Supporting I-CHARP as a middle manager

Your role as a middle manager in I-CHARP is to support both the implementation of I-CHARP as a model of care and the research study associated with that. In order to do that, you will be required to use your knowledge and skills to both lead and manage.

I-CHARP as a model of care

There are many approaches to rehabilitation/reablement available. I-CHARP is a particular model of care for rehabilitation of older people living with dementia in residential aged care. 

I-CHARP is an evidence-based rehabilitation model of care. It is delivered by Registered Nurses and Occupational Therapists working in collaboration with a resident who is living with mild cognitive impairment or mild- moderate dementia. I-CHARP is intentionally designed to be consistent with the scope of practice of Registered Nurses and Occupational Therapists.

A model of care broadly defines the way health services are delivered. It outlines best practice care and services for a person, population group or patient cohort as they progress through the stages of a condition, injury or event. It aims to ensure people get the right care, at the right time, by the right team and in the right place (Agency for Clinical Innovation, 2013, p. 3).

The Agency for Clinical Innovation (2019, p.10) has identified two key components that are essential to the success of a rehabilitation program or service. Review these and consider how your role in I-CHARP relates to each of these components.

“Implementing an evidence-based rehabilitation program into a new setting requires consideration of a range of factors: workforce capacity (OTs, RNs, and other allied health professionals) and training; resources and time; client motivation and other relevant health conditions; care partner engagement and motivation; and
organizational leadership and culture. It also requires guidance around how the new intervention or program can be delivered in the real-world setting through a model of care”.

Jeon et al.,2023.p.256

One of the most significant challenges raised in relation to the I-CHARP model of care is ‘getting the right team’ in place to deliver I-CHARP, particularly given the shortage of Registered Nurses and Occupational Therapists in care homes. Other matters that have been raised include questions such as:

  • How will I-CHARP be integrated into the usual practice and processes in the care home?
  • How will I-CHARP clinicians involve others who work with residents in the care home?

As I-CHARP is implemented, other questions and challenges are likely to arise. Identifying and responding to these will require involvement of middle managers as leaders and as managers of people and resources.

ACTIVITY

Watch this presentation from Prof Jeon

Review the I-CHARP Delivery program


In the discussion forum titled “Initial thoughts” please list any initial thoughts you have about the implementation of I-CHARP as a model of care.

I-CHARP implementation and research

I-CHARP is being implemented and evaluated as part of a research study I-CHARP is being implemented and evaluated as part of a research study. The importance of effective governance in implementation sites is highlighted in the I-CHARP Research Study Governance Framework.

ACTIVITY

In your role as a middle manager in I-CHARP implementation, do you have any questions or concerns about how the research will be conducted at the site you work at? Please post these on the discussion forum.

Middle management in I-CHARP as Clinical Leadership

You may be wondering why we characterise your role in I-CHARP as clinical leadership. Definitions of clinical leadership vary widely and there is ambiguity in how the term is used. Some authors believe clinical leadership is an informal leadership role within a profession. In I-CHARP, we take the view that clinical leadership is a central feature of clinical governance. Just as clinical governance is distributed across many roles in an organisation, clinical leadership that is required for clinical governance can be found distributed within a range of roles.

Clinical governance “is a way of thinking about clinical quality and safety that should infuse all aspects of the operations of your service and influence its culture; how it is led and managed; workforce profile and skillset; systems, policies and procedures; the built environment and other infrastructure” (Aged Care Quality and Safety Commission, 2019).

The focus of clinical governance is clinical care. Clinical care is defined by the Aged Care Quality and Safety Commission as “health care that encompasses the prevention, treatment and management of illness or injury, as well as the maintenance of psychosocial, mental and physical wellbeing”.

Our rationale for your role in I-CHARP being one of clinical leadership is:

  • I-CHARP is a biobehavioural-environmental model of care that involves clinical care for residents within a holistic, person-centered approach.
  • Implementing I-CHARP will require change.
  • Change requires management.
  • Change Management requires leadership.
  • Leadership in I-CHARP implementation is directed to supporting changes in clinical care.

ACTIVITY

Think about how I-CHARP offers opportunity to improve the quality of care for residents.

Read these 2 documents from the Aged Care Quality and Safety Commission

Share your thoughts about what implementing I-CHARP may require you to do in relation to each of the 6 elements of the clinical governance identified in the second document and listed below:

1. Leadership and culture
2. Consumer partnerships
3. Organisational system         
4. Monitoring and reporting
5. Effective workforce
6. Communication and relationships.

Enacting Clinical Leadership

Having provided you with the rationale for viewing middle managers involved in I-CHARP implementation as clinical leaders, let’s explore more about clinical leadership and consider how you demonstrate the attributes and capabilities of clinical leaders in s in your day-to day work, including in enabling I-CHARP implementation.

Definitions of Clinical Leadership

Despite continued identification of the need to recognise, support and develop clinical leadership, much of the literature about clinical leadership is in health rather than aged care.  Definitions of clinical leadership remain challenging. A review of the use of the term clinical leadership in long term aged care by Enghiad et al. (2022) found that two distinct views of clinical leadership in nursing exist:

  1. Clinical leadership associated with clinical care—which refers to informal leadership associated with clinical care and clinical management.

2.Clinical leadership associated with a formal management role—which refers to nurse leaders with a clinical background who carry formal authority, such as an administrative position.

 We take the view that clinical leadership is a core component of clinical governance. It is not demarcated by profession or position. It is a set of qualities that can be enacted at various levels in organisations where the goal is to improve the quality and safety of clinical care.

ACTIVITY

Watch this short video about clinical leadership– although it is about health care it should provide you with stimulus to think about the nature of clinical leadership.

Share your thoughts about whether you see yourself as a clinical leader? Why? Why not? 

Leadership styles

There is abundant literature about different styles of leadership. You may be familiar with much of it.

Review this overview of leadership theory and styles.

You may like to take the time (1 hours in total) to watch this video about 10 leadership styles.

At times, researchers have focused on comparing leadership styles, particularly transactional and transformational styles, and sought to determine the benefits of one over the other. A more useful way of thinking about leadership style is that different situations require different approaches and will give different outcomes. The ability to modify one’s personal style to the situation is a key feature of an effective leader. What is well established is that a passive, laissez-faire style of leadership is not effective.

Watch this short video for an overview of styles used in situational leadership

There also needs to be a fit between leadership traits and behaviours and the values in the environment or culture to make a leader’s traits desirable to others and the organisation.

Values determine behaviour and influence outcomes:

Values-based leaders

•Set an uncompromising example, demonstrating integrity;
•Selflessly serve and raise-up others in genuine humility;
• Show compassion by caring for others and developing their potential;
• Are purpose driven, aligning with corporate mission, vision, and values;
• Demonstrate courage and persevere to do the right thing;
• Are self-disciplined, holding themselves and others accountable;
• Show gratitude and appreciation, acknowledging the contributions of others.

Clinical Leaders in Aged Care value:

•Older people, their families and carers
•Staff at all levels in the organisation
•Sound clinical governance.

 ACTIVITY

Think about someone that you believe is an effective leader.
List the attributes of this leader that you believe result in them being effective.
What attributes do you already have?
What attributes would you like to develop further?
How might you go about this?


 

 


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