sara lankshear rn, phd relevé consulting services · the use of core influence tactics (rational...
Post on 12-Jul-2020
0 Views
Preview:
TRANSCRIPT
Sara Lankshear RN, PhD
Relevé Consulting Services
National Health Leadership Conference June 2013
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).
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
Nurses Perception
of Prof Practice
Environment
PPL Influence
Tactics
PPL
Organizational Power
PPL
Role Functions
PPL perceptions of
Front line
Management
Support
Organizational power (Kanter, 1993)
Personal influence tactic (Yukl, 1992)
Professional Practice Leader role
Perceptions of manager support
Professional practice environment (Lake, 2002)
Informal Power
Opportunities
Resources
Support
Information
Sponsorship
Formal Power
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).
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
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
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)
Research
Design
A non-
experimental,
descriptive
correlational
research
design.
Sample
PPLs: Professional
Practice Network
of Ontario (PPNO)
Nurses:
Stratified,
random sample
from College of
Nurses of Ontario
Data
Collection
PPLs: Electronic
via PPNO listserv
Nurses: Hard
copy mailings to
home address
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%)
1. Conditions for Work Effectiveness (CWEQ-II) Laschinger, 2001
2. Influence Behaviour Questionnaire (IBQ) Yukl, 2002
3. Professional Practice Leader Questionnaire
(PPLQ) Lankshear, 2008
4. Perceptions of manager support Lankshear, 2008
5. Practice Environment Scale (PES) Lake 2002
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
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
Original 51% 17% 32%
Recoded 85% 7% 8%
Mean # yrs
Number of years as PPL
6
Number of years in current role
3.2
Study Variables Subscales
Practice Environment Foundations in Quality of Care ( 2.3) -
Participation in Hospital Affairs (2.6)
PPL Organizational Power Access to resources (2.6) -
Access to information (4.1)
PPL Influence Coalition (3.0) - Consultation (4.4)
PPL Role Functions Research (3.3) - Consultation (4.1)
Study Variables Mean SD (1) (2) (3) (4) (5)
(1) PES Composite 2.51 .30 1.00
(2) PPL
Organizational
Power
21.83 3.9 .015 1.00
(3) PPL Influence 23.34 3.4 .024 .197** 1.00
(4) PPL Role 19.03 2.7 .057** .399** .431** 1.00
(5) Mgr.
Commitment
3.45 1.11 .068** .378** .487** .676** 1.00
** p < 0.01
Practice Prof Develop Leadership Research Consultation
Information .349** .180** .401** .161** .093**
Support .349** .180** .401** .161** .093**
Resources .165** -.055** .000 .216** -.038
Opportunity .556** .328** .526** .285** .391**
Formal Power (JAS) .233** -.007 .216** .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** .024 .362** .189** .169**
Legitimizing .562** .465** .651** .523** .472**
**P < 0.01
PPL Influence
PPL Role Function
PPL Organiz. Power
PPL Perception
of Mgr Support
Nurse Perception of Practice
Environ
Goodness-of-
Fit Indices
Chi square / df / p
39.20, df(24), p < 0.02
CFI
.905
TLI
.811
RMSEA
.017
.17
.43**
.12
.50**
.052**
** p < .001
(N=45)
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.
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…)
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.
1. Small final number of matched units (N=45)
2. Cross-sectional study design
3. Use of newly developed instrument (PPLQ)
22
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: 10.1097/HMR.0b013e31826fd517
ResearchGate : Sara Lankshear
Publications :
https://www.researchgate.net/profile/Sara_Lankshear/publications/
Sara Lankshear RN PhD Phone: 705-533-0778 Email: sara@releveconsulting.com Website: www.releveconsulting.com
top related