Strong and effective leadership is an essential part of a well-functioning team. Leadership is defined as “ the ability to lead or command a person or group of people….In this simplistic perspective, anyone who leads and facilitates change by speaking up, providing education, role modeling, and/or coaching resulting in changed behavior of an individual or group is a leader” (Kelly et.al, 2018, p. 70). As such, leadership is both formal and informal and all play a key role in prioritizing safety and keeping it in the forefront on a daily basis. This concept, along with key features of leadership will be described in more detail in the following article.
Formal and Informal Leadership
Formal leadership refers to defined roles within an organization based on experience, skills, and knowledge. Examples of this include senior-level leadership (President, Chief Nursing Officer, Chief Executive Officer), directors, managers, and charge nurses. Informal leaders have no official designation but are viewed so by colleagues based on education, experience, and qualities such as effective communication skills or the ability to speak up in concerning situations (Kelly et.al, 2018). In order to develop and sustain quality and safety initiatives and maintain a safe practice environment, there must be support and engagement of leadership at all levels within the organization.
Key Features of Leadership
Key features of leadership reflect the ability to see the big picture, define goals, and organize structure around achieving those goals. In addition, effective leaders help guide interactions among the team and provide effective communication. These features are described further as management of processes, management of people, and communication.
Management of Processes
Management of processes within a team is a leadership skill. It involves key activities as defined by the Team Strategies and Tools to Enhance Performance and Patient Safety TeamSTEPPS program. This is an evidence-based curriculum developed by the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ), that focuses on communication and teamwork among healthcare professionals, and provides a program to improve patient safety (AHRQ, 2012). According to this program, leadership involves the following activities which represent coordinating and managing the process:
- Defining a goal and a plan to reach that goal
- Delegating responsibilities
- Communicating the plan
- Tracking the progress of the plan and movement toward the goal
- Changing the plan as needed and communicating this to the team
- Evaluating the overall performance of the team (AHRQ, 2012).
Management of the team
Another key feature of leadership is management of the people or team, specifically guiding the interactions and connections among the group and processes, and eliminating barriers to help the team be successful. This involves regular and effective communication with the team, which could occur during meetings, safety huddles, through emails, or real-time discussions on the unit (Kelly et.al, 2018). Open communication aids in understanding the perspectives of different team members and helps to identify challenges and areas for improvement.
Case Example: Developing a Shoulder Dystocia Rapid Response Team
Let’s use the example of leadership as applied to developing a shoulder dystocia rapid response team. It has been identified that defined roles and a better process are needed to manage a shoulder dystocia event effectively. The goal is to design an organized, efficient activation and response with the right people responding to the right place at the right time. The plan includes the following steps: putting together a task force group, reviewing research to see what’s been done in this area, deciding on an efficient activation and response process, and lastly developing education and audits for evaluation. An interdisciplinary team is formed including bedside nurses, leadership, anesthesia, residents, attending obstetricians, switchboard, and quality team members. Meetings occur regularly to develop and communicate plans. Delegated responsibilities include:
- Assigning someone to do a literature search
- Designing education around the new process
- Participating in the education
- Designing an audit tool to evaluate how the process is working
- Doing audits and collating this information
In assigning responsibilities it is important to consider what is doable. For example, if the simulation is used to teach the new team roles and responsibilities in shoulder dystocia and bedside nurses on this team are helping with the simulations, their schedules may need to be adjusted to accommodate this. The simulation dates could be built into their scheduled weekly hours to ensure they are not accruing overtime. It’s important to also note that in delegating responsibilities, ownership of the project is given to the team members. Everyone owns a piece of the process, which also helps to balance the workload.
Next, a timeline is developed including the education plan and rollout of the formal process. Tracking of progress entails monitoring the percent completion of education and obtaining feedback on how the actual process is working through audits. This allows for minor changes to be made which are essential in designing a program that fits the individual needs of the unit and culture.
Performance of the shoulder dystocia quality improvement team could be evaluated based on the progress of the overall program and feedback from the group. Lastly, management within the workgroup team can occur through follow-up meetings, email communication, or real-time discussion on the unit.
In summary, effective leadership is an essential part of a well-functioning team. This involves working with a team to define goals and providing organization and structure in achieving those goals. Guiding real-time interactions among team members, and providing effective communication is essential to eliminating barriers and ensuring success. These are all reflective of the key features of leadership- management of processes, management of people, and communication.
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Agency for Healthcare Research and Quality (2012). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. About TeamSTEPPS. Retrieved from https://www.ahrq.gov/teamstepps/about-teamstepps/index.html
Agency for Healthcare Research and Quality (2012). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. TeamSTEPPS 2.0 Module 4: Leading Teams (Instructor’s Guide). Retrieved from
Kelly, P., Vottero, B. A., & Christie-McAuliffe, C. A. (2018). Introduction to quality and safety education for nurses’ core competencies for nursing leadership and management. Springer Publishing Company.
Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS