Trends in Leadership and Facilitation in Community Health

Review and critique current trends in leadership and facilitation, in the context of your specialty evaluate how you have led and facilitated a staff member or group.

Throughout history, the ability to lead groups, to turn people with different beliefs and abilities into people who work together as a team that succeeds in generating positive results for organisations has been a matter of discussion and focus of numerous research (Gopee and Galloway, 2017). Research about the value of leadership and facilitation for healthcare professionals and healthcare services suggest that due to an increasing demand in the health services as well as the increasing degree of literacy of the people who seek for healthcare services, there is a need to establish dynamic and new paradigms of the relationship between healthcare professionals and users (Gopee and Galloway, 2017; Sullivan and Garland, 2013).  Therefore, it is necessary to emphasise the importance of effective leadership since it requires constant improvement to achieve the desired excellence in the management of health services (Sullivan and Garland, 2013).  A leader or leaders comprises a person or group of persons who select, command, trains and influence people toward an objective which can be organisational or not(Summerfield, 2014; Winston and Patterson, 2006). And leadership comprises the ways and the strategies of how the leader manage (lead) all his or their attributions to facilitate, to motivate people and organisations to achieve the goals (Summerfield, 2014). The aim of this assignment is to criticise the current trends of leadership and facilitation in the context of its author’s speciality and provide an evaluation of how the author has led and facilitated a group of nursing students in a project of health community promotion in Angola. To achieve the goals of this research, academic articles of different authors were selected from reliable databases to support the arguments presented in the given assignment. The analyses and explanation of how the author has led and facilitated a group of nursing students are based on his experiences while leading the said project from 2013 to 2015.

In modern societies that are advanced like the UK, the challenges of how to lead and manage healthcare services effectively by providing adequate services for communities are huge and critical because of the increased demand of costumers, lack of prediction of some situations, high workload and some complexities of the organisations and communities (Bruno et al., 2017; Sullivan and Garland, 2013). Therefore, some experts argue that one of the ways to improve the quality and performance of healthcare services is related to the changes in the organisations perspective by considering the patients participation and the patients choices (Bruno et al., 2017). This suggest that healthcare leaders must be challenged to engage themselves to familiarise with these emerging roles including being able to lead and coordinate care and healthcare programs as well as provide it (Bruno et al., 2017; Gopee and Galloway, 2017; Sullivan and Garland, 2013). Moreover, healthcare mentors are challenged to be aware of modernised careers and education reforms by creating flexible roles and careers pathways which can sustain staff motivation to remain within the profession (Sullivan and Garland, 2013). Thus, involving staff should comprise the involvement of staff in the decision-making process in all the spheres of both clinical and organisational decision-making. Thus, leaders are persuaded to have sufficient communicational abilities to keep the staff informed of all the decisions.  Another challenge of the health service leader especially those working on community health promotion is to take the cultural diversity, technology and cost-effectiveness into account. Therefore, the leaders’ ability to lead with flexibility and adaptability is fundamental (Struckmann et al., 2017; Sullivan and Garland, 2013).

According to Alexander et al., (2001), healthcare policy makers along with community health agents indicate that the main causes of deficient health among people within the communities lie in the traditional systematic problems including pollution, violence and substance abuse. Thus, these problems are normally addressed as serious public health concerns which demand a delivery of health promotion services with participation of citizens and allocation of resources. For this reason, communities are persuaded to develop community partnerships with a purpose to deal with these public health issues through innovative multisector collaboration. Notwithstanding the evidence of the benefits of collaborative community health partnerships, the trends of excellent leadership in this context remain a matter of greater emphasis(Alexander et al., 2001). In contrast to the traditional organisations where the leadership process is basically associated with a formal hierarchical position which confer both legitimate authority and the approach that the leader defines the goals and strategies and influence staff, with regard to collaboration community health partnerships, the authority of the leader is limited, and the limitation may include the freedom to set an agenda, initiate the projects on time, allocate resources and solve conflicts (Alexander et al., 2001).

Moreover, there are certain limitations in the effective models of nursing and midwifery in relation to the provision of healthcare and health services in communities (Coffey et al., 2017). However, these models are necessary to guide general health services (ibid). Primary and community care is the first gateway for most people to have access to healthcare and the place where most care is provided, subsequently leading to improved health of most people (Coffey et al., 2017; Xyrichis and Lowton, 2008).  Thus, the execution of the tasks inherent to this sector requires a framework of practice with established conceptual and theoretical foundations (Coffey et al., 2017). Considering the trends in nursing and midwifery, to achieve better functioning of the conceptual model for nursing and midwifery in the communities, strong leadership and effective ability for clinical governance are critical. While working as a leader in a project of health community promotion (a voluntary project that the student union of Angola in collaboration with the school of nursing implemented in rural communities of Angola) which involved more than 300 nursing students, the author of this essay was confronted with almost all the scenarios and challenges presented above in terms of leadership. Therefore, to achieve the goals of the project, the author adopted the collaborative leadership as the ideal strategy to recruit motivate and engage students and citizens on the project.

