Sara Lankshear RN, PhD Relevé Consulting Services

Transcription

1 Sara Lankshear RN, PhD Relevé Consulting Services National Health Leadership Conference June 2013

2 The Professional Practice Leader (PPL) role is described as being responsible for the promotion and maintenance of the standards of practice for their specific profession (Miller, Worth, Barton, & Tomkin, 2001). Despite the extensive implementation of the PPL role, there are very few publications and no empirical studies which examine the impact or effectiveness of the PPL role. (Miller, Worth, Barton & Tonkin, 1999; Adamson, Shacketon, Wong, Prendergast & Payne, 1999; Comack, Brady & Porter-O Grady, 1997; Matthews & Lankshear, 2003; Chan & Heck, 2003; Lankshear, Laschinger & Kerr, 2006) Professional practice leader role was identified as a key element of a professional practice structure. (Matthews & Lankshear, 2003) Challenges associated with the PPL role include lack of role clarity, the varying degrees of organizational support provided and the lack of formal line and/or budget authority (Matthews & Lankshear, 2002; Lankshear, Laschinger & Kerr, 2006).

3 The purpose of this study is to determine the role of organizational power and personal influence in enabling the PPL to fulfill their role functions toward creating a professional practice environment for nurses. 3

4 PPL perceptions of Front line Management Support PPL Influence Tactics PPL Organizational Power PPL Role Functions Nurses Perception of Prof Practice Environment

5 Organizational power (Kanter, 1993) Personal influence tactic (Yukl, 1992) Professional Practice Leader role Perceptions of manager support Professional practice environment (Lake, 2002)

6 Sponsorship Formal Power Informal Power Opportunities Resources Support Kanter (1993) describes power as the ability to mobilize resources to get things done. The degree of sponsorship indicates to others inside and outside of the organization, that the role has the backing of someone with power (Kanter, 1993). Individuals with both formal and informal power are viewed as having greater access to opportunities, information, support and resources. (Kanter, 1979; Laschinger, 1996). Information

7 Research to determine the effectiveness of influence tactics on outcomes revealed that the use influence tactics is significantly and positively related to target commitment and agent effectiveness. (Yukl & Falbe, 1990; Yukl & Falbe, 1991; Yukl, Guinan, & Sottolano, 1995; Yukl & Tracey, 1992; Yukl, Chavez & Seifert, 2005) The use of core influence tactics (rational persuasion, inspirational appeals, and consultation) is significantly and positively related to target commitment and agent effectiveness (Yukl & Tracey, 1992; Yukl, Chavez & Seifert, 2005) Rationale Persuasion Inspirational appeal Consultation Collaboration Coalition Legitimizing Pressure Ingratiation Apprising Personal appeals Exchange

8 The purpose of the PPL role has been described as being responsible for the promotion and maintenance of the standards of practice for their profession. (Miller et al, 2001; McCormack & Garbett, 2003; Lankshear et al, 2011). The domains of the role include: expert practice, professional leadership and competency, education, care delivery, research, and practice and service development (Graham & Wallace, 2005; Ryan, 2006; Woodward, Webb, & Prowse, 2005; Mullen et al, 2011; Lankshear et al, 2011). PPL roles titles include: Professional Practice Leader Facilitator Coordinator Directors of Professional Practice VP/ Professional Practice Hybrid roles : Directors Practice/Quality/Risk/Patient Safety

9 A professional practice environment can be described as the system that supports control over the delivery of care the environment in which care is delivered and the characteristics of an organization that facilitate or constrain professional practice (Aiken & Patrician 2000; Lake, 2002). Organizational characteristics that facilitate professional nursing practice include control over nursing practice, autonomy, visible, supportive nursing leadership, and collaborative relationships with physicians (Kramer & Hafner, 1984; Kramer & Schamlenberg, 1988a, 1988b) Demonstrated the link between organizational characteristics ( e.g. magnet hospitals), patient safety and patient outcomes (Aiken, 1999; Armstrong and Laschinger, 2009; Purdy et al, 2010)

10 Research Design Sample Data Collection A nonexperimental, descriptive correlational research design. PPLs: Professional Practice Network of Ontario (PPNO) Nurses: Stratified, random sample from College of Nurses of Ontario PPLs: Electronic via PPNO listserv Nurses: Hard copy mailings to home address

