Task 1 It has been said that if












has been said that if effective running of an organisation such as the National
Health Service exists, good managers and leaders should run in unison (Bolden
and Gossling, 2006). A management technique known as target setting focusses on
individual activities for example quality measurement, however this concept is
only successful when good leadership is present (Ratcliffe, 2013). It has been recognized that although leadership and
management are separate concepts, the skills required within these two roles
overlap (Tappen et al, 1995).

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has been defined as ” a set of
processes that keep an organization functioning” (Ratcliffe, 2013).  The mentioned process includes dealing with
staffing, meeting targets, auditing, measuring performance and problem solving.
 As a manager it is your responsibility
to ensure that resource is available to staff and that any training and
development is well organized in order to ensure excellent results within care
delivery (WHO, 2017). The Health Education England states that as a manager
within the National Health Service you play a vital role in ensuring efficient
and effective care delivery is provided (Health Careers, 2017).  The World Health Organization (WHO) states
that ”the
aim of good management is to provide services to patients in an appropriate,
efficient, equitable, and sustainable manner ” (WHO, 2017). As a manager you
should aim to become a good leader (WHO, 2017). The desired characteristics of
a good manager are: good communication skills, good organisational skills, the
ability to effectively communicate tasks and expected results, good delegation
skills and clarity of purpose and tasks (WHO, 2017). Fayol categorises the
process of management into four steps; planning, organising, directing and
controlling (Triparthi and Reddy, 2006).  For a manager it is important to work as you
would expect your staff to perform by not delegating a task that you wouldn’t
do yourself. It is fundamental that to perform well in a management role you
need to adopt the qualities of a good leader (WHO, 2017). As a deputy manager I try to be an effective leader, it’s
my responsibility on nights to ensure the care that we give to patients is that
of a high quality, the staff team is well coordinated, yet the management tasks
are carried out. As a leader I try hard to lead by example. Within my role I
adopt a transformational leadership style; this promotes a positive working
environment for staff and motivates them to deliver the same standard of care.
Staffing levels, audits, appraisals and attendance management are also a part
of my responsibility as a deputy manager.

is defined as ”aligning people to the
vision, that means buy-in and communication, motivation and inspiration”
(Ratcliffe, 2013). Leaders have a clear set vision of what could potentially be
achieved within an organization; they then communicate this vision with others
to devise a strategy to achieve this vision (WHO, 2017). Gill defines a leader
as someone whom motivates and inspires colleagues to perform; a leader is there
to lead and support transition and transformation within the working
environment (Gill, 2011). McGregor states ”to understand the nature of
leadership requires understanding of the nature of power” (McGregor et al,
1966). The role of a leader is to assist the manager in helping the organization
move forward. The King’s Fund states that without effective leadership there
are no good managers (Kings Fund, 2011). The WHO states that to be a good
leader you need good management skills to become effective within your
leadership role (WHO, 2017). The desired characteristics of a good leader are:
having a sense of mission, are able to encourage people to work together to
achieve a common goal, be decisive and use good problem solving techniques to
promote better care delivery (WHO, 2017).          In
order to work effectively as a good leader certain traits from the management
role are to be adopted to ensure the vision/ target is being met and quality
care provision is delivered.

My role as deputy ward manager is that of a leader and
manager and so in my practice I need to display qualities of both roles. The
role of Deputy Ward Manager has been identified as one of the most vital in
relation to vision within the National Health Service, role modelling for
junior staff and change management within the organization (Sprinks, 2010).
This role is a combination of high quality care provision and effective
coordination of a nursing team (Bradshaw, 2010). The Royal College of Nursing
(RCN) describes this role as being fundamental in ensuring quality care is
provided, standards are maintained and high patient experience is achieved
(RCN, 2009). The Department of Health outlines this job as a role model and
advisor to other members of the nursing team (DOH, 2012).

An example of when as a manager I had to be an effective
leader was one night we were short staffed on the ward, this particular night
we had a high number of patients that had had surgery that day and so where on
enhanced observations. Due to the short number of staff I had to prioritize
work load and guide the other staff to do so. This night I had to not only
manage the ward but I had to lead the staff to ensure safe care delivery which
meant, motivating and encouraging staff to reach the end goal of a safe night,
I had to be decisive to prioritize and problem solve. The main aim was to lead
the staff well to ensure they could not only manage their work load, but to
safe guard our patients.

