Assignment: Fischer and Robeznieks articles from this module’s learning activities

Assignment: Fischer and Robeznieks articles from this module’s learning activities ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Fischer and Robeznieks articles from this module’s learning activities I’m studying for my Health & Medical class and need an explanation. Assignment: Fischer and Robeznieks articles from this module’s learning activities Critique the Fischer and Robeznieks articles from this module’s learning activities. Evaluate their appropriateness for use in a doctoral-level research paper. This paper should demonstrate strong critical thinking and your best writing. This paper should be 6 pages, not including title and references pages, and follow current APA style guidelines. Competency: 3. Appraise and apply the requirements of doctoral research, writing, and critical thinking. Learning Objective: 1. Analyze and critique a peer-reviewed journal article. Core Professional Attributes: 1. ATSU: Critical Thinking herding_academic_cats.pdf transformational_leadership_in_nursing.pdf Herding academic cats: Still OneSearch – A.T. Still University 1 of 3 http://eds.b.ebscohost.com/eds/detail/detail?vid=2&sid=d765ebed-9491-… Title: Herding academic cats. By: Robeznieks, Andis, Modern Healthcare, 01607480, 5/11/2015, Vol. 45, Issue 19 Database: CINAHL Plus with Full Text Herding academic cats Listen American Accent Engaging doctors is key to teaching hospital reforms It’s a tough challenge to engage academic physicians in managing the health of an enrolled patient population. Doctors traditionally have been trained to deal with the patient in front of them. Changing their focus to population health requires a different mindset. That’s even more true for academic medical center doctors, who are steeped in teaching hospital traditions, or who may see clinical operations merely as a backup funding source for their research and education missions. But some academic medical center leaders are finding innovative ways of working with their doctors to make their organizations more competitive in today’s cost-conscious healthcare market. They are also getting their faculty physicians to collaborate with communitybased doctors in new payment and delivery models such as accountable care organizations. Joe Landsman, CEO of the 600-bed University of Tennessee Medical Center in Knoxville, said involving physicians in all major strategies and change processes is key. That collaboration has enabled his center to implement its clinical standardization and qualityimprovement efforts. “It really starts with development of physician leaders,” said Landsman, whose operation includes 615 doctors, of whom only 158 are medical center employees. A critical component has been his center’s Physician Leadership Academy. It began as a 10-month educational program developed in partnership with the University of Tennessee business school that physicians attended for a half day each month. It has since evolved into a three-year program. “It gives them a wider base of knowledge than the world they live in, on the state of the industry and why transformation is necessary,” Landsman said. He said his center has spurred physicians to take the lead in its standardization and improvement efforts, and touts the center’s 94th percentile ranking last year in the Press Ganey survey of physician engagement. Press Ganey describes physician engagement as doctors’ appraisal of their work environment, emotional experiences and workplace attachment. The nation’s academic medical centers are stressed as payment rates are under pressure, funding for medical research has decreased and funding for graduate medical education is being threatened. Some experts say shifting academic medical centers’ focus to population-health management has to be a big part of the answer. And academic center leaders say involving doctors is key to this shift. “Academic medicine is well positioned to be a part of the solution to the next generation of healthcare delivery,” said Mark Laret, CEO of UCSF Medical Center in San Francisco. “But it also has to overcome some of its longstanding traditions about how it has carried out that work. Those traditions are sometimes costly, oftentimes inefficient, and oftentimes are physician and learner-centered, not patientcentered.” The cultural change required to get physicians to buy into standardization shouldn’t be underestimated, said Dr. Andrew Ziskind, managing director of Huron Healthcare consultants. “What typically makes academic physicians renowned is what they do differently,” he said. Assignment: Fischer and Robeznieks articles from this module’s learning activities Standardization reduces those differences. Dr. David Nash, founding dean of the Jefferson School of Population Health in Philadelphia, calls population-health management “the road to redemption” for academic medical centers. “Progressive, leading academic medical centers are reading the writing on the wall and are building or modifying their education program to focus on these issues,” he said. The hard part, however, is that population health is a team sport involving collaboration among different types of providers and staff, and 7/5/17, 12:58 PM Herding academic