CC BY
44https://doi.org/10.32921/2225-9929-2020-4-39-17-25
Original article
Nursing Leadership Competence Assessment and Development in Healthcare in Kazakhstan
Paivi Huotari 1, Hannele Tiittanen 2
1 Principal lecturer, PhD, RN, Lab University of Applied Sciences, Faculty of Social and Health
Care, Lahti, Finland. E-mail: Paivi.Huotari@lab.fi
2 Principal lecturer, LicNSc, Msc, RN, Lab University of Applied Sciences, Faculty of Social and
Health Care, Lahti, FinlandHannele. E-mail: Tiittanen@lab.fi
Abstract
The aim of the study. Describe the nursing leadership and management competences in health care facilities in Kazakhstan.
Methods. In this study the leadership competency dimensions were summarized into six leadership competency domains: Setting direction, Managing services and driving results, Leading people and teams, Enhancing nursing professionalism and ethics, Communication and team collaboration skills, and Self-leadership. The questionnaire based on these competency domains was sent to respondents electronically and in paper version for the respondents to assess their own leadership competencies.
Results. According to the results, all competency domains and different competency statements in the questionnaire were relevant. In all competency domains, the managers have some or good competency level. However, in enhancing nursing professionalism and ethics, the ability to apply the nursing reform in service development was seen challenging as only half of the respondents had good or excellent competency. The nursing reform described in the Comprehensive Plan of Nursing Care Development in the Republic of Kazakhstan until 2020 was not familiar to almost half of the respondents. According to the results, the educational degree in nursing required should be a higher education degree (bachelor level).
Conclusions. Medical universities have an important role in enhancing nursing research, nursing profession and nursing leadership education. It is recommended that the medical universities promote and support the structural changes in healthcare organizations by competence development of chief and senior nurses.
Keywords: Leadership; Healthcare, Nursing, Competence, Kazakhstan.
Казакстанньщ денсаулык сактау саласында мешргерлердщ кешбасшылык кабшетш
багалау жэне дамыту
Paivi Huotari 1, Hannele Tiittanen 2
1 Элеуметтiк гылымдар мен денсаулык сактау факультетiнih| ага окытушысы, Цолданбалы гылымдар
yHueepcumemi, Лахти, Финляндия
2 Элеyметтiк гылымдар мен денсаулык сактау факyльтетiнih| ага окытушысы, Цолданбалы гылымдар
yниверситетi, Лахти, Финляндия
Туйшдеме
Зерттеудщ мацсаты. Цазакстанныц денсаулык сактау мекемелерЫц мейiргерлерiнih| кешбасшылык жэне баскарушылык бiлiктiлiгiн сипаттау.
ddicmepi. Бул зерттеужумысында кешбасшылыкбтжт^ккелес 6 багытты камтыды: багытты тацдау, кызметтi баскару мен нэтижелерге кол жетюзу, адамдар мен топтарды баскара блу, мейiргерлiк б^кт^к пен этиканы жогарылату, коммуникация жэне топта жумыс жасай блу дагдылары, e3i^e3i баскару. Осы аталган багыттарды камтыган сауалнама респонденттерге олардыц кешбасшылык каблеттерн багалау Yшiн электронды жэне кагаз тYрiнде таратылды.
Нэтижелерь Жумыстыц нэтижеане сэйкес, сауалнамада керсетлген багыттар бойынша б^кт^^ц барлык сипаттамасы релевантты тYрде болды. Менеджерлердiц блжт:л'1г'1 карастырылып отырган 6 багыты бойынша да белгл б'1р сапалы децгейде екенi аныкталды. Алайда, кызмет сапасын жаксартуга багытталган, мейiргерлiк б^кт^к пен этиканы жогарылату бойынша жацгыртулар енжуге кабтетттж сурагы KYрделi деп танылды. Себебi аталмыш багыттагы бтжт^ктщжогаргы децгешн респонденттердiц текжартысына жуыгы гана керсете алды. Ягни, Цазакстанда 2020 жылга дейiнгi мейiргерлiк írn дамытудыц Кешендi жоспарында сипатталган мейiргерлiк írn жацгырту туралы акпарат респонденттердiц тек жартысына гана мэлiм екенi аныкталды. Нэтижелерге сэйкес, мейiргерлiк iс саласындагы
блм беру бойынша дайындык жогаргы бтш беру децгешнде (бакалавриат) ЖYзеге асырылуы muic.
