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Leadership and professional development is the bread and butter to a well established team. In this essay, a number of leadership and change management theories will be discussed, offering guidance to effective team working. Descriptions of whatteamwork is, efficient communication and personal development will also be considered when referring to clinical skills, knowledge and decision making. A review of my own personal development during a new trainee nursing associate programme will also be considered, touching upon theories I have used and how important it is for reflective practice.
Teamwork consists of a number of people all aiming to accomplish the same goals. Communication within teams is essential for an effective, collaborative way of working. Not only does it provide a strong foundation for team working but it also promotes patient safety. It helps to focus the different ideations of its participants into one providing the optimum outcome. By having a good level of communication, coordination and cooperation, care reaches therapeutic standards for patients (St Pierre et al 2011). Within in a team, there are a number of people all having their own ways of communicating and dealing with arising issues. Tacit communicators generally use non verbal ways of communication, assuming the other individual knows what is being requested. This alone could impact on the efficiency of the team. The assumption of the tacit communicator could cause tension within a team resulting in miscommunication or friction. For a team to work at optimum efficiency, explicit communication is needed. Specific details and confirmation of understanding helps to provide the best care for a service user in the quickest way possible. By knowing exactly what is needed, teams can work together to achieve the goal, using its strengths to get the job done. Explicit methods requires the use of closed loop communication helping to reduce error, allow for questions which ultimately checks for understanding as well as minimises risk. This inbuilt check ensures not only that the message has reached the intended person but the message sent is the same as the one understood by the recipient (Parish et al 2011). Closed loop communication is vital for the smooth operation of teams.
Team members must share an understanding of what is necessary to successfully achieve a desired goal (Endsley 2012). To achieve this goal, workers must be able to work on their own initiative but also be conscious of the collective efforts of team members (Gluyas and Morrison 2013). It can take time to build professional relationships that create a team working dynamic. One theory that supports this is Tuckman’s model. He noticed that groups are never working at their full potential initially and require growth through stages. When observing teams, he noticed two common features; interpersonal and group structure and the task activity. This helped to mould his idea of groups evolving via four common stages (Craig 2015). Tuckman calls this the forming, storming norming and performing model (Tuckman 1965). Tuckman accepted that team forming wasn’t easy and that it could take some time before teams reached a functional stage in its development. He understood that to evolve, teams could find themselves yo-yoing between stages; trying to make the team balance.However, Belbin believed that an effective team required individuals who balanced well together (Belbin 2015). Belbin developed a list comprising of nine roles which were evident within a team, creating a balanced workforce. He thought by classifying people, schedules and tasks were more easily allocated and completed.(Belbin 2010). These roles are Plant, Resource investigator, Coordinator, Shaper, Monitor evaluator, Team worker, Implementer, Completer-finisher and Specialist. It seems that Belbin welcomed individuality and recognised that no one is perfect, however a team could be by establishing each others roles and importance.When comparing Tuckmans theory to Belbins theory; Belbin states that teams are not groups of people with common goals but have individual roles and responsibilities that contribute to a particular goal. It is also evident that large organisations such as the NHS would struggle to incorporate Tuckmans model within effective team working.
This is due to the time needed to mould and grow an effective team in Tuckmans belief. By the time the team achieves a performing status, team members may have moved on thus creating a hole which needs replacing. Belbins theory is an effective model for team working especially within the NHS as it allows a team to embrace individuality without the need for its members to take on a role which is ill fitted.Managing and resolving conflict within a team is vital for effective team working. When faced with a conflict situation, an individuals behaviour is generally categorised into two groups; assertiveness and cooperativeness (Thomas and Kilmann, 2016). Thomas and Kilmann proposed five approaches to conflict resolution which were Avoid, Accommodate, Compromise, Collaborate and Compete. These approaches all contribute to conflict management in their own ways.Conflict management also refers to an individual and their emotional intelligence. In order to resolve a conflict, an individual must be aware of their emotions and be in the best mind possible to gain the best possible outcome. Conflict generally sparks heated discussions with strong emotions and so being both personally and socially competent is of great importance. Resolving conflict and escalating concerns is integral to having a functional team who benefit from effective communication. Teams who incorporate meetings such as huddles, can address problems and improve effectiveness of communication (Gluyas, 2015).
