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What would you do in the next three to five years if you knew for a fact that you could not fail. I ask again, what will you do in the next three to five years if you know for a fact that you cannot fail.

As you become the transformational leader in your own future, I hope you might share your secrets and leave the legacy we so desperately need in the future of healthcare. The world needs you to become the leader in transforming healthcare for the next generation.

WHAT IS TRANSFORMATIONAL LEADERSHIP?

Leadership

The purpose of this text is to help you as an advanced clinician prepare to become a transformational leader.

Transformational Leadership

Characteristics of Transformational Leadership

Bass noted that authentic transformational leadership must be grounded in the leader's moral character, a foundation of ethical values and collective ethical processes. Your job is to visualize and formulate the prototypes for transformational leadership in healthcare.

Management and Leadership

Researchers have compared the effects of transformational leadership and other leadership styles and have found high correlations between all styles with organizational outcomes and employee satisfaction (Molero, Cuadrado, Navas, & Morales, 2007), supporting the idea that a variety of leadership styles and approaches are effective in different roles and circumstances.

THE ROLE OF THE DOCTOR OF NURSING PRACTICE IN ORGANIZATIONAL AND SYSTEMS LEADERSHIP

Develop and evaluate care delivery approaches that meet the current and future needs of patient populations based on scientific findings in nursing and other clinical sciences, as well

Ensure accountability for the quality of health care and patient safety for populations with whom they work

As a DNP-prepared manager, you are expected to guide and inspire organizational systems, quality improvement, analytical evaluation, policy development and translation, and interdisciplinary collaboration to improve health care (Bellflower & Carter, 2006). Prepared at the highest level of practice, you will understand the broad perspective of resource management in a sociopolitical environment to influence policy decisions and "ultimately improve the standard of health care" (Yam, 2005, p. 564).

BRINGING THE PERSPECTIVE OF EXPERT CLINICIAN TO ENHANCE LEADERSHIP: ENVISIONING NEW ROLES

There is good reason to hope that you will be able to invent systems of care not yet known that will strengthen, correct and transform health systems as we know them today. The expert clinician's point of view is essential to leadership for the future of healthcare, but it requires nurses to specifically "move from the operational (doing) aspect of work to the strategic (reflective) element" (Savage, 2003, p. . 2).

HERITAGE AND LEGACY: HISTORICAL PERSPECTIVES

This includes people like Mary Ann Bickerdyke, who cared for Union Army men in the American War Between the States. She was one of the founders of the Association for Superintendents of Nursing and an author of one of the first textbooks for nurses and a history of nursing.

FOUNDATIONAL THEORIES OF LEADERSHIP

Futurists predict with hope that the next generation will be the age of wisdom. What will be needed next is vision and wisdom about how best to deploy information, resources and people to meet healthcare needs within complex systems.

Traditional Management Theories and Methods

We have passed from the age of "big people" to the age of information, with an explosion of knowledge of facts and complexity of systems. Ironically, the advantage of such theories is that they provide a foundation for management by objectives (Stone & Patterson, 2005).

Environment and Worker Needs Theories

Behavioral Theories

Theory Z suggested the development of work groups and quality circles to increase the sense of employee engagement and productivity at the work level. The styles describe all aspects of the leader's personality, character, motivation or behavior.

Trait Theories

One well-known and popular approach to leadership is Covey's (1989) seven habits, which is considered by some to be an extension of servant leadership theory, which needs to be discussed, but actually resembles a trait perspective in that it describes a list of character. - characteristics, orientations, actions or habits for success. For example, part of the eighth habit is cultivating positive influence to help others find their own voice and realize their best potential.

Situational/Contingency Theories

Situational factors included the nature and quality of the relationship between the leader and followers, the nature of the task or goal, and the leader's formal and informal power (Fiedler Fiedler & Garcia, 1987). Goleman's work on emotional intelligence (Goleman et al., 2002) is an example of theoretical thinking that links situational leadership style and transformational leadership ideas.

