Analysis

Nurses’ role 'more significant than that of doctors’ when spreading good practice, study confirms

Researchers call for peer-to-peer support to enable nurses to take on 'hybrid' leadership positions

Researchers call for peer-to-peer support to enable nurses to take on 'hybrid' leadership positions


Picture: iStock

A study from Warwick Business School has confirmed the importance of shared leadership involving clinicians and managers and the value of nurses in ‘hybrid’ leadership roles.

Researchers collected data from 12 projects that had reconfigured services in healthcare settings, which were then translated to other locations. 

‘Nurses have a better overview of the patient journey and an understanding of the interaction between the community and hospital’

Graeme Currie, Warwick Business School

The most successful project was transferred to 15 other sites across the country. This involved enabling people with less severe chronic obstructive pulmonary disease (COPD) to be managed in primary care.  

Leadership role

The paper, entitled Sharing leadership for diffusion of innovation in professionalized settings, looked over three years at studies with five years’ worth of data. Among the researchers’ conclusion were that ‘nurses’ leadership role in adaptation was more significant than that of doctors’.

The ‘diffusion’ of the COPD project to other sites was initiated by executive managers who shared the success with commissioners and senior executives at adopting organisations. 

Where there was an uptake, doctors took on more of a leadership role and championed the changes to their peer groups through educational programmes, the researchers found. Later, nurses took on the role of ensuring that the new service aligned with the adopting hospitals’ routine. 

Important assets

Professor of public management at Warwick Business School and one of the paper’s authors Graeme Currie says that ‘one might argue, for the diffusion of innovation, nurses are probably the most important assets because they do a number of things’.

‘Nurses weren’t just interacting with their own ranks, but with medical and managerial ranks,’ says Professor Currie.

‘Nurses have a better overview of the patient journey and an understanding of the interaction between the community and hospital.’ 

Nurses can also put new services into the context of their own organisations, he suggests. 

A specialist nurse who worked on the transferring of the service expresses their opinion in the paper: ‘It’s a tightrope between what producers of the new service model thinks needs to be done, what the doctors think needs to be done and what national policies encourage. We do this bit, aligning local efforts and national mandates.’ 

Hybrid leaders

Being a hybrid leader, who works in managerial and clinical spheres, is – according to Professor Currie – an important aspect to nurses’ success in helping translate innovations between organisations.   

‘It’s good news that the Warwick University researchers concluded that, for innovation to spread in the NHS, nurses at all levels have to be involved'

Stephanie Aiken, RCN

‘Nurses have a clinical idea, they deal with the patient in front of them, but they often get frustrated because perhaps resources aren’t allocated in the right way,’ he says. ‘The hybrid leadership role becomes important when dealing with resources as they also deliver individual care.’  

However, Professor Currie recognises that nurses were at times ‘unwilling and less able to enact as a hybrid leader’. He calls for nurses to be allowed to continue with their clinical work as well as take on a managerial role and suggests introducing peer-to-peer support and building networks of leaders.

The transformation of the COPD service has reaped an average cost saving of £124,000 per trust. During the project at the first trust, compliance of care increased from an average of 34% in first six months to an average of more than 80% for the next 14 months.

Prime movers

RCN deputy director of nursing Stephanie Aiken says: ‘It’s good news that the Warwick University researchers concluded that, for innovation to spread in the NHS, nurses at all levels have to be involved.

‘Nurses are some of the prime movers behind new and innovative ways of treating patients because, as the report points out, they are the people who deliver care on a day-to-day basis. 

‘This model of support for innovation demonstrates the importance of collaboration across all health professional roles to embed new initiatives.’

Related

Sharing leadership for diffusion of innovation in professionalized settings (2018)


The research by Professor Currie and associate professor of leadership and innovation Dimitrios Spyridonidis was funded by the National Institute for Health Research. 

For details of similar NIHR-funded research, go to rcni.com/NIHR-series

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