cats: Still OneSearch – A.T. Still University 2 of 3 http://eds.b.ebscohost.com/eds/detail/detail?vid=2&sid=d765ebed-9491-… that may conflict with physicians’ traditional preference for autonomy. Population health or any systemwide improvements won’t work without physician engagement, Nash said. “Anything that threatens the status quo is resisted.” He recommends refocusing academic centers’ three missions of education, patient care and research around population-health concepts. This can mean implementing team-based education in the medical school, setting up an accountable care structure or pursuing outcomes-based population-health research projects. “You can’t just pivot these places—you have to realign each aspect of the mission,” Nash said. “It’s like turning a battleship around inside the Panama Canal.” Laret said there are some obvious practices that academic centers need to reform. “Maybe we could rethink how we do rounds on day of discharge, so we could actually prioritize the discharge of patients ahead of the teaching rounds,” he said. “Not to eliminate the teaching, but to just rethink some of our historical approaches.” Another obvious change is reducing unnecessary diagnostic tests. “One of the traditions of teaching was, ‘Let’s just order tests because the results are interesting,’ “ said Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice. “Avoiding unnecessary tests is now considered high-quality healthcare.” Landsman of the University of Tennessee Medical Center said standardization is not readily embraced by many physicians but is essential. In 2013, his center launched its clinical pathway process with the goal of having 80% of admitted patients assigned to an evidence-based standardized treatment plan for their defined condition. Last year, 68% of admitted patients were put on a specific pathway. His organization has made sure to measure its progress. Results include a reduction in central line-associated blood stream infections (CLABSI) in adult critical-care units from 72 in 2008 to one in 2014. Another pathway success is the steep drop in critical-care catheterassociated urinary-tract infections, which fell from 121 in 2011 to 30 in 2014. To engage doctors, Dartmouth’s Fisher recommends appealing to their competitive nature by using quality measures that show what percentage of their patients have their diabetes or high blood pressure in check. “That’s tremendously motivating,” he said. “Doctors are incredibly competitive.” Like the University of Tennessee, the University of Arizona Health Network in Tucson is partnering with community-based doctors, and recently announced a merger with 25-hospital Banner Health. Nash called the merger a harbinger of a future in which more health systems own their own medical school. Assignment: Fischer and Robeznieks articles from this module’s learning activities He sees this as a positive development. “As delivery systems merge with medical schools, that will align their missions toward population health,” he said. Beth Calhoun, an associate vice president at the University of Arizona’s Health Science Center, said academic medical center researchers can help non-academic providers systematically analyze big data to better manage enrolled populations. “A university’s health policy folks and healthcare economists can look at change in the healthcare-payment structure and find models,” she said. For instance, academic center experts can help providers develop predictive models to identify patients who are high utilizers, then determine whether they use a lot of services because they’re actually sicker or because their providers are not offering the right diagnoses or treatments. Through her center, the newly merged Banner-University of Arizona system will support the state’s healthimprovement plan, integrate primary-care physicians and behavioral-health professionals, and look at local renal care practice patterns and clinical outcomes to determine what factors influence a slower transition to dialysis. Still another academic medical center partnering with community-based providers to work on population health is Nebraska Medicine, the new name for the University of Nebraska Medical Center’s clinical operations. It joined forces five years ago with the two-hospital Nebraska Methodist Health System to form its Accountable Care Alliance, now known as the Nebraska Health Network. Nebraska Medicine has about 500 employed physicians and nearly 200 community doctors. Dr. Harris Frankel, Nebraska Medicine’s senior vice president and chief medical officer, said there was “trepidation and angst” when the alliance was first announced. But the partner organizations have been able to increase physician involvement as the clinicians have seen results in achieving better outcomes at lower costs. Academic medical centers have to decide whether to create their own primary-care network or partner with established primary-care practices. “Some organizations may make the choice to build from within,” Frankel said. “Others, like ours, as we begin to dip our toe in the water of population health, we recognize the need to partner with community physicians to assist us in that endeavor.” One example of how the Nebraska ACO partners worked to increase efficiency was