Over time, many leadership theories have been proposed with the purpose to explain the nature, greatness and loyal characteristics of people who lead, manage, govern and motivate other to achieve goals.  In the context of modern healthcare organisational systems,  leadership theories  not only emphasise the heroic, hierarchic, controlled and inspirational leaders but the daily leader who reflects a competent and motivated individual able to deliver the best services to the patient and their relatives in a healthcare organisation or in the community (Sullivan and Garland, 2013; West et al., 2015). Therefore, the model of leadership to adopt regarding various context and circumstances of healthcare remains a major source of concern among researchers and healthcare professionals. Thus, one of the suggested way to adopt the ideal model of leadership of healthcare organisations is to understand the core of leadership theories which provide the adequate support for the current understanding of leadership (House et al., 2002).

According to Sullivan and Garland (2013), the major leadership theories are divided into early theories which includes the Great Man Theory, Trait theory, behavioural theories and the contingency or situational theories; and the contemporary theories that includes the transactional leadership, transformational leadership, quantum leadership, servant leadership, emotional intelligence leadership and shared or dispersed leadership. Similarly, Skochelak et al., (2016) support that since it is difficult to define what makes a good leader, it is necessary to understand the essence of each theory and interpret the advantages and disadvantages of each before adopting them into the various healthcare organisations or community healthcare promotions.

In the mid-19^th century for example, there was the idea that the ability to lead people, organisations or communities was a consequence of divine inspiration and benediction. This theory was known as the Great Man theory but the main drawback was related with the fact that only people born into royalty, or those who get good positions in the church, the military or politicians should take the position of leadership (Sullivan and Garland, 2013). Similarly, the trait theory arose emphasising the need to isolate the traits for the critical leadership, that leaders are born and not made and therefore, only people with certain isolated traits should be considered as ideal for leadership positions (Sullivan and Garland, 2013; West et al., 2015). Nevertheless, the trait approach has not escaped criticism from healthcare managers, agencies and academics due to its limited use of explaining effectively what traits define an excellent leader considering that effective leaders do not necessarily have similar traits (ibid).

Furthermore, due to the development of the human model of organisation, the behaviour of the leader become the focus of the approach of what makes an affective leader. Through this approach, an effective leader should have a pattern of learned behaviour (Sullivan and Garland, 2013; West et al., 2015). Based on the behaviour of the leaders, Weber (1905, cited in Sullivan and Garland, 2013: 17) proposed two types of leaders – the bureaucratic leader and the charismatic leader. According to Weber, the bureaucratic leader is a person who possesses a greatly structured approach and have the ability to follow the procedure and carefully ensure that the tasks are being done correctly (Schyns and Meindl, 2005; Sullivan and Garland, 2013). This style of leadership was considered “suitable to hospital, universities and banks” where tasks need to be executed correctly (ibid).  The charismatic leader is the one who infuses energy and makes sure that the success of the tasks depend on the commitment and hard work of the team. Similarly, Lewin, Lippitt and White (1939, cited in Sullivan and Garland, 2013 :18), identified three other different styles of leadership, firstly is the autocratic style which emphasises the value of external forces such us power and authority, and the leader makes all the decisions; secondly is the democratic leadership style which suggests that individuals are motivated by “internal drives and impulses”. Here, the leader appeal for the participation of the staff and the group and the team get the chance to communicate in an open manner with the leader (Schyns and Meindl, 2005); Similar to the democratic style, the third is the laissez-faire leadership style which also assumes that people are motivated by “internal drives” therefore, they should be left alone to make decisions. However, some experts like Crail (2001, cited in Sullivan and Garland, 2013, p. 18) advises that since the three leadership styles exist in continuum, the style to adopt depends on the organisational culture, the characteristics of the group and the situation. This suggests that none of previously presented leadership style is itself effective in every situation. Therefore, leaders in this context should adopt a style that best complement the organisational environment, the tasks to be accomplished and the personal characteristics of the people involved in each situation (Sullivan and Garland, 2013).

Early theories of leadership were developed from understanding leadership within hierarchical organisations whereas contemporary theories leadership theories emphasise the increased values of leaders in today’s healthcare environment place  such as the collaboration and teamwork across different services within the organisation or between organisms (Coffey et al., 2017; Sullivan and Garland, 2013). For example, in the context of contemporary partnership between different health providers and organisations, nurses may be responsible for a project which needs health promoters and community health agents to work together, and it is imperative that leadership occurs for the partnership to achieve its goals  (Coffey et al., 2017; Sullivan and Garland, 2013). Hence, leaders are persuaded to use additional skills such as team and political leadership skills to create “collegial work environment” (Sullivan and Garland, 2013). The great trend of leadership in this context is to become a collaborative leadership.  One of the modern leadership skill, the transactional leadership (Judge and Piccolo, 2004; Sullivan and Garland, 2013) emphasise the maintenance of the equilibrium and status quo. Leaders in this context are successful according to the level that they perceive and meet the needs of the staff or the group they lead, and use punishment to enhance employee loyalty and performance(Judge and Piccolo, 2004).

In the context of health community promotion, mainly when leading a group of volunteers, a major challenge of leaders is to find and adopt a leadership style that can help to promote interpersonal relationships. Transformational leadership proposed by Ward (2012, cited in Sullivan and Garland, 2013) could be ideal to inspire followers and use power to instil a belief that staff also have the capacity do exceptional things (ibid). One of major advantages of the transformational leadership lies in the fact that leaders encourage followers to exercise leadership. Thus, transformational leadership is argued to be the natural model of healthcare leaders in modern organisations due to the core of the healthcare profession which is to provide ethical and human service (Gregory Stone et al., 2004; Sullivan and Garland, 2013). Engagement of leaders with staff members alongside the leaders’ demonstration of vision, ability, and competence have a higher chance of increasing the positive attitudes of staff towards work alongside staff overall wellbeing at work (Alimo-Metcalfe et al., 2007; Sullivan and Garland, 2013, p. 23).

Values and skills of leaders are essential in the modern organisational health system. According to Daniel Goleman (2004, cited in (Sullivan and Garland, 2013, p. 24), apart from intelligence and skills, a good leader should also possess emotional intelligence to be considered as an effective leader. Furthermore, most of the literature of leadership in nursing and midwifery acknowledge the need for emotional intelligence and effective leadership in healthcare professions. Emotional intelligence is widely described in the literature as an ability, trait or a blend of both that allows a leader to cope with a multifactorial array of emotional and social competencies which determine how effectively the leader relate with himself and with others and how he deals with daily demands and pressure (Mittal and Sindhu, 2012). Moreover, Daniel Goleman (2004, cited in (Sullivan and Garland, 2013, p. 24) argue that good healthcare leaders are also expected to be self-motivated, with passion for what they do and the energy to achieve goals. Also, a good healthcare leader should have empathy for others and possess effective social skills, ability to understand other people and develop excellent working relationships (Sullivan and Garland, 2013). Again, this suggest that the trend of modern leadership is not only centred on the leader as the “boss” but also involves staff, patients and the organisation itself. Also, leaders should be able to manage the possible vision blockers when leading a healthcare organisation (Shirey, 2005; Sullivan and Garland, 2013).

For the improvement of the services that healthcare professionals or organisations provide to the patients or to the communities, it is imperative to consider the role of a leader as extremely important. The leader’s role in an organisation can be formally assigned according to his position e.g. ward supervisor, manager, head of service etc, and it can as well be informally assumed by an employee who has a certain charisma which can attract others to follow (Ruchlin et al., 2004). The main roles of leadership in healthcare organisations consist of motivating the staff which means that the leader should be able to find out the needs of employees and provide praises when necessary (Ruchlin et al., 2004). Thus, to achieve this attribute, the leader should be able to interact with the team to understand their needs (Shirey, 2005). Another role of the leader is to guide the staff by defining their role in the work place and providing them with the necessary tools to perform the tasks. Furthermore, leaders should be able to build employees’ morale and make sure that no one is losing the focus by involving and pulling everyone together, managing conflicts and encouraging team members toward the objectives (Gregory Stone et al., 2004).

