Phase II: Implementation of the Dyad Model in a Children's Hospital

Introduction: The Dyad Model of Leadership (DML) consists of a qualified physician and a qualified non-physician manager leading a service line or unit in unison.  The children’s hospital nursing leadership team held the belief that leadership models utilizing the DML would be an effective approach to aligning the hospital’s leadership vision.  The DML engages the physician in areas previously left to the nurse leader.  The dyad style of leadership promotes staff to be engaged and empowered in a continuous improvement environment.

     Background and Significance: The DML is supported in the literature for increased employee engagement, decreased stress to the nurse leader, and an increased voice of the patient in adult care settings (Brueggemann & Zismer, 2010).  Literature supported leadership education and extensive leadership training for the physician.  Educated physician leaders were then utilized in the executive role.  There is limited evidence of DML implementation consisting of a nurse leader and medical director dyad with Pediatric patients.  Pediatric patients are not always capable of speaking for themselves.  Therefore, leaders must be able to lead a staff capable of providing care for the unique population.  

     Literature Review: The literature supported the concept of physicians as leaders.  McAlearney et al. (2005) indicated the current changes in health care required physician leaders be created.  Physician leaders are impactful for resource utilization, delivering and influencing medical care and changes in medical practice.  Literature was lacking studies including the nurse leader and medical director dyad in the pediatric setting, indicating the need for further research in this area.

     Planning:Since the literature revealed limited support of a team approach to provide a favorable work environment for employees, but also to provide quality care of the pediatric population.  Therefore, research of Dyad Model of Leadership implementation began.  During Phase I the pre-education survey revealed a low understanding of the DML by Medical Directors and a fair understanding by the Nurse Managers.  Following results of Employee Satisfaction surveys, nursing leadership was concerned with the high percentage of “partially engaged” employees and decided to take action.    

   Summary of Phase I:All Phase I data was pre education/implementation.   The researcher created a survey tool to measure pre and post understanding of the expectations and effectiveness of the implementation of the DML.  Of the four units, the survey was completed by each unit’s Nurse Manager and Medical Director.  Data was entered into SPSS version 23 and frequency distributions and tables were created. The results revealed: a standard deviation range from a low of .37 (one physician result) to a high of 1.49 (one nurse manager) the range of the mean ran from 3.2 to 4.8. The median and the mode results were exactly the same for each participant response to the survey questions. The initial results for the Avatar Solutions Analysis (2015) standardized assessment of employee engagement revealed approximately one third of all units are actively engaged.  The actively disengaged ranged from a low 4.6% in the PICU to a high level of 8.6% disengagement in the NICU.  Most concerning to nursing leadership was the percentage of partially engaged employees.  The partially engaged employees ranged from a low of 54.3% in the PMSU to a high level of 59.6% in the PED.  This pre-implementation data alone held limited value. The data will be of greater significance when comparison to post implementation data is available for analysis to provide results needed and answer the research question. Still, the pre-implementation data was an important step for the completion of the study and should be reported along with Phase II data analysis.

     Description of Phase II: The educational intervention focused on relationship building, understanding DML and how to effectively function as a dyad leadership team, increase leadership skills, and understand High Reliability Unit principles and application.   Four hour educational sessions were provided quarterly.  The initial sessions were planned for the Medical Director and Nurse Manager of each unit in the Children’s hospital.  Following the education sessions of the dyad leadership groups, each unit completed a post education survey.  Results of Phase II will be presented at Research Congress July 2016.