MESO Leadership Dynamics

Decrease in Quality of Nursing Care

The Care clinic located in Summerville Florida provides care and various outreach programs and is known for its individualistic approach towards the community. Every year, the Executive Committee reviews the system to analyze client satisfaction results relating to service and quality indicators. Unfortunately, the scores indicate that the level of customer satisfaction and quality of care has considerably decreased. For instance, from a video footage, the nurse attending to the patient is seen accusing the patient of not following his recommended diet without giving him a chance to argue his case. In another video, the nurse is seen washing her hands and fails to dry her hands attending to a patient who does not look happy. Still, on the same video, the nurse leaves the patient in a hurry. It is also clear that the nurse has been careless about not recording Mr. Hock’s vitals. Towards the end, the drugs spill on the floor, and the nurse goes ahead to administer them to the patient who refuses and shows annoyance and disgust with the nurses. Similarly, a tour of the hospital indicates that the health care personnel have not been acting in the expected professional behavior when within the vicinity of the clinic. In the context of the above findings, it is clear that there is a decrease in the quality of nursing care related to interventions related to clients at the clinic, demanding an urgent need for management to address it. 

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Importance of addressing Quality of Nursing Care

Within the past decade, the quality of healthcare has continually become a subject of intense criticism. Quality care is vital to patients’ outcomes and safety, despite studies indicating flaws in the delivery of care with disturbingly little improvements. According to Izumi, Baggs & Knafl (2010), concerns on the quality of care has spread with increased interests and efforts to assess and enhance the quality of health and nursing. As a part of those efforts, various indicators have been developed to show the impact of quality nursing care in healthcare. Within the context of the case study, addressing the issue of quality of nursing care has several significant benefits to the stability of the clinic. Virtually, apart from the obvious risks to patient health decreased levels of quality nursing care can also have major financial problems to patients, care providers, the insurer, and more often the family.

Why Decreased Quality of Nursing Care

Perhaps one of the reasons why this benchmark was selected was due to the nature of service and quality indicators presented by the executive Team of Care Clinic. The meaning of quality nursing care involves meeting the needs of the patients through caring, compassionate, and respectful interactions where responsibility and professionalism are upheld (Virya, Jintana & Yupin 2015). By addressing the decreasing quality nursing care, the hospital will be able to restore the true meaning of quality nursing care within the clinic.

Understanding the Low Scores

Low scores in quality nursing care are characterized by incompetent and uncaring professionalism presented by nursing during the administration of care to patients. Although it is still not clear about what triggers decreased quality nursing care, especially in a clinical environment where operations have been running smoothly, several factors can be attributed to the low scores. For instance, decreased quality care can be associated with increased nursing workload particularly when there is a shortage of adequate nursing staff (Aiken, Sermeus & Van, 2012). By large, increased workload has several negative impacts on nurses such as work burnouts and work related stress. When this happens, nurses are likely to display episodes of irritability towards patients, and uncaring attitude towards patients. Other possible causes of the low scores may be as a result of job dissatisfaction, especially when the hospital environment is not friendly to the nurses. Nurses who are not satisfied with their jobs or who intend to leave their job are likely to report low scores on quality of care in their line of duty. Similarly, leaving out nurses in the decision-making and negative doctor-nurse relations can also be a trigger of low scores in quality of care within the clinic.

Leadership Dynamics

Leadership is the behavior portrayed by an individual when directing the activities of others towards achieving a common goal. Based on the understanding of the case study we consider six values of the system leadership as explained below.

We are in this together

The value reminds everyone who is involved that success depends on each one of them and they must continually play their role to attain the organization goals. For this to take place, the management of the clinic must create an environment where people can identify their success on the organizational success (al-Baradie, 2014). The welfare of the hospital is directly tied to that of the stakeholders, and the goal is usually a win-win for all parties involved. Teams and teamwork take center place when executing work and managers proactively look for ways to improve the situation when faced with problems.

No one is superior or subordinate

The value reflects on the relationship superiors have with their subordinates that makes it easy to relate to them, get inspired and enjoy working around them. Nurse Managers within the clinic should nurture a working environment where nurse staffs see them as colleagues and not as their superiors. The rationale for this value also recognizes the different responsibilities that people have (al-Baradie, 2014), and acknowledge that the role of the manager is to use their authority in supporting the mutual interests of their team. By eliminating the culture of superior-subordinate relationships, people will have more freedom to express themselves and seek help where needed.

Open and Honest Communication is Critical

At one time or another, most people have had conversations expressing one thing while thinking about something different. Dishonest communication is common in organizations and often leads to misunderstandings, which later create problems at the workplace. In order to encourage open and honest communication, Weir-Hughes (2013)encourages the adoption of empathy where individuals see the world from the perspective of others. By appreciating other people’s problems, their abilities, and understanding their behaviors, it becomes easier not judge others quickly, which in return promotes listening. When people form opinions about others even before they listen to them, it becomes hard for them to listen and communicate effectively. Thus, by encouraging open and honest communication, the hospital management will remove the barrier of effective communication and promote a culture of openness and honesty.

Access to Information on all Operations

Nowadays, organizations are eliminating hierarchies and replacing them with organizational structures that focus on teams, processes, and project goals. This value encourages access to information and open communication about an organization’s activities, how teams are progressing, their impact on others and encourages some potential competition for groups to do better. According to Papathanasiou, Fradelos & Kleisiaris (2010) open communication and access to information by all, allows all the relevant stakeholders to have access to patient information, allows them to advise accordingly, and avoid repeating procedures among others.

Focus on Processes

Healthcare organizations are systems made up different methods that allow input of the medical staff and for the success of the facility. The value further allows all people involved realize the importance of working as teams and the interdependence of their work. The emphasis is not focused on continuous improvement by using quality tools to evaluate performance and teamwork (al-Baradie, 2014). Implementing the value at the clinic will allow individuals to shift from the blame culture, adopt the system, and focus on fixing it in the best way possible. It will also decrease staff replacement because when people change the attitude, the system functions effectively.

No success or failure, it is just a learning experience

When starting a process, it is hard to predict if the outcome will be positive or negative. Everyone does their best based on their experience, information available, and understanding hoping for success. Unfortunately, sometimes success does not come and along with it comes failure. Nonetheless, and as Vahdat, Hamzehgardeshi & Hessam, (2014) notes it is important to appreciate that success involves the creation of mutually beneficial relationships between the hospital and consumers of health. Conversely, failure reflects unprofitable relationships between the clinic and the patients. In both cases, and as Kaplan & Harris-Salamone (2009) note, success and failure experiences should be viewed as a learning experience to help improve and sustain the success of the clinic.

Strategic Leadership

When organization success depends on people working together or sharing a common goal, leaders should focus more on the human side. Strategic leadership is the ability to influence others to make decisions from their free will and enhance long-term organization success and financial stability. Usually, strategic leadership is made up of interrelated elements and competencies, which include foresight, visioning, partnering, and motivating (Maccoby & Scudder, 2011). Essentially, foresight allows leaders to think regarding obvious forces that cannot be measured but are significant in shaping the future.  Visioning involves using foresight to ride a wave and direct its course to the future. Motivating lies in the ability of the leader to influence people in embracing a common purpose to implement the vision of the organization. Lastly, partnering ensures that strategic alliances have been forged between the leaders and the hospital staff.

Relationship-based Care

 In healthcare organizations, relationship-based care revolves around a culture of transformation model and operational framework that seeks to enhance patient safety, quality care, as well as patient and staff satisfaction (Dewar & Nolan, 2013). By implementing a relationship-based care, clinicians and nurses reconnect with the meaning and purpose of their work, focus on ensuring the success of their teams and enhance their relationships between patients for improved safety and quality care.

Change Model

The health care organization is determined by various factors such as leadership beliefs, economic issues, and the ability to recruit and retain staff among others. Virtually, care models have been used by healthcare organizations to deliver the transformation of nursing care in the hospital setting. Unfortunately, despite the variety of care models, it is hard to determine the best model that works best for a particular hospital setup. Nonetheless and in this case, the most feasible and viable change model is considered the care delivery model, which will be used to improve quality nursing care in Care Clinic. Essentially, as Kelly (2010) notes nursing care delivery model focuses on organizing the work of caring for patients and decisions are based on the needs of the patients and availability of competent nurses. For effective implementation and positive results, the care delivery model will adopt the patient-centered care. The design will focus on addressing the needs of the patient and requires care and services be brought to the patient. In this model, the effort of the nurse manager will be to ensure that the right person is doing the right thing in order to meet the needs of the patient and enhance delivery of quality care. For effective implementation of this care delivery model, it is essential for the leader to possess essential skills such as the ability to motivate staff, effective communication skills, and relate with the nurses on an emotional level.

