Leadership Conference

2001 Leadership Conference

LEADERSHIP REQUIRED: LINKING RESEARCH TO PRACTICE AND POLICY

Shirley S. Chater, RN, Ph.D., FAAN

(What follows is an excerpt from a speech presented by the author at the Leadership Conference held in Chicago, November 14-15, 2001 in association with the Building Academic Geriatric Nursing Capacity Program funded by the John A. Hartford Foundation)

I'm pleased to be invited to share with you, the Hartford Foundation Scholars, some of my leadership experiences as Commissioner of the Social Security Administration. This was a very special opportunity for me to learn more about older Americans and to visit with them personally to hear about their lives in retirement, and their desire for socialization, intellectual stimulation and active aging. Most refused to buy into the myths that suggest that aging is a time of dependency and chronic illness.

According to the Social Security Administration's records, retirement benefits are presently paid to over 44 million people, including many over the age of 100. The latter include approximately 39,450 total, including 34,000 plus women and only 5,000 men. Thus, as the over 65 population ages, more and more women live to be the oldest, making some of our domestic programs women's issues. It is increasingly important for the nursing profession to understand its contribution to research that will influence practice and policy development, especially regarding those issues pertaining to older women's needs.

It is my intent to discuss with you 3 themes:

1. To share with you some experiences in Social Security to illustrate how implementing a program of change through leadership strategies is similar to a program of research and the leadership strategies a researcher must take.
2. To define leadership so that you will look for opportunities within your programs to sharpen your leadership skills.
   
3. To use the template of leadership competencies developed by the faculty, staff and consultants for the Robert Wood Johnson Executive Nurse Fellows Program to serve as examples of leadership competencies required to bridge the gap between research and practice and policy development.

In 1993 when I began my term of office as Commissioner of the Social Security Administration, my assessment of the situation suggested that change was needed. New business practices needed to be developed; new technology was overdue; customers were in need of easier ways to access the agency and staff were eager for change. Fortunately President Clinton and Vice President Gore initiated a program of having a government "that worked better and cost less." This enabled us in Social Security to use this event as a stimulus for change, and we put into place a vision that we described as "Putting Customers First." Call it a vision, call it a new philosophy, call it a passion - no matter what, a new direction required that work be done differently, and that decisions be made differently. It was successful and many changes were made over the four-year period during my tenure as Commissioner. Most satisfying is that those changes are still in place and customers seem satisfied with the service they receive from the agency.

What were the leadership strategies we utilized? First it was important to create and maximize the stimulus from the White House to have a government that worked better. Sometimes it is a crisis event that makes something happen more quickly than usual. Perhaps having to do a doctoral dissertation within a given time frame is not different from creating the stimulus, which puts pen to paper. Next we established a vision for what we wanted to do. Like writing a mission statement or a purpose (for the dissertation) we wanted a vision that could be communicated clearly and simply - Putting Customers First. Next came the need for research, a review of staff expertise and resources, past experience about what worked and what didn't work, identification of what was available for our use, an environmental scan to provide guidance for the future and lastly, creative solutions to the problems identifies. We developed a strategic plan (not dissimilar from the methodology planned to solve the research problem), complete with business plans, timelines, and outcome measures. After implementing the plans, we evaluated the outcomes and put into place the systems guaranteed to form the infrastructure to maintain the changes. An independent company included Social Security in a survey of customer satisfaction. The Social Security Administration received the highest score when compared with other national private entities, much to the pleasure of employees and others.

How does all this relate to your experience as a doctoral or post-doctoral scholar?
Consider your gift from the Hartford Foundation for the opportunity to do and learn about research and much more. The expectation from the Hartford Foundation states, "Full career development presupposes that an individual will be capable of knowledge development, knowledge dissemination, knowledge utilization and the resource development to move all of these efforts forward." You will do research; that is, you will identify a problem about which you care a great deal. You will feel passionate about finding answers to the research question you ask. After collecting data through your preferred methodology, you will arrive at a solution. Perhaps you will finish your program at that point and feel a great sense of relief. But you can't bask in that relief, for you have leadership responsibilities which are still to be addressed.

Research data, which sits on a shelf, are useless. The first step is publication, of course. But there is still more work to be done. Who will read your research findings? How will you make it available to those who practice geriatric nursing? How will you monitor the way your research findings change practice? How will you use your findings to influence policy at local and national levels? Your leadership responsibilities go beyond just finding answers to questions. Each of us, because we are members of the nursing profession, because we are all leaders no matter what positions we hold, has a commitment to make a difference. Making that difference requires leadership strategies. The Hartford program gives you the opportunity to think about how to make that difference, day by day within the program in which you are enrolled, and through the leadership seminars such as this one. Yes, knowledge development of clinically relevant, timely information is important. But so is knowledge dissemination done in clear succinct, jargon free ways, distributed to other researchers, practitioners, policy makers, and the general public and individual patients. We must remember that not everyone speaks our professional language and some can not and will not read 20 pages when an executive summary will do. Knowledge utilization is equally important. The creation of partnerships and the creation of practice models prove successful means to demonstrate how research knowledge can be used. Lastly, one must think about developing resources to make knowledge transfer work: forming coalitions and/or client groups to support a new initiative is one example.