Healthcare organisations and community organisations are often oriented for specific actions and one of the most important abilities of leaders who want to achieve outstanding results in the organisations that they lead is the capacity to facilitate the members by teaching and orientating them through systematic educational process.  According to Mangena and Chabeli (2005, p. 293) “Facilitation is a dynamic and interactive process for the promotion of critical thinking through the creation of an environment to such thinking”. In context of nursing education  and nursing student teaching facilitation, the process consists of guiding, assisting and providing students with the means that permit them to learn content about nursing science and giving them the opportunity to efficiently apply the knowledge received to nursing care of people who need such care (Mangena and Chabeli, 2005). It suggests that a facilitator nurse should be able to demonstrate a range of skills in their role to ensure effective learning. Therefore, to be able to facilitate effective learning, a nursing facilitator should understand the content of the subject that he/she teaches and the related fields, as thoroughly as possible. The nurse leader should also understand the “conceptual, strategic, epistemological, philosophical, and educational ramifications of thinking”. Thus, they should be able to comprehend the key aspects of critical thinking by reading relevant articles on critical thinking, participation in seminars, workshops and conferences that have a thematic focus of critical thinking and share the knowledge accumulated to the students (Mangena and Chabeli, 2005).

Developing strategies for facilitating and involving nursing students in programs to promote health in the communities is an important aspect to set up when leading and managing health community programs. Due to the discrepancy in the culture of communities, in the context of community health promotion, one of the most important roles of a facilitator nurse should be  to provide students with sufficient information about cultural competence, defined attitudes, knowledge, and skills that are necessary to provide quality care to a diverse population ant to be able to accept and respect differences and preventing one’s personal believes that may impede the provision of quality care (Calvillo et al., 2009). Therefore, a facilitatory leader should be able to understand and correctly explain the standards which outline the main competencies that each nurse student should have.

Moreover, a nursing leader facilitator working with undergraduate nursing students should have competencies on teaching and learning strategies and process for undergraduate nurses. Waterkemper and do Prado (2011) believe that in modern nursing teaching systems, the main teaching and learning strategies that nurses adopt to support students are introduction of new teaching technologies, active teaching methodologies, simulation in the laboratory, dramatisation, films, integrative panel, creative games, teamwork and portfolio; criticism and reflection ability of the students in their company; classroom, pedagogic classroom and cooperative learning supported by computers.

In 2013 to 2015, I acted as a facilitator leader in a health community project in Angola. The project was a nursing student project that involved more than 300 students. It was a volunteer project, an initiative of the students of the upper institute of health sciences in which I was president of the association of students. Due to the lack of quality healthcare in the country, to meet the demands of health in the country’s communities, the project aimed essentially to involve nursing students in a door-to-door awareness program to help the people understand the importance of adopting good health habits as well as showing them how to proceed in case of illness. Because it is a community intervention project involving mainly young and popular students, as a leader and facilitator I had great challenges.

As a leader, my biggest challenge was to adopt a model of leadership that could allow me to keep the students motivated and focused on the project and its objectives and to establish an effective leadership and cooperative management with the health entities of the communities where we were implementing the project. As a facilitator, my main challenge was to develop an intervention program with contents which could reflect the real situation of the communities and bring resolution to their situation and to give the students training about the program and the sociocultural and geographic characteristics of the communities where we needed to intervene.

Therefore, I had to adopt one of the modern leadership style which is the transformational leadership. This style of leadership has helped to maintain group of students interactionss either with their fellows or with the general population, and therefore, develop effective interpersonal relationship. Another advantage that I observed by adopting transformational leadership style was related to the fact that it allowed me to create new leaders among the students. These strategies helped me to know exactly what was happening in teams, manage the conflicts among the members and to keep a good communicational flow between me, the students and the citizens. To facilitate the teaching and learning process, I had divided the group into six subgroups and in each subgroup, there was a leader and facilitator elected by the members. My first role was to make arrangements for the election of leaders and the leaders were the facilitators in their respective subgroup. In this last stage, I was acting as the general supervisor. Thus, I can argue that cooperative and participative method of facilitation was the best choice for me and I had good results by using this leadership style and facilitation method.

In conclusion, the points provided suggests that in healthcare process, particularly in the context of community health promotion, leadership and facilitation are key factors to enhance the success of the organisations, to keep the staff updated and focused in their objectives, and therefore, provide good services to the patients. Since the modern societies tend to be more dynamic than the ancient societies, there is an increased demand of patients, therefore, nursing leadership should not only focus on the staff but should also involve the patients in the process of decision making. Furthermore, it is critical to continuously improve the values and skills of leaders in the organisational health system. Nursing facilitators should have broad knowledge of the content of the subject that they teach and the related fields as thoroughly as possible. Nursing leader/facilitator working with undergraduate nursing students should also have competencies on teaching and learning strategies and process for undergraduate nurses.

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