DDHA 8113 Week 11 Leadership Platform Example

Four Commitments and What Each Has Cost: A Leadership Platform for a Neurosciences Service Line Director, Ending With the Commitment Already Broken

Student Name

Walden University

DDHA 8113: Advanced Concepts in Healthcare Leadership

Instructor Name

Month Day, Year

Four Commitments and What Each Has Cost: A Leadership Platform for a Neurosciences Service Line Director, Ending With the Commitment Already Broken

What This Platform Is For

A leadership platform is a public statement of what a leader intends to hold to. Most such statements list values that cost nothing to claim, such as integrity, respect and excellence. This platform takes a stricter approach. It states four commitments I intend to keep while leading neurosciences for the course's invented system, and for each one it names an occasion in the past year when holding it was expensive. A commitment that has never cost anything is a preference, and I cannot know whether I hold it. The platform closes with the commitment I have already broken and the conditions under which I am likely to break it again. Avolio and Gardner (2005) describe authentic leadership as resting on self-awareness and on consistency between a leader's stated values and actions, and an honest account of inconsistency is part of that self-awareness.

Commitment One: Work Is Redesigned With the People Who Do It

Changes to how clinicians and staff do their work will be designed with them, not handed to them. The occasion when this cost something was the merger of two overnight neurology rotations. I could have issued the merged schedule and a video consult protocol in the first month. Instead, I held a listening session with the reluctant south campus group and then asked all eleven neurologists to redesign the protocol. That added about two months to the timeline, during which the north campus neurologists, who wanted lighter call quickly, made their impatience clear to my vice president. The protocol they rebuilt is better than mine, but I did not know it would be when I accepted the delay.

Commitment Two: The Person Harmed Hears First

After an event that harms or may have harmed a patient, the patient or family will be contacted before any internal review, vendor call or process meeting is scheduled. This commitment was formed by a failure rather than an act. When standard drain catheters were substituted for antimicrobial ones without the neurosurgeons' knowledge, my team met every obligation but contacted the family of the infected patient on day 26, after two internal meetings. Holding the commitment since then has cost something specific: on a later event, I contacted a family before risk management had finished its review, and our counsel told me in writing that I had increased the system's exposure. Gallagher et al. (2003) found that patients want prompt, honest information about errors, and I have decided that this outweighs counsel's preference for sequence. I may be wrong about the exposure. I am not wrong about whom the debt is owed to first.

Commitment Three: Evidence Can Stop a Signed Plan

A plan that I have approved can be stopped by evidence from anyone in the service line, regardless of their position. The occasion when this cost something was the night charge nurse's memo about early transfers from the neuro ICU. Four senior leaders, me among them, had signed that plan. Stopping it delayed the start by six weeks, during which the ICU turned away transfers from outlying hospitals that we could have accepted. I had to explain that cost to the senior team. In a study of manufacturing teams, Edmondson (1999) linked a team's confidence that candor carried no penalty to more asking, admitting and experimenting, and through those behaviors to better results. A charge nurse who watches a signed plan stop because of her memo learns that speaking up works. One who watches it go ahead learns the opposite.

Commitment Four: Measures Are Shared Across Boundaries

Where two teams share a resource, they will share a measure, even when that lowers one team's numbers. The occasion when this cost something was the biplane room shared by neurointerventional and interventional radiology. The protected afternoon stroke window that the service line proposed will lower the room's booked utilization, which is one of radiology's key measures. The chair of radiology agreed only after I accepted that the service line's budget would absorb part of the cost of moving long scheduled cases to the south campus. That transfer came out of funds I had planned for a second neuro ICU educator.

The Commitment I Have Broken

I have already broken the first commitment, in a way a colleague saw and named. At this year's capital planning meeting, the nurse manager of the neuro ICU asked whether a second portable EEG unit was really a better use of capital than an additional nurse educator, whose work would change how her nurses do theirs. I had ranked the requests before the meeting, I acknowledged her question and moved on, and the finance partner told me afterward that I had treated her as an interruption. The redesign of work that an educator would have produced was decided without the people who would do it, which is exactly what the first commitment forbids.

When I Am Likely to Break It Again

Looking at that occasion and at the self-assessment I completed earlier in this course, I can name the conditions under which the first commitment is most at risk. I break it when I am confident that I know the answer, when a deadline is close and when the decision involves money rather than clinical practice. All three were present at the capital meeting. They will be present again at every budget cycle. Knowing that, I have asked the finance partner to act as the person who argues the strongest alternative at each capital meeting, and to tell me afterward whether I listened. That is a safeguard, not a cure. The conditions will recur, and I expect to fail again under them at least some of the time.

Conclusion

This platform states four commitments: work is redesigned with those who do it, the person harmed hears first, evidence can stop a signed plan and shared resources carry shared measures. Each has cost something in the past year: time, counsel's approval, accepted transfers and a planned educator position. The first has already been broken, under conditions of confidence, deadline and money that will recur. The platform is credible only to the extent that the next budget cycle shows whether the safeguard holds.

References

Avolio, B. J., & Gardner, W. L. (2005). Authentic leadership development: Getting to the root of positive forms of leadership. The Leadership Quarterly, 16(3), 315-338. https://doi.org/10.1016/j.leaqua.2005.03.001

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

Gallagher, T. H., Waterman, A. D., Ebers, A. G., Fraser, V. J., & Levinson, W. (2003). Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA, 289(8), 1001-1007. https://doi.org/10.1001/jama.289.8.1001