it summarises the theoretical and historical roots of the concept. A synopsis of the empirical evidence on DL is provided and its relevance and application within healthcare discussed. The chapter concludes by putting forward a tentative guide for introducing DL in intellectual disability services.

Importance of Leadership in Health and Social Care

Effective leadership is central to promoting the quality and integration of healthcare (Sfantou et al., 2017), improving performance and organisational citizenship behaviour (Kacmar et al., 2012; Braun et al., 2013), quality care (Gille et al., 2015), and organisational commitment (Paliszkiewicz et al., 2014).

In the last two decades, healthcare organisations and care facilities have been scrutinised intensely due to inadequate standards of care and poor performance (Curtis and Cullen, 2017). Examples include the Winterbourne View scandal in South Gloucestershire, England (Bubb, 2014), the Áras Attracta care home in Mayo, Ireland (Áras Attracta Swinford Review Group, 2016), and the maternal death of Savita Halappanavar in Ireland (HSE, 2013). The Winterbourne View Report cited a “lack of local leadership and weak accountability” (Bubb, 2014: 25) and the Áras Attracta Report contained a section entitled “Strengthening and Enhancing the Leadership and Management” with a key recommendation to implement a leadership development programme (Áras Attracta Swinford Review Group, 2016: 13). What these reports seem to suggest is that inappropriate or inadequate leadership is associated with poor patient/client care outcomes and as indicated above most have called for improved leadership and leadership development programmes. A reasonable question to ask at this juncture is what evidence exists to support the claim that leadership can indeed improve many variables including patient/client care outcomes?

Writing in the editorial of Journal of Nursing Management Wong (2015) suggested that while a large body of research demonstrates associations between leadership and better patient/client care outcomes (e.g., lower medication errors) future research needs to include longitudinal designs and ascertain causal connections among variables. Examples of studies showing a connection between leadership and patient/client care outcomes include a study by Cummings et al. (2010), who found that nursing leadership did in fact have an impact on patient mortality – staff who practised resonant (emotionally intelligent) leadership could result in lower 30-day mortality. A systematic review carried out by Wong et al. (2013) reported a definite link between supportive leadership and patient outcomes such as lower medication errors, patient mortality, hospital-acquired infections and higher patient satisfaction (Wong, 2015). These associations according to Wong et al. (2013) may be due to the fact that supportive leadership may result in better work environments (good staffing levels, improved resources, and care practices) which may in turn help reduce mortality. Agnew and Flin (2014) carried out a study to investigate the leadership behaviours practised by senior charge nurses and determine their association with safety outcomes. The findings indicated that relations-oriented and task-oriented behaviours were generally used but that during challenging situations task-oriented behaviours predominated. Interestingly, nurses’ ratings of their senior charge nurses’ leadership behaviours (monitoring and recognising) were associated with staff compliance while the senior charge nurses’ self-ratings demonstrated that supportive behaviours were associated with lower infection rates. In a similar vein, Paquet et al. (2013: 87) explored the role of thirteen work environment (psychosocial) variables as predictors of patient outcomes. The results suggest that four perceptions of work environment (“apparent social support from supervisor, appreciation of workload demands, pride in being part of one’s work team, and effort/reward balance”) were linked to reduced medication errors and reduced length of stay in care units.

In addition to associations between leadership and patient care outcomes other research studies have demonstrated relationships between leadership and improved performance (Wong and Cummings, 2009; Paliszkiewicz et al., 2014; Brown et al., 2015). Such findings are no doubt significant given that most organisations strive to increase performance and address financial pressures but a word of caution here: due consideration must be given to the unintentional consequences (e.g., breakdown in standards of care) that could occur when applying systems and activities designed to increase efficiency of services (Cohn, 2015). Additional variables that have been examined for associations with leadership include job satisfaction and work environments. A Canadian study (Hayward et al., 2016) found that nurses left their jobs because of inadequate leadership, poor professional relationships with physicians and negative work environments. Similarly, Galleta et al. (2013) reported that intention to leave a job was drastically reduced when relationships between nurses and leaders were good.

While it is well recognised that most health professionals receive lectures in leadership at some stage during their respective undergraduate programmes of study (Ahmed et al., 2015; Ailey et al., 2015) and that several universities offer leadership programmes at postgraduate level, it is important to point out that the content of these programmes can vary and may not suit the needs of everyone (Curtis et al., 2011). Moreover, leadership programmes in health have been criticised because they do not for example (a) include continuing learning opportunities that take into account participants’ experiences from practice and (b) continue to portray leadership from an individual/leader-centric perspective (Fulop and Day, 2010). Recently, there has been a call for a different kind of leadership in healthcare: one that is patient/client focused and addresses care in an integrated way. This, according to Ahmed et al. (2015) requires a change from the current situation where leadership is centred on one individual (concentrated or heroic leadership) to a more participative or distributed approach where all individuals can participate in leadership. The chapter now moves on to address this alternative approach – DL.

Why Distributed Leadership and What Is it?

For almost 60 years, research has focused on orga...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• Contributors
• SECTION I BACKGROUND AND CONTEXT
• SECTION II LEADERSHIP FOR IMPROVING AND ENERGISING
• SECTION III INNOVATING THROUGH CHANGE
• SECTION IV APPLICATION
• Index