University of Ghana http://ugspace.ug.edu.gh Succession planning practices SCHOOL OF NURSING COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA, LEGON SUCCESSION PLANNING PRACTICES AMONG NURSE MANAGERS AT KORLE BU TEACHING HOSPITAL ADELAIDE BOAMPOMAAH DAPAA 10636836 THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MASTER OF PHILOSOPHY DEGREE IN NURSING. JULY 2019 University of Ghana http://ugspace.ug.edu.gh Succession planning practices DECLARATION I declare that this research study is a true work of mine; it has not been submitted in part or full for any degree or diploma at any university or educational institution. Information derived from published works and texts from books have been duly acknowledged. ................................................................... ………………. ADELAIDE BOAMPOMAAH DAPAA DATE (STUDENT) The under signed certify that the supervisors have read this research work and recommend it to the school of Nursing for acceptance. ............................................. ................................... DR ADELAIDE MARIA ANSAH OFEI DATE (SUPERVISOR) ........................................... ......................................... MRS ATSWEI ADZO KWASHIE DATE (CO- SUPERVISOR) i University of Ghana http://ugspace.ug.edu.gh Succession planning practices ABSTRACT The pivotal role nurse managers’ play in hospitals cannot be overemphasized and as with most roles of similar nature, a great deal of knowledge and skill is needed for effective and efficient outcomes. Many nurse managers however, assume managerial positions without adequate formal preparation due to the absence of clear cut lines of succession and are therefore, faced with numerous challenges which affect patient outcomes and staff satisfaction. This study hence sought to explore the practice of succession planning among nurse managers at the Korle Bu Teaching Hospital, using the exploratory descriptive design. Twelve (12) nurse managers were purposely selected and interviewed using a semi-structured interview guide. The study was guided by the Leadership Succession Planning and Development framework. Data was analysed using thematic content analysis. The study found out that, succession planning increases nurses’ sense of career planning, helps retain intellectual capital and also helps in organizational vision attainment. The ranking system of progression is the main criteria nurse managers use in the appointment of potential successors. Challenges nurse managers encounter or perceive to encounter in the practice of succession planning include; frequent reshuffling, the tendency to generate conflict, a lack of incentives for nurse managers, and the ranking system of progression in nursing. Strategies that can be used to enhance the practice of succession planning include; promotion with preparation, provision of incentives for nurse managers, transparency in the succession planning process and talent identification. Potential nurse managers need to be identified at an early stage in their career and given the necessary preparation through a structured succession planning program to ensure efficiency and effectiveness when they assume managerial roles. ii University of Ghana http://ugspace.ug.edu.gh Succession planning practices DEDICATION I dedicate this work to my son, Kwaku Adanse Twum Offei, who started this work with me in-utero and subsequently had to endure the absence of a mother when he needed it most. iii University of Ghana http://ugspace.ug.edu.gh Succession planning practices ACKNOWLEGEMENT I am most grateful to the Most High God for granting me good health and a sound mind throughout this academic exercise My earnest gratitude goes to my supervisors, Dr. Adelaide Maria Ansah Ofei and Mrs. Atswei Adzo Kwashie for the brainy experience they guided me with to ensure this work comes to fruition. A very special gratitude goes to my husband, Mr. Samuel Offei for his encouragement, understanding and enormous support throughout the course of this project. I also wish to express my profound gratitude to my mother, Madam Lucy Asiamah for her support and prayers in the writing of this thesis. I again acknowledge the contributions of all teaching and non-teaching staff of the School of Nursing and Midwifery, University of Ghana, Legon, for the knowledge, support and guidance, which led to the successful completion of this thesis. My sincerest gratitude also goes to all the Nurse managers at Korle Bu Teaching Hospital, who offered their time and knowledge as a priceless contribution to the success of this work. Finally, I acknowledge all authors whose work I have cited, which served as essential materials to broaden my scope of understanding of the subject area. iv University of Ghana http://ugspace.ug.edu.gh Succession planning practices TABLE OF CONTENTS DECLARATION ............................................................................................................................. i ABSTRACT .................................................................................................................................... ii DEDICATION ............................................................................................................................... iii ACKNOWLEGEMENT ................................................................................................................ iv TABLE OF CONTENTS ................................................................................................................ v LIST OF TABLES ....................................................................................................................... viii LIST OF FIGURES ....................................................................................................................... ix CHAPTER ONE ............................................................................................................................. 1 1.0Introduction ............................................................................................................................ 1 1.2 Purpose of the Study.............................................................................................................. 7 1.3 Objectives of the Study ......................................................................................................... 7 1.4 Research Questions ............................................................................................................... 7 1.5 Significance of the Study ...................................................................................................... 8 1.6 Operational Definition of Terms ........................................................................................... 8 CHAPTER TWO ............................................................................................................................ 9 LITERATURE REVIEW ............................................................................................................... 9 2.1 Conceptual Framework ......................................................................................................... 9 2.2 Review of related literature ................................................................................................. 14 2.3. Knowledge of Succession Planning ................................................................................... 14 2.4 Importance of Succession Planning .................................................................................... 17 2.5 Challenges Associated with Succession Planning............................................................... 19 2.6 Strategies for enhancing succession planning ..................................................................... 21 2.7 Current Practice of Succession Planning............................................................................. 24 2.8 Summary of Literature Review ........................................................................................... 26 CHAPTER THREE....................................................................................................................... 28 RESEARCH METHODOLOGY.................................................................................................. 28 3.0 Introduction ......................................................................................................................... 28 3.1 Research Design .................................................................................................................. 28 3.2 Research Setting .................................................................................................................. 29 v University of Ghana http://ugspace.ug.edu.gh Succession planning practices 3.3 Target Population ................................................................................................................ 30 3.3.1 Inclusion Criteria .......................................................................................................... 30 3.3.2 Exclusion Criteria ......................................................................................................... 30 3.4 Sample Size ......................................................................................................................... 31 3.5 Sampling Technique ............................................................................................................ 31 3.6 Research Instrument ............................................................................................................ 32 3.7 Data Collection Procedure................................................................................................... 32 3.8 Data Management................................................................................................................ 33 3.9 Data Analysis ...................................................................................................................... 34 3.10 Methodological Rigour (Trustworthiness) ........................................................................ 35 3.10 Ethical Consideration ........................................................................................................ 37 CHAPTER FOUR ......................................................................................................................... 39 4.0 Findings................................................................................................................................... 39 4.1 Socio-Demographic Characteristics of Participants ............................................................... 39 4.2 Organization of Themes and Sub-themes ............................................................................... 42 4.3 Knowledge on Succession Planning ....................................................................................... 43 4.3.1 Identifying and Developing Potential Leaders ............................................................. 43 4.3.2 Rising through the ranks ............................................................................................... 45 4.3. Importance of Succession Planning................................................................................ 46 4.3.1Organizational Vision Attainment ................................................................................. 46 4.3.2 Increased Sense of Career Planning ............................................................................. 47 4.3.3Retention of Intellectual Capital .................................................................................... 48 4.4 Challenges Associated with Succession Planning .................................................................. 49 4.4.1 Frequent Reshuffling .................................................................................................... 49 4.4.2 Ranking System of Progression.................................................................................... 51 4.4.3 Lack of Incentive .......................................................................................................... 52 4.4.4 Tendency to generate conflict....................................................................................... 54 4.5 Strategies to enhance Succession Planning............................................................................. 55 4.5.1 Promotion with preparation .......................................................................................... 56 4.5.2 Provision of Incentives ................................................................................................. 57 4.5.3 Transparency in the succession planning process ........................................................ 58 4.6Current Practice of Succession Planning ................................................................................. 60 vi University of Ghana http://ugspace.ug.edu.gh Succession planning practices 4.6.1 Ranking system of succession ...................................................................................... 60 4.6.2 Mentoring ..................................................................................................................... 62 4.7 Summary of Findings .............................................................................................................. 63 CHAPTER FIVE .......................................................................................................................... 66 DISCUSSION OF FINDINGS ..................................................................................................... 66 5.1 Knowledge on Succession Planning.................................................................................... 66 5.2 Importance of succession planning ..................................................................................... 68 5.3 Challenges associated with succession planning................................................................. 71 5.4 Strategies used to enhance succession planning.................................................................. 74 5.5 Current practice of succession planning .............................................................................. 77 5.6 Summary of Discussion....................................................................................................... 78 CHAPTER SIX ............................................................................................................................. 80 SUMMARY, CONCLUSION AND RECOMMENDATION ..................................................... 80 6.1 Summary of the study.......................................................................................................... 80 6.2 Implications of the Study .................................................................................................... 84 6.2.1 Implications for Nursing Practice..................................................................................... 84 6.2.2 Implication for Nursing Research .................................................................................... 85 6.2.3 Implication for Nursing Education ................................................................................... 85 6.3 Lessons Learnt from the Study............................................................................................ 85 6.4 Limitations of the Study ...................................................................................................... 86 6.5 Conclusion of the Study ...................................................................................................... 86 6.6 Recommendations of the Study........................................................................................... 87 6.6.1 Recommendation to Korle Bu Teaching Hospital (KBTH) .................................... 88 6.6.2 Recommendation to Nursing Administration .......................................................... 88 REFERENCES ............................................................................................................................. 89 APPENDIX A INTERVIEW GUIDE ........................................................................................ 97 APPENDIX B CONSENT FORM ........................................................................................... 100 APPENDIX C LETTER OF INTRODUCTION FROM SONM ............................................ 104 APPENDIX D NOGUCHI CLEARANCE................................................................................. 105 APPENDIX E KBTH CLEARANCE......................................................................................... 106 APPENDIX F KBTH STC/IRB APPROVAL........................................................................... 107 APPENDIX G LETTER OF INTRODUCTION FROM KBTH................................................ 108 vii University of Ghana http://ugspace.ug.edu.gh Succession planning practices LIST OF TABLES Table 4. 1 Socio-Demographic Data of Participants..................................................................... 40 Table 4.2 Summary of Thematic Findings.................................... Error! Bookmark not defined. viii University of Ghana http://ugspace.ug.edu.gh Succession planning practices LIST OF FIGURES Figure 1: The Leadership Succession Planning and Development Framework, Copyright 2015, from the Doctor of Nursing Practice and the Nurse Executive Role (p.172) by Rundio and Wilson (2015). All rights reserved……………………………………………………………14 ix University of Ghana http://ugspace.ug.edu.gh Succession planning practices LIST OF ABBREVIATIONS Acronym Meaning ACCN American Association of Critical Care Nurses AONE American Organization of Nurse Executives CINAHL Cumulative Index to Nursing and Allied Health Literature DDNS Deputy Director of Nursing Services IRB Institutional Review Board KBTH Korle Bu Teaching Hospital MOH Ministry of Health NM Nurse Manager NMs Nurse Managers NMC Nursing and Midwifery Council NMIMR Noguchi Memorial Institute for NO Nursing Officer PNO Principal Nursing Officer SNO Senior Staff Nurse SN Staff Nurse SP Succession Planning SONM School of Nursing and Midwifery x University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER ONE 1.0 Introduction Nurse managers play a vital role in ensuring patient and staff satisfaction. They manage both human and material resources. Since nursing staff is the largest and most costly resource in health care facilities, many organizations spend much of their time and energy trying to maximize the productivity of nurses (Ofei, 2015). These organizations are incontrovertibly drawn to the role of the nurse manager in the unit, who is the pivot on which staff engagement, productivity, quality outcomes and positive experiences rest (Cathcart, Greenspan, & Quin, 2010; DeCampli, Kirby, & Baldwin, 2010; Espinoza, Lopez-Saldana, & Stonestreet, 2009; Hawkins, Carter, & Nugent, 2009; Shirey, 2008; Wendler, Olson-Sitki, & Prater, 2009). The all-important role of nurse managers requires a great deal of knowledge and skill to aid in the achievement of organizational goals. The appointment of nurse managers therefore, needs to be well thought out and executed following due process, incorporating various forms of education and skill-based training as well as mentorship and coaching. Kim and Thompson (2012) reported that, high-performing healthcare organizations utilized leadership succession planning programs to retain intellectual capital by identifying and supporting employees with potential for promotion. McAlearney, (2005) also asserted that, structured leadership development programs increase the calibre and quality of the workforce through mentoring, coaching, and educating leaders. 1 University of Ghana http://ugspace.ug.edu.gh Succession planning practices According to Harrison, McKinnon, & Terry (2006), succession planning “refers to a systematic process of developing individuals to fill an organization’s key roles”. When an organization has a well-planned succession planning and management program, there are several qualified people available who are prepared to transition into a number of leadership roles (Harrison , McKinnon &Terry, 2006). Shirey (2008) noted that, succession planning supports seamless leadership transition; ensures positive performance of the organization; and inspires individual professional growth. In the Ghanaian context, nurse mangers are mostly appointed, based on their years of service. The longer one stays in service, the greater the likelihood that, that individual would assume a managerial position, sooner or later. Conners, Dunn, Devine, and Osterman (2007) are however of the view that, the fact that an individual is a good clinical nurse does not mean he/she would make an effective manager. Potential nurse managers need to be identified at an early stage in their carrier and nurtured for their future managerial positions. It is no longer acceptable to hire new leaders who do not have the required emotional and professional competence to manage the complexity of their emerging roles (American Association of Critical-Care Nurses [AACN], 2017]). Hannon (2014) conducted a qualitative research study investigating succession planning in healthcare organizations. This investigator discovered that succession planning improved organizational ability to fill vacant leadership positions, decreased recruitment costs, improved career opportunities for emerging leaders, and increased participant commitment to the organization. Once individuals feel that they are part of an organization and have clear cut lines of career progression, they are likely to remain with the organization and follow through with their career. The sad news is that, most nurse 2 University of Ghana http://ugspace.ug.edu.gh Succession planning practices managers frequently assume new and expanded roles without adequate education, resources, or support. A climate of stability is maintained when the transition between top level leaders occurs smoothly and this is perceived internally by employees, as well as externally, by the public. With SP, there is an increased likelihood that the organization’s strategic vision will be maintained because the next leader has been groomed with existing leadership still in command and also, the needed skill and knowledge for the job is achieved, keeping the next leader on track. Not preparing for inevitable change places an organization at risk of not achieving their intended goal (Cross, 2009). Earlier researchers, such as, (Aroian et al., 1997), asserted that nurse managers are regarded as one of the most important assets in hospitals. The successes and failures of any healthcare organization depend largely on nurse managers (Jasper & Crossan, 2012) because they exert control at the most operational level of organizations. Every management decision made by nurse managers, eventually, has a direct or indirect influence on patient outcomes making their roles one that requires careful placement. The advantage of having a succession-planning program in place has been described by some authors. Kim & Thompson (2012) asserted that, high-performing healthcare organizations make use of leadership succession-planning programs to retain intellectual capital by identifying and supporting employees with potential for promotion. Brunero, Kerr, & Jastrzab (2009), in a study on development and evaluation of a succession planning program, in Australia found that, SP gives nurses a great understanding of their career pathway and also aids them in planning their career. 3 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Empirical documentation on succession planning among nurse managers in the Accra Metropolis is absent and documentations that were found, focused on how nurse managers plan care. There is the need for potential nurse leaders to assume the nurse manager role by succession, thereby ensuring that, nurse managers are well groomed and prepared for the position. The study hence sought to explore the practice of succession planning among nurse managers at the Korle Bu Teaching Hospital. 1.1 Problem Statement Research has characterized the frontline nurse manager role as frustrating, overwhelming and demanding (Wendler, Olson-Sitki, & Prater, 2009). Nurse managers are faced daily with roles ranging from managerial to clinical, social and even interpersonal domain. Nurse managers need to be skilled and knowledgeable in almost all the facets of management to help them attain the operational goals of the organization. New nurse managers are however, often promoted within direct care nurse ranks, with limited or no formal training but are expected to work effectively and efficiently (DeCampli, Kirby, & Baldwin, 2010 ; Marrelli & Hilliard, 2004). Although these nurse managers may possess some skills such as communication skills and great human relations skills, they often lack skills in managing and leading, which requires formal education and training (Jasper & Crossan, 2012). In accordance with the nature and importance of nurse managers in ensuring both client and staff satisfaction, it is imperative to understand their role, appreciate the challenges they encounter and create a more realistic support and empowerment Ofei (2015), based on succession planning. 4 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Ghana for many decades has implemented a lot of interventions to strengthen its health care system but the focus has always been at the top management level. The Leadership Development Program (LDP) for instance, which was initiated in 2008 by the Management Sciences for Health (MSH), aimed at building the leadership capacities of senior level managers. As has always been, the focus is and has remained on the top management, leaving the operational managers and supervisors such as nurse managers, who are pivotal to the delivery of high quality care, behind. Wilmot, (2006) asserts that, if the process for assuming the nurse manager role is characterized by inadequate support and preparation along with a lack of clarity, the consequence will be an inability to develop this demanding but however, exciting role. Nurse managers are expected to create a positive environment for clinical work, take on expanded roles and responsibilities with adequate training, education, resources and support (Wright et al., 2000). Regrettably, the continuing ill preparedness for this role continues to be documented (Asamani et al., 2013; Bondas, 2006) and Ghana is not an exception. How then do nurse managers effectively handle their responsibilities? The advantage of having a succession-planning program in place has been described by several authors (Brunero et al., 2009; Fennimore & Wolf, 2011; Glasgow, Weinstock, Lachman, Suplee, & Dreher, 2009; Martin & Schmidt, 2010). Kim and Thompson (2012) asserted that, high-performing healthcare organizations make use of leadership succession planning programs to retain intellectual capital by identifying and supporting employees with potential for promotion. Brunero, Kerr & Jastrzab (2009), in a study on development and evaluation of a succession planning programme, in Australia found that, 5 University of Ghana http://ugspace.ug.edu.gh Succession planning practices succession planning gives nurses a great understanding of their career pathway and also aids them in planning their career. Empirical documentation on succession planning among nurse managers in the Accra Metropolis is absent and documentations that were found, focused on how nurse managers plan care. Korle Bu Teaching Hospital, like many other hospitals in Ghana appoint nurse managers based on their years of service (Saaweh, 2018). How prepared these nurse managers are for their roles, as well as the plans they put in place for their successors, is not known. A study conducted by (Asamani et al., 2013) on “Challenges of being a Nurse managers in Ghana”, revealed that, the number one challenge of nurse managers in Ghana is a lack of managerial preparedness. There is therefore the need for potential nurse leaders to assume the nurse manager role by succession, thereby ensuring that, they are well groomed and prepared for the position. The study consequently, seeks to explore the practice of succession planning among nurse managers at the Korle Bu Teaching Hospital and also ascertain their existing pipelines of succession. 6 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 1.2 Purpose of the Study The purpose of this study is to explore the practice of succession planning among nurse managers at the Korle-Bu Teaching Hospital. 1.3 Objectives of the Study The objectives of the study are; 1. To find out the perception of nurse managers at Korle Bu Teaching Hospital on Succession Planning. 2. To ascertain the importance of succession planning to nurses at the Korle-Bu Teaching Hospital. 3. To describe the challenges associated with the practice of succession planning among nurse managers at the Korle-Bu Teaching Hospital. 4. To delineate the strategies that can be used to enhance succession planning among nurse managers at Korle-Bu Teaching Hospital. 1.4 Research Questions 1. What is the perception of nurse managers at Korle Bu Teaching Hospital on Succession Planning? 2. What is the perceived importance of Succession Planning to nurse managers at Korle Bu Teaching Hospital? 3. What are the challenges nurse managers at Korle Bu Teaching Hospital encounter or perceive to encounter in the practice of Succession Planning? 4. What strategies can be used to enhance the Succession Planning practices of nurse managers at Korle Bu Teaching Hospital? 7 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 1.5 Significance of the Study The findings of the study will be a contribution to the body of knowledge on the Succession Planning practices of nurse managers in Ghana. The findings will also equip nurse managers with strategies that can be used to enhance the practice of succession planning. The findings of the study will again, communicate to top level managers on the need for involvement and commitment to succession planning in the organization. The findings could also form a basis for the development of a policy on succession planning for nurse managers, as well as prepare nurse managers well enough to manage the wards. 1.6 Operational Definition of Terms Succession Planning: a process of identifying and developing new leaders who can readily replace old leaders when they retire, resign or die. Nurse manager: A nurse, who has attained the rank of an SNO or above, and has the responsibility to see to the quality of nursing care rendered to clients and families in a defined area of the hospital (Unit). NMs also see to the effective and efficient management of human and material resources entrusted to them in the unit. Potential nurse manager: A nurse who has the capacity to develop into a nurse manger. Practice: The actual application or use of an idea or method. 