Leading as One Team to address 'wicked' problems

August 2016 Vol. 16 (4)

KATHY HOLLOWAY looks at the importance of nurse leadership and teamwork when responding to the complex ‘wicked’ problems in the health system that have no easy answers.

Kathy HollowayLeadership in nursing is not a new concept and we are fortunate in New Zealand to have many great nursing leaders both past and present.

Many nursing researchers identify leadership as a key component for success in practice improvement activities. It is also clear that leadership is pivotal if we are to meet our ‘contract’ to deliver high-quality, evidence-based, relational nursing practice to the communities we serve.

Our healthcare system needs nursing leaders who can solve problems and provide guidance as we constantly seek to improve care quality, health outcomes and the patient experience. Globally and nationally nurse leaders face chaotic environments and complex issues that have been characterised elsewhere as ‘wicked’ problems.

Wicked problems are not inherently bad, instead the phrase is used to describe those diverse and multi-layered situations that are not amenable to a simple resolution1. Wicked problems require an approach that encompasses moral courage, perseverance, transparency and a willingness to fail and try again2. Wicked problems also respond best to a systems and policy approach that involves the wider healthcare team.

The ‘One Team’ approach

An overarching intent in the refreshed New Zealand Health Strategy is the focus on developing an integrated and cohesive system that puts people, families and whānau at the centre of care. This is conceptualised within the strategy as being linked to a ‘One Team’ approach. Inherent to the One Team approach is a need for strong leadership across the disciplines, including nursing.

A One Team approach – where nurses are full partners with physicians and other disciplines in redesigning health care – is a key platform for change identified in the US-based Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health report3. This influential global report, published in 2011, remains the most downloaded publication from the IOM website (145,000-plus downloads) and is well worth a read.

Within the One Team approach nurses must work to the full extent of their education and training (another Future of nursing message) to contribute to the end goal. Strong and effective relational nursing leadership has been linked to improved patient outcomes.

Outcomes such as patient satisfaction, lower mortality, complications and adverse event occurrence are reported as being positively affected by the presence of effective nursing leadership4. The mechanism for this positive impact is suggested to come from nursing leaders developing positive practice environments that have greater staff engagement. As nurses in formal leadership roles, or as members of healthcare teams, nurses can demonstrate leadership through their contribution to these mechanisms.

The College of Nurses, through its members, aims to provide health leadership and critical advocacy, and contribute to national health and socio-economic policy. Choosing to belong to and actively participate in the College is considered an act of professional leadership and a commitment to better health services. :

Author: Dr Kathy Holloway is the co-chair of the College of Nurses Aotearoa (NZ) Inc and also chair of NETS (Nursing Education in the Tertiary Sector Aotearoa NZ).


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