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Managment vs Leadership Case Study

 

As a risk management and patient safety professional, what type of leadership theory (transactional, transformational, situational or behavioral) might be most helpful in responding to this case scenario and why? 

 

60 Comments

  1. Sam Elizondo

    Feb. 9, 2021

    I agree, all leadership styles can potentially apply. It is important to be aware of when and how to apply these various leadership techniques to help with the investigation and ultimately to help with the corrective / improvement actions. The key goal is to improve patient safety and reducing the risk of similar adverse outcomes being repeated again. The Risk Manager has has an important role in the organizational lessons learned aspect of the adverse event and RCA. There is a always transformative goal in mind, i.e., how do we most effectively promote improvements in healthcare risk, quality and patient safety by inspiring others to improve based on the lessons learned?

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  2. Susie Jester

    Feb. 8, 2021

    I would say both situational and behavioral would be most appropriate. You are dealing with a specific scenario with many variables that need to be approached individually to identify all areas where improvement could occur.

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  3. Lisa

    Feb. 7, 2021

    I think that a mix of all leadership styles would be needed especially situational so that the leader can guide, collaborate, and empower individuals involved in the situation to look at the their processes and support them through the event.

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  4. Kristen Dixon

    Feb. 7, 2021

    I agree several leadership styles- however, behavioral and situational. I am thinking of our nations current situation with travel nurses in all hospitals- unfamiliar with process and procedures, SOPs and work instruction. This event makes me think of the swiss cheese model. Many things occurred leading up to the code- that if had they not happened- the patient may still be alive.

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  5. Beth

    Feb. 7, 2021

    I believe behavioral and situational styles would be useful during the investgation

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  6. Jen Manlapaz

    Feb. 7, 2021

    I believe multiple leadership styles would be appropriate in this situation. I think about behavioral as we must consider the mindset of the staff involved after this event as we discuss it with them. Transactional leadership is also appropriate as there are certain things we must do to fully investigate this case. Situational leadership is also important as we consider what happened that led to this event. Transformational leadership is important too as even though the nurse is an agency nurse, we can empower people to make change within the organization by valuing their feedback on how we can improve.

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  7. Doreen Herdman

    Feb. 7, 2021

    I agree, all leadership styles apply. The process to review has multiple perspectives and apply each accordingly to the steps in the risk review

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  8. Leilani Kicklighter

    Feb. 6, 2021

    The risk manager involved in this scenario would utilize all the leadership theories, individually or paired depending on the issues and individual(s) involved: - This is a devastating situation for the patient’s family and friends, for staff both directly and those indirectly involved in the care of this patient - emotional support for all levels of staff - disclosure process to family - fact gathering, utilizing a root cause analysis and individual interviews - appropriate communication horizontal and lateral - collaboration to gather corrective and mitigation ideas and implementation process - Handling legal, insurance and other regulatory issues

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  9. Jacquelyn Baker

    Feb. 6, 2021

    My thought is that situational leadership style would be used in the initial investigative period. This style requires rational approach to understanding the situation and the ability to respond appropriately to the findings. Transformational leadership would not be utilized initially due to the fact that an agency nurse is involved.

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  10. Melissa Lofton

    Feb. 6, 2021

    Thank you all for your input! Great discussions!

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    1. Mariel Kagan

      Feb. 6, 2021

      Thank you very much, Melissa

  11. Tammy Rorer

    Feb. 6, 2021

    In my opinion, the most helpful leadership theory in responding to this case scenario is situational leadership. This allows determining a best course of action through a collaborative effort while promoting safe patient care by the entire team.

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  12. Danielle Manglona

    Feb. 6, 2021

    The leadership theory in responding to this case would change over the course of time. Initial response would require the implementation of the situational leadership theory. This theory would allow for the flexibility of the risk management and/or patient safety professional when tackling fact gathering, providing support to second victims, facilitating a root cause analysis, etc. Situational leadership theory involves choosing the best course of action based upon situational variables. The risk management and/or patient safety professional may need to provide more direction or guidance given certain situations and in others they may need do more coaching for example. In supporting safety culture and high reliability, the risk management and/or patient safety professional would transition to the use of transformational leadership theory. The transformational leader would support the front line in making improvements in practice to close the gaps in the processes involved and the sharing of lessons learned throughout the organization. The risk management and/or patient safety professional, as a transformational leader would then foster a learning environment which goes a long way in making a positive impact within the organization.

