Co-ordination and Leadership in Mental Health Care

The scenario which was presented is described: A woman suffering with depression on an acute hospital ward. She doesn’t seem to be communicating or interacting with the staff and other patients. A consultant Psychiatrist makes the decision to lock her out of her room for two ours after meal time. Though she continues to annoy the rest of the nursing staff and for a stress-free environment they let her back into her room after meal times. They are not adhering to the care plan; thereby contributing to ineffective communication, leadership within the team. The assignment will be focusing on different styles of leadership used by the consultant within the scenario; the way they communicated their own responsibilities to the other members of staff and the responsibilities of the nursing staff within the team. The lack of leadership and how the consultant communicates their views to the other nursing staff is the most important aspect because if all the departments are not working collaboratively with each other then the care they give will not benefit the patient.
To analyse the leadership problems on the acute ward we have to understand the meaning of what a ‘team’ actually is; the Oxford dictionary defines a ‘team’ as “a set of people working together to achieve a common aim.” Cited by the Nursing Standard volume 14, 2000
Alongside this is the knowledge of the “National Service Framework which has set out guidelines for Leadership Qualities within the NHS, which was set up to help NHS teams at all levels” (2003) NHS Leadership Qualities Framework DoH to confidently work to achieve the same goals. The framework outlines three clusters:

1. Personal qualities, the self belief, awareness and the drive for improvement related to the management situation.
2. Setting direction, the ability to have the drive to achieve the right results, broad scanning and intellectual flexibility; to understand that everyone learns knowledge in a different way.
3. Delivering the service included collaborative working and effective, strategic influencing.

According to Nursing Management volume 7 “we can identify four styles of leadership that might be adopted in team working.” p26 Related to the scenario there seems to be a lack of leadership within the whole team. The nurses aren’t taking on the instructions communicated by the consultant; due to the lack of leadership qualities presented by the consultant they have not managed their role as the leader within the situation.
There different types of leadership styles:

1. Hierarchical Leadership
2. Pragmatic Approach
3. Facilitating Teams
4. Leadership and Empowerment
5. Teamwork and Motivational
6. Theory Different learning styles

