Leadership and OrganizationalCulture in Healthcare

Leadership

The first step in analyzing the impact of leadership on the work culture in any organization is to observe the interactions of both in that specific microenvironment. In healthcare, including in NICUs, these steps will enable the evaluation of patient safety and quality, staff well-being, and health outcomes. A leader, as defined by Peter Drucker, is “someone who has followers.” Leadership may need larger goals; it may entail the virtue of navigating through turbulent times. Interestingly, it may require a modified catechistic approach with prudence to see ahead, justice in dealing with others, fortitude with brave endurance, temperance to bring down the expectations for immediate gains, faith in the abilities of the team, humility, authenticity, maintaining the hope of eventual success, and charity to forgive errors when charting new territories.

Warren Bennis defined leadership as a “function of knowing yourself, having a vision that is well articulated, building trust in colleagues, and taking effective action to realize your own leadership potential.” A leader who demonstrates these abilities needs to take a preeminent role to shape the culture, defined as “the values, behaviors, goals, attitudes, practices and beliefs shared across an entire organization.” At a panoramic level, the executive leadership with expertise and specialized training can promote the organizational culture by clearly defining and authentically living out the mission, vision, and values. However, the microenvironment in the individual units may also affect the outcomes positively or negatively, be it on patient outcomes, perceptions of staff, or in their emotional well-being.

As in any specialized, critically important units in an organization, a NICU is a complex microenvironment that provides care for high-risk patients. The staff members interface with a host of specialists from various disciplines ranging from obstetrics, maternal-fetal medicine, pediatric subspecialists, members of palliative care teams, and others. Many other streams of staff members with different levels of experience, including nurses, pediatric resident trainees, nurse practitioners, physician-assistants, and neonatologists, are also involved. In this paradigm, the basic tenet of a physician leader with the overall responsibility in the unit is to involve/engage the team to render targeted, safe, effective, efficient, and timely care to optimize outcomes. The most important questions about the type of leadership and skill sets remain.

Leadership Types

Just as in any complex organizational microenvironment, the skill sets of a leader in a NICU have a significant bearing on his/her ability to deliver safe, effective, integrated, and well-coordinated care to the patients and their families. There are also new, evolving needs, and a leader today should be able to create a social culture of trust and consensus about the needs of tiny babies with involvement of other health systems and social media.

Physician leaders need different types of leadership styles depending on the context, and they need flexibility to adapt in a timely fashion. In the literature, six different leadership styles have been described. We have expanded on three styles that seemed most relevant to healthcare. The other three did not seem to be as pertinent/applicable in the NICU environment, so we mention those only briefly. As we developed this section, we reached out to leaders in various sectors of society; the needs to chart out the plans, inspire, evaluate, and intervene are similar.