8 University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER TWO LITERATURE REVIEW This chapter reviews literature on the succession planning practices of nurse managers at the unit level. It also provides a conceptual understanding of the succession planning practices of nurse managers at the unit level in relation to their knowledge on succession planning, the importance of succession planning, the challenges experienced or perceived to be experienced in the practice of succession planning and the strategies that can be used to enhance succession planning. The literature review highlighted current research findings on the subject and identified gaps in literature. A meticulous search of peer reviewed published literature was conducted from various databases including Google Scholar, PubMed, Science Direct, CINAHL and EBSCOhost among others. The key words used in the search of literature included succession planning, nurse manager, ward manager/leader, succession planning practices and nurse manager succession. Apart from a few milestone studies and theoretical literature, articles reviewed were from 2007 to date. 2.1 Conceptual Framework Succession planning has been an essential business strategy for identifying and developing future business leaders, yet healthcare has only recently begun to focus on succession planning as an essential organizational strategy. The advantage of having a succession planning program in place has been described by several authors (Brunero et al., 2009; Fennimore & Wolf, 2011; Glasgow et al., 2009; Martin & Schmidt, 2010). Kim and Thompson (2012) in their study on “Organizational and market factors associated with leadership development programs in hospitals” asserted that, high-performing 9 University of Ghana http://ugspace.ug.edu.gh Succession planning practices healthcare organizations make use of leadership succession planning programs to retain intellectual capital by identifying and supporting employees with potential for promotion. Brunero, Kerr and Jastrzab (2009), in a study in Australia also found out that, succession planning gives nurses a great understanding of their career pathway and also aids them in planning their career. It has therefore become necessary that, talented young nurses, with the potential to become nurse managers are identified early in their career, groomed and adequately prepared for the nurse manager role. A review of literature produced just a few succession planning models or frameworks utilized in nursing. These included the Nurse manager Succession Planning Model with Empirical Outcomes (Titzer, Shirey, & Hauck, 2014) and the Development of a leadership competency Model (Sherman, Bishop, Eggenberger, & Karden, 2007). These models were not used for the study because, the constructs of the models focused on the stages and cycles succession planning evolves through. The researcher was however in search of a model that can explain succession planning and outline an effective approach to succession planning. One such model that was discovered is the Leadership Succession Planning and Development model by (Rundio, 2014). The Leadership Succession Planning and Development model was adapted for the study because, the constructs of the model outlined the key elements that can be used to enhance the practice of succession planning. These elements are; Talent, Promotion with Preparation, Measurement, Transparency and Action Plan. Talent according to Rundio and Wilson (2015) involves identifying, developing and grooming high potential candidates to take up leadership positions. The challenge, according to them might not be succession planning but the lack of adequate personnel 10 University of Ghana http://ugspace.ug.edu.gh Succession planning practices in the pipeline to take up leadership positions. The identification of talented individuals, and nurturing them to be adequately prepared to take on leadership roles is therefore an important strategy in the succession planning process. On Promotion with preparation, Rundio and Wilson explained that, a successful succession plan promotes an emerging leader with sufficient leadership preparation, developed over years of training, education and practical experience. Preparing for leadership, they asserted, provides leaders who are knowledgeable and as a result, efficient at their work. Measurement, looked at the use of comparable strategies to measure succession planning achievements. The profession of nursing is keen on measurement outcomes to ensure continuous quality improvement. Consequently, measuring succession planning outcomes ensures that, metrics such as the number of positions required to meet the demands of future growth are known and met. Transparency is defined as the quality of being easily understood without guile or concealment, open, frank, candid and very clear (Michenera, 2013). A transparent succession plan, according to Rundio and Wilson (2015) should be easily accessible, and understood by employees. Transparency in the succession planning process is central to building trust and retaining talented individuals and intellectual capital within the nursing organization. This however, requires easy access to succession planning information, consistent communication of what constitutes success in development, and honesty in the promotion process and upward mobility (Balogh-Robinson, 2012; McCallin, Bamford- Wade, Frankson, 2009; Rundio & Wilson, 2015). Action plan, the last construct in the model, focused on the current supply, demands and gaps in the workforce. Three out of the five constructs namely; Talent, Promotion with preparation and Transparency were adapted from the model and examined under the strategies that can 11 University of Ghana http://ugspace.ug.edu.gh Succession planning practices be used to enhance succession planning. These three constructs were chosen because, the researcher was keen on finding out the key strategies essential to succession planning and at the same time, lucid enough to suit this unseasoned area in nursing. Action plan and Measurement, as explained by the authors of the model, typically presents in the top level management role and though they can be factored into the nurse manager role, a more lucid approach was employed. Due to the emergent nature of succession planning in nursing, additional constructs like knowledge, importance and challenges associated with succession planning were also explored. 12 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Talent Promotion With Preparation Leadership Succession Action Plan Planning&Development Measurement Transparency Figure 1: Leadership succession planning and development framework Source: The Doctor of Nursing Practice and the Nurse Executive Role (p. 172), by Rundio and Wilson (2015) . 13 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 2.2 Review of related literature Literature was reviewed based on the constructs of the conceptual framework and the objectives of the study. 2.3. Knowledge of Succession Planning Succession planning is defined as a systematic process of developing individuals to take up major roles in an organization (Harrison, McKinnon & Terry, 2006) through job rotations, training and mentoring (Carriere, Muise, Cummings, & Newburn-Cook, 2009). This is to ensure that there are several qualified people available in an organization to occupy major leadership positions in order to enhance productivity of the organization and inspire individual professional growth (Shirey, 2008). Effective succession planning should be core to an organization’s practice and the process should cultivate predictability rather than chaos or last-minute scrambling to find potential leadership candidates. Moreover, as people leave the organization as a result of attrition, career development and retirement (Rodrigo, 2013), it will be important to prepare a pool of potential leaders internally to occupy vacant positions in the future. Health care lags behind other businesses in succession planning efforts (Carriere et al., 2009), and health care organizations practicing succession planning most commonly focus on executive leadership roles(Bolton & Roy, 2004). Coonan (2005) in a study on “ Succession planning: Aligning strategic goals and leadership behaviours” concluded that, nurse leaders rarely think of who will replace them when they leave and this lack of strategy by nurse managers is worrisome because, healthcare service providers are already facing labour shortages (Wahl and Bogomolny 2004), making leadership replacement difficult. A study conducted by Titzer and Shirey (2013), also 14 University of Ghana http://ugspace.ug.edu.gh Succession planning practices concluded that, the fundamental principle of succession planning is the identification of potential leaders internally and grooming them to take up key organization roles in the future. Nurse managers consequently, need to identify potential leaders, groom them and ensure that, they are given adequate preparation and exposure to the delicate task of management. The identification of key positions, potential leaders, grooming of these potential leaders, appointing successors and allocating resources have been outlined as major components of succession planning (Bolton & Roy, 2004). Weiss and Drake, (2007) in a study on “Nurse leadership succession planning in veterans’ health administration” asserted that, effective succession planning can provide career-launching opportunities and encourage young nurses to think about future leadership possibilities. It also guides the choice of training and education young nurses engage in. Nevertheless, Redman (2006) in a qualitative study observed that, support from the top level management and the constant evaluation of the succession planning process are also key to the sustainability of the plan. The commitment of top level management to succession plans ensures that, the plans are followed through, sparing no effort or resource, needed to achieve it. Several terms such as leadership continuity planning, talent management, and leadership development (Carriere et al., 2009) have been used to describe succession planning in literature, but the terms are not technically the same. Literature search revealed that, terms such as a strategic process, and development of intellectual capital for the future and leadership continuity are the major terms used to describe succession planning in nursing (Carriere et al., 2009). However, Titzer, Philips, Tooley, Hall and 15 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Shirey (2013) in a study concluded that, the fundamental principle of succession planning is the identification of potential leaders internally and grooming them to take up key organization’s roles in the future. Brunero et al. (2009) in their study on the development and evaluation of “a succession planning program in nursing, in Australia” also concluded that, the succession planning program provides an opportunity for the organization to identify new leaders, who can then be groomed to take up leadership positions. Another term worth mentioning, is talent management. The definition of talent management and succession planning in literature is similar, however, Senthikumar and Kumudha (2011) in a study in India argued that the individuals responsible for both roles are different. Rothwell (2010) reported in his study on “Effective succession planning: ensuring leadership continuity and building talent from within” that, talent management is usually a human resource strategy to recruit and retain employees whiles succession planning is a subset of talent management and the responsibility of current leaders in position. In the past, many nurse leaders came into leadership roles by providence but chance is no longer acceptable in today’s complex healthcare organizations (O’Connor , 2004). Today’s healthcare needs leaders who have diverse knowledge in the dynamic nature of health in recent times and at the same time, have excellent leadership and managerial skills. Laframboise (2011) in a study, acknowledged that, seniority and being at the right place at the right time no longer constitute sufficient preparation, looking at the depth and breadth of knowledge and skill required for today’s leadership roles. An organised system of succession and preparation for would be leaders, aimed at optimizing their knowledge and skill base is therefore of utmost importance. Laframboise (2011), 16 University of Ghana http://ugspace.ug.edu.gh Succession planning practices concluded in her study that, succession planning provides leadership stability, is effective for recruitment and retention, and can increase job satisfaction, productivity and quality of service. Current managers and leaders in an organization therefore, need to make a conscious effort and commitment to give future leaders the tools, techniques, and expertise to be able to take up the organization’s key roles. This would ensure that, future leaders are knowledgeable and skilful enough to meet the increasing demands of healthcare. 2.4 Importance of Succession Planning The benefits of implementing succession-planning programs have been described by a number of researchers. A study conducted on the development and evaluation of a succession planning program in nursing in Australia, observed that, succession planning increased nurses’ sense of career planning and improved their comprehension on their career progression (Brunero, Kerr & Jastrzab 2009). An increased sense of career planning aids in a better choice of training and education aimed at acquiring career- progression specific knowledge and skills. Moreover, McAlearney (2005), in a study on “Exploring mentorship and leadership development in healthcare organizations” also noted that, formal leadership development programs improved workforce through mentoring, coaching, and educating leaders. Additionally, health care organizations that utilize succession planning have recorded improvement is staff retention rates (Kim & Thompson, 2012), enhanced financial performance (Titzer, Phillips, Tooley, Hall, & 17 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Shirey, 2013), enhanced staff engagement, increased operational effectiveness, and an improvement in the quality of care provided (Trepanier & Crenshaw, 2013). Furthermore, succession planning maintains the stability of the work environment, especially when the transition between top level leaders occurs smoothly. Again, there is an increased probability that the organization’s strategic vision will be maintained because the next leader has been groomed by the current leadership in the organization (Cross, 2009). However, succession planning could also serve as a strategy to increase diversification in leadership positions in the future (Whitman & Valpuesta, 2010). (Ivancevich, Kennavane, & Wears, 2008) noted in a study on “Organizational behavior and management” that, strategic succession planning leads to informed, purposeful and focused action plans for human resource management. This is because the vision of the organization is outlined, which provides direction and underpins all decisions regarding human resource management in the organization. Titzer, Phillips, Tooley, Hall and Shirey (2013), in a quantitative study observed that, rolling out formal succession planning program for nurse managers will prepare the organization to be ready to fill vacancies when the need arises. It will also ensure that, the organization has a pool of qualified nurses ready to take up key roles, reduce the stress usually associated with transition and promote conducive work climate. Seniwoliba (2015) also found out in his study on succession planning that, organizational vision and mission are likely to be maintained with a succession planning program in place. This is because, the next leaders with knowledge on the strategic vision and mission of the organization are most likely to come up with action plans that are 18 University of Ghana http://ugspace.ug.edu.gh Succession planning practices underpinned by the vision and mission of the organization. Titzer et al. (2013), again observed that, organizations that identify and develop internal human capital can improve role transition and reduce nurse manager turnover rates. Reduction in turnover rates results in the retention of intellectual capital. Rothwell (2010) in a study on “ Effective succession planning: ensuring leadership continuity and building talent from within”, shared a similar view that succession planning would enable organisations select the right people to take up the right roles of the organisation in the future. Employees after being supported through the promotion process with education and training, become more endowed intellectually, and their retention aids in improvement in the quality of care provided (Trepanier & Crenshaw, 2013). 