What is leadership? Leadership is a concept whose time has come. Years ago one might find a handful of books on the subject, but today it has reached such importance that hundreds of books have been written and dozens of leadership institutes and programs exist through the country.

I like Peter Drucker's definition of leadership as he differentiates it from management.
He says that management is doing things right; that leadership is knowing the right thing to do. To me leadership is all about vision and relationships. One needs vision for passion, persistence, persuasiveness and guidance. Relationships are how we mobilize people to implement the vision. It includes selecting the right people for the right part, motivating them to share the vision, coaching them to be empowered, rewarding them along the way, and celebrating success. In short -good interpersonal relationships can only come if we know who we are as individuals- our values, beliefs, attitudes and styles.

One of many examples of successful leadership programs is the Robert Wood Johnson Executive Nurse Program, an advanced leadership program for nurses in senior executive roles in health services, public health and nursing education who aspire to help lead and shape the US health care system of the future. A group of leaders from health and educational organizations came together to formulate a template of leadership competencies to form the design of the program. Several assumptions were made about the nurse fellows in the program: that they have already demonstrated leadership competencies, that a goal of the program was to move participants away from their comfort zones, that the program should offer fellows opportunities to think of "new" and "different" strategies, that each should have mentors so they could observe new and different ways of solving problems and providing leadership, and that individual coaching would be an important way for each to learn about herself/himself.

Let me share some of the program content with you so you'll have some idea of the leadership competencies you can practice during your time in this program:
The five competency areas are:

1. Self-knowledge - the ability to understand and develop self in the context of organizational challenges, interpersonal demands and individual motivation. This category includes using self as an instrument of change, developing personal change strategies, increasing leadership confidence, ability to leverage and build upon strengths and understanding how others see you.
   
2. Strategic Vision - the ability to connect broad social, economic and political changes to the strategic direction of institutions and organizations. Some of the expected outcomes include ability to identify key trends in the external environment, awareness of broader social, political, economic and technological issues impacting health care, understanding the core elements of strategy and planning, creating a shared vision and strategic direction that will assist you and your organization to succeed, ability to establish a discipline of limits, choice and focus.
   
3. Risk-Taking and Creativity - the ability to transform self and organization by moving outside the traditional and patterned ways of success. Important for this category are competencies that encourage ways to build opportunities to talk about new ideas with someone from a different discipline, to identify creative responses to organizational and system wide challenges in health care settings, to increase risk preference levels, to develop tolerance for ambiguity and chaos, to see risk taking and failure as an exciting form of learning.
   
4. Interpersonal and Communication Effectiveness - the ability to translate strategic vision into compelling and motivating messages. Outcomes include the following: ability to communicate across a broad spectrum of stakeholders, to speak with enthusiasm and expressiveness appropriate to the situation, to increase awareness of nonverbal communication, to manage power imbalances, to assist others learn new skills and change their behavior.
   
5. Inspiring and Leading Change - the ability to create, structure and effectively implement organizational change in a continuous manner. Among expected competencies are knowledge of change management frameworks and management of conflict. This category includes the ability to scan internal and external environment for trends and opportunities, and ability to anticipate the need for change before the need is apparent to others.

While the above in not a complete list of leadership competencies in the RWF template, the sample does suggests areas for improvement and focus. My purpose in sharing this template with you is to suggest that you, the Hartford scholars, will increase your awareness of leadership training opportunities. You should take advantage of every opportunity you have during your program to grow and learn from faculty/mentors and each other, not only as researchers, but also as leaders in the field of geriatric nursing so that you fulfil the goals of the Hartford Foundation program as stated above.

In summary, let me repeat the quote from Jo Eleanor Elliot that another speaker used earlier today. Jo Eleanor Elliot always asked two questions regarding research, "So What?" and "Who Cares?" The answer to "So What?" is that we need clinically and socially relevant research that is timely and urgent. Given the graying of America and the baby boomers' retirement, the urgency for geriatric nursing research is obvious. It is of crisis importance. "Who cares?" In general, American society cares very much; in particular, older Americans care deeply and personally. The same questions can be asked about leadership. Leadership is required to link research to practice and policy. The Hartford Foundation through its investment in geriatric nursing asks us to make a difference. The rest is up to all of us.

[Note: Additional information about the Robert Wood Johnson Executive Nurse Fellows Program is available from the UCSF Center of the Health Professions, 3333 California St., Suite 410, San Francisco, CA 94118; 415-502-6451; www.futurehealth.ucsf.edu/rwj.html]