Final Paper
Kareem Younes, RN, MSN, Doctor of Education Specialization in Performance Improvement Leadership (currently enrolled)
EDD8000 – Advanced Studies in Education: Theory, Practice, and Purpose
Capella University
My professional career started over twenty years ago; I graduated and started working as a registered nurse. I worked in healthcare since then in different roles and specializations, where my career goals and professional purpose evolved overtime and lead me to a passionate pursuit toward a doctorate degree in performance improvement as a goal oriented professional, I seek knowledge acquisition through formal and informal venues to be able to apply research based findings into my profession. However, I still work on refining my overall skills as an educator to deliver highly effective education to working professionals. I use relevant resources and professional organizations to acquire such needed knowledge and skills.
I learned throughout my career that collaboration among diverse professionals who contribute varies viewpoints is pertinent to achieving team goals. Leaders who practice inclusiveness and value diversity can reduce the negative effect and the unethical perception of how teams are being selected. According to Nembhard & Edmondson (2006) active inclusion by leaders can be a crucial way to facilitate others in the organization to actively engage in improvement team work. Such inclusiveness will eliminate perceived ethical and diversity issues inherited in team selection.
Through this paper we will examine my professional purpose and career goals and how it guided me toward a doctorate degree in performance improvement, will also review the literature to examine how to engage nurses in performance improvement, and finally ill discuss a case study to show case how ethical and diversity issues can be the main reasons for committees and teams to fail.
Purpose, Reflective Practice, and Career Goals
Professional Purpose
Through the evolution of my professional career, I realized that I’m motivated by implementing new ideas to create change toward achieving goals aligned with the organization vision and strategy. I am interested in how human performance effect the overall culture and success of an organization. As a registered nurse who worked in different aspects in healthcare, I’m passionate to showcase how nurses cannot just participate but lead performance improvements in healthcare toward a waste less future.
As a performance improvement coordinator’s registered nurse during the last 6 years, I found out that nurses lack the knowledge and skills in performance improvement, and it all starts from their college education. So, to be able to influence the future of performance improvement in nursing, we need nurses who are well qualified and have higher degrees in such arena to be able to help future generation of nurses to acquire the knowledge needed in performance improvement Therefore, I started looking for a doctorate degree program that will meet and is aligned with my goals.
Career Goals
Capella’s Ed D in Performance Improvement Leadership program (http://www.capella.edu/online-degrees/edd-performance-improvement-leadership/) offers the skills and knowledge I was looking for. The program will help refine my educational and leadership skills and will equip me with research based approach to performance improvement to become an agent of change in the area. I choose Capella’s program for the academic curriculum, practical application and the convenience of online non-stress educational option that it offers
Ultimately the program will prepare me to become a performance improvement specialist to be able to work in academia as a professor or lead nursing educational organization to enrich nurses with the value of performance improvement systems.
Self-reflection and professional growth
Understanding my values and the organizational vision and values is one of my important professional strengths, because I believe it is the foundation of a successful career. Throughout my professional life I use a SWOT analysis to guide my career path; it helps me assess my strengths, weaknesses, opportunities of improvement and what are the threats or obstacles to achieve my goal. The analysis showed that I have a strong self-motivation to achieve my goals, but have weaknesses toward prioritizing my personal goals over others. It also showed me that the competing priorities in my life are major obstacles that I needed to overcome in order to achieve my professional goals. This analysis helped me in creating a plan where, with the help of my family and mentors, I was able a doctoral degree in performance improvement.
I practice collaboration, two-way communication and accepts universities. I believe to be a successful and effective educator; I need to continuously improve my skills and gain more knowledge. Continuous learning, formal and informal, as well as having the motivation to seek new ideas and innovation, will create a culture of knowledge needed to be effective educator.
Gaining the knowledge needed to be a successful professional can come from different formal and informal resources. I seek formal education from universities as well as professional organizations relevant to performance improvement such as the American Society of Quality and the Institute of Healthcare Improvement. I read journals and browse the net to get specific answers or directions. Networking and having academic or professional mentors are other ways I utilize to strengthen my skills.
