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n the modern healthcare landscape where care, there’s the fact that the hospital’s reputa-
value-driven performance is a key to reim- tion and financial state are constantly at risk.
bursement, hospitals must make the most of Since its creation in 2002, the Hospital Consumer
every opportunity to obtain high scores on Assessment of Healthcare Providers and Systems
performance measures. Multiple studies show a (hcahps) survey has been a nationally recog-
link between work environment and patient out- nized tool for assessing patient satisfaction dur-
comes.1 Nurse managers have a pivotal role in cre- ing an acute care stay. When the Affordable Care
ating a positive work environment on the nursing Act was signed into law in March 2013, hcahps
unit. The Institute of Medicine’s Future of Nursing results became vitally significant for all hospitals
report advocates for leaders to collaborate with participating with the Centers for Medicare and
others as mutually respected partners, indicating Medicaid Services (CMS). Surveys that use pre-
that a leadership style which partners with em- existing data are the basis of the value-based
ployees for mutual goals is associated with better purchasing,
patient outcomes, fewer medical errors, and re- or pay-for-
duced staff turnover.2 performance,
Ensuring that nurse managers have the proper model used by
training and exposure to the concept of transfor- the CMS to re-
mational leadership is crucial to organizational imburse for
success. Unit-by-unit patient satisfaction scores care provided.
were examined to determine whether improve- In fact, 30% of
ment occurred after the implementation of a trans- hospitals’ re-
formational leadership course. Each participating imbursements
nurse manager evaluated his or her individual are tied to the
leadership style for transactional and transforma- patient experi-
tional characteristics. (See Table 1.) ence as re-
ported to the
A look at the significance CMS.5 hcahps
Nurse managers are often inadequately prepared scores are also
for leadership roles.3 Nonetheless, they’re required important because the results are publically re-
to lead a team of nurses—sometimes in excess of ported; healthcare consumers can research acute
100 employees—to meet various goals set by orga- care hospitals and make facility selections based
nizations and regulatory agencies. Nurse manag- on these easily accessible data.6
ers must meet or exceed these performance mea-
sures (employee retention rates, quality and safety Reviewing the evidence
measures, and patient satisfaction scores), all of A systematic literature review was conducted to
which have an impact on unit and organizational explore current evidence correlating effective unit
financial viability. Creating a culture conducive to leadership with selected performance measures
positive patient outcomes is an essential skill for and patient outcomes. The following online data-
frontline nurse managers. This can be accom- bases were searched for the years 2009 to 2015: CI-
plished through transformational leadership.4 NAHL, Cochrane, PubMed, and PsychINFO. The
Why’s patient satisfaction important? In addi- terms “leadership” and “patient outcomes” were
tion to the obvious reason that patients want to searched in each database for a total of 429 titles.
receive quality care and be satisfied with their Ten studies were identified as being pertinent to
should include methodology to data, which were collected after patient outcomes. Generally speak-
identify these extraneous variables the nurse managers participated in ing, the studies contained within
and isolate them from the overall the transformational leadership the literature review and the
results. The timeliness of posted course. The results of this study, results of this project are in
hcahps scores on the Hospital combined with the literature cited, agreement that there’s a relation-
Compare website is also a potential indicate that patient outcomes can ship between leadership styles and
problem. Lengthening the study’s be improved on units managed by patient outcomes. NM
duration and allowing additional leaders who exhibit transforma-
time between the two phases tional characteristics. REFERENCES
would be ideal. A possible third Organizations can benefit by 1. Boev C. The relationship between nurses’
phase could include a refresher promoting frontline managers’ use perception of work environment and pa-
course or additional education on of transformational leadership and tient satisfaction in adult critical care. J
Nurs Scholarsh. 2012;44(4):368-375.
transformational leadership. continually training nurse leaders
2. Institute of Medicine. The future of
who exhibit behaviors conducive nursing: leading change, advancing
A top priority to positively growing and trans- health. https://www.nationalacademies.
Improving patient outcomes, in- forming clinical nurses to improve org/hmd/~/media/Files/Report%20
cluding patient satisfaction scores, their practice and patient care Files/2010/The-Future-of-Nursing/
is one of the highest priorities for techniques. Specifically, organiza- Future%20of%20Nursing%202010%20
Recommendations.pdf.
nurse managers. They must pos- tions should offer opportunities to
3. Kelly LA, Wicker TL, Gerkin RD. The re-
sess the leadership qualities neces- assess leadership style, including lationship of training and education to
sary to achieve outcome goals set the degree to which a manager leadership practices in frontline nurse
leaders. J Nurs Adm. 2014;44(3):158-
163.
4. Casida J, Pinto-Zipp G. Leadership-orga-
nizational culture relationship in nursing
units of acute care hospitals. Nurs Econ.
2008;26(1):7-15.
Organizations can benefit by promoting frontline managers’
5. Centers for Medicare and Medicaid Ser-
use of transformational leadership. vices. Hospital value-based purchasing.
https://www.cms.gov/Medicare/Quality-
by their organization and standard practices transformational leader- Initiatives-Patient-Assessment-Instru
benchmarks. Transformational ship; provide transformational ments/hospital-value-based-purchasing/
index.html.
leadership is an effective leader- leadership education courses;
6. HCAHPSonline.org. HCAHPS fact sheet.
ship style to successfully meet and promote a culture of transfor- www.hcahpsonline.org/Files/HCAHPS_
these goals. Nurse leaders who mational leadership practices Fact_Sheet_April_2015.pdf.
practice transactional leadership throughout the organization. If this 7. Giordano SP. What is your hospital’s
are unlikely to be as successful as is accomplished, a “win-win-win- HCAHPS score? Why it is important to all
those who practice transforma- win” situation is created: Nurse of us. AARC Times. 2010;34(9):15-16.
tional leadership; leaders who see managers lead effectively, clinical 8. Avolio BJ, Bass BM. Multifactor Leader-
their staff members as partners and nurses are satisfied and practice ship Questionnaire Manual and Sampler
Set. 3rd ed. Menlo Park, CA: Mind Garden;
gain their respect will experience safely, organizations achieve 2004.
better patient outcomes than those maximum reimbursement for pay-
who merely direct and reward. for-performance efforts, and—most
The answer to the research ques- important—patient outcomes are Sheri Leonard McRae is an assistant profes-
tion “Do nurse managers in a com- optimal. sor of health sciences and program coordina-
munity hospital who apply a This project provides prelimi- tor of health administration at King University
transformational leadership style nary support for the importance of in Bristol, Tenn.
have units with better patient sat- transformational leadership prac-
isfaction scores?” is yes. Although tices. The results are applicable to
The author has disclosed no financial relation-
the data analysis results weren’t multiple leadership positions ships related to this article.
statistically significant, there was a within nursing and healthcare, and
stronger linear correlation and ex- are important to any organization
plained variance in the Phase II with a strategic plan to improve DOI-10.1097/01.NUMA.0000511923.13387.69