2.5 Challenges Associated with Succession Planning Literature reviewed has revealed some challenges associated with succession planning. Charan (2005) in a study reported that, many organizations do not allocate enough time to succession planning, hence, do have a few people to take up the organization’s key roles in the future. A lack of focus and understanding of the value of succession planning are major challenges linked to succession planning in many organizations (Blyth, 2005). Charan (2005) again observed that, many organizations usually focus on the current issues in the organization with less attention given to the future. Again, Mamprin (2002) in a study on “Five steps for successful succession planning” also observed that, current leaders, with a significant number of years to serve, see succession planning as a threat to their positions, especially realizing the importance of succession planning to identify and groom the future leaders. These leaders usually serve as barriers to change and prevent effective implementation of succession planning 19 University of Ghana http://ugspace.ug.edu.gh Succession planning practices in the organization (Seniwoliba, 2015). Literature further revealed that, a lack of visible support and commitment from top management is a major challenge to succession. Some experts are thus of the view that, without the support and involvement of top management, even the best succession plans are doomed for failure (Clark & Lyness, 1991; Executive Knowledge Works, 1987; Friedman; 1986; Hall, 1984; Hall & Foulkes, 1990; Lee 1981) Wieck, Dolls and Northam (2009) in their study on “What nurses want: the nurse of incentive project”, reported that, nurses know what they want and over three quarters (78.5%) of their study population indicated that nurses were moderately to extremely unhappy with incentives. This is translated into the nurse manager role and consequently, potential nurse managers seek for better conditions of service and remuneration elsewhere, distracting the succession planning process. Wieck et al. (2009) further noted that, the top two issues that nurses generally identified as affecting their intention to leave or stay at a job are better working conditions and wages. Additionally, leaders and managers who want to maintain their positions, only focus on their own needs instead of the organization’s needs (Conger & Nadler, 2004). Mehrtak, Vatankhah, Delgoshaei & Gholipour (2014) in a study in Iran also noted favouritism as one of the challenges affecting succession planning. This means that many leaders select their favourite employee to succeed them and this hinders or defeats the purpose of succession planning. Meharabani & Mohamed (2011) in a study on a “Brief review of succession planning and management approach” reported that, training, support from the management of the organisation, a well-defined vision and career pathway for employees towards succession planning and a proper communication channel in an organisation are 20 University of Ghana http://ugspace.ug.edu.gh Succession planning practices linked to effective implementation of succession plans. However, absence of the above factors could pose a challenge to the implementation of effective succession planning in the organisation. 2.6 Strategies for enhancing succession planning Different studies have identified strategies that are key to the enhancement of succession planning as well as their influence organizational success. Ivancevich (2007) in a study on “Organizational behavior and management” reported that, succession planning is a process and must follow a sequence; thus, integration of succession planning with the organization’s strategy, workforce planning, grooming of potential leaders and evaluation. This implies that effective and sustainable succession planning, must follow appropriate process and should be well integrated into the strategy of the organization in order to reap the benefits of successful planning. However, (Eastman, Lepak, & Bartol, 2007) in a qualitative study found out that, some firms managed their succession systems in different ways and suggested that the involvement of the top management, a formal succession planning system and a good communication system between the Human Resource and other divisions of the organization are essential to the success of succession systems. Similarly, Redman (2016) also identified the need for support from the senior administrative level, evaluation of positions, assessment of individuals in terms of their leadership abilities, gap analysis of the current talent pool, design and implementation of a leadership programme, and the need for periodic evaluation of the succession planning process. Meharabani and Mohamed (2011) also observed a similar finding. The researchers found that involvement of top management and other departments in the organization such as the Human 21 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Resource division, would positively influence the succession planning policy of the organisation. Literature searched again highlighted that, the commitment of the current leaders in an organization to succession plans is a key determinant of successful succession planning. This includes determining the needs of the leaders and taking steps to address the identified needs (Swan & Moye, 2009). Moreover, willingness to allocate resources such as time, money for training, and motivation, for the future prospects of the organization cannot be underemphasized (Carriere et al., 2009). Titzer et al. (2013) are of the view that if current leaders in top management positions recognise the essence of succession planning, they would provide the necessary financial support for the succession system. Hence, the appreciation of succession planning should start from the top hierarchy and must be integrated into the strategic plan of the organization (Rothwell, 2010). On the other hand, Rothwell, (2010) also observed that transparent succession planning in an organization creates an atmosphere for professional development. This means that employees must be aware and enlightened about the succession plan of the organization (Shirey, 2008). This will boost the morale of staff and promote staff retention (Coonan, 2005) because, most staff with the intention of advancing their professional development in leadership, would use succession planning as an opportunity to stay in the organization (McConnell, 2006). Furthermore, transparent succession planning will also prevent favouritism among some nurse leaders as observed by (Mehrtak, Vatankhah, Delgoshaei & Gholipour, 2014). 22 University of Ghana http://ugspace.ug.edu.gh Succession planning practices The identification of required leadership competencies and how the competencies would be measured is another critical variable necessary for effective succession planning for nurse managers because, it can serve as a guide for the succession planning program (Carriere et al, 2009). The researchers were also of the view that evaluation of the current and future leadership needs is very important in order to prepare adequately to address the leadership needs of the organisation. Beyers (2006) therefore, advised that, it would be appropriate to perform such evaluations ahead of time before the need arises. Charam (2005) further explained that the staff must be identified early and evaluated properly. Researchers proposed 4-5 years (Choram, 2005) and 3-5 years (Blouin et al., 2006) preparation for potential leaders before assuming their new roles in the organization. This will prevent the frustrations usually experienced by nurse managers as a result of inadequate preparation (Stichler, 2008). Current evidence in the literature has shown stimulation to be one of the best methods of training nurse leaders. Waxman and Delucas (2014) observed the use of simulations to enhance the training programs for nurse leaders. Other researchers have also documented that exposing the individuals to clinical scenarios that mimic real life leadership challenges would provide them with the opportunity to learn, practice, think critically, make good decisions and improve their skills and competencies (Shapira- Lishchinsky, 2012; Clark &Yoder-Wise, 2015). Likewise, mentoring and coaching cannot be underemphasised in impacting knowledge, attitude and skills needed for leadership roles in an organization (Swan & Moye, 2009; Cross, 2009). The use of transformational leadership style has also been observed to have enhanced the effective implementation of succession plans since current leaders need to focus on grooming 23 University of Ghana http://ugspace.ug.edu.gh Succession planning practices employees for the future (Cummings et al., 2010). Nonetheless, Shirey (2008) suggested collaboration between the organizations and universities, journal clubs, research committees, and involvement in professional organizations could help in the effective implementation of succession planning in the organisation. Literature searched has revealed certain key characteristics required in nursing leadership. Competencies such as communication, knowledge, professionalism, enterpreneuring skills, appearance, confidence and enthusiasm of people who want to be leaders are needed for professional leadership. Again, optimism, flexibility, visionary, openness to new ideas, balance between autonomy and collaboration, commitment to learning with a spirit of inquiry, commitment to the organization, resilience and authenticity have also been identified as key competencies needed for professional nursing leadership in literature (Leach et al., 2016; Stichler, 2008; Hewlett, 2014 & AONE, 2015). These characteristics should therefore serve as a guide for the current leaders in identifying potential leaders to be groomed for future assignment in an organisation. 2.7 Current Practice of Succession Planning Staff turnover and the realization that commitment and loyalty are key factors in an organization have greatly influenced succession planning in the healthcare industry (Beyers, 2006) even though, succession planning has not been formalized in many healthcare institutions. This has led to inadequately prepared potential nurse leaders (Titzer & Shirey, 2013) due to the fact that, there is no well-structured strategy or plan, which determines who is capable of occupying specific leadership positions in many organizations. Moreover, the ability of such organizations to develop their leadership 24 University of Ghana http://ugspace.ug.edu.gh Succession planning practices capacity tends to be slower and less responsive as compared to those with a succession plan (Hughes, 2009). Griffith (2012) observed that some organizations do not have a solid or proven succession plan for grooming leaders for the future, but make use of old models for promoting both formal and informal leaders in the organization in order to sustain their leadership capital. However, Titzer, Phillips, Tooley, Hall, and Shirey (2013) suggested that for organizations to be able to reduce staff turnover, improve staff retention and reduce cost, there is the need for formal succession planning. Carriere et al. (2009) on the other hand, also reported the use of some succession planning models, consisting of mentoring and coaching, which will enhance a healthy interpersonal relationship and help the individuals achieve their goals and improve his/her leadership skills (Shirey, 2008). Again, empirical evidence suggested that identification of potential leaders is key in succession planning. Rothwell (2010) reported that the best approach was to use an objective, systematic process, which must be based on the required leadership abilities. The training of the potential candidates is another very important factor in succession planning found in literature. Griffith (2012) observed that preparation of the potential leaders is one of the concepts necessary for successful succession plans. This implies that individuals need to be trained in order to ensure that the required abilities of a leader are learned (Meharabani & Mohamed, 2011). Coonan (2005) proposed that before training potential leaders, it must be ensured that an assessment of all potential leaders is done in order to come out with an appropriate training program for the prospective candidates as their strength and weakness would be identified during the evaluation. Cross (2009) identified coaching, performance appraisal, higher education 25 University of Ghana http://ugspace.ug.edu.gh Succession planning practices and training and self-initiated learning as best practices when implementing succession planning. Similarly, Swan & Moye (2009) explained that mentoring and coaching promotes the nurturing of individuals with leadership abilities for the future. 2.8 Summary of Literature Review The literature reviewed revealed that, succession planning has been in existence in the business world for over a decade now but is a fairly new area in nursing. The development and empowerment of nurse managers has received less attention over the years (Asamani et al., 2013). Interventions to enhance the leadership in the healthcare system in Ghana has had its focus on the top management level. For instance, the Leadership Development Program (LDP), initiated in 2008 by the Management Sciences for Health (MSH), aimed at improving the leadership abilities of senior level managers leaving the operational managers and supervisors such as nurse managers. Many nurse managers in Ghana get into their positions through apprenticeship (Ofei 2015) leading to inadequate preparedness for managerial roles (Asamani et al., 2013). This usually results in frustration of nurse managers (Stichler, 2008) and an inadequate performance output. Additionally, there is a paucity of information regarding succession planning for nurse managers in Africa as well as in Ghana. Literature found on the topic in Ghana focused on succession planning for the university and the business communities in Ghana. The literature searched did not find any study regarding succession planning in the health care organisations in Ghana. Another thing worth noting is that, the subject has received less attention in the health care setting across the globe, especially Africa. Furthermore, the career pathways which usually influence the interest and desires of employees have also received less attention in literature. 