An example of when as a leader I had to be an effective
manager was a night when I carried the Duty Senior Nurse on site bleep, This
particular night I had to attend another ward to deal with an on the spot
complaint. As the senior nurse on site it was my job to do this but by dealing
with this problem I had to leave my ward short staffed. To overcome this and
ensure patient safety I had to take a member of staff from another ward and
instructed another staff member to coordinate in my absence. This night I had
to communicate and effectively delegate to ensure the standards of the trust
where met and patient safety remained at the forefront of care delivery.

As a deputy ward manager you have a high demand of
management and leadership. This job role bases you at local level and so you
are present within the ward area. You are expected to not only manage a work
load of patients; you have to coordinate a shift and fulfil your management
responsibilities. As a leader you need to be present for staff and patients,
you need to be available for any guidance. You are there to lead by example and
to problem solve. However with this job role comes audits, staff appraisals and
dealing with staffing issues/ performance management. This job requires a great
deal of organization and prioritization in order to carry out both management and
leadership to the best of your ability, thus ensuring quality care provision is
at the forefront of your working objective.

Task 2

The role of a leader in contributing to the creation of
the organization’s vision is that of great importance. The vision of
Wrightington, Wigan and Leigh NHS Trust is to be in the top 10% of everything
we do. The mission is to provide the best possible health care for all of our
patients and the trusts strategy is to be safe, caring and effective. The
deputy ward manager’s leadership role is very much at the forefront of the care
delivery provision (Spencer et al, 2014). Deputy ward managers are ward based
and hands on with patient care. This role plays a massive part in change
management following auditing and proposed change (Spencer et al, 2014).  The Deputy ward manager needs to adopt 3
aspects to their leadership strategy: 1.to engage each member of staff and get
them invested in a common vision for a positive outcome of good care provision,
by setting clear objectives and behavioral standards,  2.Empowering and inspiring staff; this is
achieved by reaching the proposed goal thus resulting in high level of staff
satisfaction and ownership of achievement, 3.coach and improve performance by
addressing any short falls in performance in a timely manner and having an
empowering face to face conversation. By apply these three aspects the deputy
ward manager is able to engage, motivate, guide and monitor ward staff and
their performance (CMI, 2012). Poor care delivery is early detected and
addressed and quality care for patients and positive patient experience is

One change that I made personally as a leader was the way
we communicated with the multi-disciplinary team, using a colour coordinated
dot system on the patient board to assist in streamlining patient flow
throughout our ward and improve discharge times to allow staff to prioritize
their workload. A positive result of this change is that more patients met the
discharge targets. This system also allowed for the planning of patients due to
be admitted, resulting in nurses being able to forward plan their workload thus
improvement in the prioritization of care. By remaining consistent throughout
the change process I managed to get most of the staff on board resulting in an
easy transition in change, however I did meet resistance from other staff
members who opposed the change and didn’t agree that my proposal was necessary
and in their opinion more workload for them updating the dot system. As
proposed by the Chartered Management Institute I removed the de- motivators
from the situation, the main issue being added work load. Instead of assigning
this responsibility to each staff member I delegated the coordinator to ensure
the board is up to date. Soon after the ward team knew and worked by this
system with good results of achieving discharge targets and a more streamline
through process of patient flow.

Recently the trust introduced the post-operative delirium
tool. This tool works well and allows staff to see early signs of
post-operative delirium and act upon these warning signs to avoid distress of
the patient and the development of out of control situations. However when the
ward is busy some staff members see this as a tick box exercise and so fail to
complete the form, resulting in failure to detect any behavioral changes and
potential risk to the patient and staff. As a manager it is my responsibility
to ensure this form is accurately completed and to audit this. As a leader I
work to continue to motivate the staff members to complete the form and re
affirm the importance of its use.

Task 3

Ethical leadership is that of a leader who respects and
considers the ethical belief and values of others, resulting in the maintenance
of the dignity and rights of patients and staff members (Watts, 2008). This
leadership style is centered on concepts such as trust, honesty and fairness
(Brown et al, 2005). These leaders uphold their own values and beliefs, with
behaviors that are focused around trust and the commitment to do the right
thing (Marquis et al, 2009). As an ethical leader you are displaying an honest
level of working performance and leading by example, for your team to see this
they become empowered and motivated to do the same. By adopting this leadership
style you are committing to identify each individual staff member and their own
strengths and working ability. By recognizing this you are encouraging staff to
work to the best of their ability. As a leader to have a good team you need
staff to be engaged in the proposed task i.e smooth running of the ward,
meeting audit targets thus resulting in patient safety and quality care
delivery. It is said that those whom are ethical leaders are able to contribute
to the development of a positive working environment and the establishment of
productive working relationships, this in turn will have a positive impact upon
the leader themselves, the staff team and the organization (Reilly, 2006).