Цорытынды. Медициналык университеттердih| мейiргерлiк зерттеу жумыстарыныц сапасын жаксартуда, мейiргерлiк ic саласындагы квшбасшыларды дайындау бойынша мацызы ерекше. ^азакстанныц медициналык жогаргы оку орындарына ага жэне бас мейiргерлердiц бтжт^г^н арттыру аркылы медициналык мекемелердегi курылымдык взге^стерге колдау б^ру усынылады.
Туйн свздер: квшбасшылык, денсаулык сактау, мейiргерлiк с, б^кттж, Цазакстан.
Оценка и развитие лидерских качеств медсестер в здравоохранении Казахстана
Рам Huotari 1, Наппе1е ТШапеп 2
1 Старший преподаватель Факультета социальных наук и здравоохранения,Университет прикладных наук,
Лахти, Финляндия
2 Старший преподаватель Факультета социальных наук и здравоохранения, Университет прикладных наук,
Лахти, Финляндия
Резюме
Цель исследования. Описание лидерских и управленческих компетенций медсестер в медицинских учреждениях Казахстана.
Методы. В настоящем исследовании аспекты лидерских компетенций были обобщены в рамках шести областей лидерских компетенций: установка направления, управление услугами и достижение результатов, умение руководить людьми и командами, повышение сестринского профессионализма и этики, коммуникация и навыки совместной работы в команде, а также самоуправление. Опросник, составленный на основе перечисленных областей компетенций, был разослан респондентам в электронном и бумажном виде для оценки их собственных лидерских компетенций.
Результаты. Согласно результатам, все области компетенций и их различные характеристики, указанные в опроснике, были релевантными. Во всех областях компетенций менеджеры имеют определенный или хороший уровень компетенций. Однако при совершенствовании сестринского профессионализма и этики способность применения реформы в области сестринского дела в повышении качества услуг была сочтена сложной, поскольку только у половины респондентов имелись хорошие или отличные уровни компетентности. Информация о реформе сестринского дела, описанная в Комплексном плане развития сестринского дела в Республике Казахстан до 2020 года, не была известна почти половине респондентов. Согласно результатам, требуемая образовательная подготовка в области сестринского дела должна быть на уровне высшего образования (бакалавриат).
Выводы. Медицинские университеты играют важную роль в повышении уровня сестринских исследований, профессиональной подготовки медсестер и образования для лидеров в области сестринского дела. Медицинским университетам рекомендуется поощрять и поддерживать структурные изменения в организациях здравоохранения путем повышения компетентности главных и старших медсестер.
Ключевые слова: лидерство, здравоохранение, сестринское дело, компетентность, Казахстан.
Corresponding author: Paivi Huotari, Lab University of Applied Sciences, Principal lecturer, PhD, RN,Faculty of Social and Health Care, Lahti, Finland.
Address: Mukkulankatu 19, FI-15210 Lahti, Finland. Phone: Tel. +358405749130. E-mail paivi.huotari@lab.fi
J Health Dev 2020; 4 (39): 17-25 UDC 61:001.83(100) Recieved: 20-11-2020 Accepted: 04-12-2020
This work is licensed under a Creative Commons Attribution 4.0 International License
Introduction
The development of management and leadership competence in health care has been an important discussion in many countries despite the divergent healthcare and funding system [1]. Health care in Kazakhstan is currently undergoing many changes. The aims of the nursing reform are defined in the Comprehensive Plan of Nursing Care Development in the Republic of Kazakhstan till 2020 [2], and the reform creates the need to change nursing profession and nursing leadership in health care facilities. Like Viitala et al. [3] state, in organizational changes, leadership should change as well, and the role of leadership and leadership development need to be strengthened as part of strategy creation. More attention has been focused on research on leadership development [4,5]. In change, it is important for an organization to define what kind of leadership competences are required [6] and assess the present leaders' competences and roles. In this research leadership is seen as a key component and a requisite for the nursing reform. The focus of this paper is on health care leadership and management competencies. These competencies are important both in nursing and medicine, and there needs to be a holistic approach in health care [1].