Constituent Interaction Theories

According to ideas about emotional intelligence, the leader must be sensitive to the appropriate style and circumstances, mainly by listening empathetically to himself and others. Concepts include "in group" and "out group" relationships, which reflect the quality of the leader-member relationship (Miner, 2007).

Transformational Theories

Heal to Make Whole. Servant-leaders willingly address broken spirits and emotional hurts
User of Persuasion. Servant-leaders are effective at consensus building
Foresight. Servant-leaders show the ability to see the probable outcome or situation
Stewardship. Stewardship is about holding something in trust for the greater good of society
Commitment to the Growth of People. Servant-leaders have a strong belief that people have intrinsic value beyond their employable skills

The key distinction of servant leadership is the expectation that the leader's “primary motivation is to serve and meet the needs of others” (Stone & Patterson, 2005, p. 12). The popularity of the ideas of servant leadership has opened the arena for other, more spiritually focused theories that include concepts of forgiveness, kindness, and hope (Fry, 2003).

Theories and Models in Nursing Leadership

From an empirical and theoretical perspective, evidence for the effectiveness of transformational theories remains to be demonstrated. There seems to be a hunger in society for the hope and positive promise of the transformational leader.

INNOVATION AND CREATING A FUTURE

The doctor of nursing practice degree: Lessons from the history of the professional doctorate in other health disciplines. It is far too easy to simply collect lists of desired qualities of a leader.

REFLECTION AND PERSONAL MISSION

Pretend you are a stranger to the environment and reflect on situations with new eyes. You can be more aware of when you are off or on track for success.

GOAL DIRECTION

Likewise, when you formulate your personal mission statement as a healthcare leader, colleagues and the entire care environment will be attracted to develop towards your mission statement. Once you have created your personal mission statement, you should be able to wear it comfortably and it should live for you.

PRESENCE AND EMOTIONAL INTELLIGENCE

However, we still have to answer the following questions posed by Stewart (2004, p. 10): "Can emotional intelligence be learned. How can a person compensate for weakness in emotional intelligence?" Such questions must be answered by the next generation of healthcare leaders.

ACCOUNTABILITY AND AUTHENTICITY

George described five key characteristics of the authentic leader: (1) the ability to understand his or her purpose, (2) adherence to enduring values, (3) the ability to lead from the heart, (4) establishing lasting relationships and (5) the practice of self-discipline. Furthermore, you can only lead with your heart when your heart is aligned with your actions and the mission of the organization you lead.

VULNERABILITY, RISK TAKING, AND FEARLESSNESS

Humility is modesty, without pretensions, or sincerely not believing that you are superior to others (Martinuzzi, 2007). Of course, as soon as you focus on your own humility, you lose everything you could have had.

INSPIRED CREATIVITY AND INNOVATION

Perhaps that's because we often think of creativity as free and brainstorming, while critical thinking is more concrete and systematic. It is in the third decision stage that the leader should have gathered support to make the decision to adopt the innovation.

BUILDING ON STRENGTHS

The leader's role in this phase is to communicate the innovation and describe how and why it works. At this stage, the leader's job is to influence positive responses to the innovation by demonstrating its merits and benefits, and the personal or professional individual benefits of the new plan.

Building on Strengths to Prepare for the Role

Learn what your own strengths are and play with them. 2005) outlined a process called the Reflected Best Self exercise. Third, compile your own "self-portrait," a description of yourself that reflects your strengths shown in the themes of the answers.

Building on Strengths in the Role: Appreciative Inquiry

The discovery task is to align strengths for competitive advantage and to identify and share best practices to appreciate "what is." The dream task is to imagine and imagine. The delivery task is to act on the dream, to live the vision and to maintain the plan, to create "what will be" (Cooperrider & Srivastva, 1987;.

