ALR

The Birth of a Healthcare Leadership Academy:

Lessons Learned From The Ohio State University

The purpose of this article is to share the les-

sons learned from The Ohio State

University’s (OSU’s) College of Nursing’s (CON’s)

efforts to design and grow a leadership academy with a

strategic vision of enhancing the leadership skills of

nurses and other healthcare professionals, so that oth-

ers can use these lessons to inform the successful

development of similar initiatives. The ultimate goal of

a leadership institute/initiative is to strengthen leader-

ship confidence and competence for the ultimate pur-

pose of improving healthcare quality and patient

outcomes, as well as of reducing costs.

www.nurseleader.com Nurse Leader 55

Scott Graham, PhD, and Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN

This article describes how the concept of a leadership academy for peak performance (LAPP) was initiated

based on leadership demands and needs in our healthcare system; it includes the design of a relevant and useful imple- mentation plan and how we equipped and positioned our- selves to enhance, support, and sustain the development of innovative and transformational leaders at the advanced and developing levels. Plans also are underway to expand LAPP’s global access.

STATEMENT OF THE PROBLEM As stated by the Institute of Medicine, “Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Strong leader- ship is critical if the vision of a transformed healthcare system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the healthcare system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.”1

In addition to changes in nursing practice and education, strong leadership will be required to realize the vision of a transformed healthcare system. Although not all nurses begin their career with thoughts of becoming a leader, all nurses must be leaders and advocates in the design, implementation, and evaluation of the reformed healthcare system. Nurses need leadership skills and competencies to act as full partners with physicians and other members of the healthcare team in reforming and redesigning the healthcare system. Nursing research and practice must develop, implement, and sustain evidence-based improvements to healthcare and health sys- tems. Nursing leaders must be adept at translating research evidence into the practice and policy arenas.

Being a full partner in the future of healthcare tran- scends all levels of the nursing profession and requires lead- ership skills and competencies that must be applied both within the profession and in collaboration with other healthcare colleagues. In healthcare environments, being a full partner involves devising and implementing plans for improvement, tracking, and sustaining improvements over time, and demonstrating measurable returns on resource investments. It also means taking responsibility for identify- ing problems and areas of waste.

BACKGROUND There is a tremendous need to grow nursing and other healthcare leaders who have the knowledge, skills, and dedi- cation to improve the quality of healthcare through innova- tion, enhance patient outcomes, and develop other leaders who are competent and nimble to address the most pressing issues of healthcare and health today. Future leaders must be vision oriented, innovative, and passionate to pursue and accomplish their missions in today’s dynamic healthcare envi- ronment. In addition, they must be equipped to create envi- ronments that support and sustain evidence-based practice,

which in turn will improve healthcare quality and patient outcomes, as well as reduce healthcare costs. The LAPP is committed to bringing the best in education, evidence-based leadership, innovation, and research to equip leaders with the skills needed to thrive in today’s healthcare environment.

The faculty cadre in the LAPP are nationally recognized experts in healthcare leadership, innovation, evidence-based practice, and research. In addition, they have held high-level executive leadership positions in complex organizations and have consulted with healthcare systems throughout the nation and globe. The faculty brings a high level of credibility to the collaborative nature of the leadership academy’s pro- grams offered. The leaders of LAPP have the vision, knowl- edge, skills, commitment, and energy to bring innovative elements to the participants in LAPP.

Leaders must embrace the changing skill set required to help others navigate today’s complex and dynamic healthcare landscape. “Leaders must assume a wide range of new skills in a challenging and changing the healthcare system. The most significant of these is creating a new context for workers. This primary skill is pivotal to the profession’s ability to engage the realities of a new social compact for nursing practice. The central theme is the ability of the leader to enable practition- ers to identify and embrace the specifics of their own changing practice in a way that better fits the emerging mobility-based, fast-paced, high-technology transforming healthcare system.”2 These new skills and competencies need to be embraced, and developed, for adequately equipping today’s skilled, confident, and competent healthcare leaders.

NEEDS FOR HEALTHCARE-FOCUSED LEADERSHIP DEVELOPMENT Anthony M. et al stated, “Nurse retention is both an expecta- tion and major responsibility of the Nurse Manager (NM) role that has both organizational and professional implica- tions. Organizationally, a stable workforce reduces direct and indirect costs that are associated with turnover that may result in an organizations’ ability to provide services. From the professional perspective, the benefits of nurse retention are related to the quality and continuity of (patient) care.”3

Henrikson M. et al stated, “Any action a Nurse Manager takes to increase leadership skills can have tremendous influ- ence on employee, colleague, and patient satisfaction, and on organizational outcomes.”4

As stated by Weberg D., “Transformational leaders are inspiring and facilitate their employees to solve problems by helping them identify the issues and develop the resources needed to overcome their problems. With inspiration and engagement of employees, a transformational leader should have followers who report better staff satisfaction and lower burnout rates.”5 Fennimore and Wolf6 (2011) note that nurse managers are “chief culture builders” who lead professionals rather than just manage workers. The attainment of a myriad of quality outcomes requires sophisticated leadership skills to engage staff that embrace change and systematically evaluate care practices. Zori, Nosek, and Musil7 (2010) have called the nurse manager the “chief retention officer.“

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“The current evidence in the literature reinforces findings from the previous reviews with respect to the positive rela- tionships between relational leadership styles and patient satis- faction and improved patient safety outcomes. Specifically, the current evidence suggests a clear relationship between rela- tional leadership styles and improved patient outcomes, such as lower patient mortality and reduced medication errors, restraint use, and hospital-acquired infections.”8

COSTS OF RETENTION The PricewaterhouseCoopers’ Health Research Institute esti- mates that “every 1% increase in turnover costs an average hospital an additional $300,000 annually.[6] Nurse turnover costs (per nurse) are estimated to be between $82,000 and $88,000, depending on the experience of the newly hired nurse.”9

In the United States, 35% of newly graduated nurses left their place of employment within 1 year, whereas 57% left within 2 years.10 “Nurses working in units with high turnover tend to report higher levels of stress as they may be called on to cover vacant shifts and to participate in the fre- quent training and induction of new staff.”10

Recruiting and retention is an ongoing challenge faced by leaders in every healthcare organization. The overall financial and human resources spent on this problem are enormous, and it is clear that leaders must be effectively engaged in reducing the outflow of nurses through their organization’s exit doors. Preventing nursing attrition would deliver significant cost sav- ings to healthcare organizations and, in some cases, could be the key to an organization’s future—perhaps even vital to survival.

Goals for LAPP surfaced after researching evidence from the literature and creating an exciting vision for LAPP and the skills needed for future nursing and healthcare leaders (Box 1).

THE PROCESS OF CONTENT DEVELOPMENT AND FACULTY SELECTION To determine the content needed, the LAPP faculty and staff undertook a thorough search of similar leadership programs around the country, examined the literature and research on such programs, conducted an extensive review of many cor- porate training company Web sites, informally surveyed lead- ership experts, and conducted healthcare leadership focus groups. From these, the content was narrowed down to the vital few topics most relevant to new leaders (defined as hav- ing served in a leadership role/position for less than a year) and emerging leaders (defined as served in leadership roles/positions for more than 1 year but less than 5 years) (see The Ohio State University College of Nursing The 3-DAY LAPP Immersion—SAMPLE). This is the target population that was initially sought in order to have the most immediate and positive impact on the overall healthcare workforce.

CONTACT HOUR APPROVAL One of the main focus areas, aside from relevant and useful content, delivered by expert and skilled leadership academy adjunct faculty, was the need to put the program into the correct forms to earn contact hours, so vitally needed by today’s nurse corps for continuing certification. The process was made a bit more challenging in that most of the facilita- tors/faculty were outside of the CON sphere of influence, or even out of state. It was a tremendous help to have on our staff a former board of nursing executive who was intimately familiar with the contact hour approval process.

