Leadership and Clinical EducationWorkshop 1

What is leadership?What’s it got to do with clinical education?

Adding a leadership dimension to clinical facilitation

Leading clinical learning

Workshop 1: Learning outcomes

Reflect on the concept of leadership within the context of clinical education

Understand the general principles of the Leadership and Clinical Education (LaCE) framework

Discuss the application of the LaCE framework to ‘everyday’ clinical education practice

Identify opportunities for your personal/professional development as a leader of clinical education

Leading clinical learning

What is leadership?

‘60 second’ question

How do you define ‘leadership’ and what are the attributes of ‘good’ leadership?

Leading clinical learning

What is leadership?

A leader is best when people barely know he exists; not so good when people obey and acclaim him; worst when they despise him. Fail to honour people they fail to honour you, but of a good leader who talks little when his work is done, his aim fulfilled - they will say “We did this ourselves”

Lao-Tzu (6 BC)

Leading clinical learning

What is leadership?

A leader is a dealer in hope

Napoleon Bonaparte

Leading clinical learning

What is leadership?

Setting an example is not the main means of influencing others; it is the only way.

Albert Einstein

Leading clinical learning

What is leadership?

…. any behaviour that influence the actions and attitudes of others to achieve certain results

Australian Leadership Development Centre, 2007

Leading clinical learning

What is clinical education?

‘60 second’ question

How do you describe clinical facilitation/education and what are the attributes of ‘good’ facilitation?

Leading clinical learning

What is clinical education?

Clinical education (my definitional attempt) ..

a process which facilitates ‘… the translation of theory into clinical knowledge and professional skills through the provision of positive learning experiences within quality learning environments..’

McAllister et al. (1997, p.3) and...Nash

(2010)

Leading clinical learning

Clinical learning environment – an interactive network of forces

Students

Clinical staff

Care recipients

Clinical facilitators

Learning environme

nt

Learning environme

nt

Quality of the learning

experience

Quality of learning outcomes

Leading clinical learning

Clinical education: What does the evidence tell us?

Quality clinical facilitation:

Nursing students’ perceptions of effective Vs ineffective clinical teachers (n=214)

Interpersonal relationships eg. good relationships with nursing team

Personality characteristics eg. enthusiastic approach

Teaching ability eg. encourages thinking and learning

Professional competence eg. good professional knowledge

Tang et al. (2005)

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2

3

4

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Clinical education: What does the evidence tell us?

Students (n=134)

Interpersonal relationships

Evaluation Nursing competence Teaching ability Personality traits

Clinical educators (n=17)

Interpersonal relationships Nursing competence Evaluation Teaching ability Personality traits

Ratings of 5 subsets of effective clinical educator characteristics

Lee at al. (2002)

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2

3

4

5

Leading clinical learning

Clinical education: What does the evidence tell us?

Clinical learning environments:

Positive factors recognition of students’ presence, appreciation and support a collegial environment where students are perceived as

members of the team good communication team spirit a positive atmosphere democratic leadership styles positive interactions with staff

Papp et al. (2003), Clare et al. (2002, 2003)

Leading clinical learning

Clinical education: What does the evidence tell us?

Clinical learning environments:

Less positive factors lack of direction poor communication unrealistic expectations lack of collaboration between students and staff unreceptive or ambivalent staff students perceived to be a burden

Grindel et al. (2001); Clare et al. (2003); DHS, VicHealth (2009)

Leading clinical learning

Clinical education: What does the evidence tell us?

Positive ward atmosphere and effective clinical supervisory relationships with staff - the most important factors contributing to the quality of clinical learning (Saarikoski et al. 2002)

‘Optimal clinical learning requires an adequate practice environment, a good relationship with a team or individual with sound theoretical knowledge and stimulating dialogue’ (Field, 2004)

Leading clinical learning

Leadership: toward the ‘how’..

Thinking about ‘how’ leaders lead, ie. influence others to achieve desired results:

Several approaches/perspectives:

Leadership as power Personal characteristics of leaders Leadership behaviors Leadership styles Situational leadership models Transformational leadership models

Killian (2007) Australian Leadership Development Centre

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Leadership as power

positional authority, reward power, coercive power, expertise, interpersonal power

effective leaders expand their power base beyond limits of positional authority

use of rewards is one of the simplest yet most powerful forms of power a leader can exert

coercive power should be used with care & judgement expertise is useful but not sufficient on its own importance of relational power is likely to increase

Killian (2007)

Leading clinical learning

Personal characteristics

early trait / ‘great man’ theories no single list found to hold true contemporary thinking includes:

dominance, extraversion, sociability, self-confidence, high levels of energy, resilience and intelligence (reasoning + social intelligence, a sub-component of emotional intelligence)

social intelligence – single largest factor impacting on leadership effectiveness (Killian, 2007)

Aristotle once said that “we are the sum of our behaviours; excellence therefore is not an act but a habit.”

Leading clinical learning

Leadership behaviours

Competency-type models strategic thinking, change management, relationship

builder, staff developer etc.

Models based on roles/skills decision making, technical, interpersonal etc.