MORAL SENSITIVITY AND REASONING

Opening the discussion with exploration of strengths and areas of positive interdependence begins a strong foundation for collaboration. They raise awareness of what is right, good, important, and beautiful when they help heighten followers' needs for achievement and self-actualization, when they promote followers' higher moral maturity, and when they lead followers to go beyond themselves. - interests for the benefit of their group, organization or society.

MEN AND WOMEN: ARE THERE DIFFERENCES IN LEADERSHIP?

Ancona, Malone, Orlikowski, and Senge (2007, p. 92) suggested that we "end the myth of the perfect leader." Instead, a leader must incorporate the talents and perspectives of others with confidence and humility, recognizing personal strengths and challenges. Cooperrider (Eds.), Valued management and leadership: The power of positive thinking and action in organizations (rev. ed., pp. 1–35).

LEADERSHIP COMPETENCIES: HABITS FOR PERFORMANCE

As in the business literature, every health care author seems to have a list of the most important, or core, competencies for the health care manager. Each new list or model announces something like: “The model of leadership competencies presented.

VISION: PERSPECTIVE AND CRITICAL ANALYSIS

The vision should reflect the organization's unique culture, values, beliefs, strengths and direction. Because vision is built into your being as a leader, many plans and decisions will seem to flow automatically in the direction of vision.

TAKING AN ORGANIZATIONAL AND SYSTEMS PERSPECTIVE

Leaders must work from an understanding that each element of a system is a microcosm of the system. The leader can think in terms of "leverage points" or positive change in one element of the system that later improves another part (McNamara, 2009).

USING EVIDENCE TO MAKE A DIFFERENCE

Evidence-based practice is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). It remains largely the leader's responsibility to blaze the trail to enable a culture where evidence-based practice is comprehensive across all systems.

USING POWER EFFECTIVELY

In new paradigms of self-organization and transformational leadership, power is generated through sharing, is enhanced by a shared vision, and becomes the amplified energy for change when it is understood and used as the secret treasure of the leader who strategically shares it . with the organization. When people feel like power is being taken away from them, they take actions to “hoard.”

THINKING AS AN ENTREPRENEUR

The process is as old and familiar as the practice, but it's about transforming problems and ideas into solutions that call for some adventure. Given the pioneering roots of professional nursing in general and advanced nursing in particular, it is ironic that the entrepreneurial spirit seems so foreign to current day-to-day practice.

CARING FOR OTHERS: WHAT SERVANT LEADERSHIP REALLY MEANS

Authenticity: Committing oneself to show up and be fully present in all aspects of life, removing the mask and becoming a real, vulnerable, and intimate human being, a per-

Service: Focusing on the needs of others by listening to them, identifying their needs and meeting them. Truthfulness: Listening openly to the truth of others and refusing to compromise integrity or to deny universal truths – even when it might seem like avoiding the truth, especially in.

Truthfulness: Listening openly to the truth of others and refusing to compromise integrity or to deny universal truths—even when avoiding the truth might, on the face of it, especially in

CARING FOR SELF

It's rightly called a burnout, because your sense of self has burned away in the flames of your burning rage to be everything to everyone. When you can't avoid it, reframe an image and take on a role that allows you to be sensitive but doesn't let them eat away at you.

FINDING THE SPIRITUAL CENTER

If the leader doesn't tend to care about self and others, or the details of reality, the temptation for vision, passion, belief, and enthusiasm to get through the day, without the balance of ruthless respect for the reality of the details, will send success tumbling. a shooting star. Mistakes and resolutions, wounds and healing, regrets and renewed purpose are all part of the journey to find your spiritual center as a leader.

HAVING INFLUENCE

Positive health habits not only sustain the leader, but also set a standard and model for colleagues and even patients. When you find your spiritual center, you will be amazed at your abilities to positively influence others.

Securing the Position

Especially as a first impression, never underestimate the power of the image you portray in your influence and success. Whether you like it or not, people judge your abilities within the first 8 to 30 seconds of a first meeting (Martin & Bloom, 2003).

Making the Difference

Patterson's fourth principle is to "exceed your limits." Do the right thing and help others exceed expectations. The eighth principle is to "change the environment". Look at the physical, social and intellectual work environment with new eyes.

