ICN - Advancing nursing and health worldwide Nursing Leadership in Global Health The art & science of articulating the change David C. Benton

ICN - Advancing nursing and health worldwide www.icn.ch

Nursing Leadership in Global Health

The art & science of articulating the change

David C. Benton RN, PhD, FRCN

Chief Executive Officer

International Council of Nurses

26th February 2014


Archimedes - 220 BC

Mechanics Magazine published in in 1824


Areas to be addressed• Changes to enable

– Nursing’s voice to be more integrated into shaping health policy

– Nursing to have greater involvement in decision making, programme planning and strategy implementation

– Nurses to become more responsive and effective as advocates for patient populations

• .


Nursing’s Voice• What do we know ?

• Few countries have nursing and midwifery personnel providing professional and policy level services in WHO country offices.

• Data from the WHO human resources annual report of January 2013 reveals nursing specialists represent 0.6% of staff in professional and higher categories. Medical specialists represent 90.7% and dieticians and nutritionists (at 2.6 %) and pharmacists (at 2.0%) have greater representation than nurses.

• The situation has deteriorated over the past 40 years. In 1968 there were more than 200 nurses working for the World Health Organization and the representation of nursing specialists was 2.9% in 2001. Since May 2010, the position of Chief Scientist, Nursing and Midwifery has been vacant.



• More diverse than ever before.

• Level of preparation.• Certificate to Masters

• Nurses or Nursing

• Variation in scope.



• Not all bad news.• Nurses in wider government and

intergovernmental position

• More Nurses as part of WHA delegations

• Increasing availability of BSN, MSN and Doctoral provision

• Diversity can provide strength.


An experiment in perceptions


What Did You See?

?


An experiment in perceptions


The Nursing Context

• Clinical Practice• Professional Associations• Regulators• Academia• Trade Unions• Public and Private• Governmental and Non-

governmental agencies• Other Disciplines• Patients, families,

communities and Populations


• Have the facts but don’t stick to a single solution

• Agreeing the key message also provides the potential for synergistic leverage

• See diversity and differing perspectives as multiple opportunities.

The First Three Messages


How is Policy Made?• In a galaxy far far away?

• In a Government near you?

LAW MAKERS

GOVERNMENT

AGENCIES

Making Policy

STAKEHOLDER

INTERESTSThe Iron Triangle

Model


How is Policy Made?• In the Eighties, Ninety's and alive & kicking!

Kingdom’s Agenda Setting Process


The Game Changer?• Brutal criticism

Systematic reviews and concise summaries of findings are rarely used for developing recommendations.

Instead, processes usually rely heavily on experts in a particular specialty, rather than representatives of those who will have to live with the recommendations or on experts in particular methodological areas.

Oxman, Lavis and Fretheim (2007) Lancet 2007; 369: 1883–89DOI:10.1016/S0140-6736(07)60675-8


The Game Changer?• Brutal criticism"This is a pretty seismic event," Lancet editor Dr. Richard Horton, who was not involved in the research for the article.

"It undermines the very purpose of WHO.”

"If countries do not have confidence in the technical competence of WHO, then its very existence is called into question," said Horton.

"This study shows that there is a systemic problem within the organization, that it refuses to put science first."


Some WHO Resources


How is Policy Made?• The complexities of today’s reality

Policy Networks


A focus on health - missed opportunities?


Social Networks – Existing Structures


Social Networks


Social Networks


Social Networks – Impact of LFC (Before)


Social Networks – Impact of LFC (After)


Social Networks – GNLI


Social Networks – GNLI


• Know how policy is made– Who decides, when is it decided, does it get

implemented

• Understand the starting landscape– Knowing where you are helps in setting

challenging but achievable targets

• Remember topography can change– It is sometimes easier and more effective to get

others to carry your message

The Next Three Messages


Nurses as Advocates

• Power• Principles of Influence• Competencies• Opportunities


Sources of Power

• Resource Power• Information• Expertise• Connections• Coercion• Position• Personal Power


The Six Principles of Influence

• Contrast• Commitment & Consistency• Scarcity Value• Social Proof• Linking & Integrating• Emotion


Nurses as Advocates

• Competencies– Leadership – Vision, passion, commitment– Media skills – right story for the right audience– Economics – makes the world go round– Evidence – in god we trust everyone else

brings data– Alliances – achieve more


Who should we influence?

• Governments• Intergovernmental structures

– WHO, UNFPA, UNHCR, etc– WTO, UNESCO– World Bank

• Regional entities (The EU but the rest?)• Employers• GAVI, Global Fund, Gates • National and Transnational Corporations


Transnational Corporations - Opportunities?

• Funding – many have foundations

• Population for health improvement

• Target for carrying your policy message (they often spend a lot on lobbying)

• Raise our profile and our image


Final Four Messages• Map where the power lies in your universe

– You don’t need to be the head of the organisation to hold power

• Use different strategies to influence and remember that you can use more than one at a time– Using a hammer to cut a plank is not a good choice

• Integrate policy competencies into pre-registration and build upon them in post registration– Policy is set and implemented at various levels

• Understand the new policy landscape and who has control of resources– Talk is cheap – implementation is a further opportunity but

requires funding


Just in Case You Want to Move the World

http://www.starstryder.com/2008/02/18/with-a-lever-i-move-the-earth/


Bibliography Part 1• Benton D.C. (1999) Seize the moment: opportunities for parliamentary lobbying in Scotland.

Nursing Standard 14:5,16-17

• Benton DC. (1999) Assertiveness, Power and Influence Nursing Standard 13:52, 48-52

• Benton, D.C. Fernandez-Fernandez, M.P. (2014) Social network analysis: A tool for the identification of next generation trainers. Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. http://dx.doi.org/10.1016/j.colegn.2013.08.001

• Borgatti,, S. P., Everett, M.G., and Johnson, J.C. (2013) Analyzing social networks. London, Sage Publications Ltd.

• Lavis, J.N., Oxman, A.D., Souza, N.M., Lewin, S., Gruen, R.L., Fretheim (209) Health Research Policy and Systems 7(Suppl 1):S9 http://www.health-policy-systems.com/content/7/S1/S9

• National Collaborating Centre for healthy public policy (2012) A Framework for Analyzing Public Policies: Practical Guide. Québec, Institut national de santé publique. http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf

• Oxman, Lavis and Fretheim (2007) Lancet 369: 1883–89 DOI:10.1016/S0140-6736(07)60675-8

http://dx.doi.org/10.1016/j.colegn.2013.08.001



http://www.health-policy-systems.com/content/7/S1/S9

http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf

http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf


Bibliography (Part 2)• UNCTAD (2007) The universe of the largest transnational corporations: UNCTAD current studies

on FDI and development No 3. New York, United Nations. http://unctad.org/en/docs/iteiia20072_en.pdf

• Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R. Gilson, L (2008) Health Policy and Planning, 23:5, 308-317.http://heapol.oxfordjournals.org/content/23/5/308.full.pdf

• WHO (2009) Systems thinking for health systems strengthening. Geneva, WHO. http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf

• WHO (2010) WHO Country Cooperation Strategies: Guide 2010. Geneva, WHO. http://www.who.int/countryfocus/cooperation_strategy/WHO-CSS_Guide2010_Eng_intranet_24sep10.pdf

• WHO (2012) Changing Mindsets: Strategies on health policy and systems research. Geneva, WHO. http://apps.who.int/iris/bitstream/10665/77942/1/9789241504409_eng.pdf

http://unctad.org/en/docs/iteiia20072_en.pdf

http://heapol.oxfordjournals.org/content/23/5/308.full.pdf

http://heapol.oxfordjournals.org/content/23/5/308.full.pdf

http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf

http://www.who.int/countryfocus/cooperation_strategy/WHO-CSS_Guide2010_Eng_intranet_24sep10.pdf



http://apps.who.int/iris/bitstream/10665/77942/1/9789241504409_eng.pdf

http://apps.who.int/iris/bitstream/10665/77942/1/9789241504409_eng.pdf

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ICN - Advancing nursing and health worldwide Nursing Leadership in Global Health The art & science of articulating the change David C. Benton