The aim of this paper is to define and describe the nursing leadership and management competences and the role of nursing leaders in nursing reform of health care facilities in Kazakhstan. Although there are research findings worldwide on leadership and management competences and several health care leadership competence frameworks have been developed, the context is always important. Leadership practices vary across countries because of national culture, although the way leaders behave makes a difference, regardless of country and culture [7]. Gentry and Sparks [8] point out that certain competencies like resourcefulness, change management, and building and mending relationships are highly valued across different countries, and cultural values did not seem to influence this endorsement. This research is part of the ProlnCa-project, which aims to support the development on nursing profession and nursing leadership in Kazakhstan. The project is funded by Erasmus+ program.
In this paper leadership and management are seen parallel processes, and the concept leadership consists of both leadership and management. Pihlainen et al. [1] define in their study that leadership competence includes knowledge, skills, attitudes and abilities that enable management and leadership tasks. Kallas [9] adds in her definition result-based approach where leadership competencies aim to achieve excellent performance. Most of the leadership competencies required for effective leadership are often seen as universal in the for-profit and public/non-profit sector [10], but as public organizations are governed by specific regulations and are reliant on taxes, they require different strategic goals for leadership [1]. Although management and leadership competencies of nursing and physician managers are similar, a common and non-professional framework for learning leadership and management competence is required. This approach enables a shared understanding of management and leadership throughout health care [1].
Researchers and different health care management associations and organizations have developed health care, medical and nursing leadership competency frameworks and models. The defined
competence domains vary although have same or similar domains as well. Most findings and competency models present a list of different competence domains and categories [1,8,11-13]. Bender [14] defines different leadership activities and roles. On the other hand, Pihlainen et al. [1] emphasize the importance of a shared strategic mindset and holistic perspective instead of defining managerial works as a task list or profession-based approach. Kejser et al. [15] define medical leadership to facilitate change in health care, by means of yourself, others and society. For example, to lead with a vision is a competence, where these three domains, me, others, and society, overlap each other.
Research findings emphasize and list different leadership competencies. Communication [3,11,12,14,16], collaboration [17] and other interpersonal skills [1,14,16,18] are an important competence domain. Managers at all organizational levels need leadership skills to motivate employees and set goals for them [1]. In addition, strategic management [1,11,17,18], human resource management [1,11,16] and facilitating teamwork [1,12,14,17] are areas commonly listed in leadership competence research findings. In health care the research findings support the importance of professional competence and knowledge of health care as part of leadership competencies [1,11,16]. Other competence domains often mentioned are innovation and development competencies [1,12,16,17], ethical leadership and authenticity [11,12,16,17] and skills in operating in high pressure situations [16,17]. An important, even vital area of leadership in health care and in nursing, is to support evidence based practice (EBP), as nursing leaders play an instrumental role the process of implementing EBP [19,20].
Viitala et al. [3] state in their research that leaders need to be goal oriented, and the role of leadership and its development are a strategic asset and an overarching organizational-level issue. Gentry and Sparks [8] research findings show that resourcefulness, change management, and building and mending relationships are universally important leadership competencies for organizational success, and organizations should consider investing in developing these leadership practices.
Researchers divide leadership competencies into different domains. Pihlainen et al. [1] present three main categories, which are health care context-related, operational and general competence. Kantanen et al.
[16] model leadership competence consisting of two main areas general competence and specific competence. According to the researchers, general competency areas are essential on all levels of nursing management. The second, specific competence emphasizes strong profession-specific knowledge. Further, Grimm et al.