COACHING, COUPLED WITH TRAINING Leadership development efforts often utilize training programs that represent a significant investment for the organization. At

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Box 1. Goals of The OSU Leadership Academy for Peak Performance

1. Implement supporting technologies to build and maintain the infrastructure of the leadership academy

2. Develop, implement, and sustain the content and curricula for advanced leaders and emerging leaders with both in-person and online offerings

3. Measure the overall efficacy of the leadership academy

4. Pursue funded research grants to sustain the work

5. Expand marketing and delivery services to ultimately expand the reach of the LAPP

6. Implement innovations to achieve and expand the goals of LAPP to be the “go to” healthcare leadership center in the nation for the development and continued growth of evidence-supported nursing leadership

7. Collect data on participants after they return to their workplaces to determine the connection of the LAPP training and coaching, and key leadership and patient outcomes

8. Incorporate health promotion of leaders into the curricula of a leadership development academy

April 201458 Nurse Leader

The Ohio State University College of Nursing The 3-DAY LAPP Immersion—SAMPLE

Daily Events 7:30 a.m. Breakfast service begins 8:00 a.m. Program begins

Lunch and a morning and an afternoon break* with refreshments served 5:00 p.m. Program ends *(optional reception at the Longaberger Alumni House Wednesday from 5:00–7:00 p.m.)

November 4, 2013 Morning Session 8:00–8:10 a.m. Welcome Bern Melnyk and Scott Graham 8:10–8:20 a.m. Energizing Guidelines Scott Graham 8:20–9:20 a.m. Dream the Dream Bern Melnyk 9:20–10:20 a.m. The Future of Nursing–Transformation & Innovation Mary Nash 10:20–10:35 a.m. Recovery Break 10:35–12:00 p.m. Innovation Leadership Tim Porter-O’Grady or Dan Weberg

12:00–1:00 p.m. Lunch

Afternoon Session 1:00–2:30 p.m. Mentoring Styles, with Coaching Practice Lynne Genter and Scott Graham 2:30–2:45 p.m. Recovery Break 2:45–3:40 p.m. Emotional and Social Intelligence Scott Graham 3:40–4:55 p.m. Achieving Work–Life Balance: The Importance of Self-Care Bern Melnyk 4:55–5:00 p.m. Evaluation and Look Ahead to Day 2 Scott Graham 5:00–7:00 p.m.* Reception and Team Building (in the Atrium)

November 5, 2013 Morning Session 8:00–9:10 a.m. Leading with Evidence-Based Practice Lynn Gallagher-Ford 9:10–10:15 a.m. Thriving During Change Susan Brown and Scott Graham 10:15–10:30 a.m. Recovery Break 10:30–10:50 a.m. Leadership Practices Inventory Scott Graham 10:50–11:45 a.m. Peer Consultation #1 Scott Graham

11:45 a.m.–12:45 p.m. Lunch

Afternoon Session 12:45–1:15 p.m. Technology Use and Coaching Model/Approach Awais Ali and Scott Graham 1:15–2:20 p.m. Health Care Policy and Regulations, and Why You Must Care Margaret Graham 2:20–2:35 p.m. Recovery Break 2:35–3:50 p.m. Peer Consultation #2 Scott Graham 3:50–4:50 p.m. The "Rules" of Leadership: Understanding

& Applying Scope of Practice Jackie Loversidge 4:50–5:00 p.m. Evaluation and Look Ahead to Day 3 Scott Graham

November 6, 2013 Morning Session 8:00–8:30 a.m. Meeting Management Jerry Mansfield 8:30–9:00 a.m. Discover Your Strengths Scott Graham 9:00–10:00 a.m. Inter-Professional Team Building Jerry Mansfield 10:00–10:15a.m. Recovery Break 10:15–11:30 a.m. Peer Consultation #3 Scott Graham

