From vision to action: Discover the Nexus

To what degree are you contributing to the vision and reality of interprofessional practice and education? To become a part of this national and international movement, explore the resources and activities of the National Center for Interprofessional Practice and Education (the Nexus). If you are already involved in interprofessional practice and education, you should definitely consider registering and becoming a part of the growing Nexus network. The story of Amina best represents the vision of the national center in advancing a desired future for practice and education in the health professions.

People Images/iStock

Recently, I had the opportunity to facilitate a national conference hosted by the Nexus. More than 100 people from around the United States who are part of the national center’s Innovation Network came to Minneapolis to share stories, insights, and results of ongoing initiatives related to the movement. Drawing upon a variety of liberating structures, participants engaged in dialogue and shared learning about their individual projects, challenges, and issues. The social networking and cross-pollination of ideas, experiences, and lessons learned fostered additional innovations and insights among conference participants.

The center is supported by Health Resources and Services Administration Cooperative Agreement Award No. UE5HP25067 with major funding from the Josiah Macy Jr Foundation, the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, and the University of Minnesota. If you are looking for resources and ideas to advance research, teaching, or partnerships in interprofessional education and practice, explore the center’s website and go to the Nexus Learning System or Resource Center links to learn more and connect with others.

One of the most exciting aspects of the center’s work is the creation of a National Center Data Repository (NCDR) that will support comparative effectiveness research about the value and promise of interprofessional practice and education efforts to meet the triple aims of high-quality patient experiences, improved population health, and lower costs. As the center continues its work and learns over time, it will be an example of an organization turning vision into action.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Values in conflict? View your organization through a CVF lens

Robert E. Quinn, PhD, is one of my favorite leadership scholars. One of his significant contributions to the field of organizational studies and leadership development is the competing values framework (CVF). The CVF helps one make sense of the tensions people often experience in organizational life.

As noted in this video introduction to the CVF, individuals and organizations are continuously challenged to manage polarities that relate to external positioning and internal maintenance, as well as flexibility and control. The juxtaposition of these competing tensions creates different types of organizational cultures, which are animated by values associated with framing and focus. Simply put, these frames and focuses involve collaborating, creating, competing, and controlling. Which of these four values resonates personally and professionally with you?

— Dolgachov/iStock/Thinkstock

Gaining insight into these tensions helps one appreciate and value differences between and among people and processes in an organization. Such appreciation leads to development of compassion and respect for individual contributions to the organization. Using the lens of CVF, how would you describe the culture in your organization?

Three levels of analysis
Given the competing values framework, there are three levels of analysis that help one gain insight. At one level, organizations are analyzed relative to external outcomes and expectations. At another level, competing values in terms of an organization’s internal workings are analyzed. Finally, at the third level, how the framework relates to individuals in the organization is contemplated. Knowledge and understanding of CVF provides leadership insights and guidance about how to navigate tensions and issues and support alignment of people with organizational processes, purposes, and effectiveness (Cameron, Quinn, DeGraff, Thakor, 2014).

For example, if an organization is focused on internal maintenance and stability, the culture is probably hierarchical and its orientation one of control. Leaders in this type of organization focus on coordinating, monitoring, and organizing. Value drivers are efficiency, timeliness, consistency, and uniformity. By contrast, if a culture is focused on external positioning and is flexible, it is an adhocracy, and creativity is valued. Leaders in this type of organization are innovative, entrepreneurial, and visionary, and value drivers are innovative outputs, transformation, and agility.

In a market-driven culture, the focus is external positioning, stability, and control, with competition the orientation. Leaders in this type of organization are hard driving and competitive. Value drivers in a market culture are market share, goal achievement, and profitability. A fourth culture type is clan. In this culture, the focus is internal maintenance and flexibility. Leaders in this culture are perceived as facilitators, mentors, and team builders. Value drivers are commitment, communication, and development of people and relationships.

In successful organizations, the competing values of collaborating, creating, competing, and controlling are at play concurrently. Consider the conflicts that can erupt if leaders and managers in an organization have a competitive market-driven focus and workers adhere to a clan or collaborative focus. Or how does one manage tensions between a need to be creative and innovative while, at the same time, working in a hierarchical bureaucracy? Or how does one both compete and collaborate?

How about your organization?
As you reflect on your organization, how does competition among the competing values of creating, competing, controlling, and collaborating play out among leaders, managers, and staff? With your personality, traits, and behaviors, what role, from a competing values perspective, do you play in your organization? Are you a pioneer, networker, achiever, strategist, anchor, analyst, team player, or helper? How can you leverage your strengths and role to make a positive difference in the organization’s culture and milieu?

