Lead the Way! -- How to Develop an Effective Leadership Development Program
Author: Lin Grensing-Pophal
Date: May 28, 2009
Moving from a staff or operational role into a leadership position can be challenging in any profession. For nurses the challenge can be greater, however, as it involves a significant shift in focus from direct patient contact (the reason most nurses joined the profession) to a focus on more administrative issues that often remove them from direct patient care activities. Many love the transition, while others regret leaving their direct-care roles and indicate that they had no idea what an administrative role involved.
In an effort to provide a better understanding of leadership and management to nurses interested in moving into these roles, health care organizations have developed leadership development programs as a way to both develop internal staff and to ensure that staff entering these roles know what to expect.
Aurora Health Care, based in Milwaukee, has such a program. Terry Kabitzke-Groth chairs the nursing management council for Aurora Health Care's metro region. The council selects fellows, who work one-on-one with a mentor for six months to prepare them to be nurse leaders. Fellows work 8-12 hours a week with their mentors following the mentor, going to meetings, learning how to be a manager-how to hire, supervise, delegate, etc.
"The goal is to groom nurses for a position within the area they're currently working," said Kabitzke-Groth. "We want to create leaders from the ground up who also understand the business."
Building a Business Case
In the "old days," added Kabitzke-Groth, "a very clinically competent, strong practitioner, expert bedside nurse would either be told or would find her way into a management role. Over the years it became apparent that there is a very different set of skills at the bedside than in a management role. Things you need to know as a manager aren't part of the core curriculum to become a nurse!"
"You can't assume that an expert nurse at the bedside will be an expert in management," Kabitzke-Groth noted. "Quite honestly, being a nurse manager isn't always thought of as a cushy job. We have long hours, many challenges, tight budgets, challenges dealing with people both on a patient and a staff side." So, she summarized, the ability to prepare nurses to move into these roles-and to give them a realistic preview of what's in store-is critical to ensure a smooth transition.
Health care organizations that have promoted nurses into roles for which they were ill-prepared understand well the risks of promoting people prematurely. Building a business case for a leadership development program can often be quickly justified through a look at recruitment/replacement and retraining costs in situations that have not worked out.
Another benefit to homegrown leaders, of course, is that they are fully informed and engaged in the unique culture of the organization. Even outside hires can be risky when experienced nurse managers' philosophies and expectations are not aligned with the organization.
Getting a Program Off the Ground
Liz Bywater, Ph.D., is an organizational consultant and professional psychologist.
"Before establishing an in-house leadership development program, the organization must identify which leadership qualities are most relevant and impactful for their particular culture, circumstance, mission, etc.," she said.
Needs will vary based on the organization's size, hierarchical structure, whether it's for-profit or non-profit, etc.
Kevin Berchelmann, a leadership expert and management consultant specializing in human capital, leadership development and corporate strategy, noted that "the beginning stages-or creation, if you will-of leadership development efforts is where success or failure is determined. Implementation is simple, as is-generally-curriculum development. 'How and 'why' are easy-the tough part is 'what?' You've got the leaders, you've got the resources to apply-what skills do you 'develop'?"
While the answer to that question should involve input from participants, Berchelmann cautioned against simply asking and acting on participants' perspectives: "What do you think you need?" Why? Many participants don't have the overall organizational perspective to know these answers-which goes back to the significant differences between clinical and management roles. Nurses, whose backgrounds and experiences have been entirely clinically and patient-focused, may not have appropriate perspectives on what it really takes to succeed in management.
Berchelmann suggested gathering information from organizational leaders on the skills they feel are necessary-or lacking-within the organization. These conversations often need to take place at the highest level where candid feedback can be attained. He tells of a major hospital system client that had challenges with their senior team. "Recent acquisitions and expansions left them with the 'old' guard and the 'new'-determining and supporting what was really important to that group took multiple conversations with stakeholders above and beyond those directly affected." It's too easy, he says, "to be too close to the forest."
Selecting Candidates
Selecting the right people to take part in the program is obviously a key challenge. "The last thing you want to do is train somebody and find their interests are somewhere else," said Kabitzke-Groth. "We want to look for a good match to make sure we provide the most positive experience for the candidate." That's where the leadership development program comes in. It provides nurses with a realistic preview-and an opportunity to shadow and be mentored by somebody who has "been there, done that."
Not only will the wrong candidates result in unnecessary expense, but training and then failing to promote those who didn't have the requisite skills in the first place can lead to frustration and resentment. While candidates in these programs should never be promised a leadership spot once they have graduated, so to speak, the organization should obviously be striving to have as high of a placement rate as possible as one measure of success for their efforts.
"Establish some sort of criteria for determining who will be selected for leadership training," advised Bywater. "It's a myth to think that everyone should or can become a leader."
At Aurora candidates for the leadership development program go through an application process and are required to provide a letter of reference from their manager. "You want people who are above average or are over-achievers," said Kabitzke-Groth. At Aurora, that's a practical requirement as well because nurses are expected to engage in the program above and beyond their current job expectations.
In addition to the skills of the candidates, matches are made specifically to address areas of identified need within the organization. "We match individuals' talents with areas we have opportunities," said Kabitzke-Groth. One such area has been women's health.
Monitoring Progress
Aurora's program involves ongoing monitoring of the progress of the candidate and the mentoring relationship. "They report back through the management council on their progress and we help to remove any barriers along with the VP at their site," said Kabitzke-Groth. These barriers might include scheduling conflicts or candidates whose work is suffering. "Then we may need to coach for performance improvement or maybe remove the candidate," she stated. (This has not happened, but is something the council has discussed and would be prepared to address, if necessary.)
At the end of the one-year program, "we determine whether the candidate is ready to apply for a role in a manager's position somewhere in the organizational- ideally in the area that has helped them grow through the last year," said Kabitzke-Groth.
Monitoring progress needs to occur at the organizational level, as well, noted Berchelmann. "Any effort like this requires some metrics in place to determine success. Before and after snapshots can help show change, as well as available business measurements."
Showcase results-communicate about the effectiveness, or areas of improvement, for the program and celebrate successes along the way.
For health care organizations considering the development of an internal leadership program, Kabitzke-Groth says that the right environment must exist. What does that environment look like? "It's one with clear direction, values, vision and strong, open and honest communication," she says.
She also advises health care organizations to start small. "Just start somewhere. Start with what you believe a manager needs to know, then identify those with the patience and the ability to be mentors. Finally, match them up with the individuals you believe have high potential.
"Maybe your first year you don't get the outcomes you want, but then you just sit down, relook at it and make adjustments," she said. "Gather feedback, consider lessons learned and continue changing your processes and challenging yourself to be better."
Commitment is key and critical to success. Kabitzke-Groth credited her management team and the nursing management council for the passion and commitment to make Aurora's program a success. "We had the commitment from our chief nursing executive all the way down to every VP at each one of our sites."
"Remember that leadership development is an ongoing process," said Bywater. "Provide opportunities for continual learning and development through a combination of training, coaching and mentoring."
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