INTRODUCTION

This memorable quotation reflects the two types of thinking generally engaged in by nurse managers and leaders; that is, inside-out strategic thinking and outside-in strategic thinking (Thompson & Strickland 1995). This chapter has been written to assist those readers who wish to be among those who make things happen and who will, in order to do this, engage increasingly in outside-in strategic thinking.

The chapter begins by typologising these two distinct ways of thinking and then demonstrates why, in the face of turbulent and continual organisational change, outside-in thinkers will be increasingly required. The centrality of short and long-term planning to organisational or unit effectiveness will be emphasised. The chapter will then focus on leadership, the traditional view, that of the warrior-hero, and a more contemporary view, that of generative leadership, and link the latter explicitly to outside-in thinking. Then, and as the chapter title suggests, the nature and role of reflection in the development of generative leadership will be discussed. Some guidelines to assist nurse leaders and managers and those who aspire to such roles to become reflective, generative leaders will also be provided.

Readers should note that no distinction is made between the roles and qualities of leaders and managers, as is typically the case in leadership texts. This accords with the views of Grove (1986) and Gardner (1986), who distinguish only between leader–managers and routine managers. Leader–managers think long term, are visionary, inspirational and think outside-in. Routine managers, in contrast, think short term and inside-out, and are concerned with coordination and supervision.

INSIDE-OUT AND OUTSIDE-IN STRATEGIC THINKING

THE NECESSITY FOR OUTSIDE-IN STRATEGIC THINKING

Scholars at the Massachusetts Institute of Technology currently estimate that the world’s total stock of knowledge (i.e. all disciplines) doubles every ten years; by 2010, however, they estimate that it will double every two years (Aitken 1997). This has enormous implications for everyone, including those working in health (Sullivan 1998). Technological and social advances, which are the result of the knowledge explosion, allow or require the treatment of people who previously were considered (relatively) untreatable; this includes the very young and the fragile elderly, those with chronic and degenerative disorders, and those with life-threatening infectious diseases, e.g. HIV/AIDS. This puts increasing pressure on health service managers to provide more cost-effective services (Beardwood et al. 1999; Cullen 1998). Cost-effective measures have resulted in massive and repeated health service restructurings, workforce redesign, deinstitutionalisation of people with disability and chronic mental health problems, the movement towards evidence-based and interdisciplinary health care, and the promotion of preventative and primary care in all developed countries (Reid 1994).

All these general trends have implications for nurse leaders: outside-in leaders will consider what these implications are and, as noted previously, plan to take advantage/avoid disadvantage if and when they eventuate. Only in this way, by being deliberately strategic, will they provide leadership in their working environments. Environmental scanning and planning in the light of it are absolutely essential to unit wellbeing. This is especially true in times of turbulent and seemingly continuous change.

THE IMPORTANCE OF PLANNING STRATEGICALLY

According to the New Shorter Oxford Dictionary (1993), a strategy is the action to be taken, as a result of careful planning, towards a desired end. Strategic planning, therefore, is concerned with the setting of objectives (desired ends), the development of procedures for implementing the objectives (actions to be taken), and monitoring the extent to which they are achieved. It always takes account of the organisation’s operating environment and should be developed consultatively with those who will implement it and be affected by it.

THE PURPOSES OF PLANNING

There are three main purposes of planning; these are to enhance decision-making, to facilitate audit and, importantly, because the process is intrinsically valuable.

(a) Planning is intrinsically valuable

It enhances loyalty and commitment.

It provides opportunities for individuals to develop personal and professional potential (in line with the unit’s strategic direction).

It creates an effective rationale for the devolution of responsibility and accountability (who is to do what, within what timeframe and with what resources).

It builds morale and esprit de corps.

(b) Planning enhances decision-making

It reflects on fundamental strengths and weaknesses and the long-term directions the unit team wishes to take.

It imposes systematic, informed deliberation on all major decisions (this is critically important).

It invests futurity into current decisions.

(c) Planning facilitates audit

Are goals being achieved?

Are strategies achieving objectives on time?

THE TASKS OF STRATEGIC MANAGEMENT

The first task is to collaboratively form a strategic vision with the unit team; that is, a succinct statement of what the unit wishes to become (for example, ‘To become one of the top 10 per cent of units in terms of cost effectiveness of care through the systematic development of reflective and evidence-based practice’), in order to infuse a sense of purpose and provide long-term direction to the team. The second task is to convert the strategic vision into measurable objectives, both short-term (one to three years) and long-term (five to ten years) and performance indicators. The third is to craft strategies to achieve the objectives; the fourth is to implement the strategies and, the fifth, to evaluate performance against objectives. This last task involves reviewing new developments, adjusting long-term direction, strategies and objectives in light of experience, changing conditions, new ideas and new opportunities (Thompson & Strickland 1995). There is, however, another vital task to be undertaken between formulating the vision and setting objectives; that is, undertaking a situational analysis.

Situational analysis

A situation analysis has both exploratory and decision-making components. In the exploratory component the context in which the unit operates, the likely trends in health and nursing services and the other internal and external influences which could influence the development of the unit are all identified.

Identification of internal and external influences is known as a SWOT analysis (strengths, weaknesses, opportunities, threats). Strengths and weaknesses arise from an examination of the internal influences which are under the control of the unit; see Table 18.1 for some common internal influences.

Table 18.1 Some common internal influences on unit development

Unit leadership/management style (e.g. traditional, generative). Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Leading contemporary approaches to nursing practice Leading and enhancing patient-focused care: The human becoming theory in action Cross-cultural health and strategies to lead development of nursing practice Nursing leadership and management in the community: A case study Stay updated, free articles. Join our Telegram channel Join Tags: Nursing Leadership Dec 10, 2016 | Posted by admin in NURSING | Comments Off on Leadership, management and reflective practice Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access