[17] identify six competency domains: community/ organizational responsiveness, the ability to inspire, results focused, social intellect, authenticity, and composure and balance. According to Bender [14], a clinical nurse leader needs an approach of continuous clinical leadership, which comprises four fundamental activity domains: facilitating effective ongoing communication, strengthening intra and inter professional relationships, building and sustaining teams, and supporting staff engagement. Further Day et al. [18] created a conceptual model of Ave domains of nursing leadership: vision (including strategic orientation and strategic thinking), knowledge, interpersonal effectiveness, personal
mastery, and systems thinking. The competencies in one domain often overlap with or relate to those in another. Different competency frameworks are presented in a table 1. In addition, many associations and organisations
Table 1. Leadership competency frameworks
As a conclusion, different research findings and health care leadership competency models emphasize different kind of leadership competency domains but overlap each other in many areas. In this report, health care leadership competencies are categorized under
Research method and data collection
One way to assess leadership competencies is self-assessment, which should not be used as identification for 'better' or 'worse' managers like Kantanen et al. [29] mention in their research. The researcher further state, that a self-assessment tool can be used from an organisational perspective to better understand and develop leadership and management competencies [29]. This study was carried out in two phases. In the first phase, an integrative literature review [30] was conducted to identify different nursing and health care leadership competencies and competency frameworks. As integrative review draws material from diverse sources like empirical and theoretical literature, the research approach was not an exclusion strategy. In addition, different leadership competency models and frameworks were included as many of them were created based on research findings. After reading the articles with relevant titles, abstracts, and results, and summarizing different health and nursing leadership competency models, the different leadership competency domains were compiled into the table and further thematically analysed and summarized into a health care leadership competency framework and a questionnaire. The questionnaire consisted of six leadership competency domains: Setting direction; Managing services and driving results; Leading people and teams; Enhancing nursing professionalism and ethics; Communication and
have leadership competency models which are derived from the competency domains of the HLA Competency Directory [21-23].
six domains: setting direction, managing services and driving results, leading people and teams, enhancing nursing professionalism and ethics, communication and team collaboration skills, and self-leadership.
team collaboration skills; Self-leadership. The domains included altogether 85 statements. The respondents were asked to rate each item on a Likert-type scale (1. No competence; 2. Some competence, 3. Good competence; 4. Excellent competence, and 5. Not relevant to my present work). The questionnaire included open questions on managerial education and a question of the changes needed in the role and managerial structure of nursing in nursing reform in Kazakhstan. In addition, there was an open question on competencies, which were not included in the questionnaire, and which the respondents might wanted to add. The questionnaire was translated into Russian and Kazakh by a Kazakh university.
The data were collected in spring 2018. Permission to conduct the research was obtained from all of health organisations who participated. The questionnaire was sent in electronic or paper form to nursing and physician leaders in health care facilities. The inclusion criterion was that potential respondents held the role of senior nurse, chief nurse, chief physician or similar role in primary or specialised health care. A letter was sent by email describing the study and its purpose and included a public link to the electronic questionnaire (Webropol 2.0). In addition, paper version questionnaires were distributed, as some managers had not access to internet. The total number of those who received the questionnaire is not
Researcher / association Competency framework domains
Czabanowska et al. [12] A public health leadership competency framework Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership; Organizational Learning and Development; Ethics and Professionalism.
Aitken and von Treuer [11] Leadership and governance in service integration; Relationship management and communication skills; Management of people; Organisational systems and processes; Practice knowledge, and Personal characteristics and capabilities.
Day et al. [18] Vision (including strategic orientation and strategic thinking); Knowledge; Interpersonal effectiveness; Personal mastery; Systems thinking.
Grimm et al. [17] Community/organizational responsiveness; Ability to inspire; Results focused; Social intellect; Authenticity; Composure and balance
Bender [14] Approach of continuous clinical leadership: Facilitating effective ongoing communication; Strengthening intra and inter professional relationships; Building and sustaining teams; Supporting staff engagement.
NHS Leadership Academy Healthcare Leadership Model [24, 25] Inspiring shared purpose; Leading with care; Evaluating information; Connecting our service; Sharing the vision; Engaging the team; Holding to account; Developing capability; Influencing for results.
Healthcare Leadership Alliance (HLA) [27] Communication and Relationship Management; Leadership; Professionalism; Knowledge of the Healthcare Environment; Business Skills and Knowledge.
Canadian College for healthcare leaders. The LEADS Framework [26] Lead self (L); Engage others (E); Achieve Results (A); Develop Coalitions (D); Systems Transformation (S).
known, because the electronic link was sent forward to each organization and each respondent. The data were analysed in order to describe the educational background of health care leaders and to assess the competency level in different leadership competency domains.
