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Managment vs Leadership Case Study

 

As a risk management and patient safety professional, what type of leadership style (coercive, authoritative, affiliative, democratic, pacesetting or coaching) would be most appropriate or responding to this case scenario and why? 

 

47 Comments

  1. Sam Elizondo

    Feb. 9, 2021

    I think that a blend of styles could be utilized. In my experience, the members of the team are very often a key determinate in choosing which style to utilize. Also, I have found that we all have a preferred style that we lean towards. I can be very challenging to use an authoritative style if you tend towards a democratic styles.

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  2. Susie Jester

    Feb. 8, 2021

    Democratic and Pacesetting seem most appropriate in this scenario. When it comes to patient adverse events, you want the staff to feel a part of the solution and not just be told what to do better. If they find the solution, they are more likely to be compliant. We also do expect excellence and need staff to understand the importance of autonomy of thought process and decision making.

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  3. Lisa

    Feb. 7, 2021

    There is an opportunity to mix styles I think. However, based on my personality, I would choose democratic and coaching as the two main ones that I would employ in order to focus on the teaching aspect, support of the employees involved, and mitigate future events.

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  4. Kristen Dixon

    Feb. 7, 2021

    Coaching, affiliative and democratic for me. One of my favorite parts about being a leader is coaching and teaching. There is so much to learn from with this case study - process improvements to unfold from looking at the event with different "lenses" of the involved and non involved members.

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  5. Nancy Somerset

    Feb. 7, 2021

    Opportunity for joint efforts in all leadership style.

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  6. Jen Manlapaz

    Feb. 7, 2021

    I believe I'd likely use democratic leadership and affiliate leadership. I often begin with affiliate type by establishing a relationship with the staff I'm interviewing. I believe that this opens the floor for an effective democratic type of leadership. Once the relationship has been established, I can solicit different information about why things happened and what they think could help to prevent recurrence.

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  7. Jacquelyn Baker

    Feb. 6, 2021

    Democratic and coaching would be my preferred style. Democratic to increase collaboration and coaching to build upon knowledge and develop skills.

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  8. Leilani Kicklighter

    Feb. 6, 2021

    Again I believe that each of these leadership styles would be utilized, one or more in partnership depending on the issue or the group or individual. There are too many aspects to address in this scenario to use just one style.

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  9. Danielle Manglona

    Feb. 6, 2021

    Multiple leadership styles would be implemented in the response to this case. In garnering participation by involved parties in discussions to gather the facts regarding what happened a democratic approach would be useful. The goal would be the focus on facts to prevent recurrence and not place blame. Over the course of time pace setting and coaching would be needed to support the improvements that are generated as an outcome of this event as well as to sustain those improvements. These latter leadership styles promote trust and a learning environment which in the long run would foster the organization’s safety culture.

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  10. Tammy Rorer

    Feb. 6, 2021

    In my opinion, the most helpful leadership style in responding to this case scenario is democratic. This allows for the team to become actively involved as management guides the decision making process. It gives the entire team a voice and opportunity for all who participate to become vested in outcome.

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  11. Lauren Hyer

    Feb. 6, 2021

    I think it would require a blend of democratic and coercive. There would need to be an immediate stop gap implemented to prevent the confusion around tele monitoring and further team-based discussions about solutions for the subsequent issues that occurred post-operatively.

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    1. Danielle Manglona

      Feb. 6, 2021

      Great point about the immediate stop gap implementation! Agree with you about the use of coercive leadership style to get this resolved to avoid any further confusion.

  12. Melissa Lofton

    Feb. 6, 2021

    Thank you all for your input! Great discussions!

    Reply
  13. alex bowers

    Feb. 6, 2021

    Initially I would use authoritative leadership to ensure those helping with gathering information knew the importance and timeliness required for the review. During my review I would use affiliative leadership to develop trust with those closest to the event and find the root cause. Once the review is complete i would engage in a coaching leadership style to deploy risk reduction strategies to prevent this event from happening again.

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  14. 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. Mariel Kagan

      Feb. 6, 2021

      My thought is that it would not change my direction and style - The order to transfer a pt to "telemetry"carries with it an implication of cardiac monitoring. I would coach the nurse that because the specific order for cardiac monitoring was missing from the actual order, it would have been appropriate to immediately query the physician as to his/her intent and/or bring the order to the attention of the nurse/unit manager for clarification.

  15. LisaSunday

    Feb. 6, 2021

    Coaching style is personally preferred to help everyone walk through the process during the various stages. However, the authorative style is sometimes needed depending on the needs of various organizations and individuals. Blending and mixing various methods is a benefit as needed.

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  16. Debi Seagroves

    Feb. 6, 2021

    I would start by building consensus through participation (Democratic) and move into coaching as a means to teach people what went wrong and how to develop a process so that outcomes are better.

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  17. Jenna

    Feb. 6, 2021

    I believe initially the Democratic style to ensure you are hearing from and listening to all parties involved. Then a combination of all of the styles would be utilized throughout the duration of the investigation. Certainly affiliative and coaching are essential in this particular scenario.

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  18. Jana Lyner

    Feb. 6, 2021

    Based on the scenario, pacesetting would encourage the high standards expected in this department of the hospital, surgery and progressive care. You could also use coaching with the employee(s) to help find what motivates him/her and build upon that which in return would improve the process through the improvement of his or her skills.

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  19. Mariel Kagan

    Feb. 6, 2021

    As an RM and PS professional, I would recommend that a leadership style of coaching be initially implemented during the review of this case scenario. This is a tragic outcome, and individual participants will need the opportunity to reflect on it, understand what “went wrong,” and then reconcile what happened with their commitment as to what should have been done, so that it will never happen again. As there are components in the scenario that are very capable of repetition, it is important that ‘lessons learned’ be realized and implemented for future quality care. The leader’s ability to both understand and support the participants, while simultaneously coaching on how to appropriately treat a patient in this situation (given the scenario presented), will yield optimum learning and a commitment to patient safety.

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  20. Lory Harte

    Feb. 6, 2021

    Based on the scenario, I would start with an affiliative style to build trust and to allow the caregivers to open up about the event. Then I would use a democrative style to build consensus around the root cause and correct actions. Finally, I would use coaching to help inspire and empower the leadership to implement change.

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  21. Nadia Cheevers

    Feb. 6, 2021

    I think a democratic approach would be important because there were so many different roles involved. There were many assumptions made in ordering and delivering care, and it would be useful to learn from each member of the team and bring the group together for discussion which would likely be enlightening to all. I think a bit of coaching would be needed too as events like this can be demoralizing. Team members may need some support in being able to look towards the future to know they can be part of the solution, as well as in realizing that this event can impact their practice positively.

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    1. Nancy Somerset

      Feb. 6, 2021

      Agree, with supportive efforts despite outcome and everyone discussion on their role can be a great lesson learn and how to go forward with opportunities of improvement among caregivers and share across the practice to prevent re-occurrence.

  22. Ashley Mikhail

    Feb. 6, 2021

    Keeping aspects of democratic style in mind, I would primarily focus on a coaching style that seeks to understand the event in a supportive way and identify processes to prevent future harm.

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    1. Melissa Lofton

      Feb. 6, 2021

      Definitely required everyone's input to immediately address the order part of the scenario. There was input from physicians, administration, staff nurses, clinical informatics and risk and patient safety. We all came together with suggestions how to correct the technology/ordering piece so to not have the same scenario repeat.

  23. Lavonneda Hyland

    Feb. 6, 2021

    I do think a combination approach is best - we need to bring everyone together to get to a consensus around the "why" of the event (democratic). But - and this may be an unpopular opinion - I think to get fully to the bottom of it and to get to the root cause you will need to blend in authoritative. In my experience we can get almost to the root of the event but there has to be a a leader that takes the consensus and then moves the group forward past the discomfort to acknowledgment of the true root cause.

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  24. Faye Robbins

    Feb. 6, 2021

    This will require a combination approach in my view. Democratic in that we need input from ALL caregivers from surgeon, PACU, and bedside staff. What handoff information was provided at each transition in care? A coercive or affiliative style may be needed to promote an "open your eyes into your soul" perspective of possible human failures. Did the RN neglect to clarify with the ordering provider? Did the ordering provider make assumptions about telemetry based on physical location, or was this simply an oversight. Finally, a coaching style is helpful in meeting the emotional needs of all members of the healthcare team. This was not a people failure; it was a process failure. One of our mantras in addressing the 5 Whys of RCAs is that if you end with the root cause being a person, you haven't looked deeply enough.

