NU703 Unit 7 Leadership Philosophy Statement Example

I Cannot Be in Five Clinics at Once: A Leadership Philosophy Statement for an Urgent Care Director, Built on Complexity Leadership Theory and Three Principles for Designing the Conditions of Frontline Adaptation

[Student Name]

Purdue University Global

NU703: Professional Role Development of the DNP-Prepared Nurse

Unit 7 Leadership Philosophy Statement

[Instructor Name]

[Date]

The author, organization and numbers are composite; figures are bracketed.

My Role

I direct the advanced practice clinicians of a regional urgent care network: [twenty-two] nurse practitioners and physician assistants spread across five sites between [forty] and [ninety] miles apart. I report to a regional vice president and work alongside a medical director, who holds clinical authority over protocols and credentialing. I control schedules, hiring, orientation and operational workflows. I do not control clinical standards on my own, the budget for new equipment, or the shared services, such as scheduling and radiology reading, that all five sites depend on.

On a typical day I am physically at one site. The other four are running without me, and that is the fact my philosophy has to answer.

A Map of Where Decisions Sit

When I drew the network for this statement, I found three layers. Each site has its own clinicians, front desk and informal ways of working; decisions about patient flow within a shift are made there, usually by whichever clinician is most experienced. Shared services, including central scheduling, a radiology group that reads images for all sites, and the laboratory courier, sit across the sites and are managed by other departments. And the network's policies, including clinical protocols, staffing ratios and budgets, sit with the medical director, the vice president and me. Most of the problems that reach me start at a site but depend on a shared service, such as a delay in reading an X-ray that holds a patient for an hour.

The Theory

Complexity leadership theory, as described by Uhl-Bien, Marion and McKelvey, views an organization as a complex adaptive system, where much of what matters, including new solutions, emerges from interactions among people rather than from directives (Uhl-Bien et al., 2007). The theory names three leadership functions. Administrative leadership is the formal, bureaucratic work of planning, coordinating and controlling. Adaptive leadership is the informal, emergent process by which people in the system generate new responses to problems. Enabling leadership works between the two, creating conditions in which adaptive responses can arise and helping the useful ones move into the formal system.

This framework fits health care well. Plsek and Greenhalgh argued that health care is a complex adaptive system in which agents act in unpredictable ways and their actions interconnect, so that rigid planning often fails and leaders do better to set simple rules and let local solutions emerge (Plsek & Greenhalgh, 2001).

At the systems level, my job is not to solve the problems at each site but to design the conditions in which the people at each site can solve them, and to carry their best solutions to the other four.

Principle 1: Standard Work Where Variation Harms Patients

This is my administrative function. Some things must be done the same way at every site because variation causes harm. Sepsis screening at triage, the process for calling a patient back about an abnormal result, and the handoff when a patient is transferred to an emergency department are examples. For these I work with the medical director to set one standard, train every clinician in it, and audit it monthly. I do not invite local redesign of these processes, and I explain why: a patient should not face a different risk because of which site they walked into.

Principle 2: Local Redesign Where Variation Does Not Harm

This is the adaptive function, and my role is mainly to protect it. How a site organizes its rooms, sequences its patients on a busy evening or divides work between the front desk and the clinicians can differ from site to site without harming anyone. At one site, clinicians began seeing low-acuity patients in a chair by the front desk during surges, which cut waits without any change in outcomes the site could detect. I did not design that. My job was to let it happen and not to standardize it away. Research on the spread of improvements in health care suggests that local variation often reflects self-organization that fits a particular context, and that forcing uniformity can remove the very adaptations that made a practice work (Lanham et al., 2013).

Principle 3: Cross-Site Forums That Carry Solutions

This is the enabling function, and it is where most of my time goes. Because I cannot be at every site, I have created a monthly forum where one clinician from each site presents a problem and what they tried. The chair-by-the-desk idea reached two other sites through this forum. So did a workaround for radiology delays, in which clinicians at one site began calling the radiology group directly for urgent reads rather than waiting in the queue; that workaround then became a formal agreement with the radiology group, which is exactly the movement from adaptive to administrative that the theory describes. I also bring shared-service problems from the forum to the departments that own them.

The Limits of My Authority

My philosophy has limits I have to respect. I cannot set clinical standards alone; the medical director owns those, and a solution from the forum that changes clinical practice must go through her. I cannot fund changes that require equipment or staff beyond my budget. And I cannot control the shared services; I can only make their effect on patients visible to those who do. Complexity leadership does not remove hierarchy. It asks me to use my formal authority to protect the space in which others adapt, and to know when a problem is beyond that space.

Signs the Philosophy Holds

I want to be able to test this philosophy, so I have chosen three signs to watch over the next year. The first is whether the audited standards hold at every site, measured by the monthly sepsis screening and result callback audits. The second is whether the forum keeps producing solutions that travel, which I will count by the number of practices adopted by at least one other site. The third is whether clinicians feel they can change how their site works, which I will ask about in a short annual survey. If the audits slip, I have been too loose where I should be firm. If nothing travels between sites, the forum is not working. And if clinicians say they cannot change anything, I have been too tight.

Conclusion

I lead five sites I cannot be at. My philosophy is to standardize only what must be standard, protect local redesign where it does no harm, and build the channels through which good local solutions reach the whole network. I judge my leadership less by what I decide than by what the sites solve without me.

References

Lanham, H. J., Leykum, L. K., Taylor, B. S., McCannon, C. J., Lindberg, C., & Lester, R. T. (2013). How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts. Social Science & Medicine, 93, 194-202. https://doi.org/10.1016/j.socscimed.2012.05.040

Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625

Uhl-Bien, M., Marion, R., & McKelvey, B. (2007). Complexity leadership theory: Shifting leadership from the industrial age to the knowledge era. The Leadership Quarterly, 18(4), 298-318. https://doi.org/10.1016/j.leaqua.2007.04.002