In the same article, leadership is described as being a quality that can be taken on by each member of a team at different times within the management of a situation. Hierarchical leadership takes the form of a manager being able to take the leaders’ role within a team. They would be able to use formal influence which their position would allow them to have, though this type of leadership has a few negative impacts on how well the team will work to get to a common goal, the leader needs to be absolutely clear that the team is not passing all the responsibility to the leader. If hierarchical leadership is not the right leadership, management is not going to be effective in getting the team to the target, then this should not be used within the scenario. When looking at the pragmatic approach “work in teams that compromise of a number of professional colleagues with a strong sense of autonomy…who can quit whenever they wish” Nursing Management volume 7, 2000, p26
Though this approach does have some positive impacts; for example according to Hayes (1997) cited by Nursing Management 2007 states that “a team leader keeps the purpose, goals and approach of the team relevant and meaningful by clarifying its aims and values.”p27
there are situations were a team that facilitates itself may be put into place especially in a hospital environment. This type of leadership is known as facilitating team management; were a lot of the responsibility is taken from the manager or in this instance the consultant and is given to the team as a whole; so that individual members within the team can use their specific knowledge to decide how to achieve the best solution for the patient.
Another type of leadership is self-managing teams. A lot of teams within the NHS are made up of multi-agencies and different departments. Shown in the scenario as it is an acute ward in which the lady with depression is on; so they had a consultant psychiatrist coming to treat her. Leadership and empowerment giving the team more responsibility allowing them to feel empowered about the situation; the consultant did not respect or believe that the nursing staff would make sensible decisions where the patient was concerned, this enabled them to make the wrong decision and undermining their leadership. This was shown in the fact that they allowed the patient to lead them and had no regard for the instructions given by the consultant.
In relation to the present scenario the consultant could show aspects of a humanistic approach to their leadership skills, another name for this type of leadership style stated by Bass & Avolio (1994) “transformational leaders concentrate on….humanistic approach…leader as being concerned with values, ethics, standards and long term goals.” Nursing Standard volume 14, 2000. There were no motivational tactics to encourage the nurses to follow the consultant’s care plan. The consultant did not come back round to the ward to make sure their instructions were being followed. If they had come to make sure the long term goal was being adhered to, then the care plan would have been of some benefit to the patient. “Motivation is a key concept of leadership and management in nursing…creative, interesting and continuous ways to make people feel good about what they are doing.” Huber (2006) cited in Leadership and Nursing Care Management. Motivation was the one of the personal qualities that the consultant was lacking and no one was making the nursing staff feel good about how they were helping the patient, hence this was the reason why the care plan was not being followed.
According to Nursing Standard 2000 p43 ” Organisational psychology and motivational theory explore the dynamics of effective team work.”
The team dynamics can be vital to good leadership communication organizing different departments to work collaboratively together to reach a shared goal, in this case helping the depressed patient to interact better with staff and patients.
“It’s only the unsatisfied need that motivates…The greatest need of a human being is psychological understanding – to be understood, to be affirmed, to be validated, to be appreciated.” Covey (1992) pp241
The nursing staff needed to feel empathically listened to by the consultant as every human strives for appraisal in the form of understanding and appreciation from a higher source in this case the consultant should have made sure that the nursing staff felt as though they were making a difference to the patient’s treatment and recovery.
The nursing staff didn’t fully understand the knowledge base practice behind the instruction from the consultant to lock the patient out of her room for a few hours. The consultant needed to understand that “ward pressures took a heavy toll on staff…pressures on nurses’ time meant that increasingly they dealt with demanding and ill patients with others being left to their own devices”, stated by Nursing Management volume 6, 2000 p10
Due to lack of time and increased paperwork, there were a lot of other patients on the ward needing the nurses’ attention; the patient took the lead as the nurses had a lack of time and support to entertain the patient creatively. The nurses’ had no desire to follow the consultants lead because the consultant was not fully understanding their lack of motivation as there were so many different stresses present on the ward. This would have been a breakdown in verbal communication between the nurses and the consultant.
“Basic motivational model; needs or expectations – driving force – desire – fulfillment” Nursing Management volume 7, 2000 p30
The nurses had no expectation that the care plan put in place by the consultant would work. Due to the fact that the consultant had no driving force to get the best results for the patient. The nurses could not see the consultant’s vision for the care of the patient and did not fully understand why he locked her out of her room and they could not envisage the end result.
After analyzing the scenario it becomes clear that the consultant would benefit from a National Leadership Programme were they could learn how to find more interesting and inspiring ways to motivate and drive the nurses allowing them to empower themselves. Enabling them to make their own decisions, “problem solving and decision making are two key areas of competence central to the work of all healthcare professionals.” Nursing Management volume 9, 2002
Motivation of the nursing staff had a lot to do with the way the consultant tried to solve the patient’s problem. The competence of the leading role (consultant) was not respected and the nurses over did the decisions laid down in the care plan for an easier life; rather than communicating their opinions on how the consultant decided to cope with the situation. This could lead back to the hierarchy which has been developed by management within the NHS. Nursing Management, volume 8, 2001 pp32-33 “leadership skills are developed now and sustained for the future, development must permeate all levels of the NHS.”
Allowing the nurses to be able to practically evaluate the situation and decide on the relevant means to solving the problem; in relation to their own individual leadership qualities. One of the main factors which were learnt during reflection was that by aiding the development of a close relationship with the nursing staff the consultant’s leadership skills could have been developed. The communication skills whether they are of verbal or non-verbal, they play a huge part in the working of a team that will work collaboratively together to offer high quality patient care. The consultant and the nursing staff would have benefited from team building exercise day to build respect, drive and the desire to achieve individual needs. While developing the personal leadership qualities of all the individuals within the healthcare team so that everyone would understand the theories and approaches put in place to achieve the values, ethics and empathic understanding that is needed.