Capella University’s Career Center (https://campus.capella.edu/web/career-center/home) is packed with resources and guides that I will be visiting often through out to manage my career. From exploring my own values, beliefs, abilities and goals, to promoting myself and brand through networking and connection, the career center is a valuable hub that I will be using. I found the resources available follow a logical process; assessment, planning, implementing and finally evaluating and re-evaluating your career. As a registered nurse who use the nursing plan that follows the same logic, I tend to use these criteria to evaluate approaches and system, I found the career center well organize and the tools available are well designed to help me manage my career.
Topic Selection and Literature Review
Engaging Nurses in Performance Improvement (PI)
Performance improvement and quality improvement are used interchangeably; although they have different roots and sometimes different starting points, both are systemic and formal approaches to analyzing the performance of the organization in order to improve its outcomes. An organizational adoption of performance improvement is crucial to its success; therefore, an inclusive approach within the organization assures a path of success or at least less resistance, since everyone in the organization will be effected by the changes. In healthcare organization in particular, nurses represent the majority of the workforce. They are in important position to change and improve quality of care and improve both organizational and clinical outcomes. Including nurses into performance improvement work can lead to an environment and culture of improved professional nursing practice, which in turn will improve patient outcomes. To achieve optimal nurses’ engagement in performance improvement work, healthcare organizations need to plan and create the infrastructures that allow nurses to feel valued and educationally well prepared, support nurses practice by accessing real time data and connecting outcomes to practice and processes.
Review of the literature
Creating a culture of inclusiveness and ownership where employees are actively participating in the organization, is essential to the organization’s success. In healthcare, nurses comprise the majority of the employee, therefore involving nurses as stakeholders in the organization is important as they bring different perspective to the table. It is not enough to support nurses’ knowledge and skills; they need to be included in the organization strategies including their participation in the organization performance improvement process (“Population Reports,” 2002). Nurses need a forum to discuss their issues, to be empowered and to feel supported. Developing the infrastructure where nurses can be supported to use and apply change management and evidence based strategies will improve their job satisfaction and professional development (Schloffman & Hage, 2012) which in turn improve nursing practice, clinical and organizational outcomes (Moore, & Stichler, 2015).
Another important element of the infrastructure need to focus on nurses’ professional development and education preparation to give them the needed knowledge and skills to actively engage in the performance improvement process. The idea is to instill confidence in nurses to use the performance improvement methodologies and be able to transfer knowledge and outcomes to practice. Nurses education can start by illustrating the relationship that exist between the quality of the care provided and the clinical outcomes of the patients; this can be achieved by giving nurses the opportunities to participate in identifying the issues that exist and the data that support them (Albanese, Evans, Schantz, Bowen, Disbot, Moffa, Piesieski, & Polomano, 2010). For clinical nurses, formal in-house education combined with mentoring and coaching found to improve nurses’ ability to identify areas where improvement is needed, enhanced their abilities to manage improvement projects and their abilities to apply finding into practice. This professional development created a culture among nurses, where nurses showed appreciation of the quality improvement process (Moore, & Stichler, 2015). Therfore, healthcare organizations need to incorporate nurses’ professional development in their organizational strategic plans, because if nurses succeed in performance improvement, so well the organization.
It is also necessary to have process in place to bring real-time and relevant data to nurses daily practice; healthcare organizations need to establish structures and processes to disseminate data and findings to nurses. Connecting nurses practice to patient outcomes is the cornerstone of showcasing the importance of nurses’ involvement in the performance improvement process at the organizational level as well as on the unit level. Organizations need to illustrate to nurses how their work is relevant to the organization success and patient quality outcomes. As staff, nurses need to understand the importance of data to their daily practice, they also need to be included in the selection of their units’ quality measures. Such inclusiveness will help nurses own the outcomes and give them the opportunity to identify if improvement work is needed (Meredith, 2011). It was shown that sharing unit level data with all staff members and include them in the improvement work, hold everyone accountable to actively engage in the process (Schloffman & Hage, 2012). Ultimately healthcare organizations need outcomes and data be one with practice; the way to achieve this is by educating nurses about performance measures, allowing nurses to actively identify and collect meaningful data, and nurses realizing the value performance improvement work brings to their daily practice (Albanese, et al., 2010).