Within my area of practice, we hold a weekly service user meeting to allow for any concerns or compliments to arise. This consists of the attendance of unit staff, management and service users. My unit has 13 service users at it’s maximum capacity however we would rarely see more than half attend the meetings. As well as the unit meetings, staff offer one to one key worker sessions to be able to provide a more personal care package. It is usually here where complaints are mentioned and so having a low turn out was concerning. The low turn out was affecting the efficiency of resolutions and thus causing agitation from service users. I was tasked with announcing the commencement of the meeting and so would approach service users. After experiencing a number of declines; I decided to re-approach service users and ask on a one to one basis if they had any input for the meeting. I was pleasantly surprised with the amount of cooperation from service users. This small change enabled service users to express their concerns in a safe environment without the need to speak in front of a large group of people. As I was making this change, I was concerned about the service users basic activities of daily living. By not speaking out and informing staff of any issues, service users were going without assistance or receiving care which was below expectations. When asking service users of any issues, one issue raised was that a service users bedroom tap was not working, resulting in no running water. By not being informed, staff were unable to support an activity of daily living as simple as washing. By not meeting needs, service users would not receive the care needed to improve their health (Care,2018). Continuing on with this, another concern was the service users instrumental activities of daily living which included his mental support. By being acutely unwell, his need for water could have affected his mental health causing him to deteriorate. This particular service user had difficulty being in social areas. His need to stay in his room and avoid staff ultimately resulted in a need not being met. Those suffering with a severe mental health disorder often have social dysfunction and can cause most of the distress experienced (Bellack et al., 2007).
When considering leadership theories, I believe Maslows hierarchy of needs is an appropriate one to support my area of change. Maslow expressed how important it is for a person to meet their most basic needs to feel able to achieve needs such as safety, love and esteem (Maslow, 1943). Abraham Maslow developed a hierarchy of needs which could be interpreted to help leaders mould their own ways of working within a team. Maslow suggested that it could hone leaders styles to suit the needs of their followers (Mack 2018). Maslows pyramid consists of five levels of motivation. They include Physiological needs, Safety and Security needs, Love and belongingness needs, Self esteem needs and finally Self actualisation. Leaders tend to not worry about the bottom motivations and so can assist workers in achieving these to help reach optimum performances. The basic needs described are vital in acute mental health settings where people are more restricted and less able to have choice. When a persons needs are not met, it can have a negative effect on their social functioning and recovery (SCIE 2014).As the leader of this activity, my needs sat towards the top of the hierarchy. I realised that in order to have an effective team and to have service user satisfaction, I would need to reconsider my approach to the meeting. By supporting service users needs to privacy and wanting to raise issues on a one to one basis, I found a higher rate of issues or concerns. To lead this idea to success, I needed to consider the physiological and safety and security needs of my service users. By doing this, staff are more able to attend to the basic needs of service users without affecting their wellbeing and recovery. Another theory which would apply to my clinical practice is John Adair’s leadership theory. He devised a three circle diagram which outlined the needs for leadership. Adair stated that a good leader helps to achieve the task, create synergy, and respond to needs (Valuing-your-talent-framework.com, 2018). At whatever level leadership is being exercised, Adair’s model takes the view that task, team and individual needs must be constantly considered. A strength of this theory is that is can be applied to any situation with the level of leadership being irrelevant.
When considering this theory’s influence on my area of practice, I noticed numerous relatable points that aided my leadership. Adair noted that there are eight leadership functions which would assist leadership. They were defining the task, Planning, Briefing, Controlling, Evaluating, Motivating, Organising and Setting an example (The British Library, 2018). When preparing for the area of practice change, I defined the task and made sure it was specific, measurable, achievable, realistic and time constrained (Hewitt-Taylor, 2013). My task appeared straight forward and easy to implement. I then planned the change with some of my colleagues, expressing how easy the change was with the benefits it could bring. I then briefed the team with my idea, following Adair’s three circles of leadership; Empower individuals, Build the team and Accomplish the task. I controlled and evaluated the change by delegating effectively and also asking the opinions of my colleagues throughout the process. I engaged with my team and service users to maintain motivation, reminding them of the improved quality of care we could reach. I organised the change by compiling a list of tasks and equipment that could be resourceful. For example: notepads for service users and staff to keep for meetings. This also empowered the service users, making them feel a part of the team.