26 University of Ghana http://ugspace.ug.edu.gh Succession planning practices In addition, empirical documentation on succession planning among nurse managers in the Accra Metropolis is scarce. There is the need for potential nurse leaders to take up the nurse manager role through a formal succession planning program to ensure that they are well groomed and prepared for the position. This study will hence provide a deeper knowledge and understanding of the succession planning practices of nurse managers in Ghana to fill the identified gaps. 27 University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER THREE RESEARCH METHODOLOGY 3.0 Introduction This chapter describes the methods used in attaining the stated objectives and it includes the research design used, research setting, target population, sample and sampling method that was used. It also looked at the tools used, the method of data collection, data analysis as well as data management. In addition it contains information on how ethical requirements were met and trustworthiness of the study. 3.1 Research Design The exploratory descriptive design was used for this study. Exploratory research is defined by Burns and Groove (2010) as research conducted to gain new insights, discover new ideas, and for increasing knowledge of the phenomenon. The focus therefore lies on in-depth understanding of words, opinions and experiences rather than on numbers. Qualitative methods concentrate more on the individual than on the general (Mayring, 2007). The exploratory study design was used for the study because, it looks at the dynamic, holistic and individual aspects of the human experience, and attempts to capture those experiences in their entirety, within the context of those experiencing them (Polit & Beck, 2014). The study design was used since the researcher was interested in obtaining and finding out in-depth information from respondents on succession planning. Consequently, instead of measuring the phenomenon by numbers, this study used open ended questions to explore the views of nurse managers in Korle Bu Teaching Hospital on succession planning. 28 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 3.2 Research Setting The study was conducted at Korle Bu Teaching Hospital, which is situated in the nation’s capital Accra. It is located on the coastal savanna belt covering an area of 441 acres. Korle Bu is a national referral centre and is currently the third largest hospital in Africa to which most cases are referred in the sub-region. It was established in 1923 with an initial bed capacity of 200. KBTH now has a bed capacity of 2,000 in addition to 21 clinical and diagnostic Departments and three centres of excellence with more than 4,000 medical and paramedical staff. The entire hospital reports an average daily attendance of about 1,500 patients and an average of about 250 daily patient admissions. The hospital functions as a semi-autonomous organisation which draws directly from a management board charged with the responsibility of giving broad policy guidelines for efficient administration of the hospital. The daily administration of the hospital is conferred in the chief executive, who is supported in his duties by seven directors including the Director of Nursing Services (DNS). Administrative authority is vested in the Budget Management Centre (BMC), which is headed by the Chief Executive, power is devolved to the departments referred to as the sub-BMCs. These sub- BMCs include the Obstetric and Gynecological, Medical, Surgical, Accident Centre, Plastic Surgery and Burns Centre, Child Health, and Allied Surgery. The others are the Pathology, Anaesthesia, Radiology, Laboratory, Psychiatry and Allied Surgery Sub- BMCs. Participants were recruited from the Obstetrics and Gynecology, Medicine, Surgical, Psychiatry, Anaesthesia and Accident Center departments. These departments were chosen because, they are large departments within the hospital and have an average 29 University of Ghana http://ugspace.ug.edu.gh Succession planning practices of about 10 nurse managers each. Korle Bu Teaching Hospital was chosen as the site for the study because, it is the largest hospital in the Accra Metropolis and has an average of about 100 nurse managers. 3.3 Target Population The target population for this study was all nurse managers who work at the Korle Bu Teaching Hospital. Their varied experiences on the various units helped the researcher to obtain an in-depth understanding of their succession planning practices. 3.3.1 Inclusion Criteria Nurse managers who met the criteria for inclusion in the study were;  Nurse managers who work at the Korle Bu Teaching Hospital  Nurse managers who are currently in-charge of a ward or unit in Korle Bu Teaching Hospital  Nurse managers who have been in their current position for not less than three years. 3.3.2 Exclusion Criteria Nurse managers who did not meet the criteria for inclusion and as a result were excluded from the study were;  Nurse managers who did not consent to be part of the study.  Nurse managers who do not work at the Korle Bu Teaching Hospital  Nurse managers who have not served in their current position for at least three years. 30 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 3.4 Sample Size A sample size of 12 nurse managers with not less than three years’ experience in their current position gave enough information to explain the succession planning practices among nurse managers in the Korle Bu Teaching Hospital. The sample size for the study was determined by data redundancy. The researcher reached data redundancy by the 12th participant. Data redundancy is reported at the point in which no new information or theme is observed or useful in a data (Saumure & Given, 2008). At this point, the researcher recorded no new information or idea and an in-depth understanding of the succession planning practices of nurse managers at the Korle Bu Teaching Hospital had been attained. 3.5 Sampling Technique A purposive sampling technique was used to select the participants for the study. This is because the researcher believed that, the population under study was identifiable and the members were experts in the area of study. The strategy adopted for this purposive sampling was maximum variation sampling according to Patton (2002). This involved purposely selecting cases with a wide range of variation on dimensions of interest. The 12 participants were purposely selected to be varied in one or more of the following: gender, age, type of ward, number of years in management, and educational level. The researcher recruited participants by visiting the various units and informing the nurse managers about the study. Nurse managers who volunteered to be part of the study were noted, their contact numbers taken and an appropriate date and time agreed upon to meet. 31 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 3.6 Research Instrument To obtain data for this study, an in-depth interview was conducted using an interview guide prepared in English, made up of open-ended questions. It had main question areas in line with the research questions and also contained probing questions to elicit clarification to obtain accurate information. The interview guide was made up of two sections (see appendix A). Section A sought for demographic information such as age, gender, marital status, highest professional education, number of years served in management position, among others whilst Section B sought for information on their understanding of succession planning, its importance, challenges faced or perceived to be faced in the process of implementing succession planning, and strategies that can be used to enhance succession planning. The interview guide was piloted at the Greater Accra Regional Hospital, using two nurse managers. Feedback that was gotten from the pilot study was utilized in the amendment of the research tool before the actual study was done. 3.7 Data Collection Procedure The recruitment of participants begun after ethical clearance was granted by the Institutional Review Board (IRB) of the Noguchi Memorial Institute for Medical Research (NMIMR) with certificate number NMIMR-IRB CPN 028/18-19 (see Appendix D) and Institutional Review Board of Korle Bu Teaching Hospital (KBTH IRB) with certificate number KBTH-IRB 00018/2019 (see Appendix E). An introductory letter from the human resource department of the hospital was sent to the research site to introduce the researcher and the purpose of the research to the participants. A total of about 20 nurse managers were contacted from the Obstetrics and Gynaecology, Medicine, Surgery, Psychiatry, 32 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Anaesthesia and Accident Centre departments of Korle Bu Teaching Hospital. These departments were chosen because, they are large departments within the hospital and have an average of about 10 nurse managers each. Korle Bu Teaching Hospital was chosen as the site for the study because, it is the largest hospital in the Accra Metropolis and has an average of about 100 nurse managers. The researcher, visited the various units under said departments and interacted with the in-charges concerning the study. After finding out the number of years they have practiced, the eligible nurse managers were given thorough details on the study and the part they would need to play. They were also assured that, anonymity and confidentiality will be ensured in the study. Nurse managers who consented to be part of the study were thence asked of convenient days and time at which the interview can be granted. All the nurse managers consented to take the interview in their offices. On the scheduled day, the researcher got to the office of each nurse manager with copies of her consent form, an audiotape and a field note pad. Consent forms were given to participants to read and sign before the commencement of the interview (see Appendix B). Permission was also sought from participants to audiotape the interview and also take field notes during the interview. Interviews lasted between 45 and 60 minutes. Participants were reminded that anonymity and confidentiality will be ensured in the study and the researcher hence continually reminded the participants not to mention their names or say anything to reveal their identity. 3.8 Data Management Data management is concerned with the conversion of large quantities of data into smaller more manageable segments (Polit & Becks, 2010). The recorded interviews were 33 University of Ghana http://ugspace.ug.edu.gh Succession planning practices transcribed verbatim after every interview session unto a personal computer and stored with a distinctive code name. Comparison of the transcribed interview with the audio recordings was done and where there were discrepancies, the nurse managers were contacted for clarification to ensure that accurate data is obtained. The printed transcripts were read over and over to make corrections. The acronym “NM” was used to denote nurse managers and numbers 1 to 12 were used to denote the interviews. Participants were hence given pseudonyms, NM1, NM2, et cetera. Basic sorting and filing procedure was used to safely keep the audio recordings, transcribed data, signed consents forms and field notes. The information was made available to only the researcher and her supervisors. The demographic data of clients was separated from the general data to aid in maintaining anonymity. All data has been stored under lock and key with the researcher and will only be produced if the need be. A soft copy of the data has also been kept in a protected file to serve as backup. Data will be kept for a period of five years, after which, it will be disposed of by shredding all printed data and formatting storage devices. 3.9 Data Analysis Data analysis involves clustering related types of narrative information into coherent scheme with the purpose of organizing, providing structure to, and eliciting meaning form data (Polit & Beck, 2010). Data were analysed using Braun and Clarke (2006)’s six phases of thematic analysis framework. Thematic analysis involves identifying, analysing and reporting patterns (themes) within data (Braun & Clarke ,2006). The phases of thematic content analysis identified by Braun and Clarke are familiarizing yourself with your data, generating initial codes, searching for themes, 34 University of Ghana http://ugspace.ug.edu.gh Succession planning practices and producing the report. The researcher transcribed each interview, read the data over and over again and noted down initial ideas. Data were coded based on the constructs of the conceptual framework. These codes were collated into the various themes of the framework and all data relevant to the theme gathered. The themes were reviewed at the level of the coded data extracts and in relation to the whole data set. The themes and sub- themes were revised repeatedly until it was suitable to present the findings according to the objectives of the study. 3.10 Methodological Rigour (Trustworthiness) Trustworthiness refers to the extent to which a research study is worth paying attention to, worth taking note of, and the extent to which others are convinced that the findings are to be trusted (Babbie & Mouton, 2001). This is usually addressed during the planning stage to guide the study process. Hammersley (1990), defines validity as ‘the extent to which an account accurately represents the social phenomena to which it refers’. The researcher sought to ensure accurate findings by using a method that is consistent and can be used by researchers in other projects. There are varied views on how to measure the trust worthiness of data in qualitative studies. Yin (2003), believes that, documenting every step of the procedure is a means by which rigour can be ensured. Gibbs, (2007), presented four steps to ensure reliability; checking the transcript to ensure it is devoid of mistakes, ensuring a correct definition of the codes, communication among coders, cross checking codes among coders (inter-coder agreement). According to Miles and Huberman (1994) if there is eighty percent (80%) inter-coder agreement the study can be said to be reliable. 