Now, to improve nurses’ engagement in the performance improvement work, healthcare organizations need to show how nurses involvement in performance improvement professional development projects will not only improve patient outcomes but will also enhanced nurses’ professional role by allowing them the ability to change their practice, showcase their professionalism and celebrate their accountability (Moore, & Stichler, 2015). Healthcare organizations need to also have the commitment and the engagement of their leaders to address staff needs and support their daily practice (Meredith, 2011). Therefore, healthcare organizations must include both financial and logistic resources to allow staff the time needed to engage in organizational improvement processes and initiatives.
Finally, it is all about organizational and clinical outcomes. Albanese, et al. (2010) illustrated how relevant are quality improvement skills, knowledge and practice to develop nurses’ professional role to meet the demand of ever changing healthcare environment and meet the ultimate goal of the patient; high quality care and in turn organization success. Creating an environment of performance improvement where nurses are managing quality improvement projects, demonstrated improvement in both patient and organizational outcomes (Moore, & Stichler, 2015). Clinical nursing outcomes are indicators of how well nurses perform their daily activities; therefore, it is essential to have real time organizational and unit level outcomes data available for nurses to access, study and use to identify opportunities for future improvement.
Synthesis of the literature reviewed
Clinical nurses influence on the healthcare organization success and viability is very extensive. Not only because they form the largest segment of the staff, it is also because they are on the frontline delivering care and interacting with the patients. To deliver high quality care and showcase high clinical outcomes, healthcare organizations need to create strategies and plans to engage clinical nurses into the organization decision making and improvement processes. This requires well planned initiatives and the creation of a culture of inclusiveness to leverage nurses’ knowledge and skills. This also requires organizational commitment and leadership to address nurses needs and establishing the infrastructure needed to promote and enhance nursing practice.
To engage nurses into performance and quality improvement activities and initiatives, nurses need to be well prepared through continuous ongoing education, mentoring and coaching. Nurses need to be shown the values of their work and its influence on the clinical outcomes of the patients and the organization. They need to be valued as a stakeholder and an owner of these outcomes. They need to understand the effect these outcomes have on their daily practice and allow them the opportunity to change it and improve it. Finally, for future work, a concept to consider is what is the effect of how well nurses were prepared in performance improvement through their academic and college education on their engagement in the performance improvement process at work.
Ethical Behavior and Diversity in Education
Case Study
In a community hospital, the administration team conducted a gap assessment to formulate a short and long term strategic plan for the organization. The gap assessment showed that there is a gap in nurses’ involvement and engagement in hospital affairs and organizational plans. The assessment also identified the lack of performance improvement committee for nurses. In response to the results and gaps found, the administration team tasked nursing manager to assemble a team of nurses to participate in a performance improvement committee.
The committee will be responsible for conducting quality and process improvements throughout the hospital. The committee will meet for two hours twice each month. The nurses will be paid for the time they spend in committee meeting and the work they will be doing outside the meetings while conducting improvement work. The nurses will also be trained and educated on performance improvement methodologies and tools. They will also be acting is informal leaders to get other nurses involved in future work.
During the recruitment process, the manager selected nurses based on her preference and nurses who she befriended over the time she worked in the hospital. There were no objective selection criteria nor the nurses selected represented the different diversity or segments of the organization; the nurses that were selected were females from the same cultural and ethnic background and all worked in the inpatient side of the organization, none from the outpatient side.