GENERATIVITY: PREPARING THE NEXT GENERATION

Avoid or minimize the effects of toxic individuals and find ways to mutually support people who nurture each other and uphold the principles of the organization. Enhancing skills for evidence-based health care management: the Executive Training Program for the Application of Research (EXTRA).

CHAOS, QUANTA, AND COMPLEXITY IN HEALTHCARE SYSTEMS

The context of caring for leadership has become as challenging as any aspect of leadership itself.

Chaos, Quanta, and Complexity Theory

In its most simplified sense, the idea of quantum refers to a kind of fluidity of the particles of reality, such that the state or speed of the particles, or fundamental units, cannot be determined with certainty (Capra. Self-organization is the tendency of the organization to generate new patterns and structures, and order emerges from such relationship patterns (Stroebel et al., 2005).

Theory of Complex Adaptive Systems

Some of the current health care problems may be related to the challenging transition from traditional thinking to a complexity perspective. Penprase and Norris (2005) provided a specific example of the application of complex adaptive systems theory to nursing management.

Chaos, Quanta, and Complexity as Metaphors for Health Care

They offer an invitation to the most adventurous and courageous actions to lead others into the next century of healthcare, where systems truly offer hope and healing. The role of the leader is to “pay more attention to the quality of the relationships between agents than to the quality of the individual agents.”

DEALING WITH CONTINUAL CHANGE Living and Working in Change

We are now in the middle of the transition from the industrial age to the information/technology age. Porter-O'Grady and Malloch (2007, p. 9) describe a universal cycle of transformation in the transition period of chaos, driven by sociopolitical, economic and technical forces towards our adaptation from the industrial age to the era. of technology.

Supporting Others in Change

In a few hundred years, when the history of our time will be written from a long-term perspective, it is likely that the most important event that historians will see is not technology, not the Internet, not e-commerce. We are beginning to realize that the moment we get comfortable, another age will come.

Leading Change

Establish a sense of urgency
Form a powerful guiding coalition
Create a vision
Communicate the vision
Empower others to act on that vision
Plan for and create short-term wins
Consolidate improvements and produce more change
Institutionalize new approaches

Wheatley (Boyce, 2008, p. 104; Wheatley & Frieze, n.d.) further stated that “effective change never occurs as a result of predetermined top-down strategic plans. Change begins when local action occurs simultaneously in many different areas.” We have learned that “the world does not change one person at a time.

Change and Reflective Adaptation

Vision, mission, and shared values are fundamental in guiding ongoing change processes in a complex adaptive system
Creating time and space for learning and reflection is necessary for complex adaptive system to adapt to and plan change
Tension and discomfort are essential and normal during complex adaptive systems change
Improvement teams should include a variety of system’s agents with different perspectives of the system and its environment
System change requires supportive leadership that is actively involved in the change process, ensuring full participation from all members and protecting time for reflection. (Indianapolis

And it's important to remember that no matter how agile your organization is, change usually takes longer than you expect. Even if you feel that immediate change is needed, especially in a new role, take some time to assess – be the chief listening officer for a while.

Change as a Personal Challenge for the Leader

THE LARGER WORLD OF PRACTICE: DRAWING FROM ALL OF THE EXPERTS

Communities of practice are themselves organized in an emerging method by groups of people in similar endeavors in a process of collective learning. Soon you will be surprised how others will be attracted to your leadership and your organization.

THE LARGER WORLD OF LEADERSHIP: WORKING WITH AGGREGATES AND PATIENT POPULATIONS

Contemporary issues of medical informatics and population health: II. medical school goals project report. Informal structure is an extension of social structures that develop in a formal context.

