APA :Self-Assessment of Leadership, Collaboration, and Ethics

5004: Communication, Collaboration, and Case Analysis for Master's Learners

Self-Assessment of Leadership, Collaboration, and Ethics

Leadership is a journey, and a commitment to continual growth and development of leadership skills is a must.  As part of this, ongoing candid self-reflection, self-awareness, and taking action when there are opportunities are critical steps in an effective leader’s evolution.  In response to the scenario from the Western Medical Enterprises Questionnaire, the sections of this assessment will explore leadership attributes and behaviors, techniques to promote interprofessional collaboration, and the application of an established code to address ethical dilemmas.

Section I:  Leadership and Collaboration Experience

            I have been working for Optum, a segment of UnitedHealth Group, for the past fifteen years as a Registered Nurse case manager.  I have been in a leadership role for the past nine years and currently lead a team of 17 Registered Nurses across the nation.  UnitedHealth Group is the world’s largest healthcare organization by revenue and ranked 7th on the 2020 Fortune 200 list.  Know for innovative solutions, Optum acquired Vivify, a remote patient monitoring company, in 2019. 

Our Medicare Advantage team is among those selected to pioneer a remote patient monitoring program using the Vivify platform and biometric devices, a radical shift from the previous case management program model.  Our shared vision is to improve the member experience, empower members to take charge of their health, and prevent avoidable hospitalizations.  To ensure the success of such a significant program redesign, effective leadership, communication, decision-making, and collaboration is critical.

I have been using the servant leadership model to lead this initiative since its launch in March 2020, incorporating attributes such as compassion, trust, and empowerment.  This style fosters innovative behaviors (Su, Weilin, et al., 2020), paving the road to success for innovative projects such as this.  As an example of compassionate leadership, I acknowledged team members’ anxiety when I initially announced the change, listened with an open mind, and gave them time to process the news.  An example of building trust is when I showed I value staff input.  Using staff feedback and suggestions, we streamlined the feedback loop between staff and Vivify technical support, which improved both the member and nurse experience.  I have empowered the team members by including them in the decision-making process regarding frontline workflows, creating opportunities for them to participate in pilot groups to test processes, and engaging them in user acceptance testing of new tools and technology.  These approaches have energized the team, instilled a sense of ownership, and promoted the flow of creative and innovative ideas.

I have been mindful of using an assertive communication style, including active listening, being open-minded to staff feedback, and setting clear expectations (Bocar, 2017).  For example, we introduced a new care management application in ongoing development, which led to staff frustration.  Aligning with an executive directive, I set clear expectations to utilize the tool to its fullest extent with the expectation that staff would share what worked and what needed improvement.  Frustrated by the tool’s instability, which significantly affected their productivity, team members proposed using an alternate application until the new one is more useful.  By listening to understand and keeping my mind open to different perspectives, I objectively considered then implemented the proposal.  Effectively using an assertive communication style has allowed team members to feel understood and valued, safe to share opposing ideas, and motivated about the way forward.    

Although I prefer the behavioral style of decision-making, which promotes empowerment, feelings of value, and enhanced communication (Luqman et al., 2016), the directive style is inherent to my personality.  I regret the times I defaulted to this in the program’s earliest and most chaotic days, leading to poor decisions.  For example, we had a significant disparity in caseload size amongst the nurses early on.  Instead of allowing the team to formulate a strategic solution, I was directive and made a snap decision to randomly reassign members across nurses.  Staff felt excluded from the decision-making process, which affected their morale at a critical time.  I have since been more intentional in using the behavioral decision-making style, which aligns more closely with the servant leadership style.  For example, there was recently a need to adjust four team members’ primary responsibilities.  Including the team members in developing a strategy to address this empowered them to brainstorm and share creative ideas, and we ultimately decided to solicit volunteers for the new role.  Using the behavioral decision-making style resulted in team members feeling valued and empowered, which improved their engagement.

Our team is venturing into uncharted territory with our new program, and collaboration is crucial to our success.  All members on the team are permanent telecommuters, including me.  67% of the team members live in the Greensboro, NC area and have relationships outside of work, which has built camaraderie amongst that subgroup.  The remaining 33% live across several states without the opportunity to meet face-to-face with anyone on the team.  This structure has caused feelings of isolation and exclusion, and a noticeable imbalance in team collaboration.

To promote collaboration, inclusion, and engagement across the team, I have implemented the use of Microsoft Teams, Jabber instant messaging, and Webex video conferencing.  Microsoft Teams has improved our collaboration by enabling multiple persons to edit documents and other projects simultaneously while having real-time discussions.  Team members have shared feeling like they are in the same room and are experiencing a renewed sense of energy and excitement.  Our daily group chat in Jabber has improved engagement by enabling all team members to share personally and professionally in the conversation.  Team members have shared that they now feel more included and valued, and I have observed strengthened relationships and improved communication across all team members. 

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Perhaps the most successful approach to improve collaboration, motivation, and engagement has been implementing video conferencing via Webex.  Many team members have never met or seen each other in a live environment, and video conferencing enables more profound personal interactions.  Video conferencing allows participants to observe nonverbal cues and connect deeper emotionally, promoting enhanced collaboration and engagement amongst remote team members.  Additionally, the speaker can more easily determine participation levels and the degree of understanding amongst participants, and participants are not as likely to multitask during video conferencing (Karis et al., 2016).  Several team members pushed back initially, reporting feeling distracted by the video feeds; we solved this by restricting video playback to the primary speaker during presentations.  Staff now report feeling more engaged with the team, better cooperation and collaboration, and less conflict due to fewer misunderstood messages. 

