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Meso Level Leadership and Friendliness at the Clinic

The concept of patient experience that is usually compared to satisfaction has been already studied by several researchers to prove its complexity and importance in health care. The investigations show that some organizations face the same mistake in their intentions to rate the level of satisfaction instead of rating the factors that are usually experienced by a patient before, during, and after caregiving (Berkowitz, 2016; Zgierska, Rabago, & Miller, 2014). The two videos with the examples of communication between patients and the medical staff developed in Care Clinic demonstrate the style and attitudes of the personnel to their patients and prove that certain improvements are required in terms of client services and quality indicators.

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Though it seems that the team understands the rules of appropriate communication with patients and follows the standards of primary and clinical care, there are some doubts about people’s true intentions and their desire to cooperate. There are many hidden moments in clinical care; therefore, the decrease of client satisfaction scores related to courtesy and friendliness of staff at the Care Clinic is the chosen benchmark to be addressed in this project due to the necessity to understand why the results of the clinic have been dramatically worsened and clarify if it is possible to promote some changes.

Reasons for Low Scores

The main reasons for a remarkable decrease in patient satisfaction are the attitude of the medical staff to their patients and the inability to demonstrate personal emotions and support to clients. On the one hand, the staff knows that it is necessary to greet a patient, ask several general questions about the current condition, and explain further steps. On the other hand, all these steps may be taken in different ways, and the way chosen by the employees of Care Clinic is not correct. They look like being not interested in what they have to do. Nurses and doctors say that they are busy to clarify the details of treatment. In one case, the medical worker says that additional information and required explanations will be given during the next visit because at this moment she does not have time. Patients feel the medical staff care and desire to help. In both videos, neither friendliness nor courtesy is demonstrated. Nurses neglect their duties, lie to cover certain professional mistakes, do not wash hands, and do not even change the pill when it falls on the floor. These reasons should be enough to explain why the level of patient satisfaction is decreased.

Leadership Dynamics

Values of System Leadership

Effective leadership in health care is one of the main aspects to strengthen the quality and succeed in management. It is not enough to provide the healthcare workers with clear instructions and requirements and expect that all of them follow these rules and provide high-quality care. Effective leadership is a possibility to establish professional relationships between a person who leads and individuals who follow a leader and explain the required behaviors, coordinated activities, and professional goals (Sfantou et al., 2017). Leadership is an example of the behavior that has to be followed while directing the activities of different people and promoting change (Al-Sawai, 2013). Finally, leadership is a properly developed system with the help of which reality can be seen from different perspectives to encourage people to discover their best qualities (Senge, Hamilton, & Kania, 2015). The Care Clinic improvement plan has to be based on the identification of the leadership qualities and the requirements that cannot be neglected.

From the perspective of system leadership, there are several important values to be considered by an effective leader in the chosen healthcare facility. First, a leader has to understand the importance of change and promote this requirement among all team members. Despite a variety of leadership styles and approaches to cooperate with people, change remains one of the most influential and hard-to-resist requirements (Al-Sawai, 2013). In addition to micro-level leadership where the relationships between a leader and a follower are discussed and macro-level leadership where the influence of leaders on social groups is identified, there is meso level leadership within the frames of which interorganizational changes are evaluated to promote the achievement of collection action (Wukich & Robinson, 2013). Therefore, passion for change is a crucial value of system leadership that has to be used in Care Clinic.

The second value is based on openness and flexibility of leaders. These qualities help to support meso level leadership and understand what should be done with new information and how to navigate the activities of a team (Wukich & Robinson, 2013). For example, in the recorded video, the patient is too polite to report on the nurse’s lie when she says that she has already managed to check the patient’s vital signs without even starting a physical examination. Such situation proves that openness has to be encouraged in a team in order to promote high-quality services and increase patient satisfaction.

The third value is a cooperation of leaders with their teams. A leader has to be aware of the team’s needs and understand how to use these needs in the work of the organization. Coordination has to be voluntary to develop strong relationships, use available resources, and involve the required stakeholders (Wukich & Robinson, 2013). Open communication and cooperation make it possible to remove fears and doubts, clarify the expectations of leaders, and introduce the services that are necessary for patients.

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The next value is information exchange. Sometimes, not all team members use the same amount of information. Therefore, leaders have to check how employees hare information and what improvements may be required. Friendliness can be determined by the way of how the information is given. Even if a medical worker is not able to provide the required service in time, it is possible to give clear explanations and exchange information in a friendly and clear way so that the patient may understand the reasons and support a person.

The fifth value includes the necessity to focus on processes. Leadership is the field where a number of steps have to be taken, and several activities of different people have to be controlled. Leaders should be involved in these activities and understand that their example can be a serious contribution to the performance of the whole clinic.

Finally, evaluation has to be defined as a serious value of the system leadership perspective. It is not enough to control, give examples, and explain something. It is also necessary to be ready to evaluate the work of other people, as well as personal progress. Evaluation of patient satisfaction is based on the evaluation of organizational needs and resources (Zgierska et al., 2014). The combination of all these issues is a part of the success of the clinic and the possibility to improve the level of satisfaction in a short period of time.

Strategic Leadership

In this care improvement project, the approach known as strategic intelligence can be used to share such qualities as foresight, visioning, partnering, and motivating. The ability to foresight helps to scan a situation, identify threats and opportunities, and start designing future implementations. Visioning is used to recognize all options and define the offerings and organize the work of people in a proper way. Partnering is a crucial issue to identify a team for improvement, investigate what patients think about current services, and understand if it is necessary to invite additional suppliers and stakeholders. In addition, partnership promotes communication and negation between the team in order to realize what can be done at this moment. Finally, leaders have to be good at motivating the team. In Care Clinic, the base of employees is strong. They are knowledgeable and responsible. The only problem is the inability to use their skills in a proper, friendly way. A leader has to use the already gained skills of employees and guide them.

Relationship-Based Care

Culture plays an important role in healthcare settings. Therefore, a relationship-based care approach can be used by a leader to improve safety and quality of services and increase the scores of patient experience, as well as employee engagement in the workplace. As a part of the relationship-based care approach, leaders have to focus on their professional skills, the needs of patients, and the abilities of colleagues. Team connection is the key to success in this improvement plan. It promotes lifelong learning, personal contributions to organizational success, and the exchange of information at different levels.

Change Model

Elements of the Model

In addressing the problem of the clinic, which is the lack of a friendly and supportive environment for patients, it is suggested to use the ADKAR model that includes the possibility to educate the staff, explain the change, and motivate all participants. There are five main elements of the model. Awareness is the first stage that includes the necessity to recognize the need for change in the setting. The decrease in patient satisfaction scores is a solid reason for thinking about new actions and improvements. The next element is Desire according to which a leader has to support change and make sure that all employees participate in it. Knowledge is the third step in the model according to which the participants have to be aware of how the change can work and what skills should be used (Shepherd, Harris, Chung, & Himes, 2014). The last but one element is Ability with the help of which it is possible to implement the change and make sure it helps the organization. Finally, Reinforcement is required to sustain change and reward all participants (Shepherd et al., 2014). A specific order of these steps is integral because it indicates where change has to be identified, implemented, and analyzed.

Application and Leadership

This change model is applicable for a quality indicator in clinical care. It is required to educate the staff and explain how to develop trustful relationships with patients despite their business, personal problems, and organizational duties. A patient is a core of care for the clinic, and employees have to know how to demonstrate respect, care, and understanding. ADKAR is chosen because of the possibility to combine education of medical workers and the opinions of patients. It is wrong to inform the staff about the necessity to change. It is necessary to make sure that employees have enough background knowledge and know what they do wrong and right in the clinical setting.

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The leaders of the clinic benefit from the ADKAR model and improve its stability because of the sequential nature of the work. The role of a leader to support this change process includes the identification of the goal (the establishment of friendly relationships with patients), the invitation of the participants (all medical workers who have to cooperate with patients), and the explanation of the steps (open communication, explanations, details, and support). The presence of such skills as trustworthiness, creativity, communication, and motivation can help the leader to support the change and assist the personnel in accepting all new requirements.

Course of Action


Several groups of stakeholders have to be involved in this change process. First, a leader should clarify the goals and the problems of the organization. Second, nurses and other medical employees of the clinic have to be invited to participate in this change. Patients introduce a group of people whose influence remains crucial for the clinic. Their opinions and suggestions can be used as motivation and inspiration for a leader and every nurse. Finally, it is possible to introduce several educators who can help to understand why changes are important in this setting from the point of view of non-native employees. In other words, the evaluation of the clinical performance by several outside managers can be a helpful tool.


A new process will address the gaps and problems in the area of the development of friendly and courteous relationships between patients and medical workers. Regarding the change model offered and the goals established, positive results may be observed in the next month after its implementation. A list of steps that have to be taken in a logical order is as follows:

  1. Opinions of patients about care and services are gathered to identify the main problematic areas;
  2. Several clear examples are used to prove the presence of a problem;
  3. Several meetings and discussions should occur to check the readiness of the staff to participate in the change and promote improvements;
  4. Reasons for poorly-developed relationships between patients and nurses have to be given;
  5. Available sources and exchange of information should help to clarify the options and abilities of the participants;
  6. The participants receive new instructions and follow the rules demonstrating positive attitudes to all patients;
  7. The evaluation of the work done is required through the opinions of patients and score changes.


In general, many hospitals, care clinics, and other healthcare organizations aim at improving their scores and providing patients with the best services. A number of significant drivers measure the quality of performance and cooperation that can be developed between a patient and the medical staff. When the team of Care Clinic faces the necessity to improve its services and re-organize its work, a number of questions and requests take place. However, the main task is to understand why the low scores have been attained and if one particular person or a group of people should be blamed for such development of the events. The ADKAR model of change may be used to support the improvements and positive attitudes of the team to their patients. Fair and open communication, respect, care, and support are the main elements of the change that is promoted by a system leader. Regarding the final action plan, such goals as increased patient satisfaction, cooperation, and performance evaluation can be achieved.


Al-Sawai, A. (2013). Leadership of healthcare professionals: Where do we stand? Oman Medical Journal, 28(4), 285-287.

Berkowitz, B. (2016). The patient experience and patient satisfaction: Measurement of a complex dynamic. The Online Journal of Issues in Nursing, 21(1). Web.

Senge, P., Hamilton, H., & Kania, J. (2015). The dawn of system leadership. Stanford Social Innovation Review, 13(1), 27-33.

Sfantou, D.F., Laliotis A., Patelarou, A.E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare 5(4), 73-89.

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Shepherd, M.L., Harris, M.L., Chung, H. & Himes, E.M. (2014). Using the awareness. Desire. Knowledge. Ability. Reinforcement model to build a shared governance culture. Journal of Nursing Education and Practice, 4(6), 90-104. Web.

Wukich, C., & Robinson, S.E. (2013). Leadership strategies at the meso level of emergency management networks. International Review of Public Administration, 18(1), 41-59. Web.

Zgierska, A., Rabago, D., & Miller, M. M. (2014). Impact of patient satisfaction ratings on physicians and clinical care. Patient Preference and Adherence, 8, 437-446. Web.

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