5
Something unforeseen and magnificent is happening. Health care, having in our time entered its dark night of the soul, shows signs of emerging, transformed.
—Barbara Dossey and Larry Dossey (cited in Porter-O’Grady & Malloch, 2011, p. 433)
Introduction
As the health care system responds to changes in the environment, nurse leaders refine and adapt leadership tools and care processes. Leadership tools such as organizational mission, vision, and value statements, which guide both administration and patient care providers through their daily work, are routinely reviewed and modified. “Delegation of care” or transfer of responsibility from one classification of care provider to another is an example of an important health care process adaptation that has occurred in response to rapid system-wide changes. Nurse leaders play an important role within this complex adaptive system as they retain a focus on maintaining a strong care provider culture that supports quality care and improved patient outcomes, regardless of unending change.
Learning Objectives
- Apply systems theory to health care.
- Identify the relationships between organizational culture, leadership, cultural intelligence, and change.
- Identify the importance of the vision, mission, and value statements of an organization.
- Conclude that relational leadership and empowerment play an important role in organizational cultural change.
- Examine the standards for delegation of care established by the Saskatchewan Registered Nurses’ Association (SRNA) from RN to unregulated care providers and from physician to RN.
5.1 Systems Theory and Health Care
In Chapter 1, we discussed complexity science and complex adaptive systems in nursing. It is important to realize that causality in a complex adaptive system is not linear, meaning that it is difficult to predict the end result of a specific employee- or patient-focused intervention. As nurses we know that the success of our patient-centred care interventions is dependent upon many factors. All too often, despite extensive planning and hard work, a patient care intervention fails to lead to the intended results. Factors beyond our control, and often beyond our knowledge, change the intended outcomes. This is typical of events in a complex adaptive system.
So how can we be successful leaders if we cannot predict what will happen when we attempt to guide others? Perhaps a review of the first two principles of the complex adaptive system, discussed in Chapter 1, will provide an answer to this question. The first principle, which is focused on using the lens of complexity, and the second principle, which describes good enough vision, provide us with clues on how to lead others within the complex adaptive health care system. Organizations and nurse leaders acknowledge that they cannot control change, and thus they do not try to control every aspect of organizational change. Successful health care leaders attempt to give a general sense of direction to