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    1. Melissa Lofton

      Feb. 6, 2021

      Completely agree!

  13. Melissa Lofton

    Feb. 6, 2021

    One additional piece of info to see if it changes anyone's direction and style. When physicians entered the order to transfer to "telemetry" as a level of care (not specifically a telemetry unit) the assumption was they would be put on continuous cardiac monitoring. However, in reality that order did not trigger a specific order for continuous cardiac monitoring. So therefore the agency nurse is correct that there was not an order for continuous cardiac monitoring.

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    1. Angel Barber

      Feb. 6, 2021

      True, but there should be some protocol for telemetry and the physician would or could have been involved in that protocol as one would like to think that the protocol for telemetry would have been discussed and recommended thru medical staff meetings. But again not having all the facts was the physician a locum? was the physician a hospitalist etc. Again not knowing more can't really know for sure and don't want to immediately judge. I would also want to know if the agency nurse had been thru orientation of the unit? How long had the agency worked on the unit? again all factors that would need to be investigated.

    2. Lavina Davis

      Feb. 6, 2021

      Definitely agree. There are opportunities to improve this ordering process for more clearly defined orders with prompts driving the provider to address telemetry status when ordering telemetry unit transfers and remove the human factor component. Even more so important in our current climates with staffing challenges due to COVID and need for potential use of more agency staff.

  14. Lauren Hyer

    Feb. 6, 2021

    In the beginning it's important to employ transactional leadership. However, as you progress, I think it's important to tailor your leadership style to your audience and stage of response.

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  15. Alex Bowers

    Feb. 6, 2021

    I believe using a collaborative approach would be most useful. In the beginning of my investigation as a risk manager using situational leadership to plan how I will plan my review. I would also use behavioral leadership to gain more insight and provide empathy for the second victims.

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  16. MELANIE OSLEY

    Feb. 6, 2021

    Initially situational. Then be flexible as to which one to use as the investigation rolls along

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  17. Debi Seagroves

    Feb. 6, 2021

    I am not clinical but in this incident I would choose situational leadership. I would discuss this incident with a clinical leader and choose the best course of action based on the situational variables.

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  18. Melissa Lofton

    Feb. 6, 2021

    After the initial phase when transactional is most needed and helpful (in my opinion), transformational leadership is key to getting everyone to understand the desired outcome and key patient safety issues. It's with that overall understanding of what the desired goals are that drive the necessary input and participation.

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  19. Jenna

    Feb. 6, 2021

    I believe all leadership styles will be utilized throughout the duration of the investigation. Initially Transactional as the first step.

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  20. Cyndi Nation

    Feb. 6, 2021

    I have read others points of view and I agree to a lot of what everyone has provided. I too believe it may be situational and transactional based on the circumstances and again for the same points outlined by others. I also think that transformational would be beneficial as leadership culture plays a big part in influence of patient safety.

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  21. Jana Lyner

    Feb. 6, 2021

    Situational is best since it is based on the theory that there is no best style and how the leader responds depends on the situation. The leader has to look at the culture of the organization, the team members involved and the situation before responding to any event.

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  22. Melody Saikali

    Feb. 6, 2021

    This incident, I'm sure many of us have either seen the likes of, or experienced it ourselves, highlights the need to build a stronger system. To address these "assumptions" that were made, and make sure we have processes/protocols in place to act as the safety barriers, even when us humans "assume" or "forget". Incorporating that with coaching/education of staff, and as mentioned earlier, empathy when talking to staff, who are often the second victims here. Addressing inherent system gaps, showing staff what would be the best course of action ultimately fostering a transparent and learning from errors culture, is what I think is key.

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  23. Lisa Sunday

    Feb. 6, 2021

    Some of all styles will most likely be used at various times. After the initial handling of the details of the situation, there will be a lot of time spent in staff interviews for their benefit and to assess future prevention. Collaboration from multiple areas of the hospital (ie. PACU, pharmacy, ICU, Nursing, Personnel, etc.) will be necessary to put in place and monitor an effective correction plan to decrease this potential in the future.