The committee started to work on performance improvement projects assigned to them by the administration team. During the six months follow up, the administration team decided to dissolve the committee due to inefficient use of resources and due to the fact that there were no tangible goals met. During the review, the administration team found that there was resistance from the hospital nurses to engage with the committee and the manager tasked to lead the committee didn’t hold members accountable to complete tasks and follow up with project plans.
Case Study Analysis
Creating a functional committee is similar to conducting a performance improvement project; goals need to be defined, criteria need to be created, implementation oversight need to be in place and continuous review of progress need to be inherit with the process. There are many reasons why projects will fail and each project has its own reasons of failure. It can be one single cause or multiple causes cumulatively result in the failure. Looking at the case study above, there were multiple reasons why the committee failed to accomplish its goals and create tangible positive change in the organization.
Poor planning, insufficient trust in management, lack of buy-in by the staff and the absence of performance expectation follow up are some of the main reasons why projects and initiatives fail (Longenecker & Longenecker, 2014). In the case study above the administration team didn’t have a detailed plan and direction for the nursing manager to create the committee, and at the same time the nursing manager didn’t ask for guidance from the administration team. This resulted in a committee with team members that are not qualified and do not represent the different segments and levels in the organization. There was no diversity in the team members and they were selected based on friendship not based on a need assessment. This is the fault of both the administration team and the nursing manager.
From the outside looking in, the hospital nurses viewed the committee to be biased because it contains specific ethnic background and they the rest of the hospital nurses were not given the fair chance to join and participate in the committee and viewed the process as being unethical. This created lack of buy-in the committee work and there was no sense of ownership to engage in the committee work thereafter. Also, the hospital nurses formulated a mistrust in management and viewed them as ineffective leaders, because they failed to recognize the diversity among nurses and the multicultural involvement needed to be a successful team. Finally, the nursing manager failed to establish performance expectations and to hold committee staff accountable to completing tasks. Allowing ethnic divers staff to participate in committees and teams will enhance the staff engagement and decrease the mistrust they might feel toward the team or the committee.
In one hand, the case study illustrated ethical issues with the team selection process and not holding the committee members accountable to expectations, on the other hand, the case study showed lack of diversity inclusion to represent the different levels and segments of the organization.
Case Study Proposed Resolution
First of all, selecting members based on subjective opinions and personal relationship is an ethical issue the case presented and need to be addressed. According to Hsu, Weng, Cui & Rand (2016) in its nature, teams are complex with interdependence relationships, therefore managers should select team members based on interdependent relationships, individual knowledge, skills, and abilities. Team members’ selection must be based on needs assessment and an objective fair criterion. The most important concept is to select a suitable team by analyzing and comparing the committee work requirements and the team members’ abilities to perform the work needed (Hsieh, 2010).
The case study above showed how selecting members based on subjective opinions and personal relationship is an ethical behavior that resulted in mistrust and lack of buy in. To resolve this issue, the following steps are proposed: The administration team will give clear direction to the nursing manager to the type of nurses needed for the committee. The membership for the committee should be open to all nurses to apply for. The nursing manager will use criteria designed by the organization to select team members. Finally, If the nursing managers have personal relationship with an applicant, they will ask other colleagues to interview the applicant. Following the above steps will eliminate any ethical and bias issues and it will show that the selection was based on analyzing the fitness between the abilities of the candidates and requirements to undertake the committee work.
Secondly, selecting a team without considering the diverse population in the organization is considered a diversity issue that need to be addressed. Yeager & Nafukho (2012) suggested that both demographic differences such as gender and ethnic background and non-demographic differences such as attitudes, education and knowledge should be considered when creating teams in order to achieve higher performance. At the same time, Yeager, et al. (2012) suggested that multiple steps and interventions such as time and education need to take place in order for a diverse team to be effective. The nursing manager in the above case study failed to recognize these facts, therefore, the team was not successful as it didn’t represent the diverse population of nurses in the organization. To resolve such issue, the following steps need to be followed: Demographic, skills and knowledge assessment need to be conducted to understand the makeup of the nurses’ population in the hospital. The committee members need to be selected to represent the different diverse population and the different demographic segments of the organization. Following these simple steps, will create a committee that is represented and diverse. This will result in having informal nurses’ leaders within the organization, where other nurses will be welling to engage with.