When implementing this change, I hosted the first meeting, showing staff and service users our new way of approaching it. This area of practise has since become a very effective way of communicating with service users and also promoting their right to choice and privacy as well as supporting their basic needs. The impact of my change has been phenomenal. Service users appear to be less agitated, showing an improvement in their mental health recovery. Staff are now aware of the need to individualise each complaint, moulding their approach to service users in order to support basic needs.In this section, I will be using the Driscoll model of structured reflection to assist my reflection on an element of practise significantly improved since beginning the course. (Nottingham.ac.uk, 2018). Previously, when dealing with challenging behaviour, I would have taken a backseat position, physically supporting nurses who were attempting to de-escalate a situation. De-escalation is a preferred technique used by staff prior to any implementation of restrictive interventions (NHS Anonymous, 2018). When a service user was verbally and physically aggressive, I would assist with restraining if needed. I would not communicate with the service user, unless they directed a question towards me. I would always allow the nurse to initiate de-escalation, thinking that I would be seen as over stepping my role within the team. In this situation, the service user began threatening the nurse eventually lunging towards her, striking her left cheek.
During this movement, myself and a colleague initiated a level 3 restraint. Our reaction was to hold the service user appropriately following my AVERTS training (NHS Anonymous, 2018). Initially, I felt that if I had reacted quicker, they may not have been injured. I also felt that I should have intervened when the service user was showing verbal aggression towards the staff. During the debrief, I discussed my feelings towards the event and noticed reflected feelings from staff. I did feel as if I had let my colleague down. I knew that staff need to be aware of the patient, observe changes in behaviour, recognising signs of escalation or de-escalation (Lowry, 2016). I felt that I had not reacted quick enough to protect my colleague. It made me second guess my abilities of being able to work in mental health. Initially, this effected my mood and also my performances at work. I also noticed that I was becoming physically unwell as well as emotionally insecure. I have since read that this happens quite frequently and does have an impact of the everyday lives of those affected (Richards et al, 2006). I did however, notice some positives, firstly recognising that my approach to conflict management needed to change in order to feel able to perform at work. This enabled me to utilise peer and management supervision more. I am now willing to take the lead role in managing aggression and engaging with a service user who may feel agitated. Despite this, I must note that having this confidence could come with extra risks.
By being the lead, I am susceptible to increased amounts of verbal aggression and also physical outbursts. I am also at risk from future targeting from service users who may hold onto historical events. Nonetheless, by being more assertive and involved in de-escalation, I would be providing a better service for my service user as well as providing a more supportive role for my colleagues. Upon writing my reflective piece, I have noticed that I briefly utilised Kotters Eight Step Plan (Kotter, 2018). I established that the changes needed were important to allow me to perform at a level required to aid recovery and support. I created a new vision for myself, thinking about how I would like to perform in future situations. I then engaged in reflective practice, removing barriers which were stopping me from achieving this. I would then notice praise from management when initiating de-escalation myself. Following this, I would meet with management and get updates on new training material which could further develop my practice. Overall, I would reinforce this change, resulting in a better understanding of communication and de-escalation. Kotters model for change builds from Kurt Lewin’s Unfreeze, change and refreeze model (Burns, 2004). By using this model of reflection, I have noticed that I have engaged in extra study and become more confident when dealing with challenging behaviour. One further area for development of practice would be my approach to dealing with strong emotions. I am aware that I panic when faced with a service user who is crying or emotionally unstable. I do believe that this course will help mould my approaches to this as it continues to broaden my knowledge. By having a greater knowledge to support my practice, I am able to provide a service which is both beneficial to service users and colleagues. To conclude, leadership and management theories are vital in the movement towards change.
They assist with improving service quality especially within health care and also aid personal development. By using such theories, teams can work effectively and have a good standard of communication and unison. Effective communication is the foundation to a well organised, successful team and so utilising individual skills from team members will ensure professionalism and interdisciplinary working. The most important discovery about this topic I have made, is how crucial Maslow, Belbin and Tuckmans theories are to effective teamwork. Their simplicity and efficiency when guiding professionalism and interdisciplinary working can help change the way teams perform. Kotter and Lewin’s theories not only help assist teams to function at a level therapeutically beneficial but also aid with reflection and development for team members. Upon reflection, I would definitely encourage the use of these theories within the NHS to help support teams that are failing to work together effectively. By both the team and its members moulding their clinical practice using these theories, I believe that leadership and professional development would go hand in hand to accomplish effective teamwork.
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