Category: Health Care Policy

Safety and health are some of the biggest worries among humans. They are some of the factors that strive us to keep prospering. There are many different worries among humans regarding health, and safety. Normally, we tell others to drive safe, and want them to make healthy lifelong decisions. We normally think of just daily activities, travelling, staying active, and things of that nature. Our workplace is seldom thought of when it comes to safety and health in our everyday lives. There have been many different accidents, and life changing injuries and even deaths that have occurred in the workplace. There have been incidents from asbestos, to collapsing buildings. These things should not be taken lightly. OSHA was created to cut these incidents and injuries down to a minimum.

OSHA (Occupational Safety and Health Administration) was created for the purpose of keeping employers, workers, staff, and any other persons in the workplace safe and healthy. OSHA uses three basic strategies, authorized by the “Occupational Safety and Health Act”, to help employers and employees reduce injuries, illnesses, and deaths on the job: Strong, fair, and effective enforcement; education, and compliance assistance; and Partnerships, Alliances and other cooperative and voluntary programs.” (United States Department of Labor) President Lyndon B. Johnson proposed the legislation of OSHA and it was later put into effect under President Nixon. Although, there were some failed attempts at reducing the hazards, injuries and deaths in the workplace, President Richard Nixon finally passed the law (Occupational Safety and Health Act of 1970. OSHA’s mission is: “With the “Occupational Safety and Health Act of 1970′, Congress created the “Occupational Safety and Health Administration” (OSHA) to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.” (United States Department of Labor) Richard Nixon, The President started many acts which have led to the full creation of “OSHA”. In December of 1970, Nixon signed into the act of “Williams-Steiger “Occupational Safety and Health Act”, which gave the Federal Government the authority to set and enforce safety and health standards for most of the country’s workers.” (United States Department of Labor) OSHA was created ultimately created because of the rising injuries and deaths of workers from the ‘60s and increased until the regulations and laws put a cease to the mistreatment of workers.

“OSHA” has grown over the course of 50 years. They have a larger workforce in the modern day, which with then unemployment rate at an all-time low. With there being the larger workforce and a higher population of worker, “OSHA” must increase their inspectors, and rules and regulations. “OSHA” has a whopping 7 million worksites that are in their jurisdiction, and they have 6 different priorities when it is time for an inspection. “1. Imminent danger situations: these are problems in the workplace that can cause death or a major physical or mental harm. Those are the top priority. 2. Severe injury and Illness: work related fatalities must be reported in 8 hours of the incident. Any other related injuries are allowed 24 hours of injury. 3. Worker complaints: if there are any allegations of hazards or violations, they will be a high priority and employees can request that their allegations can be anonymous when they are filed. 4. Referrals: of hazards from other agencies are allowed inspections. 5. Targeted inspections: if these inspections are aimed at industry with a high hazard, and they have high rate of injury or illness, they are a high priority. 6. Follow up inspections: checks for the change of any flaws or hazards in the workplace.”(United States Department of Labor) OSHA is divided into four main categories: general industry, construction, maritime, and agriculture. “Out of 4,779 worker fatalities in private industry in calendar year 2018, 1,008 or 21.1% were in construction — that is, one in five worker deaths last year were in construction. The leading causes of private sector worker deaths (excluding highway collisions) in the construction industry were falls, followed by struck by object, electrocution, and caught-in/between” (United States Department of Justice) These four categories put am emphasis on the jurisdiction of OSHA. General Industry are jurisdictions that are not agricultural, maritime, or construction. They are things such as stores, shops, restaurants, etc. “Slips, trips, and falls on slippery floors back and arm strain from lifting heavy trays and boxes burns from hot serving ware and cooking equipment cuts during food preparation.” ( Webstaraunt Store)

Construction is one of the broader categories in “OSHA’s” jurisdiction. Construction needs a broad perspective because of the lengths and heights that they work through on an everyday basis. . They go through extended hours of heat, harmful equipment, and height hazards. Maritime deals with those at sea. “The guide sheets reflect 42 actual “OSHA” case file summaries of workplace incidents in which longshoring workers were killed while performing their jobs. The guide sheets are divided into three major categories: vehicular accidents, falls/drowning, and material handling accidents. The most frequent cause of longshoring fatalities were accidents in which employees were struck by or run over by vehicles such as trucks, front-end loaders, or forklifts. The next most frequent causes of death were by falling or drowning. The remaining fatalities occurred while employees were performing a variety of cargo and material handling activities involving improperly loaded forklifts, unstable cargo that toppled over, and working below improperly secured loads that fell from cranes.” (United States Department of Labor) Marine Biologists, Lead Divers, and Marine Archaeologists all deal with the marine life, and the scary hazards that are out at sea. Agriculture is also very important to think about when it comes to the safety of the farmers, harvesters, etc. They encounter deadly and harmful chemicals in their everyday lives. The scary side of agriculture is also the heavy farm equipment, the accessories with the tractors, harvesters, combines, and even the gins. These four categories put into perspective the strengths and care of our workers. They do not put a category in to a lesser category than another. They all are just as important as any other job.

Surprisingly, there are some myths that small businesses that do not have to abide by “OSHA” regulations. “Businesses that are exempt from “OSHA” regulations are those that have less than 10 workers”. “Businesses that have more than 10 workers are exempt from some inspection.” Those inspections are categorized as “low hazard industries. (Huffington Post). There was a dispute that there were some small businesses that did not have to abide by “OSHA’s” regulations. That sounds accurate, but all businesses must abide by regulations. “The short answer is, unless you are a small farming operation, “OSHA” does have jurisdiction in almost every circumstance. There are some partial exemptions and exclusions from certain types of OSHA activity, such as maintaining Injury & Illness Recordkeeping logs and forms, and from certain types of inspections or citations, but those limitations rarely apply and really offer too little relief to small employers to be meaningful.” (Becker) “OSHA” can stop in at any given time to see if there are any violations. It can be an expected visit or an unexpected visit. There are numerous statistics that have shown the benefits of what “OSHA” does. Here are some for example: “Since OSHA’s creation in 1970, the nation has made substantial progress in occupational safety and health. “OSHA and its many partners in the public and private sectors have for example: Cut the work-related fatality rate to historic lows for 2002 to 2004; From 2003 to 2004, reduced the number of workplace injuries and illnesses by 4 percent and lost workday case rates dropped by 5.8 percent in that same period; Virtually eliminated brown lung disease in the textile industry; In 2005, OSHA conducted close to 39,000 inspections and issued just over 85,000 citations for violations; In 2004, the Consultation Program made over 31,000 visits to employers.” (United States Department of Labor) Those statistics show the great impact that “OSHA” has done for American businesses.

Furthermore, “OSHA” has helped society tremendously over their creation since 1970. There will always be incidents, injuries, and deaths in the workplace, but “OSHA” has cut a vast majority of these issues to a minimum. The history, the progression, and the effect that “OSHA” has accomplished is amazing. The agency puts safety and health as the top priority, and we should also. Think about your loved ones and yourself when it comes down to the safety of our workers. “OSHA” has done many positive things for the workers in America. They are always increasing their regulations to accommodate the expansion of the workforce and workplace. They have impacted the safety and health of all the workers. There are some individuals that take “OSHA” lightly, but I strongly agree with their standards and regulations. They allow us to have a low hazard workplace, to be free of health hazards, work injuries, and be free of injuries. “OSHA” is one of the most helpful administrative agencies in the modern day, and it is up to our generation to keep it strong.

Introduction

We are living in a time in which the NHS is facing many economic and social challenges. Our healthcare system is suffering budget constraints, an increased and aged population, higher patient expectations, nursing staff shortages and we are now treating more complex illnesses than ever before (Rivett 2015). In order to implement the changes needed to address these issues the government has put its focus on leadership and developing strong leaders in the NHS (NHS England 2014). However, the term ‘leadership’ is a wide concept and throughout history, there have been many lines of thought on what leadership means and what attributes a good leader must-have. For the purpose of this essay, the focus will be on transactional and transformational leadership because according to the literature those are the leadership styles most prevalent. The current policy agenda regarding leadership in the UK encourages skills attributable to transformational leadership to address the challenges the NHS is currently facing, as opposed to transactional leadership. Nevertheless, the literature suggests that transactional leadership is still the leadership style most followed among nurses. In this essay, I argue why transformational leadership is the way forward to address the leadership crisis in the NHS. First, I give an overview of the theories of transformational and transactional leadership linked to the context of an operating theatre department. Then, I describe the NHS policy framework in relation to leadership, its origin, and its links to the transformational leadership theory. This leads to a discussion of the further benefits of transformational leadership which I argue comes in the form of increased theatre staff development, motivation, and engagement. Following on from this, I discuss the objection that transformational leadership is insufficient to address challenges such as national nursing staff shortages, meeting surgical targets, or lack of funding, and training a manager with the transformational theory requires more training and time. Transactional leadership on the other hand can more easily achieve short-term goals, it’s more structured and easier to implement. I reject this by arguing that transformational leadership can lead to more productivity and efficiency, therefore, minimizing the effects of reduced budgets and the lack of nurses and can lead to better outcomes in the long term. I conclude that transformational leadership is the way forward to archive the NHS vision for the future despite the economic and socio-cultural challenges the UK is facing.

Leadership

The concept of leadership can be defined as the process in which a leader interacts and influence others in order to achieve a goal (Sadler 2003). However, Sadler’s definition can lead to multiple interpretations because of its general and unspecified nature. Dugan (2017) argues that there is no one way of defining ‘leadership’ because there are potential as many definitions of leadership as leadership theories. Leadership means different to different people according to their approach to leadership based on their perceptions, preconceptions, and life experiences (Dugan 2017). This may be explained in the context of an operating department in an acute hospital setting because it can be easily observed that different theatre nurse managers interpret how a team should be led differently, influenced by how they were led, what they were taught, and what they have seen other theatre managers doing. Therefore, to better understand the topic is necessary to narrow the issue by looking at specific leadership theories.

In order to better understand the need for strong leadership in the NHS is important too, first of all, take a look at the actual socioeconomic context in the UK. In recent years we have witnessed an increase in the demand for health services and an increasingly older population above 85 years old (Maguire et al 2016). In the last 10 years, from 2007/8 to 2017/18 there has been an increase of 30% of hospital admissions (NHS Digital 2018). When looking at surgical procedures carried out. In 2007/2018 there was a total of 8,606,493 procedures and interventions and in 2017/18 it went up to 11,897,542. This represents an increase of 38.24% in the number of surgical procedures in 10 years (NHS Digital). The increased activity has caused an average increase in spending of 4% every year (King’s Fund 2018). However, it is estimated that this year the NHS budget will only see an increase of 1.9% in 2018 in comparison with the 2017 budget (Nuffield Trust 2018). Personal experience supports this fact; in the operating theatre department where I work there has been a clear increase in activity and Saturday theatre lists and late evening, sessions have been introduced to meet the demand. This profound gap between spending, healthcare spent, and increased demand has made the government look at ways to improve productivity utilizing the current resources (Maguire et al 2016).

In recent years, there has been an increasing interest in leadership as a tool to tackle NHS budget constraints. In 2010, the department of health published the health White Paper Equity and Excellence: Liberating the NHS (DOH, 2010), a document that outlines the vision of the NHS as an organization that put patients at the center and focuses on quality of care, equality, efficiency, and transparency. In order to achieve this, a year later, the NHS leadership academy (2011) issued the Clinical Leadership Competency Framework which acknowledged that in order to successfully meet the targets described in the white paper and transform services it was necessary to have strong leadership in place. This document was therefore developed as a guide and aimed to provide a structure to standardize leadership training and education (NHS Leadership Academy 2011). The importance of leadership in the clinical setting was also reinforced after the Francis report (2014) which highlighted leadership failures as one of the reasons for poor patient care in the Mid Staffordshire NHS Foundation Trust. The focus on leadership is, in addition, highlighted in the NHS England (2014) Five-year forward view which outlines the vision for the NHS for the next 5 years supporting the idea that innovative ways of working are needed to deliver more efficient and cost-effective care. Nevertheless, there are still many questions answered because these NHS policies still fail to help the front-line nurse manager on how to be a better leader despite the time and economic constraints they face.

Leadership theories

For the purpose of this essay, the focus will be on two leadership theories: transactional and transformational leadership. The reason why these two theories have been chosen is that according to my experience these are the two theories mostly represented among nurse managers in the operating theatres. This assertion can be supported by a recent systematic review carried out by McCay et al (2018) in which the author looked at literature published between January 2009 and September 2016 in a bid to study the relationship between leadership styles and staff satisfaction. McCay et al (2018) identified transactional and transformational leadership as the most mentioned leadership styles in the literature. Nonetheless, this study used articles that were not published in the United Kingdom and it only focuses on articles in which leadership styles are linked to staff satisfaction therefore not covering the wide variety of articles published on the topic of leadership. Further research should be undertaken to determine what are the most prevalent leadership styles in the NHS and in particularly among nurses working in the operating theatre as at the moment there is a lack of evidence. However, despite McCay’s limitations, his work does give an idea of the most common leadership styles in healthcare which as mentioned previously are the most common styles I have been able to identify in my nursing career.

The concepts of transforming and transactional leadership were first introduced by James MacGregor Burns in 1978. Burns developed the concepts while studying the attributes of great leaders throughout history and the influence of their socio-cultural and political context (Burns, 1978). According to Burns (1978), a transactional leader identifies the objectives that need to be accomplished, directs staff in order to achieve them, and punishes or rewards employees according to their performance. However, Winker (2010) argues that Transactional leadership tends to be unidirectional as it does not take into consideration the qualities the follower brings to the team. Later in 1985, Bass developed Burn’s concept of transforming leadership and came up with the concept of transformational leadership (Bass, 1985). Transformational leadership differs from transactional leadership in which the former, challenges actual structures and focuses on changing them with the involvement of the employee while the latter, focuses on achieving objectives utilizing the working structures already in place (Kakabadse et al 2007). According to Bass, a transformational leader empowers staff to challenge the status quo and encourages them into finding new ways of learning and working, the focus is now on the employee. Northouse (2010), however, argues that the concept of transformational leadership has some weaknesses because the theory is not specific enough and can lead to multiple interpretations and, in addition, the concept showed an inclination towards heroinism and has the potential to be used in a negative way by leaders. The reason for this is that the transformational leadership theory compound multiple traits and characteristics, some of them included in other theories, and its boundaries are not precisely defined (Nemiro et al 2008). The development of these two theories was significant because reinforced the belief that leadership is not just about the leader but about the interaction and the relationship between the leader and the follower.

Growing evidence from two quantitative research studies (Negussie & Demissie 2013,) suggests that transformational leadership is the preferred leadership style among nursing employees. The reason for this is that transformational leaders inspire employees to achieve a goal for the greater good, hence, making their motivation come from within (Marshall 2010). Marshall (2010) goes further and explains that this is not only about having a clear and defined vision but also about demonstrating interest and concern for employees, coaching them to develop their skills, and valuing staff’s input. In her book, Marshall talks from her personal experience therefore not supporting her argument in a study, however, my personal experience reinforces her statement because theatre nurses often verbalize that their favorite theatre managers are the ones that engage staff in the decision-making process giving them a sense of ownership. Therefore, this confirms the hypothesis that transformational leaders contribute to making staff more motivated to do their job.

Leadership and staff satisfaction

Staff’s motivation is linked to staff’s satisfaction which has been shown to have a clear link with decreased clinical errors among nurses as well as decreased infection rates in the clinical setting (Aiken 2018). This statement is significant in the current economic climate because according to the Department of Health and Social Care clinical errors cost the NHS up to £2.5 billion a year in litigation costs (DHSC 2014). This finding has an important implication not only because as we all know a clinical error can have a deep and lasting effect on patients but because the money spent on litigations and compensations could be used to bridge the current gap between expending and budget. However, some argue that transformational leadership on its own is not enough to keep staff motivated. There are other aspects that can affect staff’s motivation which often nurse managers have no control on such as staffing levels and external workload pressures caused by hospital targets and business plans (McKenzie & Addis 2018).

In contrast, though, the literature argues that at present, the majority of nurse manager’s leadership style is transactional (Jodar I Sola 2016, Morsiani et al 2017). This fact can be explained because often nursing managers lack formal leadership training and still rely on the old fashion way of leadership inherited from previous generations of nurses (Morsiani et al 2017).

Leadership and staff turnover

When looking at staff turnover, Raup (2008) found that in a hospital where managers following the transactional leadership style there was a staff turnover of 29% comparing to 13% in a team where the manager was a transformational leader. This data has a great significance in current times when social changes and restricted budgets mean that being able to retain staff is very important.

This data is significant from an economic point of view. Fidgerald (2015) states that the potential cost of recruiting one band 5 nurses is £403.70 without taking into consideration the cost of supernumerary time and additional training.

Conclusion

This essay has discussed the reasons why transformational leadership is the answer to the crisis the NHS is currently facing. Over the last ten years, there has been a clear increase of activity in the NHS and therefore spending, however, government healthcare budgets have not increased at the same speed creating a funding gap. As a result, the UK Department of Health has put its focus on leadership as a tool to manage services more efficiently to bridge the funding gap. However, conflicting evidence on what effective leadership means is associated with different theories on leadership. This essay has identified that transformational leadership is not only the preferred leadership style among employees, but it is also linked to increased staff motivation, productivity, and staff turnover. However, whilst these aspects are linked to safer practices and therefore reduced litigation spend and more efficient use of resources, evidence suggests that lack of training and economic and time constraints often make nurse managers unable to put the transformational leadership ideas into practice. This explains why currently, transactional leadership is the most common leadership style followed by nurse managers because it is easier

Wages and Hours Protection-The Fair Labor Standards Act (FLSA): FLSA is a United States Federal law that was established in 1938. It ensures specialists by setting norms for the lowest pay permitted by law, additional time pay, recordkeeping, and youth work. This law covers full-time and low maintenance laborers in the private division and administrative, state, and nearby governments. The law may apply to you in light of the sort of organization or association for which you work, known as ‘big business inclusion’, or the kind of work you perform known as ‘singular inclusion’ (Mckay, 2018).

Equal pay act of 1963: A government rule which forestalls separation in the installment of advantages or wages dependent on a person’s gender when ladies and men perform work including comparable ranges of abilities, endeavors, and employment obligations (Wilkins, 2012).

Workplace Safety-The Occupational Safety and Health Act of 1970 (OSHAct) was passed to keep specialists from being executed or truly hurt at work. The law necessitates that businesses give their representatives working conditions that are free of known perils. The Act made the Occupational Safety and Health Administration (OSHA), which sets and upholds defensive work environment wellbeing and wellbeing models. OSHA additionally gives data, preparing and help to specialists and bosses. To help guarantee a protected and energizing work environment, OSHA additionally furnishes laborers with the privilege to:

Receive data and preparing about perils, strategies to anticipate hurt, and the OSHA models that apply to their working environment. The preparation must be in a dialect you can get it; Observe testing that is done to discover perils in the work environment and get test results; Review records of business-related wounds and sicknesses;Get duplicates of their medicinal records; Request OSHA to review their working environment; and Use their rights under the law free from striking back and separation. OSHA norms are decided that portray the strategies that businesses must use to shield their workers from risks (Osap, 2018).

History of Employment Discrimination Law: Antidiscrimination law is an unpredictable collection of resolutions, which turns out to be progressively immense and confounded with each authoritative alteration and with continuous legal elucidations. From the point of view of ‘formal uniformity,’ this assortment of law has added to the objective of incorporation of ladies and minorities in the work environment. U.S. antidiscrimination law tries to address a past filled with working environment avoidance of people and gatherings based on race, sex, national source, and religion. Added deeply insurances against segregation on these bases, later enactment has perceived the need to grow the law to incorporate separation based on age and incapacity. However, as noteworthy as antidiscrimination law has been, the U.S. workforce keeps on pondering word related isolation these bases. Added to these issues is the developing instability of workforce made up progressively by unforeseen representatives, who are frequently drawn from similar gatherings requiring insurance under business discrimination laws (Lieberwitz, n.d.).

What is Title VII of the Civil Rights Act of 1964: When Title VII of the Civil Rights Act of 1964 was passed, work discrimination on the premise of a person’s race, religion, sex, national source or shading wound up unlawful. This law ensures workers of an organization and in addition work candidates. All organizations with at least 15 workers are required to cling to the principles put forward by Title VII of the Civil Rights Act of 1964. The law additionally settled the Equal Employment Opportunity Commission (EEOC), a bipartisan commission that is comprised of five individuals selected by the president. It keeps on upholding Title VII and different laws that ensure us against business discrimination. Here a business can’t settle on contracting choices dependent on a candidate’s shading, race, religion, sex or national beginning. A business can’t segregate dependent on these elements while enrolling work hopefuls, promoting for an occupation or testing candidates (Lieberwitz, n.d.).

References

1. Lieberwitz, R.(n.d.). Employment Discrimination Law in the United States: On the Road to Equality? [PDF file].Retrieved from https://www.jil.go.jp/english/events/documents/clls08_lieberwitz.pdf
2. Osap.(2018).Retrieved from https://www.osap.org/page/GuideOSHA
3. Mckay, D.R.(October 08, 2018). The Fair Labor Standards Act (US) [Blog post].Retrieved from https://www.thebalancecareers.com/the-fair-labor-standards-act-us-524845
4. Wilkins, E.R.(April 09, 2012). Equal Pay Act of 1963 [Blog post].Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/9781118364741.ch34