Examination of Personal Bias
I’m looking at the committee creation from a performance improvement perspective, where I’m treating the committee as a project. However, this point of view might not be similar to how the nursing manager in the case study viewed the committee and she might have her own personal experience that effected the way she managed the committee. I do realize that my resolution suggestions are not the only possible resolutions, however, they are guidelines based on my own knowledge and skills in process improvement. Also, others might not see any ethical and diversity issues with the above case study and might attribute the failure of the committee to other reasons like time, resources and leadership support.
Conclusion
Avoiding actual and perceived ethical and diversity issues in team selection is crucial to the success of the team in achieving its goals. Planning is the main phase in creating a committee, during this phase goals, objectives, criteria and guidelines need to be established as the framework to establish the committee and they need to include measures to avoid ethical and diversity issues. Also, having a buy in and trust from the staff is another factor to enhancing the potential success of any team. Also, inclusiveness is the key to a successful organization and to achieve effective engagement of the nursing staff, the organization need to have a structure and process in place to support the staff. It is also need to empower the staff and holding them accountable to patient centered common shared goals.
It was a great opportunity to write this paper as it allowed me to reflect on my professional career, where I started, where I’m now and what is the plan for my professional future. It took me back to why I became a nurse; to help people and take care of the sick. It all started from a single point and evolved to an amazing career that I enjoyed. My professional purpose always was my guide to what do I do next. I wanted to acquire the needed skills to become a better leader and that’s why I pursued my master in nursing administration. Now I want to be a better educator and that’s why I’m pursuing my doctorate degree.
References
Albanese, M. P., Evans, D. A., Schantz, C. A., Bowen, M., Disbot, M., Moffa, J. S., Piesieski, P.,
& Polomano, R. C. (2010). Engaging clinical nurses in quality and performance improvement activities. Nursing Administration Quarterly, 34(3), 226.
Hsieh, P. J. (2010). Cross-functional Team Selection concerning Members’ Cooperative Effects
and Capabilities Overlap. Systems Research and Behavioral Science, 27.3, 301-18.
Hsu, S., Weng, K, Cui, Q., & Rand, W. (2016). Understanding the Complexity of Project Team
Member Selection through Agent-based Modeling. International Journal of Project Management, 34.1, 82-93.
Longenecker, C. O., & Longenecker, P. D. (2014). Why Hospital Improvement Efforts Fail: A
View from the Front Line. Journal of Healthcare Management / American College of Healthcare Executives, 59.2.
Meredith, E. K. (2011). Developing frontline staff in performance improvement: Part 1: Tools
for success. Nurse Leader, 9(2), 50-53.
Moore, S., & Stichler, J. F. (2015). Engaging clinical nurses in quality improvement projects.
The Journal of Continuing Education in Nursing, 46(10), 470.
Needleman, J., Pearson, M. L., Upenieks, V. V., Yee, T., Wolstein, J., & Parkerton, M. (2016).
Engaging frontline staff in performance improvement: The american organization of nurse executives implementation of transforming care at the bedside collaborative. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources, 42(2), 61.
Nembhard, I. M., & Edmondson A. C. (2006). “Making It Safe: The Effects of Leader
Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams. Journal of Organizational Behavior 27.7, 941-66.
Performance improvement. (2002). Population Reports, 30(2), 1.
Schloffman, D. H., & Hage, A. V. (2012). Listen to your nurses! improving work environments.
Nursing Management (Springhouse), 43(9), 50-53.
Yeager, K. L., & Nafukho, F. M. (2012). Developing Diverse Teams to Improve Performance in
the Organizational Setting. European Journal of Training and Development, 36.4, 388-408.