Results
Altogether 252 responded of which most were female (92.3%). Over half of the respondents (58.8%) worked as a senior nurse and 31.4% as a chief physician and 3.4% as a chief nurse (6.1% had some other position). Off the respondents, 66.2 % had a vocational education, of which half had a speciality in nursing (52.2%). Other educational background chosen was medical doctor (26.4%), and 4% had a PhD. About 40% of the respondents had had managerial training during their professional education. The most mentioned management training the respondents had received during their professional training were management and/or leadership training
In the first competency domain, setting direction, the competencies in identifying environmental changes and creating strategy were at lower level than implementing and assessing chosen strategy. Most (74-79%) of the respondents had good or excellent competence in implementing strategy and change. On the other hand, in applying evaluation results 61% had good or excellent competency, and 33% had only some competency.
In managing services and driving results, 60% of the respondents assessed their competency to be good or excellent in applying national health care legislation and regulation, understanding the governance structure, and collecting and analysing data from service outcomes. The respondents had better competencies in quality assurance and in analysing the effectiveness of the current clinical processes. In issues concerning finance management, only about half of the respondents had good or excellent competence in identifying the funding
According to the respondents, all competency domains and different competency statements were relevant. In all domains the results are reported combining good or excellent competencies as this can be seen the level leaders should aim to achieve.
(over 50 respondents), communication skills and resource management (both nine mentions), conflict management skills (seven mentions), and economics (four mentions). Other areas mentioned were team management, negotiation skills, stress management, psychology, and corporate governance. Over half of the respondents (57%) were familiar with the nursing reform in Kazakhstan [2] (the Comprehensive Plan of Nursing Care Development in the Republic of Kazakhstan until 2020) and over 40% of respondents were not aware of the nursing reform at all. (Table 2.)
system and understanding the impact and consequences of financial decision making. Operational level finance management competence was at better level, and 60% of respondents had good or excellent skills.
In leading people and teams, the respondents' competency was quite good. Applying human resource laws and regulations was seen the most challenging area. The respondents assessed to have good competencies in valuing, respecting and promoting employee equality and diversity, and assessing the competency, performance and educational needs of the employees. In addition, in leading teams and individuals with a goal-oriented approach was a well-managed area of competence. The respondents assessed the competence in developing and implementing training programs to be more challenging (65% had at least good competency, but a quarter of respondents had only some competence).
In enhancing nursing professionalism and ethics, the ability to apply the nursing reform in service
Table 2. Demographic data (256)
Frequency Percentage (%)
Gender
Male 18 7.2
Female 232 92.8
Present job position
Senior nurse 144 58.8
Chief nurse 9 3.7
Chief physician 77 31.4
Other 15 6.
Work experience as a manager
Less than 1 year 27 10.9
1-5 years 71 28.6
6-10 years 44 17.7
11-15 years 55 22.2
16-20 years 13 5.2
over 20 years 38 15.3
Educational background
Vocational education in nursing 138 55.2
Vocational education and training 16 6.4
Academic bachelor 15 6
Master's degree 1 0.4
Medical doctor 66 26.4
PhD 10 4
Other 4 1.6
Familiar with the aims of the nursing reform
Yes 51 21.4
At some level 86 36.1
No 101 42.4
development was seen challenging as only half of the respondents had good or excellent competency. In all other items, 67-73% had at least good competency. The respondents assessed their competency level in communication and team collaboration skills to be at good level, 76-89% of the respondents had good or
excellent competency. The best competency level was in respecting, valuing and acknowledging the roles and expertise of others. In facilitating team discussions 73% had good or excellent competence, and almost a quarter of respondents had some competence. (Figure 1. & 2.)
Figure 1. Competency domain Leading people and teams
In self-leadership competency domain, 64-73% of the respondents have good or excellent skills. In changing one's leadership style in the light of feedback and reflection skills almost third of the respondents had some skills. The respondents' competency level was best in upholding organizational and professional ethics and values and in. The respondents had good competency in adjusting own schedule and plans of actions flexibly if needed by the team and colleagues, 80% had good or excellent competence.