INTERPROFESSIONAL COLLABORATION

Cultural: Strongly held value systems of each profession
Structural: Different schedules and locations (in educational preparation)
Faculty: Not comfortable and not rewarded (for interprofessional collaborative endeavors)
Nonsustaining: Series of “cameos.” (Most programs have been short-term demonstration projects dependent on limited or temporary resources.)
Lack of leadership from the top: Usually driven by passion of one or two faculty members
Asymmetry: [Have not been] equally supported by all participating professions

Increasingly, the preparation of nurses for advanced leadership in health care is recognized and nurse managers are given a wider range of management and control, including areas beyond nursing practice (Arnold et al., 2006), but this is not enough. We are just beginning to understand the real value of interprofessional collaboration on actual patient outcomes (Zwarenstein et al., 2009).

COMMUNICATION, CONFLICT, AND DECISION MAKING

Effective collaboration is not only personally and professionally satisfying for those involved, but also contributes to a unified approach to patients and customers, facilitates faster internal decision-making, reduces cost through shared resources, and promotes innovation (Weiss & Hughes, 2005). It will be the responsibility of future leaders to develop working models for collaboration and shared decision making (Stacey et al., in press) and to demonstrate the effects of such partnerships and collaboration on actual health care outcomes (Davoli & Fine, 2004). ; Zwarenstein et al., 2008).

Communication

Get the bad news out as quickly as possible. Only then can you get out of the bunker and begin to move forward

If you have been found guilty in the court of public opinion, you must apologize—publicly

Make sure that employees are attuned to what is going on. If there is bad news, let them hear it from you before they read it in the newspapers

Dealing With Conflict

Have ample opportunity to express their views and to discuss how and why they disagree with other group members
Feel that the decision-making process has been transparent, that is, that deliberations have been relatively free of secretive, behind-the-scenes maneuvering
Believe that the leader listened carefully to them and considered their views thoughtfully and seriously before making a decision
Perceive that they had a genuine opportunity to influence the leader’s final decision
Have a clear understanding of the rationale for the final decision

Conflicts can arise between individual employees or between individuals and representatives of the organization. In most cases the doctor is a free player, more often a guest, to the regular operational dynamics of the organization.

Decision Making

Believe that the leader listened to them carefully and considered their views carefully and seriously before making a decision. Fortunately, most leaders make relatively few strategic life-and-death decisions, but it is the leader who does make the strategic decisions.

DEALING WITH FEAR AND FAILURE

Ken Chenault explained, “In some situations you have to be very directive because people look for clear direction from the leader. You can't have one without the other." Likewise, to be afraid is to hope that you will not be afraid.

MOTIVATION AND MARKETING: TELLING THE STORY

Wheatley (p. 82) recalled that if we would remember that "we are hope, it becomes much easier to stop being dazzled or seduced by hopeful prospects". We are fully committed to being part of the solution, and then we throw ourselves into despair at the enormity of the challenges and the fear that our efforts will fail.” Wheatley reflects the concerns of so many of us, leaders, followers, patients, everyone.

Motivation: What It Is and What It Is Not

Motivation is a force, positive or negative, that creates action
Understanding the underlying motive that leads to taking action is the key to motivating people, including ourselves
Every motive for taking action comes from a need and a desire to satisfy it
Motives come in many forms and change throughout life
Motives can change rapidly, even during a specific activity

To motivate others is to listen to their fears and show the way to hope. Understanding the underlying motive that leads to action is key to motivating people, including ourselves.

Marketing: Telling Your Story

Look for themes that reflect your message, such as values, priorities, interests, or experiences
Look for consequences reflected in the cause and effect of choices that generate meaning
Look for lessons. What can be learned from the story?
Look for what worked. Success strategies are often found within the narrative of a good story
Build for future experiences. A story can plant an image in the mind that can provide advice in some future situation

Sandelowski (1991) noted the enormous power of narrative's ability to inform, educate and enlighten. The negative impact of nurse-physician disruptive behavior on patient safety: A review of the literature.

ELIMINATING HEALTH DISPARITIES: REACHING THE UNDERSERVED

Smedley and Stith (2002) wrote, “The diversity of the American population is one of the nation's greatest assets; one of its greatest challenges is to reduce the deep disparities in the health status of America's racial and ethnic minorities. Closing health disparities is one of the biggest challenges facing healthcare leaders today.

IMPROVING HEALTH LITERACY

This is a problem for all settings, including acute care, primary care, and community health care. Poor health literacy too often goes unnoticed, but is a critical issue for leaders who mentor and inspire physicians.

BEYOND PATIENT SAFETY TO PRACTICE EXCELLENCE

In fact, the failure to improve health literacy among those we serve can be considered a risk to patient safety. We research, plan, engage experts and fund safety-specific programs – but let's not forget that safety is just the beginning.

QUALITY IMPROVEMENT AND CUSTOMIZED CARE: THE CURRENCY OF CUSTOMERS AND CLIENTS

Identify benchmarking partners or
Determine what constitutes the benchmark calculation or data source
Gather information from peer sources
Compare actual data to benchmark data
Identify variances and calculate gaps in performance
Identify ideas for improvement, set goals, and develop and implement an action plan
Measure results and compare with the benchmark
The management, philosophy, and practice of nursing services
Adherence to national standards for improving the quality of patient care services
Leadership of the nurse administrator in supporting professional practice and continued competence of nurses
Understanding and respecting the cultural and ethnic diversity of patients, their significant others, and healthcare providers (Urden, 2006, 25)
No unanticipated deaths
No needless pain and suffering
Clinicians, staff, and students will say, “I contribute to an effective care team within a sup- portive environment that nurtures my professional career/growth and continually strives
Patients will say, “They give me exactly the help I want (and need) exactly when I want (and need) it.”
Unnecessary documentation is eliminated, reducing total documentation by 50%
Clinicians spend 70% of their time in direct patient care
Develop a vision for change
Focus on the change process
Analyze which individuals in the organization must respond to the proposed change and what barriers exist
Build partnerships between physicians and administration
Ensure that change is well communicated

Much of the recent discussion of health care quality has considered patient safety as equivalent to quality. Much of the focus among these efforts is on hospital care, but similar issues of quality characterize health care throughout our communities.

ASSESSING AND MANAGING RISK

PATIENT AND PROVIDER SATISFACTION

Patient Satisfaction

Solve the customer’s problem completely by ensuring that all the goods and services work, and work together
Do not waste the customer’s time
Provide exactly what the customer wants
Provide what is wanted exactly where it is wanted
Provide what is wanted where it is wanted exactly when it is wanted
Continually aggregate solutions to reduce the customer’s time and hassle

What we can learn about patient satisfaction from an authentic patient backstory. Born, Rizo and Seeman (2009) proposed the idea of understanding patient satisfaction from data available from social media, such as patient stories on social networks and social rating websites.

Provider Satisfaction

Creative staffing policies that recognize the realities of workers, such as offering elder care and/or child care to providers, acknowledge the real experience of workers at both ends of the family caregiver life experience. Furthermore, we have little experience dealing with issues of interprofessional satisfaction, such as between doctors and nurses, when we actually work together as a team.

IMPROVING PATIENT AND HEALTHCARE OUTCOMES

Never underestimate the influence of the quality of leadership on patient outcomes. 2002) found significant correlations between leaders' management of employees and patient mortality in hospitals. But research on healthcare leadership has been largely descriptive and related to the styles or characteristics of the leaders.

HEALTHCARE INDUSTRY WORKFORCE ISSUES

Soon the citizens of that world begin to use only the language of the new world, speak only to each other, and build systems and processes around themselves. The reality is that health care is an ongoing, iterative process to promote health, relieve suffering, and promote healing.

Shortages of Professionals

Sternin (2007) argued that such positive deviance has changed some of the world's most pressing problems. They do not reflect the wider picture of the growing need for qualified nurses.