35 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Lincoln and Guba (1985) and Creswell (1998, 2009) suggests the use of the term credibility, confirmability and transferability in place of the term validity. Aside the triangulation of methods that is generally accepted and used by most qualitative researchers, Leedy and Omrod (2010), recommends the use of the proceeding five areas to promote reliability; extensive time in the field, negative case analysis, thick description, feedback from others and respondent validation. Aspects of Leedy and Omrod’s approach that were suitable for this study were adopted to ensure trustworthiness of the current study in addition to other ones. To enhance credibility, the researcher had an extended time in the field; by visiting the chosen units regularly and acquaintance was struck with the participants. The researcher visited participants to locate them, the participants were met on the scheduled interview dates and follow-up visits were made to obtain more information or clarification. This gave the researcher the opportunity to better familiarise with the site of study and have a long interaction with the participants (Leedy & Omrod, 2010). The researcher being a nurse, based on her knowledge and clinical experience in this area as well as literature that was reviewed and this enabled her further to satisfy the criterion of being knowledgeable about the phenomenon under investigation (Lincoln & Guba, 1987). Bracketing of existing knowledge and preconceived ideas and especially personal views about the existing problems in the clinical area; was written down. Some of the ideas bracketed by the researcher are the notion that, ranking system in nursing makes it difficult for nurse managers to practice succession planning. The notion that, nurse managers may perceive succession planning as a top administrative task was also 36 University of Ghana http://ugspace.ug.edu.gh Succession planning practices bracketed. Again the researcher being a staff of the hospital, bracketed her knowledge of the fact that, there was no existing succession plans for nurse managers in the hospital. The review of interview guide by supervisors to ensure that, it is void of any form of bias was done (Lincoln & Guba, 1985). Respondent validation (Member checking) was ensured by the researcher. The conclusion of the study was taken back to the participants for review to ensure accuracy and representativeness. Inter-coder agreement was also done in this study. The categories identified by the researcher in the analysis of the data were compared with those identified by the other coder. No major discrepancy was identified but rather additional information was obtained. Also an in-depth literature review further helped to confirm these categories. Exhaustive description of the activity and findings was done by the researcher explaining clearly the steps taken in data collection, data analysis and interpretation of the research findings, in the research report. Feedback from others was also attained. The two supervisors of the study consistently reviewed the study from proposal, through implementation to report writing. Constructive suggestions and inputs were made by them, also some colleagues read through the scripts as well and inputs were made. These series of actions by the various stake holders helped to ensure trustworthiness of this study. 3.10 Ethical Consideration Informed consent involves the potential participants having full and open information about the study. Participants entered into the research voluntarily with good 37 University of Ghana http://ugspace.ug.edu.gh Succession planning practices knowledge of the nature of the research and any disadvantages or obligations that may be involved. A consent form was given to every participant to assist them make an informed decision. Anonymity and confidentiality were considered in this study, with the researcher continually reminding the participants not to mention their names or say anything to reveal their identity. The researcher ensured that, she handled the data alone especially during data collection, transcribing of the recorded data, discussion and analysis. The researcher also sought for ethical clearance and approval from the ethical committee at the Institutional Review Board of Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, Legon. The rights, safety and protection of the participants which are of importance was also assured. An introductory letter, requesting for permission to undertake the study was taken from the head of department of the Research, Education and Administration department of University of Ghana to KBTH IRB, and after a thorough review of the study protocol, permission was granted for the study to be conducted. Consent forms, audiotapes, field notes and typed transcripts are being kept confidential under lock with the researcher, and this will be for at least five (5) years, subsequent to the completion of the study, whereafter data can be destroyed. 38 University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER FOUR FINDINGS OF THE STUDY 4.0 Findings Chapter four (4) presents the findings of the study. The first section of the chapter looks at the personal and professional profile of the participants of the study and the subsequent sections look at the key findings under varying themes and subthemes. 4.1 Socio-Demographic Characteristics of Participants An overall number of twelve (12) participants were involved in the study. Eleven out of the twelve participants were females, and the remaining one, a male. Participants were aged between 35 years and 56 years. All but one of the participants were married. Five (5) out of the twelve participants lived at the Korle Bu Nurses’ quarters, whilst the remaining seven (7) lived outside the hospital quarters. Participants had been in leadership positions for periods ranging between three (3) and six (6) years with two (2) out of the twelve participants, holding a Master’s Degree, Eight (8) with a Bachelor of Science Degree, and two (2) with a Diploma in Nursing. Three (3) of the twelve (12) participants acknowledged having formal education on leadership. Ten (10) of the participants led specialty wards and consequently, had a background in such specialty area. The distribution of participants by grade showed that, ten (10) of the participants were Principal Nursing Officers, one (1) a Senior Nursing Officer and the remaining one (1), a Deputy Director of Nursing Services (DDNS). Details are presented in Table 4.1. 39 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Table 4. 1Table 4.1 Socio-Demographic Data of Participants Participa Gender Age Marital Years in Educatio Years Current nt Status Leadershi n in Grade F=Femal p Service e M=Marrie d M=Male S=Single NM1 F 47 M 3 SRN 18 PNO NM2 F 35 M 3 RGN/BS 12 PNO C NM3 F 37 M 3 SRN/BS 12 PNO C NM4 F 51 M 5 SRN/BS 29 PNO C NM5 F 52 S 6 SRN/BS 26 PNO C/MSC NM6 F 55 M 5 SRN 23 PNO NM7 F 50 M 5 SRN//BS 25 PNO C 40 University of Ghana http://ugspace.ug.edu.gh Succession planning practices NM8 F 42 M 4 SRN/BS 17 PNO C/MSC NM9 M 45 M 4 SRN/BS 15 PNO C NM10 F 56 M 6 SRN/BS 32 DDNS C NM11 F 54 M 4 SRN/BS 26 PNO C NM12 F 35 M 3 RGN/BS 10 SNO C Source: Data from field (2019) 41 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 4.2 Organization of Themes and Sub-themes The themes derived from data collected were: 1) Importance of Succession Planning, 2) Knowledge on Succession Planning, 3) Challenges associated with Succession Planning, and 4) Strategies to enhance Succession Planning. These four (4) main themes have been organized into sixteen (16) sub-themes. An additional theme; Current practice of Succession Planning also emerged with two (2) sub-themes. See Table 4.2 below for details. Table 4.2 Summary of Thematic Findings THEMES SUB-THEMES 1 Knowledge on Succession Planning Developing potential leaders Rising through the ranking system 2 Importance of Succession Planning Organizational vision attainment Retention of intellectual capital Increased sense of career planning 3 Challenges associated with Frequent reshuffling Succession Planning Ranking system of progression Lack of incentive Tendency to generate conflict 4 Strategies to enhance Succession Promotion with preparation Planning Provision of incentives Transparency in the SP process Talent identification 42 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 5 Current Practice of Succession Ranking system of succession Planning Mentoring The subthemes are presented with verbatim anonymous participant quotes using pseudonyms. 4.3 Knowledge on Succession Planning The theme, Knowledge on Succession Planning sought to find out what the Nurse managers understood by the phrase Succession Planning and how applicable they think it is in nursing. Participants explained their knowledge on succession planning under two (2) sub-themes, namely: Identifying and developing potential leaders and Rising through the ranks. 4.3.1 Identifying and Developing Potential Leaders Ten (10) nurse managers explained SP as a practice of identifying and developing potential leaders, and in this case, nurse managers, who can hold the fort when the current nurse managers are no more in position. Participants also said that, SP is about getting someone ready or preparing someone to take up a position in the absence of the leader or when the leader is fading out. Other participants viewed SP as a future action and a form of mentoring and preparation given to young people who are eligible to take over when current leaders are no longer in position. NM5, for instance, explained SP as identifying and developing a person for future positions. She said that: 43 University of Ghana http://ugspace.ug.edu.gh Succession planning practices It is a way of identifying a person or persons and developing them to take future positions when the active ones future retire. It is of paramount importance. It is very very important. NM3 also expounded that, SP is about getting someone ready to take up positions in the absence of a substantial leader: I think it is about getting somebody ready to be able to take up whatever position you are occupying or heading in your absence…Yes I do think it is very very very necessary, it's very important to our field because you will not always be there as a leader or as a the lead of a team. Something might happen for you. It could be leave, it could be getting to do something else that you would have to leave. So if you're leaving, you have to ensure that somebody you know that can do better than you is able to occupy that position. It is very very very important. NM9 also explicated that, SP is a future action that leads to successful succession in future: Succession planning has to do with, future action. I mean any kind of action that will lead to succeeding when you are not there or improving future, you know... Nature of work in future. It is applicable in every organization. There must be a succession planning, so in case you are not there or as you are moving out or fading out, you need a successor. Another participant opined that, SP involves the plans and measures put in place to develop the next person inline for leadership: The way when you're not around...if you think you are not around, how you plan for someone to take over when you are not around. So there's a way you go about it whatever you are doing to develop the next person to take up as a leader when you are not there and yes we can practice it because, we are not always around.. (NM12) NM4 shared a similar opinion and was also of the view that, SP involves preparing another person to take over from the current nurse manager: Succession planning is preparing another person to take over from you, as a nurse manager, that is succession planning. It is something that we 44 University of Ghana http://ugspace.ug.edu.gh Succession planning practices must do. Because we mentor the younger ones so that they can take over from us when we are going on retirement and it doesn't take one or two years, it should take a longer period of time. Another NM was also of the notion that, SP involves identifying and developing people who can take over from a leader when the leader is no longer at post: …yes so what I understand by succession planning is that as a leader definitely you would not stay at the post forever so you'd have to plan that if you are not there who will take up and so you would have to plan and identify people that can work if you're not there and then, you can develop them so that when your time is up for you to go they can take up from you. (NM2) 4.3.2 Rising through the ranks Two (2) participants opined that, SP is synonymous with the nursing system of promotion, where staff rise through the ranks after years in service. As one goes through the nursing ranks, they learn the duties that comes with the ranks. NM6 explained SP as a system of progression in nursing, which occurs as one gets promoted from one rank to the other. “All nurses on the ward, we work with ranks. Say PNO, as the top rank then SNO, NO, SSN before the staff nurses and the rest. So because of our job, every category has a job description. So PNO has its own job description. Though, we work together, but there are particular ones that PNOs are to be do. So the moment you are climbing the ….”This thing”, you are growing. You become a senior staff nurse and then NO. Then as you are moving through the ranks, you are learning the duties of the ranks, till you come to the managerial duties. That is how our job is. So by the time you reach that managerial position you have learnt a lot through experience”. Another NM also explained SP in a similar way, she said that, the ranking system of progression usually takes into account the staff’s date of appointment : 45 University of Ghana http://ugspace.ug.edu.gh Succession planning practices There's a schedule, with planning the system …the nursing system. You go through the ranks… we use, according to the ranks, your experience and the date of your appointment. Usually, they use the date of your appointment, so you know from here you are going here who follows this one, who follows that one”. (NM10) 4.3.3 Importance of Succession Planning The importance of SP looks at the benefits or gains derived by the organization from implementing or practicing succession planning. Participants talked about these benefits under three sub themes namely; Organizational vision attainment, retention of intellectual capital and increased sense of career planning. 