The questionnaire contained an open question on the changes needed in the role and managerial structure of nursing management. In the data, there emerged six thematic areas: nursing education and competency development, nursing autonomy, nurse and doctor partnership, international and national benchmarking and cooperation, patient self-care development and changes in payment system. According to the results, the nursing reform also requires reform in nursing education at all educational levels. Many respondents suggested that the educational degree in nursing required should be a higher education degree (bachelor level). With higher education there would emerge a new generation of nurses who are able to enhance nursing profession and nursing process in health care. In developing nursing education at higher education level, international cooperation was seen important. In addition, in order to support the new role of nurses, also nursing leadership and management education should be strengthened at universities. Based on the comments, there is a need for nursing leadership discipline to be established. Overall nursing competency development was seen an essential area in the implementation of the nursing reform.
The respondents stated that defining and developing autonomy of nursing profession is based on
identifying the areas of nursing responsibility. Nurses need to define the nursing process as an independent process and specialization. Nursing is an autonomous profession and separate from medical care. Especially in health promotion and working as paramedics, nurses have their independent role. Nursing professionals are the main force in health promotion. Nurses need empowerment from the society, doctors and themselves. Beside the nursing autonomy, the respondents emphasized nurse and doctor partnership. Nurses should be more involved in clinical decision-making. In addition, some responsibilities of doctors could be delegated to nurses. International cooperation and benchmarking is according to the respondents a good way to enhance nursing profession and nursing leadership in Kazakhstan. Different models and clinical processes between Kazakhstan and different European countries and for example Japan and the USA, could be could compared. In addition, nursing reform would benefit from international mentors. National cooperation and benchmarking were also mentioned. According to the results, one area to develop was nurses' payment, since better payment could raise the profile of nursing profession.
Figure 2. Competency domain Enhancing nursing professionalism and ethics
Discussion
The aim of this study was to explore nursing leadership and management competencies of nursing leaders in Kazakh health care facilities. The leadership competencies used in this study were based on literature review and existing models on health care and nursing leadership competencies. The respondents assessed their own competencies, which can help leaders to reflect and consider their own competency level. Although, like Kantanen et al. [28] mention, the assessment was not meant to identify good or poor leadership skills. The aim was to give the respondents and different health care organisations a perspective to understand and develop the needed nursing leadership competencies for the benefit of nursing profession and the nursing reform in Kazakhstan.
Self-assessment is a context-specific tool. National and organizational culture may influence the use of the competency scale. The respondents may assess their competencies better than they are, if it is not socially acceptable to talk about own weaknesses or lack of competencies. On the other hand, a respondent may reflect one's own competencies too critically [28]. In this study, the respondents saw the different competency domains and statements relevant and assessed their leadership competencies quite good. Still, the results must be critically reflected as the nursing profession, nursing education and nursing leadership in Kazakhstan are seen areas to develop. Like Skela Savic and Robida [30] state leaders might rate their leadership skills better than their employees.
Conclusion
According to the results, nursing is not yet seen as an autonomous profession. The educational background is mostly at vocational level except with chief physicians. These study findings need to be considered in their national and social context. It seems that there is a need for more research on the present and future leadership competencies required in the nursing reform in Kazakhstan. Medical universities have an important role in enhancing nursing research, nursing profession and nursing leadership education. It is recommended that the medical universities promote and support the structural changes in healthcare organizations by competence development of chief and senior nurses:
1. Medical universities provide flexible further education possibilities to the chief and senior nurses to upgrade their degrees and competences.
2. Nursing leadership discipline should be established to the medical universities and nursing leadership research programmes should be started to strengthen the nursing leadership and management education, and to support the independent role development of chief and senior nurses.
3. International cooperation should be developed in medical universities to join to the international nursing leadership communities, also grands for the international benchmarking and exchange programmes should be
targeted for the nursing leadership educators.
4. Cooperation between the medical universities and nursing leadership practice should be developed to support the evidence-based nursing practice implementation and the cooperation based on the
knowledge triangle to increase the abilities for innovative solutions in nursing practice.
Conflict of the interests: The authors declare no conflicts of interest.
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