As a result of learning more about the competing values framework, I have developed more compassion for and insight into the dynamics of academic and health care organizations, and this has enabled me to positively influence change and transitions. I invite you to learn more about the framework, and apply leadership insights you gain to the culture in which you find yourself. Developing a competing-values leadership skill set will enable you to maximize, influence, and activate your own success, as well as the success of your organization.

Reference:

Cameron, K.S., Quinn, R.E., DeGraff, J., & Thakor, A.V. (2014). Competing values leadership. Northampton, MA: Edward Elgar Publishing.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Influence, power, and activism

There is focused effort to get more nurses on governing boards. The goal is to have 10,000 nurses serving in that role by the year 2020. There is no doubt that nurses have much to offer in terms of knowledge, skills and experience, but many are apprehensive about issues of influence, power, and activism.

I continue to be perplexed by the paradox that, although nursing is ranked consistently as one of the most respected professions, nurses are not regarded as being very influential. What does it take for nurses to own and master their influence skills? Eleanor Sullivan, PhD, RN, FAAN, a past president of the Honor Society of Nursing, Sigma Theta Tau International (STTI), tackles this issue in her book Becoming Influential: A Guide for Nurses, 2nd edition (2013), Prentice Hall, Boston, MA. In "Taking the Mystery Out of Influence," Sullivan advises reading the subtext of situations and going beyond the non-verbal to gain influence insights. Suggesting that professional presence supports influence consciousness, she notes that power is a foundation for influence. Perhaps nurses need new ways to think about the powers they possess?

Six stages of power
Janet Hagberg’s model of personal power is a useful guide for reflecting on the dynamics of what she identifies as the six stages of power: 1) powerlessness, 2) power by association, 3) power by achievement, 4) power by reflection, 5) power by purpose, and 6) power by wisdom. She believes there is a developmental trajectory to these stages and that people grow and evolve from one stage to another. She describes the characteristics of each stage, where people can get stuck, and how a person can move forward from stage to stage. 

mindscanner/iStock/Thinkstock

Observing that individuals can be, at any particular moment and relative to other people, at various stages of power, Hagberg links these stages to issues of leadership and motivation. Using her model and reflecting on one’s own developmental progress in regard to stages of power leads to insights and understanding of self and others. I personally believe that, to be effective and successful as a governing board member, power by reflection, power by purpose, and power by wisdom—stages 4, 5, and 6—are required.

Armed with influence, empowered nurses activate leadership skills. As Karen Kelly, EdD, RN, CNAA, BC, notes in “From apathy to political activism,” published in American Nurse Today (2007), there is a developmental trajectory associated with activism. It moves from apathy to buy in to self-interest to acquisition of political sophistication to leading the way. There is an emerging community of people who are becoming health activists and there are great stories about nurse activists. To prepare nurses to serve on boards, we need to do a better job of helping them own their influence, master their power, and be better activists, particularly at the grass-roots level.

What are your current beliefs and values in regard to the triple helix of influence, power, and activism? Where are you developmentally on the journey from powerlessness to wisdom? What are the compelling issues that ignite your reflection, purpose-power, and wisdom? How will you contribute your leadership talents to a nonprofit or for-profit organization that is meaningful to you? How will you move beyond apprehension to confidence? On what governing board will you serve? Will you be one of 10,000 nurses who serve on a board? The year 2020 is not far off.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Partnering for a caring economy

There is a movement afoot, based on partnership theory, to create a caring economy, and nurses around the world are positioned to accelerate it. Fundamental success requires that each of us recognize differences between a domination and partnership paradigm and consequences associated with those differences. To support cultural transformation, we need to take personal and professional responsibility for starting new conversations about the value of partnership and the economics of caring. Fortunately, there are new ways to share and engage in conversation and dialogue.

I recently had the privilege of attending an event to launch a new open-access resource, the Interdisciplinary Journal of Partnership Studies. This new journal is dedicated to the integration of knowledge that supports cultural transformation. Teddie Potter, PhD, RN, and Marti Lewis-Hunstiger, BSN, MA, RN, the journal’s executive and managing editors, are members of the Honor Society of Nursing, Sigma Theta Tau International (STTI). The publication builds on the work of noted scholar Riane Eisler, JD, co-founder of the Center for Partnership Studies. I invite you to explore this new journal and contribute to its success, vision, and mission.

iStock/Thinkstock

As people come to value, understand, and believe in the power of partnership, they feel freer to contribute to and participate in making change, exploring alternatives, challenging the status quo, and opening up channels of communication. Partnerships invite a learn-and-grow attitude and weaken a protect-and-defend stance. When people feel valued, respected, and included, a sense of community heightens and solidifies commitments to sustainability and co-creation of desired futures.

One of the most important initiatives to emerge from the Center for Partnership Studies is the Caring Economy Campaign. Consider how the campaign is aligned with the vision, mission, and goals of STTI to advance world health through nursing knowledge, learning, and service, including its dedicated commitment toward meeting the United Nations Millennium Development Goals. A key initiative of the Caring Economy Campaign is the development and diffusion of new metrics and measures related to social economic wealth indicators.