The Value of Diversity

ETHICAL ISSUES FOR THE LEADER OF THE NEXT CENTURY

Autonomy: The right to select a course of action
Beneficence: The actions that promote “good” or appropriate outcomes
Nonmaleficience: The duty to avoid harm
Veracity: Telling the truth about decisions to the persons affected
Justice: Treating all persons fairly and equally
Paternalism: Assisting persons to make difficult decisions
Fidelity: Keeping promises
Respect: Treating all others with equal respect and concern

As it is now, nurses are seen as part of the health care funding problem in the US. Healthcare leaders must embrace the mandate of the future to design, lead and manage care models for the future.

MODELS OF CARE ON THE HORIZON: EMBRACING THE ENTREPRENEURIAL SPIRIT OF INNOVATION

We need to analyze our current models and find ways to evaluate them from an organizational perspective to improve the whole system. We need to identify new ways to promote health and care for the suffering, keeping an eye on productivity and efficiency.

Models of Care for Nursing Practice

The emergence of the Doctor of Nursing Practice (DNP) holds the promise of fostering environments of professional practice for nurses as colleagues in interdisciplinary approaches to care. The study represents the beginning of the important dialogue about researching, inventing and sharing models of care that work.

Care Model Design and System Change

Drucker shared the example of the Ford Edsel, which is the most famous failure of a carefully designed car in the modern automotive industry. They will make sure to prepare contingency plans for resistance (Morjikian et al., 2007) and they will take the whole organization and system perspective.

ASSESSING ORGANIZATIONS, IDENTIFYING SYSTEM ISSUES, FACILITATING SYSTEM-WIDE IMPROVEMENT

In other words, we can't run two businesses at the same time, but we don't have to do everything at once either. Finally, leaders of new care models should always pursue the perspective of the broader organizational culture, mission, and strategic planning; They will identify champions for plan success and expand creative authority, engage internal and external interdisciplinary team members and allies, and identify opportunities for internal and external formal partnerships.

Challenges in Taking the Organizational or Systems Perspective

Manifests a philosophy of clinical care emphasizing quality, safety, interdisciplinary collabo- ration, continuity of care, and professional accountability
Recognizes the contributions of nurses’ knowledge and expertise to clinical care quality and patient outcomes
Promotes executive-level nursing leadership
Empowers nurses participating in clinical decision making and organization of clinical care systems
Maintains clinical advancement programs based on education, certification, and advanced preparation
Demonstrates professional development support for nurses
Creates collaborative relationships among members of the healthcare provider team
Utilizes technological advances in clinical care and information systems
Create the environment of practice
Establish and ensure the standards of nursing care delivery
Coordinate patient care with inputs from all types of health professionals
Select and develop the nursing workforce
Evaluate and plan the work of nursing to meet patient requirements for care
Provide adequate staffing
Impetus to transform
Leadership commitment to quality
Improvement initiatives that actively engage staff in meaningful problem solving
Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization
Integration to bridge traditional intraorganizational boundaries among individual components
Mission, vision, and strategies that set its direction and priorities
Culture that reflects its informal values and norms
Operational functions and processes that embody the work done in patient care
Infrastructure such as information technology (IT) and human resources that supports the delivery of patient care (Lukas et al., 2007)

Almost as important as the environment for patient care is the concept of the work environment for the clinician. Alignment to achieve consistency of organizational goals with resource allocation and actions at all levels of the organization.

INSPIRING EVIDENCE-INFORMED PRACTICE: USING EVIDENCE FROM ALL DISCIPLINES

Only [the manager] can ensure that the new organization gets the necessary resources and is free to create processes and values that fit the new challenge. A writer for the New York Times (Rae-Dupree, 2009) recalled that two key factors in current health systems, the general hospital and the physician's practice, are largely based on business models over 100 years old.

Using Evidence for Practice

Several models have been proposed for the systematic implementation of evidence-based practice in healthcare settings (Marchionni & Ritchie, 2008; Stetler, 2003; Stetler, Ritchie, Rycroft-Malone, Schultz, & Charns, 2007). Stetler and colleagues (Stetler, McQueen, Demakis, & Mittman, 2008; Stetler, Ritchie, Rycroft-Malone, Schultz, & Charns, 2009) suggested that operationalizing evidence-based practice requires a formal strategic approach and role models.