Task 4

The two leadership styles that will be discussed are
transformational leadership: this style of leader is one who challenges and
inspires their team. They work hard to communicate their ideas of change; they
have self-belief and a good energy at work (Schultz et al, 2010). This leader
allows a team to have an input on decision making but is not solely led by the
opinions of others (Schultz et al, 1998). The second is authoritarian
leadership: this style of leader only creates relationships with team members
on a professional basis (Salin et al, 2010). They focus their leadership on
direct delegation and supervision with a clear expectation of how they believe
successful running of a team to be (Salin et al, 2010). 

Self-confidence within an individual offers a necessary
foundation in the nurture of a good leader (Dao, 2008). Leadership within the
NHS is about having the confidence to make difficult decisions, challenge bad practice
and promote a culture of change. Without self-confidence and belief this will
not be achieved. To lead a team well you need them to be invested in you and to
gain their trust (Edomi, 2014). A leader with a strong sense of self will
quickly gain the trust of their team and there for a stronger workforce is
established (Edomi, 2014). For the transformational leader self-confidence is
beneficial when introducing new ideas from approaching the team, to having the
confidence to ultimately make the end decision. This confidence could have a
negative impact on this leader at the decision making process, as team members
may have had their input yet their opinion has not been the final outcome.  For the authoritarian this confidence is
beneficial where in some cases direct delegation is needed to deal with a
stressful situation and so self-confidence with in this leader will be welcomed
by the team, however this way of decision making is that of a single individual
and so in other circumstances where there is room for discussion, the team are not included and so become separate
from their leader.

A leader who is
committed to their role is more likely to gain the trust of their team as they
will invest in the success of the organization (Ferguson, 2012).  Ferguson has stated that ”commitments can define a leader.
And leaders can define their commitments” (Ferguson, 2012). A leader who is
committed to change and service provision will motivate a team to do the same,
a committed leader can create an environment from which lasting change is
evident (Ferguson, 2012) thus resulting in the achievement of the vision of the

As a manager the way
you lead your team is vital to the success of service provision. To take a
transformational leadership style, enables the manager to clearly communicate
to the team the specific targets they are expected to reach. However there is
room for discussion in the change process and so staff are likely to be more
invested as they are given the opportunity to voice their opinions on the
proposed target/ change. Ultimately the target is likely to be reached leaving
the team feeling valued and successful with the achievement of the given task,
resulting in a positive outcome for the organizational objective. The manager
may meet resistance but their approach to getting people on board will
eventually get the team working unanimously.  Taking the authoritarian approach to change/ meeting
targets the end result may be the same however staff members could be left
feeling invaluable and a low morale may be present amongst the team. With this
type of leadership style the manager may experience more resistance from staff
and find it harder to motivate the team.

Within the NHS there
is a need to interchange between leadership styles. There is a culture of
change and educational progression within health care and so managers regularly
need to communicate expectations and change proposals to their staff. Management
approach depends on circumstance, personal style, environment, organisation,
structure and process (Sutherland and Canwell, 2004). Within my role of
deputy ward manager there is the need to change the way I lead on a daily

An example of when I
had to take a transformational leadership style was when the electronic patient
record was introduced. In this circumstance I had to lead by example to motive
the team.  A lot of staff expressed
resistance and negative attitudes towards this change. It was my responsibility
to get staff invested in this new product as ultimately this was going to be
the new way of working. By taking this approach the staff were able to voice
their concerns and together we came up with ways to overcome these problems.
Even though we are still seeing resistance with this system, ward staff have
accepted and continue to thoroughly complete the online patient records as
expected by the organistaion. If I was to take the authoritarian approach the
team wouldn’t have responded the way they did, they had a lot of doubt which
needed to be voiced and overcome, this leadership style would not have been
appropriate for this situation.

An example of a time
that I have had to take the authoritarian approach was one night I was senior
nurse on site. There was a need for staff movement over to our acute hospital
and there was confrontation between staff on who had to go. That night I needed
to stand up and be heard. One staff member needed to go and there was no
discussion on that, although the staff members weren’t happy they respected me,
my position and the decision that I had to make. If I had taken a
transformational approach the situation could easily have got out of hand as a
discussion over the move was not necessary and this would have resulted in
conflict between staff members.

In conclusion it is
evident to see that although leaders and managers have two different job roles
there are traits of each role that overlap. From the underpinning evidence it
is clear that either role cannot be successful without the other. These two roles
have to perform at the same standard to gain the best possible outcome in
meeting organizational targets.