Let the Trombones and the Strings Tell You: Valuing Diversity, Engaging Staff, and Promoting Collaboration
“I think true innovation comes from the staff themselves.” Nurse leaders all described the importance of staff engagement for any creative or adaptive outcome and an environment where leaders “really listen to the staff.” Structures and processes were intentionally created to engage staff in sharing ideas and creative solutions.
You have to figure out how your structure is going to engage them. Everything from structured meetings to open-door policies, emails, hotlines—all the diverse ways to get input…It's having conversations, doing observations, it's storytelling, it's listening, whatever would work in an organization to generate that 2-way communication.
Nurse leaders described purposeful leadership rounds and other structures such as roundtable meetings with executives, shared governance, and staff champion meetings as opportunities to give staff a voice and the ability to influence and drive change. Leadership paid particular attention to ideas emerging from these forums and committed the time and resources required to ensure their success.
“You have to value it” and be “open to it and create the right teams of people.” There was much emphasis on how diversity of staff skills, disciplines, and perspectives enriches the process and produces better results. Each leader described the intentional creation of conditions where diverse people could interact and collaborate. Frequent face-to-face interaction enabled them to be better problem solvers and to move the organization forward. Each member of the team was seen as a valued contributor: “we take our gifts and use them together in a really intentional way.” In these environments, “there really are shared beliefs that you'll be better together than you are going to be apart.”
The nurse leaders described needing to achieve a balance with staff engagement and the limits of organizational constraints. Having to produce results in a budget-neutral way challenged them to be creative within their fiscal constraints. Leadership set clear expectations about what decisions were shared and which ones were not appropriate for shared decision making, but they were “willing to incorporate people's ideas about how things ought to be.”
The value of engaging diverse staff in collaborative efforts to creatively achieve better results in an organization was captured by one nurse leader in this way. “I think very seldom do we need to empty the plate and start over again. It's like being an orchestra leader, maybe the trombones need to be lower and the strings need to be a little more, but you don't need to wipe out the trombones. How do you do that in a way that the trombones will tell you or the strings will tell you and it will be a collaboration?”
Creating the Conditions: Values, Support, Accountability
All of the participants emphasized the importance of a supportive environment in order for creativity, adaptation, and learning to emerge. They described a sense of integrity, authenticity, and an ability to trust. In these environments, leaders and staff felt free to take risks and were willing to be accountable. Skill development was valued, and there was a willingness to invest in staff learning and the resources necessary to produce positive results.
Leaders experienced supportive environments where they were allowed “great freedom to be creative” in an organization that actually delivered on whatever it promised. “It was an authentic environment,” where they felt valued and supported, and were able to “exercise strengths,” “engage others in creative processes,” and have an impact.
Nurse leaders described “daily role modeling” at the executive level and leadership that built trust through effectiveness; delivering on commitments, but also by being genuine. It was apparent that their “heart was in the right place” and that actions would be based in shared values. The staff developed “trust that you'll advocate for them and the patients because they've seen that in you.”
Creating an environment that supports risk-taking is a key component of leadership that enables creativity, adaptation, and learning in an organization. One nurse leader described the role of leadership in creating an environment where people feel safe enough to take a risk. This means that people “feel supported and that if they screw up and make the wrong decision, they were not going to get eaten up, chewed up, and spit out.” Participants used terms like “incubator,” “one big experiment,” “test and try new ideas,” “latitude,” and “freedom.” They described an environment that encouraged a practice of questioning and understanding “why.”
Leadership in these environments also challenged the participants to weigh the risks and benefits, and be willing to articulate the rationale and intention behind their actions. If the creative ideas were aligned with the mission, vision, and values, there was a willingness in the organization to give staff the freedom to implement creative ideas, recognizing there would be mistakes. One leader described the creation of a “safe holding environment” where people know “there would be no gotchas.”
Along with risk taking, leadership also created an expectation of ownership and accountability. Clearly articulated expectations fostered both risk taking and accountability. All of the nurse leaders described experiences where leadership established clear expectations that they “would not fix it” for staff, that they expected involvement, ownership, and engagement. Clear behavioral expectations contributed to accountability and improved performance.
Leaders recognized that to expect staff accountability and achieve positive results, there had to be investment in skill development. Selecting people with “a more creative nature and…that inquiring mind” and “tapping on the shoulder” those individuals who have creative potential were key. Competency development was targeted and tailored for the team to optimize learning. “We need to help people develop skills so nurses see themselves as designers and creative people.” Effective leadership recognizes staff learning needs and is willing to make “purposeful investments” in education, giving staff “the tools of the trade,” whether it is in quality and patient safety science, leadership, or a clinical field. Organizations support staff “to become the expert so their colleagues could use them as a resource.” In addition to investment in education, it requires “mentoring, coaching, guiding, or teaching the next person” and providing opportunities to learn and grow. With this investment, one leader described that “everyone has generally been high performing; oars in the water.”