Nurses know that caring societies lead to stronger economies. It is time to invest in the development of metrics and measures that help determine and make explicit the social wealth that is essential to our insights, understanding, and strategic-foresight actions relating to future sustainability. Add knowledge about the caring economy to your intellectual capital so you can be a part of the partnership for cultural transformation story. Consider how you might use partnership theory and the notion of a caring economy as you exert nursing leadership influence in your spheres of influence.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Take off the blinders!

I have come to admire and appreciate the work of Gary Klein, PhD, who authored the book, Seeing What Others Don’t: The Remarkable Ways We Gain Insights (2013, Public Affairs, NY). Klein notes that most performance-improvement models involve decreasing errors and uncertainties through standards, controls, documentation, checklists, reviews, rigors, and procedures. Sound familiar?

Insights, on the other hand, come from grappling with curiosity about contradictions, connections, and coincidences. Klein posits that an insight is an unexpected shift to a better story for understanding how things work and can lead to changes in how we understand, act, feel, and desire. Wrestling with contradictions and connections to gain insight is often catalyzed by creative desperation—when the need to reconcile opposite or contrary experiences or understandings results in the creation of something new or innovative that better solves a problem or helps reconcile competing beliefs or frames of reference.

How often do you see things that others don't?

Failure to gain insight is often characterized by lack of experience, a passive stance, concrete reasoning, and adherence to flawed beliefs. Gaining insights requires experience, an active stance, playful reasoning, and a willingness to question long-held assumptions and beliefs.

How often do you see things that others don’t? How often do you try to make sense of contradictions, connections, and competing ideas, of understandings, stances, or frames of reference in your professional practice? To what degree do you apply curiosity and creativity to foster insight development in yourself and others? Do you think cultivation of insight is important to your education, practice, and research leadership skill set? How do you foster insight development with your peers, colleagues or protégés?

As I studied and learned more about Klein’s theory and ideas about insight formation, I connected his work and ideas with those of Barry Johnson, PhD, father of polarity management. I realized polarity management is a key leadership skill set that assists individuals, groups, teams, and organizations in defining and working through contradictions, connections, and polarities. Unpacking and working through polarities oftentimes leads to development of insight.

Bonnie Wesorick, recipient of the 2011 Edith Moore Copeland Award for Excellence in Creativity—a Founders Award presented by the Honor Society of Nursing, Sigma Theta Tau International—provides an excellent overview of polarity management, as well as principles and leadership practices needed in today’s health care environments. Consider identifying polarities in your work context, and then experiment with managing those polarities, based on the strategies and techniques she describes. [Learn more: “Bonnie Wesorick: Nurse on a mission,” and “Bonnie Wesorick: Putting the care back in health care.”]

Improving performance, decreasing errors, and establishing standards and controls are necessary in health care today. However, each of us should be curious about and sensitive to contradictions, connections, and coincidences we experience. Subjecting those experiences to playful reasoning and polarity management can lead to wisdom insights and a better story for understanding how things work. Decide now to learn more about polarity management. Maybe you will begin gaining some wisdom insights and see what others don’t.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Systems thinking and generative leadership

Nursing leadership has a significant role to play in sensemaking and supporting development of learning for the purpose of strengthening global health care systems.

Through understanding of system dynamics and interaction patterns over time, a leader’s influence and impact on positive organizational change can be strengthened. Such influence requires attention to the five disciplines of a learning organization: personal mastery, ability to discern and make mental models explicit, co-creating with others a shared vision of a desired future that is contrasted with a present state, and team-learning that supports an ongoing cycle of action-oriented systems thinking. Working intentionally in systems that aspire to become learning organizations requires development of personal mastery, based on one’s strengths and professional purpose-management.

Personal mastery requires dealing with paradox, ambiguity, and holding the creative tension of opposites, especially when people have competing or contrasting mental models or worldviews. Being open, honest, and direct supports exploration of mental models. Having a vision supports a generative—as opposed to remedial—mind-set. Understanding how the parts of a system influence each other aids sensemaking. Finally, building a shared vision requires contrasting a present state of affairs with a desired future state.

The gap between here and now, and there and then, sets up a creative tension that activates generative leadership. Navigating and negotiating tensions between compliance and commitment result in shared visions in service of greater purposes in the context of an organization’s mission, vision, and contribution to the social order. Consider exploring the world of systems thinking to enhance your leadership skill set.

Archetype learning

For some years now, in leadership courses I teach, I challenge and engage students to analyze situations and experiences through positive and negative system archetypes. The results are always fascinating. Students gain new and surprising insights into system dynamics they need to negotiate. Through systems thinking and sensemaking, students realize there are creative and generative solutions to seemingly intractable problems.

