Étude descriptive qualitative de l'exercice du leadership stratégique de directions des soins infirmiers visant la qualité des soins des établissements de santé en réforme au Québec

In spite of the significant impact of nursing on the performance of health care organizations, the practice of chief nursing offices’ strategic leadership oriented towards high quality of nursing care remains poorly documented. This type of leadership refers to the ability of the chief nursing officer and her team, positioned in the health care organization’s higher levels, to work strategically with other executives so as to provide effective and efficient health care to patients and their relatives. Aim of the study: To describe the strategic leadership practice of chief nursing offices regarding the quality of nursing care in the health care organizations of Quebec. This is done using a frame of reference based on elements from two models: An Integrative Model of Strategic Leadership (Boal et Hooijberg, 2000) and Fitting Strategic Leadership Into the Strategic Framework (Hambrick, 1989). Method: A qualitative descriptive research was conducted among senior and middle managers of Quebec’s chief nursing offices. The sample consisted of thirty-five (N=35) participants from 18 chief nursing offices out of the 34 health care organizations, corresponding to a participation of 53% of Quebec’s chief nursing offices. Three focus groups as well as 31 semi-structured interviews were conducted. Findings: It appears that in order to practice strategic leadership, chief nursing offices should: 1) take ownership of their strategic positioning to influence the quality of nursing care, 2) develop and communicate a clear vision of quality nursing care, 3) make strategic, systematic and measured, choices focused on the quality of nursing care to guide the contribution, 4) reframe the roles to increase the influence regarding the quality of nursing care, 5) be involved in strategic decision-making process, 6) develop political capacity to influence the quality of nursing care and 7) establish strategic and collaborative alliances focussed on the quality of nursing care. Moreover, the clinical credibility and a team comprising an adequate number of educated (graduate-level) people, promotes the strategic leadership practice of chief nursing offices. The culture and size of the organization are the organizational components that constrain the practice of chief nursing offices’ strategic leadership. Finally, the efficiency of the strategic leadership practiced by the chief nursing offices depends on their ability to strike the right balance between hierarchical and transversal governance for an optimal contribution to the quality of nursing care. Conclusion: Results indicate that the practice of strategic leadership generates influential areas, allowing not only the improvement of the chief nursing offices’ contribution to the quality of nursing care, but also to the overall quality of the organizations. Chief nursing offices can refer to these results in order to continue the development of strategies aimed at improving the quality of nursing care in constantly evolving organizations of increasing complexity.

Keyphrases: Strategic leadership, Executive-level nursing leaders, Capacities, Chief nurse offices, Descriptive qualitative research, Quality of nursing care