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Article
Publication date: 21 March 2019

Alistair Hewison, Yvonne Sawbridge and Laura Tooley

The purpose of this study was to explore compassionate leadership with those involved in leading system-wide end-of-life care. Its purpose was to: define compassionate…

Abstract

Purpose

The purpose of this study was to explore compassionate leadership with those involved in leading system-wide end-of-life care. Its purpose was to: define compassionate leadership in the context of palliative and end-of-life care; collect accounts of compassionate leadership activity from key stakeholders in end-of-life and palliative care; and identify examples of compassionate leadership in practice.

Design/methodology/approach

Four focus groups involving staff from a range of healthcare organisations including hospitals, hospices and community teams were conducted to access the accounts of staff leading palliative and end-of-life care. The data were analysed thematically.

Findings

The themes that emerged from the data included: the importance of leadership as role modelling and nurturing; how stories were used to explain approaches to leading end-of-life care; the nature of leadership as challenging existing practice; and a requirement for leaders to manage boundaries effectively. Rich and detailed examples of leadership in action were shared.

Research limitations/implications

The findings indicate that a relational approach to leadership was enacted in a range of palliative and end-of-life care settings.

Practical implications

Context-specific action learning may be a means of further developing compassionate leadership capability in palliative and end-of-life care and more widely in healthcare settings.

Originality/value

This paper presents data indicating how compassionate leadership, as a form of activity, is envisaged and enacted by staff in healthcare.

Details

Leadership in Health Services, vol. 32 no. 2
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 22 June 2021

Alistair Hewison, Emma Hodges, Sundaravadivel Balasubramanian and Tina Swani

The purpose of this study is to report how the palliative and end of life care community in one region of England worked together to create a new model for integrated…

Abstract

Purpose

The purpose of this study is to report how the palliative and end of life care community in one region of England worked together to create a new model for integrated palliative and end of life care to respond to the challenges of changing demography, the need to reduce unnecessary hospital admissions of people nearing the end of life and to improve the quality of provision in line with current policy.

Design/methodology/approach

A co-production approach to system transformation was adopted involving 73 members of the palliative and end of life care community in one region of England.

Findings

A new model for the delivery of integrated palliative and end of life care services was produced. The breadth of membership of the co-production working party and constructive/collaborative working helped ensure a viable model was produced.

Practical implications

Although systems’ thinking perspectives can help address the challenges of large-scale transformation because they focus on promoting the value of relationships, recognise the nuances of context and the need to understand system behaviour over time, the potential for systems to benefit from this approach is limited by the complexity of the processes involved and the sheer number of issues to be addressed in practical terms by policy makers and change leaders.

Originality/value

The paper explores the contribution that theories of large-scale transformation can make to the design of palliative and end of life care services in health and social care.

Details

Journal of Health Organization and Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 27 March 2018

Alistair Hewison, Yvonne Sawbridge, Robert Cragg, Laura Rogers, Sarah Lehmann and Jane Rook

The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data.

Abstract

Purpose

The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data.

Design/methodology/approach

Qualitative semi-structured interviews, a focus group and thematic data analysis. Content analysis of 1,500 nominations of compassionate acts.

Findings

The scheme highlighted that compassion towards staff and patients was important. Links to the wider well-being strategies of some of the ten organisations involved were unclear. Awareness of the scheme varied and it was introduced in different ways. Tensions included the extent to which compassion should be expected as part of normal practice and whether recognition was required, association of the scheme with the term leadership, and the risk of portraying compassion as something separate, rather than an integral part of the culture. A novel model of compassion was developed from the analysis of 1,500 nominations.

Research limitations/implications

The number of respondents in the evaluation phase was relatively low. The model of compassion contributes to the developing knowledge base in this area.

Practical implications

The model of compassion can be used to demonstrate what compassion “looks like”, and what is expected of staff to work compassionately.

Originality/value

A unique model of compassion derived directly from descriptions of compassionate acts which identifies the impact of compassion on staff.

Details

Journal of Health Organization and Management, vol. 32 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 30 September 2013

Alistair Hewison

The aim of this paper is to examine the leadership role of the ward sister/charge nurse in the English National Health Service and demonstrate that its influence in…

Abstract

Purpose

The aim of this paper is to examine the leadership role of the ward sister/charge nurse in the English National Health Service and demonstrate that its influence in maintaining standards of care has been undermined.

Design/methodology/approach

This is achieved through a critical review of the relevant research and policy literature. Evidence relating to recent failures in the provision of nursing care is summarised to establish the nature of the problem. This is followed by an analysis of existing research concerned with the ward sister/manager role in the context of recent policy.

Findings

The evidence demonstrating that the ward sister/charge nurse is one of the key determinants of quality care has been overlooked in recent years and this in part accounts for the quality failures that have occurred in NHS hospitals of late.

Practical implications

Action is needed to place the ward sister/charge nurse at the heart of the hospital system. Systems of organisational and mutual support are needed to ensure that these ward-based leaders can reach their full potential as the guardians of care.

Originality/value

The perspective offered in this paper illustrates how a solution to pressing organisational problem can be found through accessing the appropriate literature. Although the recommended action may not be “new” it is novel in the sense that it is based on rediscovering a role that already exists and can be supported to bring about change, rather than seeking wholesale complex change.