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    1. dotti m Cahill

      Feb. 6, 2021

      i totally agree

  24. Lory Harte

    Feb. 6, 2021

    I believe that situational and behavioral leadership styles are most necessary during this circumstance. As a risk manager, I have to do a lot of listening. I have to react and respond based on what I hear. I have to be empathetic but also ask good questions to get to the root cause and support the local leadership in developing corrective action plans to prevent this from happening again. The caregivers involved in the event may need different types of support. I have to be nimble and flexible in my approach.

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  25. Angel Barber

    Feb. 6, 2021

    I think situational leadership might be best served here. though all would be good but given the circumstances my opinion is situational would be the better of the four. This is because due to the condition and situation that was at hand patient being admitted to step down unit, telemetry but not placed on continuous monitoring and agency staff all of this are part of the situation that didn't appear to be norm therefore adapting to the situation at hand would be the best in my opinion.

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  26. Mariel Kagan

    Feb. 6, 2021

    I believe that components of each type of leadership theory would be helpful in this situation. From a transactional perspective, there will need to be a comprehensive review and investigation into the events that preceded the patient’s expiration. An RCA, held in a very collaborative manner, will unearth some concerns including but not limited to, the ordering of the telemetry /PCU unit (as opposed to Transplant ICU) and the agency nurse not realizing that continuous cardiac monitoring should be implemented; to noting the elevation in B/P during V/S; the non-noticing of the Dilaudid given in the PACU, and subsequent meds given in the PCU, etc. Behavioral and situational leadership will be much needed in working through the event, and its effect(s) on those involved. Coaching will be important as well, especially in anticipation of the need for support of the ‘second victim.’

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    1. Melissa Lofton

      Feb. 6, 2021

      Correct there were second victim issues. Especially, given the patient's young age.

  27. Melissa Lofton

    Feb. 6, 2021

    There was definitely a lot to unpackage here. There were misunderstandings about what was being ordered from a physician standpoint. There was the agency nurse who normally worked Med/Surg rather than PCU. Definitely had second victim issues to deal with as well.

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  28. Nadia Cheevers

    Feb. 6, 2021

    I think several of the leadership theories would be useful here. In an event like this, individuals will be likely to feel upset, scared and even angry towards others. Behavioral leadership would be helpful to establish the intention of being non-blameful and with the goal of learning about this event for the current patient/family and the good of future patients. Along those lines, transformational leadership can be helpful here in guiding a group through a crisis like this to see the goal and to support them in getting there. A lot of situational leadership will be needed, as things are often not as they seem. Being open to hear and learn about the specifics of the situation is essential before making decisions on next steps.

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  29. Ashley Mikhail

    Feb. 6, 2021

    I think a combination of these are all relevant, but mostly situational in this scenario. It's important to focus on our emotional intelligence, compassion, and objective fact-finding skills here.

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  30. Lavonneda Hyland

    Feb. 6, 2021

    I think a combination of transactional as well as situational. From a transactional standpoint there are certain steps that must be done when beginning an investigation. But considering situational variables specific to the event may also be a good way to approach this situation as well.

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  31. michelle

    Feb. 6, 2021

    I would start off as situational, ensuring that I make everyone involved in the event feels that they can provide information to me and feel supported. I would have transactional approach mixed in later as I complete the "to do list" for investigating the event.

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    1. Michelle

      Feb. 6, 2021

      I agree with you. Involving everyone in the investigation makes is feel less punitive and more about improving care for the patient.

  32. Suzanne

    Feb. 6, 2021

    I'd start with transactional and incorporate behavioral as I work thru gathering evidence and understanding the whole event

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  33. trish

    Feb. 6, 2021

    In order to investigate what happened, I'd say situational.

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  34. Faye Robbins

    Feb. 6, 2021

    I agree that all elements may be required, but perhaps focus the analysis with transformational style. Though this was an agency RN, perhaps a deficit in understanding the patient population for a tele unit was in place. The RN noted there was no order for telemetry, but did not clarify with the surgeon. A transformational style encourages staff to look beyond task completions and seek the why behind the patient's response to each care process. This will facilitate and promote the critical thinking that we often lament as lacking in bedside care

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  35. Nancy Somerset

    Feb. 6, 2021

    Transformational to focus on working as a team to review and collaborate on opportunities for improvement in pt care.

