A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada

Abstract

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

Effect of project-based experiential learning on the health service delivery indicators: a quasi-experiment study

“…Team coaching consequently is a holistic approach for creating meaningful and lasting change for individual team members, the team as a whole, and the organization that the team serves [25]. Coaching is a means of enabling individuals or teams to clarify, prioritize and act towards improving performance through reflection and dialogue [27][28][29][30]. The role of the coach is to provide a unified team's agenda and moderates conversations that foster teamwork towards a shared goal [28,31,32].…”

Appropriate leadership in nursing home care: a narrative review

“…Ten studies showed that team-related factors could influence leadership: turnover and absence (Cloutier et al , 2016; Havig et al , 2011); interpersonal relations (Corazzini et al , 2015; Havig and Hollister, 2018); workload (Corazzini et al , 2015; Westerberg and Tafvelin, 2014); willingness to be coached (Cummings et al , 2014; Havig et al , 2011); employee well-being and satisfaction (Cummings et al , 2014; Nielsen et al , 2008); self-efficacy (Nielsen et al , 2009; Nielsen and Munir, 2009); and interdependent workgroups (Havig and Hollister, 2018). …”

“…Two articles relate a high turnover and/or absence rate of employees to less effective leadership (Cloutier et al , 2016; Havig et al , 2011). In a Western Canadian case study, Cloutier et al (2016) report that “With greater staff mobility and change, the leadership had less knowledge of their staff to mobilize existing skill sets, use the expertise and build cohesion” (Cloutier et al , 2016, p. 12). Close interpersonal relations – staff/staff, leader/staff and staff/resident – were found to be positively related to leadership (Corazzini et al , 2015; Havig and Hollister, 2018).…”

Developmental Evaluation of the CHOICE+ Champion Training Program

“…This can make it challenging, if not impossible, to implement and sustain improvement initiatives if home leadership does not protect the time and space required for staff to receive proper education, training, and support (Cammer et al, 2013). For these reasons, organizational support is absolutely essential to implementation of any new practice (Cloutier et al, 2016). As noted by others (Tyler et al, 2014;Rodriguez et al, 2015), good team communication is needed to support unit level changes like CHOICE+.…”