11 PPL 74 completed PPL surveys 47 Hospitals Nurse 2873 completed surveys 127 Hospitals 51.2% response rate overall Matched sets : PPL / Nurse 45 Organizations 62/74 completed PPL surveys (84%) 2128 / 2873 completed Nurse surveys (74%)

12 1. Conditions for Work Effectiveness (CWEQ-II) Laschinger, Influence Behaviour Questionnaire (IBQ) Yukl, Professional Practice Leader Questionnaire (PPLQ) Lankshear, Perceptions of manager support Lankshear, Practice Environment Scale (PES) Lake 2002

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14 PPL Educational background Master prepared = 56.5% Bacc. Prepared = 35.5 % Full Time Equivalent Allocation Full time = 71.4% Reporting relationship Vice-President = 64% Experience Mean # yrs Nurse Professional designation Registered Nurses 82% Educational background Diploma prepared = 73% Employment status Full time = 65.8% PPL role in place? Yes No Not sure Number of years as PPL Number of years in current role Original 51% 17% 32% Recoded 85% 7% 8%

15 Study Variables Practice Environment PPL Organizational Power PPL Influence PPL Role Functions Subscales Foundations in Quality of Care ( 2.3) - Participation in Hospital Affairs (2.6) Access to resources (2.6) - Access to information (4.1) Coalition (3.0) - Consultation (4.4) Research (3.3) - Consultation (4.1)

16 Study Variables Mean SD (1) (2) (3) (4) (5) (1) PES Composite (2) PPL Organizational Power (3) PPL Influence ** 1.00 (4) PPL Role **.399**.431** 1.00 (5) Mgr. Commitment **.378**.487**.676** 1.00 ** p < 0.01

17 Practice Prof Develop Leadership Research Consultation Information.349**.180**.401**.161**.093** Support.349**.180**.401**.161**.093** Resources.165** -.055** ** Opportunity.556**.328**.526**.285**.391** Formal Power (JAS).233** **.078**.018 Informal Power (ORS).505**.470**.427**.410**.547** Total Empowerment.462**.235**.429**.274**.234** Inspirational Appeal.396**.235**.352**.452**.159** Rat. Persuasion.060**.079**.174**.096** -.102** Consultation.094** -.095**.152** -.074** -.080** Collaboration.221**.168**.263**.194**.201** Coalition.353** **.189**.169** Legitimizing.562**.465**.651**.523**.472** **P < 0.01

18 (N=45).17 PPL Influence.12 PPL Perception of Mgr Support.50** PPL Organiz. Power.43** PPL Role Function Goodness-of- Fit Indices Chi square / df / p 39.20, df(24), p < 0.02 CFI.905 TLI.811 RMSEA ** Nurse Perception of Practice Environ ** p <.001

19 Organizational power (e.g. structure) significant contributor to PPL ability to achieve role functions. PPL use of Influence tactics also a significant, direct contributor to achievement of role functions. Informal power and Legitimizing influence tactics contributing to achievement of PPL role functions. Small, yet statistically significant relationship between PPL role and Nurses perception of practice environment not surprising due to current structure and strategic scope of the role.

20 Practice Strong theoretical foundation for design, implementation and evaluation of PP structures and/or role. Evolving nature of PPL roles requires equivalent organizational power to achieve desired outcomes/deliverables. Identification of the desired skills and competencies for PPL role PPL fully embrace and operationalize legitimate role within the organizational re: professional practice related issues and initiatives. Application to wide variety of PPL roles ( e.g. Chief of Staff, Department Chiefs, Infection Control professionals )

21 Future Research a) Application to Interprofessional Hybrid Professional Practice Portfolios and impact on organizational outcomes; high performing health systems. b) Expansion to include PPLs outside of Ontario. c) Further investigation of the impacts of sponsorship, organizational culture on PPL role effectiveness.

22 1. Small final number of matched units (N=45) 2. Cross-sectional study design 3. Use of newly developed instrument (PPLQ) 22

23 Lankshear S, Kerr M, Laschinger H & Wong C. Professional Practice Leadership Roles: The role of organizational power and personal influence in creating a professional practice environment for nurses. Health Care Management Review; In press. doi: /HMR.0b013e31826fd517 ResearchGate : Sara Lankshear Publications : Sara Lankshear RN PhD Phone: sara@releveconsulting.com Website: