Crucial Conversations In Healthcare Management And Leadership

The Dysfunctions in the Team

Business management in nursing is a field that relates to the management of nurses and their respective roles in the facility. The five dysfunctions, which are written by Patrick Lencioni, are essential in the development of a good working relation and employee work protection in the execution of their duties concerning following their job regulations. The regulations are to be adhered to without being bought out by the situation at hand.

The  suitable  style of leadership is often based on the the nature of the persons that are to be managed coupled with the prevailing conditions of the work environment . The most recommended structure of leadership the healthcare profession is the hierarchical style of leadership. In hierarchical leadership format, the leaders of the nurses organize those who work under them into a that is pyramid-like in shape formation. The lowlevel is  often allocated for the workers who bear basic educational levels and those who lack experience. For the leadership structure to be operational, there has to be effective communication that flows from the top of the pyramid structure to the bottom. The leaders are responsible for decision making with little input from their other workers (Lencioni, 2007).

The execution of a leadership structure that is functional in the healthcare sector gives provisions for the leaders to establish an apparent hierarchy of command. The nursing leaders can direct each functional department in healthcare organizations towards the development of their plans with each plan aligning to the overall strategic goal of the organization. Numerous layers of approval characterize such a leadership structure before any decision is reached and this result to a long decision-making process. The fact that the leadership structure does not require any contributions from employees in decision-making means that the subordinate health officials are left out, resulting in a decreased satisfaction in their jobs and lack of motivation. The management of the institution has issues about the executive, and other workers are not working in unison, which has a negative impact on the organization. It is evident that the team of nurses struggle in accepting responsibilities, which brings negative morale among the working force. There is apparent lack of trust, lack of commitment and lack of accountability on the part of the other nurses as they left the single nurse to handle the entire situation on her own.

The dysfunctions in the team include; lack of trust, fear of conflict, avoidance of responsibility, lack of commitment and their lack of attention to results. The team’s lack of awareness of consequences emanates from the inability of the nurses to be held accountable, as they tend to look out for their interests rather than the interests of their team and profession. The team avoids accountability as they are not holding and making clear the teams standards and what is to be done by each worker as they leave it all to the single nurse to stand for their standards (Lencioni 2007).

Leadership Structures in Healthcare

The ambiguity of the prevailing situation shows the ability of the team members to commit t decisions which result from conditions that arise which brings too light their lack of commitment in case there is a conflict. The nursing team is afraid of disputes as they were incapable of having a debate about things that matter, as there is an artificial form of harmony. The workers do not adhere to the importance of conflicts to become productive. The workers lack trust, as they are not able to show their weakness, as they perceive they will be vulnerable to the others. The nursing and medical team are to overcome their dysfunction through sharing their experiences.

Consideration for a personal measure of approach in communication and conflict resolution to resolve the prevailing situation is essential in the diplomatic resolution of the problem at hand.  Patrick Lencioni brings forward the importance of trust as being a critical precursor in a professional relationship. The executives are to have high expectations for their staff conduct towards the colleagues, the toxic nature of the co-workers with a negative, dismissive and unbecoming behavior as one nurse tolerated as clinically competent refers to another as being grouchy. Leaders are to consider avoiding incivility for the sake of clinical competence. Crucial negotiation and conversations are essential in leadership to resolve conflicts (Lencioni, 2007).

As a quality expert, it was evident that the majority of the work is dependent on the ability to convince others. Sharing knowledge, for instance about the importance of a patients safety and the following of best procedures are useful in conflict resolution. The crucial conversations about the medical practices are objective in the current generation, which directly affects the relationship between departments. Employees are to be made free to provide their constructive criticism and feedback on their job performance without hesitation.

When someone comes at an individual with an authoritative instructive approach, the natural instinct is to be defensive. To address the uncivil habit of the security forces can be difficult but the choice to remain silent impacts the job performance of the patient care as it jeopardizes their job. My take from experience is about the degree that one would move to silence and violence and feel right about it. There are three types of stories; victims, helpless and the villain. Crucial conversations can create intimacy and a connection to a goal. Effective communication is helpful, and rapport has the power to develop responsiveness in their relationship. The crucial conversation will be about communication and the need to adhere to health standards. The nurse who did not show any resistance to the violation of the code of conduct in the health facility is to be taken through the need to stand up for what they believe in their profession.

Effective Communication and Conflict Resolution

Health facilities have a defined hierarchical structure of leadership which bears job descriptions from the senior to the junior employees. The nurse leader or the nurse in charge usually report to the service manager on the operational running of the wards. The nurse leader also reports to the DON for professional accountability. It is a requirement for the service managers to have a background in nursing though they are not required to have a current annual practicing practice as a qualification. The service managers do not have any professional accountability to the DON.      However, these hierarchies have resulted in complexities in the country’s public hospitals as they have resulted in bureaucracies that delay the deliverance of quality health care services to the public. The hierarchical ladder in the public hospitals have formed a nucleus of administration and has also resulted in the ability of healthcare organizations to adapt to the set health care regulations. The availability of two reporting roles in healthcare in the country, which are service accountability and professional accountability, results in confusion.

Health facilities may choose not to emphasize on the hierarchical style of leadership as the  leaders in the profession can choose to make use of the non-hierarchical style of leadership structure that would enable them to base highly on the better job performance in nursing. By using this leadership structure, the leaders will focus on the job itself and quality deliverance of nursing care. The leaders often delegate their authority to nursing experts in their performance of individual tasks in healthcare organizations. It increases job satisfaction because the junior workers have autonomy and they are empowered.

Each registered nurse is a leader in the clinic as leadership is adminithe stration that is based in the behaviors, which are professional in nature that are demonstrated by the staff nurses. That means that all professionally registered nurses are empowered to engage in different actions that can help in the direct address of issues of patient safety. Non-hierarchical leadership structure is evident was the Institute of Medicine grants power and decision-making authority to subordinates such as junior nurses. They bear the power and the ability to mobilize resources and materials that are essential in the realization of the organizations objectives. The Institute prefers this leadership structure over the hierarchical one where the nurses are framed as a hierarchical concept (Lencioni, 2013).). It has been established that those healthcare organizations where the nurses are empowered into practicing their profession, they usually optimize the necessary conditions for the provision of safe patient care. Nurses who are empowered are much able to perform well as nursing adaptive leaders.

Personal Measure of Approach in Communication and Conflict Resolution

In order to realize the best delivery system in nursing, the leaders are to mix both the hierarchal and the open leadership formats. Use of both structures of leadership would ensure the leaders are focused on the tasks of the nurses as well as on the welfare of the nurses. The delivery of quality nursing care requires the development of increased nursing skills and experience, and this can only be achieved if the leaders can nurture and develop the health practitioners. Once nurses formulate high skills and knowledge in nursing, they are in a better position to provide patients with quality healthcare with limited supervision, as they bear advanced levels of accountability for their work. In addition, the combination of both the hierarchical and non-hierarchical leadership structures would help in the reduction of the bureaucracy that is evident in the country’s healthcare sector, which will then result in the reduction of confusion and enhance health care service delivery (Lencioni, 2013).

The most important conversation is to be centered on employee unity and coordination in the work environment. Lack of accountability and nursing unity is lacking in the facility as most of the nurses judged and condemned their colleague who stood up for her profession. The employees are not to be bought into prevailing circumstances at the expense of their job. Employee dysfunction is to be taken care of by developing measures to eliminate the lack of trust and avoidance of responsibility by the nursing employees.

The hospital’s nurses seem to be used to the theory of transactional leadership as punishment and command sequences are the only means through which the workers are to work correctly. This theory assumes that punishment and rewards motivate people. The argument also assumes that systems operate best when there is an evident structure of command, the principal purpose of aides is to do what their managers tell them and when persons agree to work, they cede their authority to their supervisors. Transactional leadership that is based on contingent rewards positively influences the satisfaction and performance of the followers. A transactional leader usually focuses on the management of work and does not shade light on the values shred in a team. This leadership  structure and style is task oriented and can be quite capable when it comes to meeting the deadline and during emergencies. A transactional leader works through the creation of precise structures where it is clear of what is required by the subordinates as well as all the rewards that the assistants get from following orders. In majority of the cases, punishments are not often stated, but they are understood properly and effected by use  formal systems. The aides are to entirely accountable for the work they are allocated by their leader.

Leadership in nursing is essential in the profession because it helps in nurturing of skills for the health officers.

To eliminate the challenges, which emanate from bureaucracies of the hierarchical leadership form, the health section embraces both hierarchical and open-ended leadership structures. The combination of both systems of leadership has resulted in the reduction of confusions and enhanced the clinical health workers autonomy making them more motivated, increasing their productivity and ultimately improving the level of delivery of quality health services. Various theories of leadership are applicable in the health sector and especially in the department of nursing. The application of each approach is based on situations, outcomes that are desired, the leader’s values, and the staff outcomes, the individual values and the effects it bears in the organization.

 It is essential for nursing profession managers to bear a full recognition of the various nursing leadership structures, as this helps them to determine the best leadership style that bears the reflection of their values in the different prevailing situations. The health leaders are to understand the leadership structure they have adopted in any medical setting has a direct effect on the satisfaction of their nursing colleagues and ultimately affect the comfort of their patients.


Lencioni, P. M. (2007). The Five Dysfunctions of a Team: A Leadership Fable. New York: Wiley.

Lencioni, P. M., & Recorded Books, LLC. (2013). Overcoming the five dysfunctions of a team: A field guide for leaders, managers, and facilitators. San Francisco, Calif: Jossey-Bass.

oregoniannews. “Body Camera Shows Nurse Getting Arrested for Not Allowing Blood Draw by Police.” YouTube, YouTube, 1 Sept. 2017,

techilovsky. “Patrick Lencioni – The 5 Dysfunctions of a Team.” YouTube, YouTube, 9 July 2013,

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