Details

Leadership in Health Services, vol. 26 no. 4
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 5 August 2014

Abeda Mulla, Alistair Hewison and Jonathan Shapiro

The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals…

Abstract

Purpose

The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals designed and delivered change at organisational and clinical service level to improve services for patients, and the role of clinical leadership in this process.

Design/methodology/approach

A comparative case study involving semi-structured interviews was undertaken. These involved a range of senior managers in 2009 (n=77), 2011 (n=21) and 2012 (n=29). Interviews with staff involved directly in service delivery were also carried out in 2011 (n=92). The interviews were recorded digitally, transcribed verbatim, and analysed thematically using the Framework Method.

Findings

The value of, and approach taken to clinical leadership varied across the hospitals and over time. This was affected by the culture and priorities of the organisation. Some strategies for developing clinical leadership were developed, however they were limited. It was expected that capable clinical leaders would emerge, and be supported. Effective clinical leadership during organisational and service change required direct executive or managerial support and relied on clinical “champions”.

Originality/value

The paper demonstrates that despite the importance of clinical leadership being widely recognized in policy and research, there were no established programmes in place at the hospitals that were studied to support it. Rather there was a reliance on clinical staff coming forward to take on leadership roles as part of organizational efforts to bring about change.

Details

International Journal of Leadership in Public Services, vol. 10 no. 3
Type: Research Article
ISSN: 1747-9886

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Article
Publication date: 15 March 2013

Yvonne Sawbridge and Alistair Hewison

The aim of this article is to report some of the work undertaken by a nursing “think tank”, focussed on examining the causes of poor nursing care in hospitals, and…

Abstract

Purpose

The aim of this article is to report some of the work undertaken by a nursing “think tank”, focussed on examining the causes of poor nursing care in hospitals, and potential solutions.

Design/methodology/approach

A “think tank” was convened which incorporated widespread discussion with national, regional and local stakeholders, a critical literature review, and a focus group of senior nurses.

Findings

It was found that there are no widespread systems of staff support that help nurses working in hospitals to cope with the emotional component of their work. This is one element that contributes to nurses providing poor care. A number of approaches to staff support have been developed that warrant further study.

Practical implications

If episodes of poor care are to be prevented it is necessary for hospital boards to recognise the importance of supporting nurses in managing the emotional labour of caring. The introduction of routine systems of staff support should be considered.

Originality/value

In addition to highlighting and condemning poor care, it is important to seek solutions. This article offers a new perspective on an enduring problem and identifies approaches that can be part of the solution.

Details

Journal of Health Organization and Management, vol. 27 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 3 July 2007

Claire Whittle and Alistair Hewison

The purpose of this paper is to demonstrate that, if teams in healthcare focus on the patient using the framework of a care pathway, change can occur without the overt…

Abstract

Purpose

The purpose of this paper is to demonstrate that, if teams in healthcare focus on the patient using the framework of a care pathway, change can occur without the overt need to “manage” it directly.

Design/methodology/approach

In this paper the relevant literature is reviewed and it is demonstrated that if this approach is used it also provides a means for addressing difficult professional and organisational issues that are often unresolved in broader projects of organisational change. This is not presented as a panacea or the solution to all change projects, rather the contention here is that it is one means among many that can be used to bring about important changes in practice.

Findings

The paper finds that care pathways represent a useful tool, which teams can use to work through the contextual and practical issues involved in changing practice.

Originality/value

The paper describes the development of integrated care pathways, which can be regarded as a fortunate fusion of managerial and professional concerns.

Details

Journal of Health Organization and Management, vol. 21 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 15 March 2013

Alistair Hewison, Nicola Gale, Rowena Yeats and Jonathan Shapiro

The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four…

Abstract

Purpose

The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision‐making, and the related literature.

Design/methodology/approach

A mixed‐methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used.

Findings

The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were “championed” by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation.

Practical implications

The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations.

Originality/value

Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

Details

Journal of Health Organization and Management, vol. 27 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 December 2004

Alistair Hewison and Maggie Griffiths

Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development…

Abstract

Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development programmes have been developed to meet this need. This paper reviews the evidence concerning leadership development in nursing. The conclusion reached is that leadership is only one element in the changes that need to occur in health care. Too much emphasis on leadership without an equal concern for transforming the organisations nurses and other health personnel work in may result in leadership being added to the list of transient management “fads” which have characterised health care in recent years.

Details

Journal of Health Organization and Management, vol. 18 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 October 2004

Alistair Hewison

The rise of evidence‐based medicine and more recently evidence‐based policy reflect the increasing importance of evidence as a basis for the organisation and delivery of…

Abstract

The rise of evidence‐based medicine and more recently evidence‐based policy reflect the increasing importance of evidence as a basis for the organisation and delivery of health care. Evidence‐based practice is central to the “modernisation” of health care in current UK policy. The latest manifestation of this process is the emergence of evidence‐based management in health care. This paper examines the development of evidence‐based approaches in health care and questions the appropriateness of such an approach to management. The problems inherent in applying the principles of EBP to management are explored and alternative apporoach based on the notion of craft is suggesteed as more practical and realistic.

Details

Journal of Health Organization and Management, vol. 18 no. 5
Type: Research Article
ISSN: 1477-7266

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