Leading clinical learning

Leadership styles

concern for people / concern for results eg. Blake-Mouton grid

1,1 delegate and disappear 9,1 produce or perish 5,5 middle of the road 1,9 friendly but not productive 9,9 team environment

high satisfaction & high production

Leading clinical learning

Situational approaches

importance of context in deciding the ‘right’ leadership approach in a given situation

eg. Hersey & Blanchard’s model

S1 – telling/directing S2 – selling/coaching S3 – participating/supporting S4 - delegating

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Transactional / transformational approaches

transactional leaders - focussed on day-to-day operations

transformational leaders - motivate followers to perform to their full potential ….. translate intention into reality and sustain it … use power wisely

(Burns 1978; Bass 1985)

Leading clinical learning

Leadership and Clinical Education (LaCE) framework

So, to the LaCE framework....

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Leadership and Clinical Education (LaCE) framework

This is a leadership framework that is designed to build your professional capabilities now and in the future.

The LaCE framework conceptualises clinical education leadership as involving:

cognitive and behavioural complexity personal valuing of ‘best’ practice critical observation and reflection commitment to ongoing learning and

development

Leadership and Clinical Education (LaCE) framework

The Framework is designed around 4 key areas, all of which relate to the role of a clinical facilitator/supervisor. The precise emphasis on individual areas will vary depending on the individual context / situation.

Each section of the Framework contains key attributes of clinical education leadership practice that are supported with self-assessment tools for personal reflection.

The Framework is underpinned by core professional values in relation to ongoing learning for quality practice and professional development.

Leading clinical learning

Leading clinical learning

Establishingdirection

Enacting self development

Executingthe role

Enactingto achieve

Dimensions of practice

AttributesSharing vision and values

Setting clear goals

Promoting a culture of learning

Communicating effectively

Interacting in a range of contexts

Empowering others to achieve

Clinical teaching & learning

Assessing students’ performance

Managing day-to-day business

Knowing self

Obtaining feedback on performance

Engaging in personal and/or professional development

Professional learning Personal development

Enhanced student outcomes Achievement of personal / professional goals

Leadership and Clinical Education Framework RE

FLEC

TIO

N O

N P

RACT

ICE

ACTION

LEARNIN

G

Leading clinical learning

Using the framework to enhance clinical education practice

Personal reflection on your own practice

Reflecting on feedback obtained from others

Identifying areas for personal improvement

Putting an action plan in placeEvaluating the outcomes

achieved

LaC

E d

imen

sion

s an

d

attrib

ute

s

Leading clinical learning

Some closing thoughts…

Leaders are responsible for getting results through others.

Leaders should be judged not by what they do, but rather by what those around them are doing and achieving.

In this light it is very clear that leadership is people work, with a focus on achieving results.

Australian Leadership Development Centre

Leading clinical learning

The task of leadership is not to put greatness into humanity but to elicit it - for the greatness is already there

John Adair, 1990, “Not bosses but leaders”

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References

Bass, B. (1985). Leadership and performance beyond expectations. New York: The Free Press. Bennis, W. & Nanus, B. (1985). Leaders : the strategies for taking charge. New York: Harper & Row.Blake, R. & Mouton, J. (1994). The managerial grid. Houston: Gulf Publications.Burns, J. (1978). Leadership. New York: Harper & Row. Clark, D. (1997). In Zilembo, M. & L. Monterosso. (2008)., Nursing students’ perceptions of desirable

leadership qualities in nurse preceptors: a descriptive study, Contemporary Nurse, 27(2), 194-207.Harvey, G., Loftus-Hills A., Rycroft-Malone J., et al. (2002). Getting evidence into practice: the role and

function of facilitation. Journal of Advanced Nursing, 37, 577–588.Hersey, P., Blanchard, K. & Johnson, D. (2001), Management of organizational behavior: leading human

resources. Upper Saddle River, N.J. : Prentice Hall. Kouzes, J. & Posner, B. (2003). The five practices of exemplary leadership. In Kouzes, J. Business

Leadership. San Francisco: Jossey-Bass. Lambert, V. & Glacken, M. (2006). Clinical education facilitators’ and post-registration paediatric

student nurses’ perceptions of the role of the clinical education facilitator, Nurse Education Today, 26(5), 358-366.

Lee, C., Cholowski, K. & Williams, A. (2002). Nursing students’ and clinical educators’ perceptions of characteristics of effective clinical educators in an Australian university school of nursing, Journal of Advanced Nursing, 39(5), 412-420.

McAllister, L., Lincoln, M., McLeod, S. & Maloney, D. (1997). Facilitating learning in clinical settings. Cheltenham, UK : Stanley Thornes.

Pratt, D., Arseneau, R., & Collins, J. (2001). Reconsidering “good teaching” across the continuum of medical education, The Journal of Continuing Education in the Health Professions, 21, 70–81.

Robinson, C. (2009). Teaching and clinical education competency: Bringing two worlds together, International Journal of Nursing Education Scholarship, 6(1), 1-14.

Tang, F., Chou, S., Chiang, H. (2007). Students’ perceptions of effective and ineffective clinical instructors, Journal of Nursing Education, 44(4), 187-192.