Section II:  Ethics Experience

Ethical dilemmas concerning staff members can be among the most challenging, sensitive, and emotionally charged issues a Registered Nurse leader faces.  Due to an ethical violation’s seriousness, nurse leaders must know and follow both the nursing profession’s and their employer’s code of ethics.  Optum adheres to UnitedHealth Group’s Code of Conduct based on its value pillars:  integrity, compassion, relationships, innovation, and performance.  The expectation is employees will hold themselves and others to the most rigorous possible ethical behavior standards, never wavering from being honest, just, and acting in the best interests of those we serve (UnitedHealth Group, 2019).

A few years ago, I encountered a situation where I discovered one of my employees had violated the workplace code of ethics and the professional code of ethics for nurses.  The employee was a telephonic Registered Nurse case manager working from home who had recently transferred to my team.  Her production call metrics and overall performance were subpar, so we collaboratively developed a performance management plan to meet her goals.  After a few months and several different strategies, including comprehensive virtual retraining and virtual precepting with a seasoned team member,  there was still no improvement.  The nurse could not provide any insight into her lack of progress or suggested strategies to improve with direct questioning, so we proceeded to the corrective action plan phase of performance management. 

As I was scrolling through social media one evening shortly after moving the nurse to a corrective action plan, her profile appeared in my suggested friend list.  I noticed her caption referred to having worked a night shift at a local hospital the previous night.  It struck me as odd that she had never mentioned having another employer to me.  When I considered her lack of progress with her performance management plan and the fact that she had worked that day with Optum, this new information piqued my moral compass.  I suspected her night job might be impacting her performance at Optum. 

Our organization’s business telephone system is very sophisticated, with an integrated application able to track all activity, even if not call-related.  Assuming positive intent and acting in good faith, I requested the nurse’s telephone system records the next day and started digging into her performance.  Going back 6 months, I was disturbed to discover a pattern in which she would log in and immediately move to the status indicating she was actively making outbound calls to our members. Yet, no calls were being made for up to 2 hours several mornings each week.  Our standard is to place a call within 5 minutes of indicating we are in an outbound call status.  Based on the information I was aware of, I suspected the nurse of intentional dishonesty, a direct violation of the character and integrity standard of the nursing code of ethics (American Nurses Association, 2015) and the integrity value within UnitedHealth Group’s code of conduct (UnitedHealth Group, 2019).  I formulated a plan of action to ensure I addressed the situation respectfully and acted in good faith to align with the American College of Healthcare Executives Code of Ethics  (American College of Healthcare Executives, 2017). 

I met with the nurse, using positive intent and a respectful tone.  I hoped the nurse would offer a reasonable explanation, at which point I could provide coaching for the outbound call process.  We reviewed her activity reports, and I shared my concerns regarding the pattern of frequent and significant periods of lost time.  When given the opportunity, the nurse did not explain why she was making telephonic outreaches to members without making calls.  I respectfully shared my concerns that she seemed unwilling to explain the lost time.  I advised that effective the following business day, we would need to temporarily suspend her telecommuter privileges to allow greater visibility into her workflow.  The next business day, she did not report for work and abruptly resigned effective immediately. 

An analysis of my actions and responses shows I acted within the American College of Healthcare Executives Code of Ethics framework.  I monitored staff adherence to our organization’s code of conduct. I also created an environment promoting ethical conduct by suspending the employee’s telecommuting privilege to gain greater visibility into her activities and discourage any dishonest actions which may have been occurring (American College of Healthcare Executives, 2017).  I acted within the framework of the UnitedHealth Group code of conduct by holding myself accountable for investigating and acting upon my employee’s suspected violation of that code (UnitedHealth Group, 2019).  I should have put aside my discomfort and avoidance of confrontation by being forthcoming with what I saw on her social media profile, which would have aligned with our organization’s expectations regarding integrity (UnitedHealth Group, 2019).    If she was dishonestly using her activity codes at Optum to get some sleep the morning after she worked her other job, perhaps we could have worked together on a solution that did not involve her termination. 

Summary and Conclusion

The agility to apply leadership attributes and behaviors, decision-making techniques, and communication skills appropriate for the situation is essential to effectively lead a diverse team and meet the organization’s objectives.  Leaders also have a vital responsibility to their organization, their profession, and those they lead to model ethical behavior by adhering to an accepted ethical framework and holding those they lead accountable for the same.  Continually reflecting on their actions and behaviors, making adjustments when needed, and keeping themselves and others accountable to the highest professional conduct standards will help leaders be the best they can be for their organization, their profession, and those they lead.   

References

American College of Healthcare Executives. (2017). ACHE code of ethics.  ACHE.org. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursingworld.org. https://www.nursingworld.org/coe-view-only

Bocar, A. C. (2017). Aggressive, passive, and assertive: Which communication style is commonly used by college students? SSRN Electronic Journal.  https://doi.org/10.2139/ssrn.2956807

Karis, D., Wildman, D., & Mané, A. (2016). Improving remote collaboration with video conferencing and video portals. Human-Computer Interaction, 31(1), 1-58. https://doi.org/10.1080/07370024.2014.921506

Luqman, O. O., Windapo, A., & Rotimi, J. O. B. (2016). Relationship between decision-making style, competitive strategies and organisational performance among construction organisations. Journal of Engineering, Design and Technology, 14(4), 713-738. https://doi.org/http://dx.doi.org.library.capella.edu/10.1108/JEDT-04-2015-0025

Su, W., Lyu, B., Chen, H., & Zhang, Y. (2020). How does servant leadership influence employees' service innovative behavior? The roles of intrinsic motivation and identification with the leader. Baltic Journal of Management, 15(4), 571-586. https://doi.org/10.1108/BJM-09-2019-0335

UnitedHealth Group. (2019). Code of conduct:  Our principles of ethics & integrity. UnitedHealthGroup.com. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/UNH-Code-of-Conduct.pdf