Archetype learning and systems thinking require perspective taking and a “balcony view” that reveals patterns that are often tacit. Systems thinking helps make these patterns explicit. Mapping and representing system dynamics help one visualize the balancing and reinforcing loops, as well as the delays and unintended consequences, of system dynamics. Being able to discern one’s own mental models, as well as those of others, requires reflection, inquiry, and advocacy. Mastering techniques of systems thinking, inquiry, and advocacy is essential to insight and action.

Negative archetype dynamics can easily be identified in health care scenarios today—for example: limits to growth, shifting the burden, eroding goals, escalation, success to the successful, tragedy of the commons, fixes that fail, growth and underinvestment. Knowing the early-warning signs of each of these negative archetypes can activate a management-leadership principle that will help in the resolution or remedy of the negative system dynamic, in service of one that is more positive.

Knowing the negative archetype dynamic is useful in terms of thinking of its opposite. Positive archetypes include: plan for limits, strut your stuff, collective agreement, invest for success, fixes that work, bite the bullet, stay on track, cooperative partners, win-win, and be your best! System archetypes are held in place by actors, policies, and procedures that may be in competition with espoused beliefs, values, or intentions.

Systems thinking is an essential knowledge management or leadership skill and supports integral understanding of the interconnectedness of all parts in a system. Systems thinking, generative leadership, and sensemaking are skills that nurses possess. It is our systems thinking and generativity, as well as our sensitivity to negative and positive system archetypes, that provide insight and direction for the nursing leadership crucial to strengthening global health care systems.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

It's 2014. Do you know what the future holds?

As we begin a New Year, thoughts turn from what was to what will be or could be! Imagining and creating the future is especially important in the context of President Hester Klopper’s 2013-15 presidential call to action: Serve locally, transform regionally, lead globally. Klopper’s request to provide input and respond to the work of the Global Advisory Panel on the Future of Nursing (GAPSON) calls for development of futures literacy among nurses around the globe.

Improve your futures literacy and help transform health care.

Consider that, in 1997, the International Council of Nurses (ICN), on the occasion of their 100th anniversary, partnered with the Institute for Alternative Futures to create the Guidebook for Nurse Futurists. The World Future Society is home to a number of resources that educators, clinicians, and administrators can use to exercise and influence the development of future-thinking skills. Perhaps, in 2014, it is time to renew and resurrect our learning about futures thinking, research methods, and the creativity associated with design-thinking about the future we want to create.

Intentional use of futures thinking and the application and evaluation of futures-related research methods is a chance to inspire agency in the face of uncertainty. How will you use these resources to anticipate, forecast, and respond to future trends and scenarios that have cascading consequences? What future do you want to create for yourself and the nursing profession at large?

Riel Miller, PhD, argues that futures literacy involves dynamic interactions between narrative capacity, our collective interactive sense-making intelligence, and our capacity to reframe situations. Nurses are very good at sense-making and, if provided the time, space, and resources, we excel at activating our collective intelligence and reframing situations with a greater good in mind.

In addition to Miller’s work, the ideas and insights of Margo Greenwood, PhD, and colleagues provide a road map for developing agency in the face of uncertainty. It is useful, they suggest, to reflect on the cross-impact of two variables: locus of control (to what degree do we see our response to the future in our own hands or the hands of others) and certainty versus uncertainty about the future. Such a 2-by-2 reflection reveals four positions. As you consider the positions below, discern what stance best represents the perspectives of your organization, colleagues, and your own personal or professional opinions.

• Position 1, Building site: People assume the future is open and undetermined, and they have control determining the way forward into possibility.
• Position 2, Route map: People are confident of a particular future coming to pass, and they have control over their path to that future.
• Position 3, Carried along: People are confident of a particular future coming to pass and do not see themselves having control over their path to that future.
• Position 4, Into the mist: People assume the future is open and undetermined, and they do not see themselves as having control over determining their way forward in relation to possibilities.

Is it possible to change peoples’ opinions, beliefs, and points of view? I believe it is, and An Educator’s Guide: Realistic and Creative Strategies for Thinking About the Future, is a wonderful resource that supports development of futures literacy skills and helps people see a way forward. The exercise included in this resource helps people explore and unpack tacit beliefs, values, and positions and nudges people toward more proactive insight and understanding of the need for agency and action.

As you think about your engagement with the Honor Society of Nursing, Sigma Theta Tau International, over the next biennium, consider how you can develop your futures literacy. Explore and experiment with some of the references, tools, and resources cited in this post. Share your learning and discoveries with others. Consider how exerting nursing-leadership influence can shape the future and contribute to the positive transformation of a 21st-century health care system. Move beyond the fear of uncertainty to agency and action.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.