The Responsive Leadership Intervention: Improving Leadership and Individualized Care in Long-Term Care

Caspar, S., Le, A., & McGilton, K. S. (2017). The responsive leadership intervention: Improving leadership and individualized care in long-term care. Geriatric Nursing (New York, N.Y.)38(6), 559–566.

Health care aides (HCAs) provide 80-90% of the direct care to long-term care (LTC) residents; they play an essential role in the provision of high quality, individualized care because they are arguably the most knowledgeable team member with regards to daily resident care preferences and concerns.

Reviews of the literature indicate the existence of low levels of interdisciplinary respect, communication, and collaboration among HCAs and other professional care staff in LTC settings. Thus, HCAs’ unique and important understanding of residents’ care needs is often excluded from the residents’ care plans, and they are unable to influence organizational decisions regarding care practices. This results in low levels of empowerment and self-determination and ultimately influences the quality of individualized care residents receive in these environments.

Incorporating team huddles into the daily care practices in LTC facilities may be one way to improve communication, information sharing, and collaboration among these essential care-team members, thereby increasing the provision of individualized care in these institutions. Team huddles are small group meetings during which each member has the opportunity to exchange information vital to the team’s performance. The use of huddles can result in improved collaboration and information sharing in the workplace. However, successful initiatives designed to improve team communication and collaboration depends on supportive and responsive leadership. Supportive supervisors and team leaders in LTC settings positively impact HCAs’ stress, job satisfaction, and turnover. In addition, research has shown that supportive and positive leadership practices play a fundamental role in the transfer and sustained use of best practice guidelines in clinical decision making. Despite these findings, there have been few training interventions in LTC facilities developed to enhance nursing supervisors’ leadership and supervisory skills.

Summary: These findings guided the development of the Responsive Leadership Intervention (RLI) multi-faceted intervention. This study offers evidence that the RLI is an acceptable method for improving responsive leadership practices by team leaders in LTC settings. Following the intervention, HCAs perceived that their team leaders were more supportive at 1, 3 and 6 months post intervention. Improving leadership skills in institutions has been associated with increased ties among employees, lower employee turnover, fewer conflicts, greater involvement of people in the work process and better use of resources. In addition, effective leadership has been linked to sustainability of program change in healthcare settings. This study also demonstrated that the RLI results in increasing the HCAs’ perceived ability to provide individualized care. This study’s promising results indicate that the RLI is a feasible method for improving leadership practices and individualized care in LTC facilities.