4.3.4 Organizational Vision Attainment Participants explained that, Succession Planning aids in the attainment of organizational vision, because, potential nurse mangers are groomed with the organizational vision in mind and so when they finally attain the managerial role, they set goals and plan their career in accordance with the organizational vision. As they achieve their personal goals, organizational vision is also achieved. Others recounted how SP helped in attaining the vision of the organization through training and education. Nurse managers were also of the view that, education broadens one’s scope of knowledge and thinking and this in turn helps in attaining the vision of the organization. NM5 asserted that, SP ensures that potential leaders are groomed with the vision of the organization in mind and so assume leadership positions with knowledge of the vision, and they work towards its attainment: “...it helps because once the person is a senior and the person has been in the system for quite a number of time, he or she knows the units vision, because going through grooming helps you to know the vision of the 46 University of Ghana http://ugspace.ug.edu.gh Succession planning practices organization. And coming to serve, the vision of the organization will definitely be achieved, since the person is aware of it”. NM1 recounted how Succession Planning helped her organization achieve its vision of providing specialist healthcare, through further education and training. By planning succession, her superiors realized the need for specialist care in her department and this helped to curb preventable deaths. “In fact when we started, the new department, things were very bad so the death rate was high. So that time, I was sent to school because I was to be the lead nurse soon. I went and did critical care. When I left and they opened the place they realised that the death rate was high because they did not know how to manage the cases. They added accident and emergency cases. So in fact, when I came back from school it wasn't easy. It reduced suddenly! They were shocked so they called me and asked in fact, I wasn't going home early because those at the emergency did not know how to manage the head injuries and things. Immediately they had the knowledge, there were few deaths and that is our main vision”. NM4 also opined that, succession planning creates avenues and enables staff to upgrade themselves and by so doing, their mind-sets and attitudes are changed, to conform to the vision of the organization. “When you upgrade or go to school, at least it changes your mindset, your attitude and a whole lot. Because if you take an enrolled and you take a degree nurse or a graduate nurse, you will see a very vast difference between the two in terms of their behaviour, the way they relate to patients, the way they talk and the way they handle things...Yeah. So as we plan it will, I mean, help us attain our vision of better care”. 4.3.5 Increased Sense of Career Planning In terms of Succession Planning increasing nurses’ sense of career planning, participants explained that, putting succession plans in place will serve as a guide and motivational factor to push and enhance career planning. Nurse managers explained that, leaders with succession plans can make inputs and draw the attention of potential 47 University of Ghana http://ugspace.ug.edu.gh Succession planning practices successors to career paths that would be of importance to them later in their career. They also explained that, knowledge of the lines of succession would aid potential managers in planning their career. NM5 explained that, outgoing Nurse managers with succession plans will be able to encourage potential nurse managers to take courses and training that will be of help to them later in their career. She said: “It will help to plan in the sense that, the senior will know that, the next two, three years, she’ll be retiring so somebody is needed. If you have an SNO, and the person is very good and she’s a senior, you can advise or suggest that the person should start getting managerial or short courses whilst you’ll be mentoring her or him as well so that by the time the person is released for the program and comes back, you’ll be getting ready to retire and the person will take up the position so it’s very important”. NM7 also explicated that, when potential nurse managers know that, they are next in line for the managerial role, they tend to take courses to that effect. She said: “Well it helps one in planning her career in the sense that, the person knows within herself that I want to stay in this job till I retire and I am next in position so I have to take this program or that program so that when I come, I know that, yes I have the knowledge and the cert (certificate) for it. Some people do it a lot, when they know they are next in position, you see them taking managerial courses at GIMPA and UG just to give them more knowledge on management”. 4.3.6 Retention of Intellectual Capital Nurse managers explained that, Succession Planning aids in the retention of intellectual capital. When staff know the plans of progression, they are likely to return to the unit with the skill and knowledge they acquire through further education. 48 University of Ghana http://ugspace.ug.edu.gh Succession planning practices NM9 recounted that, even though they do not have a working succession plan, they help their staff acquire additional knowledge, by giving them a flexible time table and they always return to the unit with the knowledge acquired. “As for the intellectual capabilities, we build it up. I mean, following your education, acquiring other skills. Even though we don’t have a working succession plan, we help them gain more knowledge through schooling, with a flexible time table and they bring it back into the unit and we benefit from the knowledge they have acquired”. So I think if there is a working succession plan, intellectual capital will surely be retained”. 4.3.7 Challenges Associated with Succession Planning Challenges associated with SP looked at the difficulties and problems Nurse managers have faced or perceive to face in the implementation of Succession Plans. Nurse managers talked about these challenges under five sub-themes namely: Frequent reshuffling, Ranking system of progression, Lack of incentives and the Tendency to generate conflict. 4.3.8 Frequent Reshuffling Some participants were of the notion that, frequent reshuffling of staff is a great impediment to the implementation of succession plans. Nurse managers articulated that, staff are reshuffled even after you have mentored them and sometimes people who know little about the kind of work they do are also reshuffled to come and head their units. Other nurse managers opined that, people in authority normally foster these reshuffles due to pressure some individuals mount on them. This they explained, hinders the development of succession plans. NM2 opined that, staff in the department are reshuffled due to general changes even after the person has been groomed and this affects the SP process: 49 University of Ghana http://ugspace.ug.edu.gh Succession planning practices “First of all, you can be in a department where people are changed a lot so someone can be working at your place and the person is good but can be changed overnight due to general changes. You've mentored the person but he has been changed another person comes and you would have to still go through training”. She again explained that, other senior staff can be brought in at any time to head the unit, even though they do not have adequate knowledge on the kind of work that is done in the unit: “You can be there and they will ask somebody from another unit who is a PNO and hasn't gotten an office or any position to hold to be brought to come and hold that position and so sometimes they come and don't know anything about the work you are doing but because they are PNOs or DDNS’, they just come and take over. So with the way they do general changes anyhow in the unit it will be difficult to have a succession plan”. NM5 also buttressed the point by saying that, regular changes makes it difficult to start with SP because, just when someone is done grooming, they’re taken out of the unit: “…regular changes, two, three months changes…you find it very difficult, extremely difficult to start something (SP) because as at the time the person is about to or almost done with grooming, then the person will be taken out to a different unit. It’s very difficult”. Another NM reiterated that, sometimes the department’s administration brings in other staff they deem fit to manage the unit but in actual sense, these staff are not sufficiently knowledgeable about the unit to enable them manage it. This the participant said, disrupts the SP process: “…and sometimes the higher authority also have somebody in mind. Maybe somebody is pressing them somewhere so they will try to bring in the person. I have encountered a similar situation somewhere… they were trying to push somebody, the person cannot work with us. Here we deal with knee-bending, and then lifting as well as the bullying from the surgeons. Bringing this woman, she can't work with us. So, we sat down and then discussed with them and they accepted it and then we didn't bother to make that change. So there is departmental authority who make unnecessary changes and it disrupts the SP process”. (NM9) 50 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 4.3.9 Ranking System of Progression The ranking system of progression was described as another challenge that affect the implementation of SP by some Nurse managers. The ranking system of progression is a policy of promotion, where a Staff nurse (SN) after working for three years, moves to the Senior staff nurse level (SSN), and after five years to the Nursing officer (NO) level, and then after every five years moves to the next grade, namely the Senior nursing officer (SNO) level, the Principal nursing officer (PNO) level and finally, the Deputy director of nursing services (DDNS) level. Participants explained that, appointing a nurse to manage the ward, because of her rank is sometimes not the best because, despite rising through the ranks, some nurses are not well equipped with managerial skills and hence, do not work effectively. Some also explained that, it prevents the younger ones with the skill and zeal from exhibiting their full potential since their rank may not allow them to assume certain duties. Participants were again of the view that, nurses should receive the same salary across all levels of education and this would aid in doing away with the ranking system of nursing which pushes leaders to the top without considering their competency level. NM12 said that, the ranking system of promotion is the reason nursing is facing its current problems and that SP needs to be employed to ensure that, potential nurse managers are well prepared before assuming managerial roles: “The ranking doesn’t help because you should be able to leave the ward for someone who is competent to handle not because the person is due for that position so we have to give it to the person, no! Nursing is facing all the problems we see because of this ranking system. The people who are given the positions cannot manage the place well. There must be a process, like the SP which will make sure that they are prepared well”. 51 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Another NM was also of the view that, the ranking system denies younger nurses of the opportunity to make an impact since their lower ranks are not considered: “I think if you ask me personally, I don't believe in the ranking system because I think that the ranking system has failed us to some point…. to some extent, because I believe that there are people who have the zeal, they have a lot to offer but they are not given the opportunity to do so. Because they have not gotten to that rank, they are not able to make those inputs and these are things that can really bring a lot of innovation and a lot of advancement in nursing. Hmmm it's unfortunate that we are still holding on these old things”.NM3 NM11 also reiterated that, she thinks it will be a good idea if nurses are given salaries based on their qualification and not on their rank. She believes this will enable proper SP to be done: “Initially I talked about the hierarchy in nursing which is also a problem. Quite recently I heard that they wanted to give the salary based on your qualification and I'm in. All degree holders receive the same salary across board and all those who have done the certificate too should receive the same salary across board. If this thing comes to play then we can do proper succession planning other than that nursing hierarchy that moves competent or incompetent person automatically to the top”. 4.3.10 Lack of Incentive Participants explained that, another challenge nurse managers confront in the implementation of SP is an absence of incentives for nurse managers. They explained that, the nurse manager role comes with no incentive, despite its difficult nature. Their salaries, they said are not attractive, coupled with the fact that they receive no additional allowance for the extra roles they play. The NM role therefore becomes unattractive to the younger ones and they show no interest in grooming, which is a crucial aspect of SP. They rather veer into other areas where they can get better remuneration and conditions of service. Some nurse managers were of the view that, some incentives like free medical care and accommodation should be given to make the nurse manager role attractive. 52 University of Ghana http://ugspace.ug.edu.gh Succession planning practices NM12 explained that, the lack of incentives for nurse managers makes the role unattractive for the young nurses: “Probably maybe there should be some incentives because if there are incentives who wouldn't like that? When you go to certain institutions and you are given a position as a manager, you have certain entitlements but with nursing, it’s not there. So if I am a manager and I don't get those incentives, then I mean it's nothing. So your subordinates don't see anything, so it does not even motivate them to stay on the ward, and if they don’t stay and go veer into other things, how can succession planning be done”? She went on further to say that, the healthcare of nurse managers as well as that of their dependents, for instance, can be taken care of, as a form of incentive: “…especially when it comes to our healthcare. When you are sick, you are supposed to pay your own bills, buy your own medications. If all these things are taken care of, and your dependents too, maybe your spouse, your kids are given free healthcare, many people will stay but if you don't have those things here and there's a place that you get all of these things why wouldn't I go? They end up leaving and with time, there will be no one to plan succession with”. NM9 also reiterated that, the nurse manager role comes with no risk allowance despite the risks they are exposed to and the salary is not rewarding too. Young nurses hence do not stay to follow through with succession plans: “People out there think as a nurse manager, you're ok, nothing worries you but it is not true. Salary is not rewarding at all. I mean looking at the risk we expose ourselves to, there is nothing like risk allowance. You just come and mingle yourself with these diseases and all the germs and all that. You go home and there is nothing like risk allowance. The young nurses see all this and the role becomes unattractive to them so they look for other areas and they leave. If this continues, how can we plan for the future”? Another nurse manager also said that, the aura surrounding managers in other professions is not seen in nursing. Young nurses are hence not attracted to the position: “And then it is also about making that position attractive to the young ones. Yes, getting people to understand that, if you go to the bank, a manager has an office. I'm not talking about just the office but that aura surrounding the person as a manager, is not found in our profession. Our young nurses don’t see anything about the profession to make them proud. So they do other courses and leave”. NM3 53 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 4.3.11 Tendency to generate conflict Participants explained another challenge of succession planning is the tendency to generate conflict in the unit. According to the nurse mangers, bypassing the ranking system and choosing someone you deem fit and competent for the position may create conflict in the unit. They explained that, other staff on the unit may not understand the reason why the manager has chosen a particular individual over the others. They may end up perceiving it as favouritism and this tends to generate conflicts in the unit. NM11 explained that, it might be perceived as favouritism by the other staff, especially those who are senior to the chosen potential nurse manager. “We face that, “I am here before she came, and I am senior to her”. People fight it and there will be a whole lot of issues. They think “I’m senior-most so why do you give it to the junior”? And in a way they see it as favouritism but it's not favouritism. It is what the senior has seen in the junior that brings them together”. NM12 also buttressed the point that, other staff may see it as favouritism, especially when they are of the same rank: “Sometimes some people think it is kind of favouritism. probably you have two NOs or two SNOs probably they think sometimes you like this person more they wouldn't even know sometimes it's based on their competency level that you would want to groom them. They will think you like this person that's why you've given it to her, especially when they came at the same time (started work at the same time) that one, you really have to use your discretion.it is a very great challenge”. 