REVIEWED BY BELLA O. MAHONEY
Meeting the Leadership Challenge in Long-Term Care: What You Do Matters
By David Farrell, Cathie Brady and Barbara Frank
Health Professions Press, 2011
336 pages, $48.95
I approached these pages with some hesitation. As a long-term care administrator for more years than I care to remember, I have read many books and articles that address issues of leadership, staff development and organizational improvement in long-term care. Yet I found myself surprisingly impressed at the beginning, as I read the foreword by V. and Mary Tellis-Nayak. It was as if someone were describing the life I have lived as an administrator. I thought to myself, someone really understands the stress and the challenges we as nursing home administrators and directors of nursing face on a day-to-day basis.
This is a book of considerable value, although I think its best audience is not seasoned, effective, nursing-home administrators. In my view, much of the information and advice is in the category of relatively basic leadership and management skills — especially helpful to new and inexperienced leaders. The text provides a thorough overview of the stress factors that contribute to long-term care facilities' common problems and offers solutions adaptable to other care settings as well.
David Farrell's personal journal is an interesting section and offers positive insight into the daily activity of a nursing home administrator. It would be important to understand, however, that strategies used in one setting will not necessarily be effective in another. If I have learned anything in my many years managing long-term care facilities under a variety of organizational structures, it is that one size does not fit all.
I noted small inconsistencies. For example, in his journal Farrell refers to interviewing every applicant who applies for a position, yet farther on he notes the need to empower staff to make positive management decisions, including employee selection. As the book so aptly indicates, a long-term care facility, to be well managed, must have a leadership team. This means it is essential that administrators and nursing directors understand their responsibility to mentor and develop staff. In particular, it is essential that processes of care, financial management and human resources be directed by individuals who have specific content expertise.
I certainly would agree with the premise that direct caregivers, in particular certified nursing assistants (CNAs), are a critical factor to success, particularly to patient and family satisfaction, as these are the employees with whom patients and families most often interact. That said, readers should take care to interpret this information in context. In emphasizing the role of CNAs and their importance to the success of the facility, the authors do not explain that all functions of the organization must work in support of one another. A facility could have the best trained, most caring CNAs, but if it doesn't have an effective dietary, housekeeping or financial program, a CNA will not be able to fulfill his or her direct patient-care responsibilities. On another note, I found that the discussions of techniques regarding absenteeism could be used as effective learning devices.
As the management guru Peter Drucker has stated, health care facilities are among the most complicated organizations to manage effectively. The critical factor of leadership requires that a nursing home administrator and the director of nursing understand that all elements of the facility have to work in unison. I think this is an area the authors might address, perhaps in follow-up books.
In general, the authors should be congratulated on publishing a book that is practical and valuable, possibly essential, for those who wish to improve their skills and direct their facilities in such a way that they continually improve.
BELLA O. MAHONEY is president and chief executive at Our Lady of Fatima Villa, Saratoga, Calif.