to standardize orthopedic procedures. “We’re still competitors, but we are working together to create a critical mass of primary-care physicians between our institutions to manage the population in an effective manner,” Frankel said. 7/5/17, 12:58 PM Herding academic cats: Still OneSearch – A.T. Still University 3 of 3 http://eds.b.ebscohost.com/eds/detail/detail?vid=2&sid=d765ebed-9491-… Other engagement challenges include building a health information technology infrastructure, negotiating how to pay for it, and developing a governance structure. Frankel said 80% of those challenges are political and 20% are technical, but academic and community doctors have shown “a willingness to achieve a common good.” Frankel predicted that academic medicine, using its research and education missions, will drive major changes in clinical care and propel the move to population-health management forward. “Academic health science centers are going to play a vital role in population health,” he said. MH TAKEAWAYS The cultural change required to get physicians to buy into population health and clinical standardization shouldn’t be underestimated, experts say. ~~~~~~~~ Assignment: Fischer and Robeznieks articles from this module’s learning activities By Andis Robeznieks This article is copyrighted. All rights reserved. Source: Modern Healthcare Mobile Site iPhone and Android apps EBSCO Support Site Privacy Policy Terms of Use Copyright Contact Us powered by EBSCOhost © 2017 EBSCO Industries, Inc. All rights reserved. 7/5/17, 12:58 PM CONCEPT ANALYSIS Transformational leadership in nursing: a concept analysis Shelly A. Fischer Accepted for publication 5 May 2016 Correspondence to S.A. Fischer: e-mail: [email protected] F I S C H E R S . A . ( 2 0 1 6 ) Transformational leadership in nursing: a concept analysis. Journal of Advanced Nursing 72(11), 2644–2653. doi: 10.1111/jan.13049 Shelly A. Fischer PhD RN NEA-BC FACHE Assistant Professor Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming, USA Abstract Aim. To analyse the concept of transformational leadership in the nursing context. Background. Tasked with improving patient outcomes while decreasing the cost of care provision, nurses need strategies for implementing reform in health care and one promising strategy is transformational leadership. Exploration and greater understanding of transformational leadership and the potential it holds is integral to performance improvement and patient safety. Design. Concept analysis using Walker and Avant’s (2005) concept analysis method. Data sources. PubMed, CINAHL and PsychINFO. Methods. This report draws on extant literature on transformational leadership, management, and nursing to effectively analyze the concept of transformational leadership in the nursing context. Implications for nursing. This report proposes a new operational definition for transformational leadership and identifies model cases and defining attributes that are specific to the nursing context. The influence of transformational leadership on organizational culture and patient outcomes is evident. Of particular interest is the finding that transformational leadership can be defined as a set of teachable competencies. However, the mechanism by which transformational leadership influences patient outcomes remains unclear. Conclusion. Transformational leadership in nursing has been associated with highperforming teams and improved patient care, but rarely has it been considered as a set of competencies that can be taught. Also, further research is warranted to strengthen empirical referents; this can be done by improving the operational definition, reducing ambiguity in key constructs and exploring the specific mechanisms by which transformational leadership influences healthcare outcomes to validate subscale measures. Keywords: concept analysis, healthcare reform, leadership, management, nursing, patient safety, performance improvement, practice environment, transformational leadership Introduction Awareness of undesirable patient safety outcomes became widespread in the USA when the Institute of Medicine 2644 (Kohn et al. 2000) reported that preventable medical error led to nearly 100,000 deaths in the USA every year; recently, James’ (2013) analysis of the same data increased the estimate to nearly 400,000 preventable USA deaths annually. While patient safety data from other countries are © 2016 John Wiley & Sons Ltd JAN: CONCEPT ANALYSIS Why is this research or review needed? • Unprecedented reform is essential to the survival of the healthcare system and global economy. Transformational leadership context, including a discussion and application of the results specific to nursing education, research and practice. The application of TFL as a style and competencies in the business arena is beyond the scope of this concept analysis. • Healthcare reform is dependent on leaders who think in innovative ways and have the skills, attributes and courage that enable them to implement rapid change. • A full understanding of the concept of transformational leadership, including its meaning, usage and operational definition, is essential for preparing current and future leaders to significantly improve the healthcare system. What are the key findings? • The term ‘transformational leadership’ has consistent usage in the literature, yet it will benefit from an improved operational definition, as proposed in this report.Assignment: Fischer and Robeznieks articles from this module’s learning activities • Transformational leadership is a leadership style as well as a set of competencies that can be taught. • Transformational leadership is not a panacea for improving patient outcomes; it should be used in conjunction with other leadership skills to optimize the performance of a workgroup. How should the findings be used to influence policy/ practice/research/education? • This analysis creates a foundation for teaching these competencies in practice and academic settings. • The new operational definition of transformational leadership should be tested and validated by expert opinion and empirical research. less available, researchers indicate that this concern is a global one (Arulmani et al. 2007, Redwood et al. 2011, Bates 2009). Public and government pressure is high for transformational change in health care to improve patient safety outcomes internationally. A prominent potential solution to the patient safety conundrum that has emerged in recent years is transformational leadership (TFL), which encompasses the leadership behaviours and characteristics that positively influence organizational performance and patient safety outcomes (Mullen & Kelloway 2009). While TFL is not a universal remedy, TFL competencies can have a salient role in developing cultures of safety in the patient care environment (Kohn et al. 2000) and have been linked with improved performance and outcomes in many measures of healthcare performance (Howell & Avolio 1993, Wong & Cummings 2007, Mullen & Kelloway 2009). Yet, the literature has not been clear as to how and when TFL positively affects patient safety outcomes in healthcare settings. This article presents a concept analysis of TFL in the nursing © 2016 John Wiley & Sons Ltd Background A concept analysis of TFL for nursing fills an important gap in knowledge on the theory and practice of nursing. According to Chinn and Kramer (2008), clarifying the meaning of a concept is integral to theory development and, subsequently, to practice and research that is guided and informed by it. In measuring healthcare performance, factors associated with leadership styles have been strongly linked to patient outcomes. Among the most useful measures of healthcare performance are nursing satisfaction, retention (Kleinman 2004, Casida & Pinto-Zipp 2008), patient satisfaction (Raup 2008) and workgroup effectiveness (Dunham-Taylor 2000). Of particular importance for healthcare performance and subsequently for patient outcomes, are the ways healthcare teams are led. A strong relationship has been established between patient safety processes and outcomes on one hand and leadership on the other (Thompson et al. 2005, Wong & Cummings 2007). For example, the use of patient restraints and the occurrence of immobility complications —two patient outcomes that are generally considered negative—are inversely related to the level of relationshiporiented leadership and nurse managers’ years of experience (Anderson et al. 2003). Much research suggests that to improve patient outcomes, we would do well to consider how leadership is understood and practiced in healthcare contexts, particularly on nursing units. Further research is warranted to test theories related to TFL and patient care outcomes. Concept analysis of TFL is a logical first step to designing research that more fully assesses the impact of TFL on patient outcomes. One example of how TFL can be tested as a concept is offered by Kanste et al.Assignment: Fischer and Robeznieks articles from this module’s learning activities (2009), whose research explicates Full-Range Leadership Theory in the context of nursing. Their findings emphasize the value of TFL in nursing in relation to staff willingness to exert extra effort, perception of leader effectiveness and leader job satisfaction. The FullRange Leadership Theory model, with TFL in bold, is found in Figure 1. Data sources Databases searched for the concept analysis of TFL included PubMed, CINAHL and PsychINFO, with limits 2645 S.A. Fischer Individualized Consideration na sfo rm a tio Intellectual Stimulation l EFFECTIVE Tr an Inspirational Motivation Idealized Influence ACTIVE PASSIVE FR EQ Tr an Management by Exception (Active) UE NC Y sa cti o na l Contingent Reward Management by Exception (Passive) Laissez Faire INEFFECTIVE Figure 1 The Full Range Leadership Model, adapted from “Developing Potential Across a Full Range of Leadership (TM),” by B.J. Avolio and B.M. Bass, Psychology Press: New York, p. 4. Copyright 1991 by Bruce J. Avolio & Bernard M. Bass. Leaders with more frequent use of Transformational Leadership behaviors (individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence) and less use of transactional leadership behaviors (contingent reward and management by exception – active) are generally considered to be more effective than those more frequently employing transactional or highly avoidant (management by exception – passive and Laissez Faire) behaviors. set for 5 years and Engl … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10