11:30 a.m.–12:30 p.m. Lunch

Afternoon Session 12:30–1:00 p.m. Leading with Good Budgeting: The Principles Jerry Mansfield 1:00–2:00 p.m. Leading with Good Budgeting: The Practice Mary Jean Girard 2:00–2:15 p.m. Recovery Break 2:15–3:15 p.m. Communication Skills for Transformational Leadership Jerry Mansfield 3:15–4:20 p.m. Employee Engagement and Toxic Leadership Scott Graham 4:20–4:30 p.m. Evaluation and Graduation Scott Graham

the same time, human resource development professionals have realized that training alone is not sufficient to ensure the trans- fer of training to practice in the workplace.11

In a quantitative content analysis study of training profes- sionals, Burke and Hutchins12 (2008) found coaching and the opportunity to practice newly learned skills to be the best practice for transfer of training strategies, second only to supervisory support and reinforcement. Evidence exists indi- cating that support following a training program significantly impacts the transfer of training.13 Coaching is quickly becoming a critical strategy for developing leaders in organi- zations and is 1 of the top 5 leadership development choices in large organizations today.14

In a study on how to make training more effective, researchers found that training alone increased productivity by 22.4%.16 The training when combined with leadership coach- ing, which included goal setting, collaborative problem solving, practice, feedback, supervisory involvement, evaluation of end results, and a public presentation, increased productivity by 88.0%, a significantly greater gain compared to training alone.15

Every participant in the workshop gets access to coaching from experts and peers. This unique feature of the program serves the sole purpose of helping emerging leaders and LAPP graduates to better ensure the leadership competencies “stick” and become habit in their daily leadership activities. Coaching, over time, helps the leaders to become more competent and confident leaders with sharper and more relevant skills.

The following is a description of the coaching process with LAPP. Upon graduation from the LAPP immersion program, each attendee gets an OSU e-mail address and a Web account to access an OSU Web site to communicate and collaborate with peers and experts, and to be coached by each another and by content area experts. Participants use their Web discussion board to share ideas, lessons learned, and success and failure stories (because we can learn from both). Each participant receives a monthly Coaching Connection e-newsletter with vari- ous tips, techniques, tools, and strategies that can be used imme- diately to become a more confident and competent leader.

Participants may communicate directly with the Director of LAPP if the participant has special challenges that he/she wish- es to work on privately. The LAPP Director can funnel this challenge to the faculty expert or respond directly to the partic- ipant. In the first 2 pilot programs conducted in August 2012 and February 2013, upon graduation, the participants and LAPP Director often met face to face to work on a particular leadership challenge, or they met over the phone or via a Web chat room. In the 2 pilot programs, the Director of the LAPP also met once each month on the OSU campus, same place and same day each month, from 8 to 9 a.m., for anyone who wished to show up to talk about leadership challenges. This format can easily be transferred into an online, synchronous format once the program goes national later in 2014. These coaching options are available for up to 12 months.

FUTURE PLANS FOR LAPP There are plans in place to in 2014, to offer LAPP on sites across the country. Sites such as Philadelphia, Los Angeles,

Phoenix, Orlando, Bombay, Shanghai, and San Paolo are being considered. LAPP will also be offered online in 2014. LAPP Online will encompass the same content with the same expert facilitators who would share content and lead discussions in a Web-based setting, both synchronously and asynchronously. Each of the options—On Campus, On Site, or Online—may include up to 12 months access to expert coaching to help facilitate the healthcare leaders’ development of positive leadership habits in the work envi- ronments. The OSU masters and doctoral students will research evidence-based leadership practices and their impact on key outcomes.

LAPP LESSONS LEARNED TO DATE 1. Conduct a thorough needs assessment of a sample of

the target population to ensure the content meets the healthcare leaders’ needs.

2. Identify content area experts who also are skilled teachers and facilitators. Lock them into the schedule as early as possible.