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  25. Cheri Graham-Clark

    Feb. 6, 2021

    Affiliative then Democratic then Coaching This clinical scenario is likely to have some second victim impact. In doing the initial investigation the affiliative approach with the caregivers will help to establish trust and psychological safety if the stakeholders are new to the process or the person doing the investigation. As the process moves forward, then Democratic, having stakeholders from the various areas of the care process engage in discussion of the problems and identification of solutions as well as Coaching comes into play as move to identifying solutions and implementing changes to reduce risk of or prevent occurrence in the future.

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  26. Nancy Somerset

    Feb. 6, 2021

    Democratic to provide everyone the opportunity to share their thoughts on the event for participation, learning opportunity and improving processes.

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  27. trish

    Feb. 6, 2021

    I'd say coaching is needed in this situation, but because there were assumptions made and other factors at play, maybe authoritative as well because you want to mobilize people toward a common goal/vision which is ultimately patient safety.

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  28. Suzanne

    Feb. 6, 2021

    I'd start with affiliative - creating bonds - especially if it involves a team I don't know well. Coaching and democratic styles would also be used as we identify the root causes and work towards solutions.

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    1. Melissa Lofton

      Feb. 6, 2021

      We definitely had to build those bonds and trust relationships as we worked through the interview/meeting process.

    2. Michelle

      Feb. 6, 2021

      Creating bonds is important. For the clinicians involved in the care and the code, this is a traumatic event. Having a bond with each other can definitely improve the investigation and everyone working toward the same goal

  29. Candace Eden

    Feb. 6, 2021

    I might mix Democratic with some pace setting. We need to get everyone's feedback and important to get to the real reasons of what happened but the pace setting part is to keep everyone on track, not going down rabbit holes, and getting something in place to prevent it from happening during the next similar case. The monitoring piece about the provider thinking they are on a cardiac monitor if on a telemetry unit makes sense. I might address that one first.

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  30. Angel Barber

    Feb. 6, 2021

    Both Coaching and pacesetting would be appropriate. Coaching because of the need for improve for future in mitigating the event from reoccurrence, but also pacesetting too to encourage self direction and excellence in the roles and expectations

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  31. Becky Singleton

    Feb. 6, 2021

    Meet with all parties involved (get feedback) and then coach team to prevent similar incidents from occurring.

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  32. Karen

    Feb. 6, 2021

    Affiliative to initially create a trusting relationship with individuals involved. Then coaching and for the team in an RCA, democratic.

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    1. Candace Eden

      Feb. 6, 2021

      I do agree with you too with an affiliative start as well. that trust piece is critical to getting the correct information.

  33. Michelle Miller

    Feb. 6, 2021

    Given the negative outcome and emotions involved for everyone, coaching would be the best way to start. Getting everyone together to discuss the facts, without placing blame and to come up with solutions to prevent reoccurrence. Meanwhile, keeping it democratic is always a key factor.

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  34. Kristen Sapienza

    Feb. 6, 2021

    I feel affiliative leadership style would be beneficial in this situation to promote teamwork and mutual problem solving.

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  35. Kim

    Feb. 6, 2021

    Given the situation, I would most likely use "coaching" to be able to engage with people, understand and empathize in this difficult time.

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  36. Michelle

    Feb. 6, 2021

    I think we want to hear from everyone involved in the case, bringing everyone together to understand the sequence of events that lead to this outcome so that we can all learn from this. This would be a democratic approach.

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    1. Melissa Lofton

      Feb. 6, 2021

      Definitely opportunities for multiple styles. We definitely need to speak to everyone and get the facts but we also need to get the why's behind the actions as well.

  37. Melody Saikali

    Feb. 6, 2021

    I would say coaching is key here at first. To keep in mind that throughout the coaching phase, it would be important to leave room for a democratic leadership style along the way.

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  38. Lavina Davis

    Feb. 6, 2021

    Democratic leadership would allow a shared leadership model among the group to improve participation and input from all members. We want to engage the team in the decision-making process so they feel empowered and have ownership in the success of the plan developed by the team.

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  39. Heather J-B

    Feb. 6, 2021

    Based on what was presented, it appears that coaching would be the best means to address the individual issues. I don't think anything was willful but rather insufficient knowledge. Just my two cents.

    Reply

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