Acibadem builds community of nurse leaders pivotal to patient and staff satisfaction

Thursday, August 4, 2005

How does a fast-growing family of hospitals foster leadership abilities among busy nurses so that they can better attract, motivate, and develop staff, while continuing to meet the daily pressures of their 56-hour workweeks?

Many health care organizations would not even attempt such an ambitious undertaking. But in April, Acibadem Healthcare Group in Istanbul, Turkey invited two health care professionals, Joanne Ayoub and Patricia Folcarelli, PhD, RN from Beth Israel Deaconess Medical Center (BIDMC) to join HMI’s Elizabeth Brown, RN, MSN, MBA and Saliha Koc, RN in Istanbul to deliver a three-day workshop designed to further the development of the health care network’s nursing management team.

The workshop was part of an extensive nursing education initiative aimed at helping Acibadem’s three hospitals better meet their clinical requirements and address the high nurse turnover that plagues health care institutions worldwide.

Nursing education is one of the top priorities within a larger HMI-Acibadem partnership, says Brown, HMI’s director of clinical services. Acibadem recently opened a state-of-the-art cancer and neuroscience center with some strategic input from HMI and members of the Harvard Medical School faculty. Over the past year-and-a-half the two organizations have collaborated to create multidisciplinary education programs, build community awareness, and implement quality improvement initiatives.

“ We decided to focus on nursing leadership this year because it is a long-term initiative that will set the tone for every other program going forward,” explains Brown. “The nurse managers expressed a void in leadership development, and we recognized that by building a leadership team they would be better prepared to deal with ongoing challenges.”

Acibadem Healthcare Group is undergoing rapid expansion. In addition to opening the cancer and neuroscience center last January and launching an outpatient clinic, Acibadem plans to open a fourth hospital in Bursa. As a result, the organization is constantly recruiting, hiring, and training nurses, and promoting young nurses from clinical roles into managerial positions without providing much education about how to make that transition.

In this context, developing leadership skills is the equivalent of designing a new transportation vehicle while driving the old one 100 miles per hour, notes Ayoub, director of organizational development and staffing at BIDMC. “The challenge is to do the work of today and the work of tomorrow in parallel.” But she notes that the momentum also serves as an advantage, as Acibadem is open to change.

Koc, director of nursing for Acibadem, reports that the initial phase of the program met with great success. “The interactive participation and information sharing were very good,” she says. “We created a leadership model suitable to Acibadem Healthcare Group and to our culture, and participants believed they developed themselves as leaders and shared the experience with people in other departments.”


Step One: “Managing Self”
At the program’s start, the team from HMI and BIDMC emphasized that the workshop was going to focus on “self,” says Ayoub. “I believe our best leaders are those who are centered, self-nurturing, and take time for reflection.”

They used a model from the Center for Creative Leadership, a non-profit educational institute in North Carolina, as the foundation of the curriculum. The model is based on three elements: challenge, assessment, and support. It posits that leaders need three elements at all times in order to grow: new and important challenges, knowledge of their current skills, and good support from good bosses in a good work environment.

The “assessment,” piece is particularly important for Acibadem’s charge nurses, notes Folcarelli, director of professional nursing practice development at BIDMC. Many are young women who were promoted to a role equivalent to nurse managers in the U.S. based on their clinical expertise and have little experience managing their peers.

The workshop was designed to help the charge nurses better understand all aspects of themselves, such as their personal leadership styles and why and how they react to certain situations.

Because self-knowledge isn’t easily taught through a lecture, the workshop was interactive. Participants warmed up with yoga postures and used breathing as a metaphor for finding themselves as leaders. In addition, as they moved through the interviews and discussions, the HMI facilitators used the information they gathered from the nurses hour by hour to design the curriculum. “The strategy was to say that the knowledge and wisdom exists within the group and we’re here to hold up a mirror and help to organize what they told us in ways that will allow them to build a model for leadership development,” says Ayoub.

In addition to learning to manage self, the charge nurses worked on communication skills. They practiced giving and receiving feedback, having difficult conversations with other staff members, and managing conflict. These skills are important, observes Folcarelli, because of the pivotal role charge nurses play in nurse retention and job satisfaction and the quality of patient care.

The nurses in Turkey are far from alone, she observes. “What always surprises me when I meet with international visitors is that the challenges faced by nurse managers and charge nurses are universal. There is very little difference throughout the world.”


Taking charge
At the end of the three days, Acibadem had much to be proud of—and much to work on. The charge nurses now have the beginnings of a core competency model that describes the qualities and skills that make for a good charge nurse. This document, says Ayoub, will set the expectations for the charge nurse role going forward.

In addition, Acibadem is instituting a self-assessment, a questionnaire designed to help charge nurses better understand their strengths, areas that need improvement, and personal management styles. This will serve as the basis for one-on-one meetings scheduled for July and August.

Last, the facilitators demonstrated methods for leading change, which is the only constant for the expanding organization. Equally important, says Brown, the program fostered relationships among the nurses who work at the different Acibadem hospitals and initiated a dialog with nurses in Boston. Ayoub adds that the ability to spend three days focusing on themselves, in itself, was an important outcome. It helped to raise consciousness about leadership and why it is so important.

Brown, Ayoub, and Folcarelli plan to return to Istanbul in October for phase two of the initiative, which will continue to focus on managing self by creating “personal inventories.” These are expected to help the charge nurses learn even more about themselves, their communication styles, and why others react to them the way they do.

“Acibadem is doing a wonderful job of balancing clinical education with leadership education,” concludes Folcarelli. “It shows foresight and wisdom that they recognize how important it is to educate and develop charge nurses.”