3. Keep the facilitators updated along the journey in order to ensure they are engaged in the process and have a stake in successful outcomes.

4. Select a diverse focus group with significant leadership experience and/or education to provide key insights on content and delivery.

5. Begin working on the contact hours as early as possible. 6. Work on the technical and logistical components of

the workshop delivery, in tandem and early. 7. Marketing and branding are key (promotion, pricing,

products delivered) to reaching the appropriate audi- ences. Reach the key decision-makers who determine how training funds are allocated.

8. Provide a detailed participant workbook with the content materials, schedules, handouts, etc.

9. Be flexible because changes to the plan will have to be made, for reasons within and outside of the control of the design team.

10.Ask for feedback early and often from the participants. Use their feedback to improve their workshop and the experience of future participants.

11.Make coaching a high priority. Keep in touch with participants. Send them helpful tips, suggestions, ideas, and strategies for the full 12 months.

12.There is a need to measure leadership outcomes in the workplace; this will begin in 2014.

SUMMARY Leadership development for nurse leaders and other healthcare leaders is vital because all healthcare leaders wrestle with the significant challenges faced in our dynamic and ever-changing healthcare landscape. If healthcare leaders have the knowledge, skills, and competencies to meet those challenges, the ultimate winners will be the patients we all are there to serve. NL

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Continued on page 74

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The Birth of a Healthcare Leadership Academy Continued from page 59

References 1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing

Health. 2010. http://www.iom.edu/reports. Accessed December 2011. 2. Porter-O’Grady T. A different age or leadership, part 2: new rules, new roles.

J Nurs Adm. 2003; 33:173-178. 3. Anthony M, Standing T, Glick J, et al. Leadership and nurse retention: the

pivotal role of nurse managers. J Nurs Adm. 2005;35:103-155. 4. Henrikson M. Great leaders are made, not born. AWHONN Lifelines.

2006;9:473-477. 5. Weberg D. Transformational leadership and staff retention. Nurs Adm Q.

2010;34:246-258. 6. Fennimore L, Wolf G. Nurse manager leadership development. J Nurs Adm.

2011;41:204-210. 7. Zori S, Nosek L, Musil C. Critical thinking of nurse managers related to staff

RNs’ perceptions of the practice environment. J Nurs Scholarsh. 2010;42:305-313.

8. Wong CA, Cummings GG, Ducharme L. The relationship between nursing leadership and patient outcomes: a systematic review update. J Nurs Manag. 2013;21:709-724.

9. Ulrich B, Krozek C, Early S, Aslock C, Africa L, Carman M. Improving retention, confidence, and competence of new graduate nurses: results from a 10-year longitudinal data base. Nurs Econ. 2010;28:368-375.

10. Duffield C, Roche M, Blay N, Stasa H. Nursing unit managers, staff reten- tion, and the work environment. J Clin Nurs. 2011;20:23-33.

11. Locke A. Developmental coaching: bridge to organizational success. Creat Nurs. 2008;14:102-110.

12. Burke L, Hutchins B. A study of best practices in training transfer and proposed model of transfer. Hum Resour Dev Q 2008;19:107-128.

13. Brinkerhoff RO, Montesino MU. Partnerships for training transfer: lessons from a corporate study. Hum Resour Dev Q. 1995;6:263-274.

14. Bennett J, Bush M. Coaching in organizations. OD Practitioner. 2009;41:2-7.

15. Olivero G, Bane K, Kopelman R. Effective coaching as a transfer of training tool. Public Personnel Manag. 1997;26:461-469.

Scott Graham, PhD, is a director of the Ohio State University Leadership Academy for Peak Performance in Columbus, Ohio, and associate professor of Leadership, Wright State University in Dayton, Ohio. He can be reached at scott.graham@wright.edu. Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, is the dean of the College of Nursing and chief wellness officer at Ohio State University in Columbus, Ohio.

1541-4612/2014 Copyright 2014 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2014.01.001