Practice-Based Evidence

An evidence-based approach from practice has shown effectiveness in identifying best practices in a variety of clinical situations, including pediatric bronchiolitis (Willson, Landrigan, Horn, & Smout, 2003), stroke rehabilitation (Conroy, DeJong, & Horn, 2009) . and pressure ulcer treatment (Bergstrom et al., 2005). To date, formal practice-based research methods have been limited to large hospital systems or groups of institutional settings.

Using Evidence for Leadership

From the method, several measures of severity indices that are used in clinical practice have been developed (Horn et al., 2002). Although showing promise in public health and certainly useful for political leaders, the practice-based evidence approach needs further development in these areas.

TECHNOLOGY: INFORMATICS, ELECTRONICS, AND OTHER TOOLS OF THE FUTURE

Informatics and Health Care

While we all seem to have an idea of what technology means, there is no clear definition. That will change for the next generation of advanced physicians, especially among nurses with DNP degrees (Trangenstein, Weiner, Gordon, & McArthur, 2009).

Electronic Health Records

Westra and Delaney (2008) have begun work to identify the unique knowledge and skills required of the health care leader.

Tele-health and Tele-medicine

Technology and Simulation

Technologies on the Horizon

Other technologies and tools of the future that will change healthcare as we know it are out there, happening, yet unknown. Innovative technologies on the immediate horizon include the legacy of the Human Genome Project that will forever change the timing, processes, and ethics of the entire care process, from history and diagnosis to prevention, therapies, and interventions.

Implications of Technology for Leadership

Our care models of the future will move away from traditional clinical practice, physician-based designs, toward information-based consumer access models “that inform, empower and update the consumer to take individual action regarding his or her health status. ” (Porter-O'Grady, 2001, p. 66). Furthermore, the leader's promotion and management of technology use can be an important recruitment factor as nurses and other health care professionals gravitate to work environments where technology is used effectively (Fitzpatrick et al., 2010).

PRODUCTIVITY AND EFFECTIVENESS

Using Appreciative Inquiry to Promote Evidence-Based Practice in Nursing: The Glass Is More Than Half Full. The evidence-based practice mentor: A promising strategy for implementing and sustaining EBP in healthcare systems.

THE PRIMACY OF CULTURE AND CULTURAL SENSITIVITY

Cultural Competence, Sensitivity, and Humility

Apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts
Use relevant data sources and best evidence in providing culturally competent care
Promote achievement of safe and quality outcomes of care for diverse populations
Advocate for social justice, including commitment to the health of vulnerable populations and the elimination of health disparities
Participate in continuous cultural competence development

The Office of Minority Health (2000) defined, “Cultural and linguistic competence is the ability of health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by patients to the health care encounter. health care." Thus, leaders commit to recognizing, valuing and promoting differences and leading as models of cultural humility.

Organizational Culture of Healthcare Environments

Care is customized based on patient needs and values. Health professionals have the capa- bility to respond to individual patient choices and preferences
The patient is the source of control. Health professionals should be able to accommodate differences in patient preferences and encourage shared decision making
Decision making is evidence based. Health professionals should provide care based on the best available scientific, standardized knowledge
Safety is a system property. Health professionals should ensure safety by, paying greater attention to systems that help prevent and mitigate errors
Transparency is necessary. Health professionals should make information available to patients and their families that allows them to make informed decisions about all as-
Needs are anticipated. Health professionals should be able to anticipate patient needs through planning
Waste is continuously decreased. Health professionals should make efforts not to waste resources or patient time
Cooperation among clinicians is a priority. Health professionals should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of

Additionally, there are likely to be both lovely and annoying subcultures within the larger culture of the organization. Individuals and populations of patients, indeed the very experience of being a patient, contribute their own subculture to the entire gestalt of the organization.