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  36. Candace Eden

    Feb. 6, 2021

    I'm choosing Transactional Leadership for this one:Lead through motivating their followers, helping them see what success looks like and how it leads to the greater good. I think we need to discern what was missed, how it was missed, put safety nets in place to prevent it again but to demonstrate to the staff this helps us become a highly reliable unit/hospital/organization as we take the time to influence the need to review these cases and collaborate on solutions from help with OR/PACU/The unit/and the physician and staff in this instance and in future events in other areas.

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  37. Michelle Miller

    Feb. 6, 2021

    A mixture of situational and behavioral would probably work well. Remaining unbiased until you obtain all the facts. The ability to remain supportive to all involved, including the family. Keeping your actions professional, non-biased and empathetic shows maturity and leadership.

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  38. Cheri Graham-Clark

    Feb. 6, 2021

    I would probably use Situational Leadership as there are many stakeholders in this care scenario and several variables to consider as approach the investigation and work with the stakeholders.

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  39. Kristen Sapienza

    Feb. 6, 2021

    I think situational would apply specifically to this situation because it is in response to a clinical event. We have to evaluate the specific event and provide guidance in how to walk through the situation. I am always hesitant to provide guidance in a clinical nature but to point them toward their practice and policy so that they may come up with a solution.

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  40. Becky Singleton

    Feb. 6, 2021

    I agree with a little bit of each.

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  41. Karen Rubeor

    Feb. 6, 2021

    Situational. During the initial phase, there may be some second victim issues and folks requiring support and resources to help them through. Then gently probing to determine how systems may have failed. Democratic style to have input from those involved on what could have prevented this event.

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  42. Kim

    Feb. 6, 2021

    I think a little of everything will be needed. Many things to unbundle and lots of emotion from folks involved to be able to understand situation, processes and move towards solutions.

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  43. Melody Saikali

    Feb. 6, 2021

    I think a combination of mostly situational and behavioural leadership at first, to help staff see how or what is the best course of action that should have been taken, and then help motivate them to see what a successful (i.e safe) course of action can lead to.

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    1. Melissa Lofton

      Feb. 6, 2021

      Agree. As I stated in a couple of replies, I'm initially employing my transactional side as I work through my initial "must dos."

  44. Lavina Davis

    Feb. 6, 2021

    When reviewing and analyzing any event, I think situational leadership should always be part of the approach, even if mixed with other types. The leader should lead based on a particular situation depending on information discovered during analysis. Behavioral leadership would also be important for support and coaching during a difficult event.

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    1. Melissa Lofton

      Feb. 6, 2021

      All very true. In the initial stages, I'm always more transactional as I go through my checklist of my initial "must dos". But I certainly agree with you.

  45. Heatther J-B

    Feb. 6, 2021

    Seems as all would be applicable but think a collaborative approach would work best. There are many factors that influenced this event. Ordering, medication management, nursing. This seems to warrant a top to bottom review. Not one causal factor but a collection of unfortunate events which lead to a bad coutcome.

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    1. Magdalie Gedeon

      Feb. 6, 2021

      I definitely agree.

    2. Melissa Lofton

      Feb. 6, 2021

      Absolutely. In beginning an investigation, I usually employ the transactional leadership style as there are must dos that need to occur sequentially. Examples are 1) Reviewing the record, 2) Interviewing staff and providers, 3) any family meetings for disclosure, etc.

  46. Melissa Lofton

    Feb. 6, 2021

    What do you think would be the most important style to employ at the beginning?

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    1. Lavina Davis

      Feb. 6, 2021

      Agree that transactional leadership is needed in the beginning to complete the required tasks. I do think it is important how that is approached so the involved staff feel support during those difficult "must complete" tasks. I have seen leaders complete those tasks as if they are checking a box and forget how their approach affects the second victim. Word choice and how we interview staff is so important for them to feel safe in speaking up.

  47. dotti m Cahill

    Feb. 6, 2021

    I would say a little bit of all types but esp Behavioral...

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    1. Melissa Lofton

      Feb. 6, 2021

      Agree. Different leadership styles will apply at different times during the investigation.

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