Course of Action

Visualizing change in health care is accessible, but hard to maintain. As a starting point, leaders should focus on generating small wins as a way of motivating teams and encouraging them to progress further. Once minor changes have been effectively implemented at the care Clinic, it is possible that quality numbers will begin to go up and as this happens, the most appropriate things for the leaders to do is show appreciation and acknowledge everyone involved. This way, the leader instills in them a sense of ownership and pride to ensure continued success and ultimate motivation to push on with the change. After achieving the short-term goals, the next step will be focusing on attaining the long-term goals until the organization goals are achieved successfully. At this point, the best forward is for leaders to track the changes and explore the room for further improvement. After all is set and ready, then the leaders should be ready to institutionalize the change and turn it into standard practice in enhancing the quality of care. Nonetheless, change is a never ending cycle, where leaders must constantly support change and celebrate progress with teams as a way of ensuring focus is not lost in between. At the center of course of action, nurses are the major stakeholders due to the state of change that is projected to be implemented. Other parties involve physicians, medical staffs, hospital management, and patients who will be the beneficiaries of the improved quality care. 


The objective of this study was to get a clear insight on the quality care issues that resulted in low-quality nursing care scores at the Care Clinic. Evidently, by adopting the six values of system leadership, strategic leadership, a relationship-based care, and change model, leaders have the ability to implement effective and long-lasting changes. By large, the values of systems leadership help managers to create and sustain a quality culture. Similarly, strategic leadership allows success through foresight, visioning, partnering, and motivation of teams. In addition, by implementing relationship-based care, hospital enhances improved quality and safety or patients. Change models such as the care delivery model focused on patient-centered care delivery is critical to ensure improved quality and patient safety is enhanced.


Aiken, L. H., Sermeus, W., Van, . H. K., Sloane, D. M., Busse, R., McKee, M., Bruyneel, L., … Kutney-Lee, A. (January 01, 2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. Bmj (clinical Research Ed.), 344(e1717), pp. 1-14.

al-Baradie, R. S. (2014). Encouraging the heart. International Journal of Pediatrics and Adolescent Medicine, 1, 1, 11-16.

Dewar, B., & Nolan, M. (2013). Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting. International Journal of Nursing Studies, 50(9), pp. 1247-1258.

Izumi, S., Baggs, J. G., & Knafl, K. A. (2010). Quality nursing care for hospitalized patients with advanced illness: Concept development. Research in Nursing and Health, 33(4), pp. 299-315.

Kaplan, B., & Harris-Salamone, K. D. (2009). Health IT success and failure: recommendations from literature and an AMIA workshop. Journal of the American Medical Informatics Association : Jamia, 16(3), pp. 291-299.

Kelly, P. (2010). Essentials of nursing leadership & management. Clifton Park, NY: Delmar Cengage Learning.

Maccoby, M., & Scudder, T. (2011). Strategic intelligence: A conceptual system of leadership for change. Performance Improvement, 50(3), pp. 32-40.

Papathanasiou, I. V., Fradelos, E. C., Kleisiaris, C. F., Tsaras, K., Kalota, M. A., & Kourkouta, L. (2014). Motivation, leadership, empowerment and confidence: their relation with nurses’ burnout. Materia Socio-Medica, 26(6), pp. 405-410.

Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (January 01, 2014). Patient involvement in health care decision making: A review. Iranian Red Crescent Medical Journal, 16(1), pp. 1-7.

Virya Koy, Jintana Yunibhand, & Yupin Angsuroch. (2015). Nursing care quality: a concept analysis. International Journal of Research in Medical Sciences, 3(8), pp. 1832-1838.

Weir-Hughes, D. (2013). Clinical Leadership: From A to Z. Hoboken: Taylor and Francis.

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