54 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Another participant also explained in a similar way that, other staff might feel the nurse manager is being choosy by preferring to groom a particular nurse or group of nurses but it is not so. Their cooperation and eagerness to learn draws the managers to them. : “Some feel that you are being choosy. Probably you prefer this one but it's not like that. Because some will easily give you their support or they will corporate with you but some too they don't feel like that because they feel you are putting too much pressure on them. Some are ready to learn, even the children at home, I mean the smart ones or those who are cooperative you tend to draw them to yourself. So we also have same challenges”. NM4 NM7 also reiterated that, when staff are of the same rank, grooming someone may be perceived as favouritism, even though the other person might have a weakness he or she is not ready to work on: “It is a challenge in the sense that, they are class mates and they are of the same rank if you should pick one person and do that, (groom) it’s like you have chosen your favourite. You understand, and it feels like you like this person and you don’t like that person but the person knows that he has a weakness and is not ready to work on it. Some of the juniors are more responsible than the seniors because they (the seniors) come to work and just dally around and leave”. 4.3.12 Strategies to enhance Succession Planning Nurse managers outlined some strategies that can be used to enhance the practice of SP, in accordance with the theoretical framework used for the study. Strategies were sub themed as: Promotion with preparation, Provision of incentives, Transparency in the succession planning process and Talent identification. 55 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 4.3.13 Promotion with preparation As an individual climbs the promotional ladder, some nurse managerss are of the view that, the individual should be groomed and mentored through further education and in-service training. This they believe will aid in ensuring appropriate and adequate preparation of potential nurse managers before they assume the managerial role. Some participants stated that, they help their subordinates get prepared for future positions by ensuring that, the timetable is flexible enough to enable them school whilst working. This they agree is sometimes not accepted by the departmental heads but they see it as a way of ensuring that, their staff are well prepared for future positions. NM5 said that, staff must be well prepared through in-service training and conferences to aid them gain more knowledge on managerial duties: “We can start with in-service education, from time to time, let them have in-service training on how to get here. Then at a point we can even invite an expert, in managerial position, not necessarily nursing to come and give a talk as well. You have to understand that you have to go through some kind of steps as part of the SP process before you get into the managerial position. Staff must be well prepared for that position, so that they can perform better”. Another nurse manager opined that, it is very necessary to equip potential nurse managers with knowledge through education: “The other thing is about equipping the person (potential nurse manager) with education. It is very, very, very necessary because skill without knowledge is nothing. If you have knowledge behind your skill, it perfects what you do. I see it as a challenge not equipping most of the upcoming nurse managers with education and ensuring that they are well prepared before promotion. It is not the best”.NM3 56 University of Ghana http://ugspace.ug.edu.gh Succession planning practices NM9 explained that he ensures that, all his staff are adequately prepared for promotion by making the timetable flexible enough, so that they can all further their education while, working at the same time. “…for instance, education plan. You always, recommend to them, “go to school” and they always do. In fact, in my unit, there is no single staff here who is not. Maximum 2-3 years they are going to school. And we also plan in such a way that everybody can go to school and come to work as well. We have a flexible timetable system, and this ensures that staff are well prepared for the task ahead”. NM10 also reiterated that, she helps her staff prepare for promotion by ensuring that, they further their education even before they are due for study leave. “That is why I started with the schooling. You know nursing is dynamic now. Things are changing. Formerly we didn't have that chance, we just completed, you finish your midwifery, you come and work, work, work then they pick few of you for the position, and you are good but now it’s different. So we talk to them and ensure that they go to school even before they are due for study leave and that helps them to prepare for the future”. 4.3.14 Provision of Incentives A good number of participants were of the view that, incentives in the form of better conditions of service and better remuneration, is a good strategy to enhance the effective practice of SP. According to participants, the remuneration nurse managers get is not enough, coupled with the fact that, they are exposed daily to different kinds of diseases yet receive no risk allowance, and when they get sick, they have to foot their own bills. This they say, makes the position unattractive to the young ones and if along the line they get a better job, they pay no heed to the lines of succession but instead leave for better remuneration and conditions of service. NM9 opined that, salaries and other allowances should be rewarding enough to match the risks staff are exposed to: 57 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Salary is not rewarding at all. I mean looking at the risk we expose ourselves to, there is nothing like risk allowance. You just come and mingle yourself with these diseases and all the germs and all that. You go home and there is nothing like risk allowance. The young nurses see all this and the role becomes unattractive to them so they look for other areas and they leave. If this continues, how can we plan for the future”? NM12 also explained by saying that, the change subordinates see in the lifestyle of their nurse managers after they assume leadership roles, motivates them to aspire for those roles but if they see no change, then nothing motivates them. “Probably maybe there should be some incentives because if there are incentives who wouldn't like that? When you go to certain institutions and you are given a position as a manager, you have certain entitlements but with nursing, it’s not there. So if I am a manager and I don't get those incentives, then I mean it's nothing. So your subordinates don't see anything, so it does not even motivate them to stay on the ward, and if they don’t stay and go into other things, how can succession planning be done”? 4.3.15 Transparency in the succession planning process Transparency in the SP process is another strategy some nurse managers believe will aid in a smooth transition. With transparency, they explained that, conflicts will be minimal since the lines of succession is made clear to all. NM5 explained that, when the lines of succession is made clear to all staff, they support and do not feel like things are being imposed on them. “I think things should be made clear to all staff. So let them have an open view and by doing that, they know who is next to take the position already. Expose everything to them. Lay the facts there for them, no need to hide anything. At times it’s not too good imposing on them too. It will help to gain their support and avoid confusion”. NM7 also remarked that, it is not necessary to hide succession plans from staff, and not doing so aids in gaining the support of the staff: 58 University of Ghana http://ugspace.ug.edu.gh Succession planning practices If we are planning succession, I don’t think we have to hide the fact that, this person is next. No! It is when you hide that you see that people are against her and don’t want to help or support. It should be clear for every staff to know. 4.6.4 Talent Identification The identification of potential nurse managers with the skill and knowledge to take over from current managers is the central theme of SP, and talent is what underpins this identification. Some participants were of the view that, talent should not be overlooked and staff with potential should not be intimidated but rather be encouraged to build on their potential. Some nurse managers also added that, young nurses with talent who think their talents are being hoarded can move on to other units within the department where their talents will be put to good use. Young nurses with talent were also advised to stay humble and dedicated to their superiors. NM10 explained that, she encourages those with talent by giving them additional tasks in addition to their routine tasks. “…if you know that the person is good, you allow that person to help those who are not vocal. For instance, the partograph that I did, I made two of them, from the labour ward to be the preceptors. I said, you are going to do it go and read on it. Anyway, I was happy. So if you see that she is vocal, encourage her to know that you appreciate what she is doing. And they were happy that I made them do that work. They said it's their first time, I said fine, in everything, there is a first time. Though, I am in charge I said you are going to do it and I will support you. And they did it very well”. She further explained with a scenario where, a young (in terms of rank) talented nurse was identified and made a lead nurse. This she said, yielded good results: “Though we have two PNOs at the first floor labour ward, I have an SNO, who even came just about getting to two years but very talented. She went to practice midwifery. I said sister, be in charge though do we have a PNO, be in-charge. There is indiscipline there I want you to be in-charge. So make sure that they are disciplined there. And it is changing them. She is doing a good job. So me I will always look out for someone who is good and talented”. 59 University of Ghana http://ugspace.ug.edu.gh Succession planning practices NM3 buttressed the point and went further to say that, if as a young person with potential, you realize your talent is not being put to good use or is being hoarded, you can choose to move to a unit where your talent will be recognized and put to good use: “So even if your talent is being hoarded somewhere, maybe you'll be needed somewhere else or in another unit. So you shouldn't allow your talent or whatever to be hoarded you should move on. You should go to where you will be needed so that you can shine there”. NM7 was of the view that, the young talented nurses should be humble enough so that their superiors can help them build their talent and career. This she believes will aid in a smooth implementation of succession plans as well as empower young nurses: “It depends on that person who has that talent. You shouldn’t also look down on your senior person because, when someone is older than you, the person doesn’t want you to bring him or her down. Like in this era of computer, it wasn’t in the system so the younger ones that are coming, they are more conversant with these things. So if maybe the DDNS or the nurse in charge needs this and you are well vested in it, you don’t look down on her but help her wholeheartedly. This will also draw her attention to your talent in her future succession plans” 4.7 Current Practice of Succession Planning Current practice of succession planning is an emerging theme that was derived from the data gathered. Participants described their current practice of succession planning under two subthemes namely: Ranking system of succession and Mentoring. 4.7.1 Ranking system of succession Most nurse managers did not have an existing succession planning system in place. They however, depended on the ranking system in choosing leaders and Potential nurse managers for their units. Though other aspects of succession planning like on the job training, and education were being practiced, there was no clear line of succession apart from the normal ranking system. Most nurse managers had deputies who were 60 University of Ghana http://ugspace.ug.edu.gh Succession planning practices derived from the ranking system. They also explained that there is no clear policy on SP making the ranking system their most used option. Nurse managers also recounted how a lack of a succession plan put them in their current positions. When asked about who succeeds her when she goes on leave, NM4 explained by saying that: “I have another PNO, she’s my deputy. So, when I am going on leave, I hand over to her and then she will take over”. NM11 also answered to the same question by saying that, they do not have a succession plan and so her immediate junior, based on the raking system takes over when she is not around: Hmmm, actually we don't have that plan as you want to understand, we don't have that plan so anybody immediately my junior, I mean in terms of rank, takes over. Another nurse manager also reiterated the use of ranks as a current practice of succession planning: “There's a schedule, with planning the nursing system, you go through the ranks, you use, according to the ranks, your experience and the date of your appointment. Usually, they use the date of your appointment, so you know from here you are going here who follows this one who follows that one”. NM10 NM5 also explained that, the policy is not very clear on succession and so they choose successors based on the ranking system. 61 University of Ghana http://ugspace.ug.edu.gh Succession planning practices “The policy is not too consistent. It’s not too stable. So we choose based on the ranking system. We look for the senior most staff and choose as our deputy so when you’re not around, she automatically takes over”. NM2 recounted how the lack of an existing succession planning system pushed her into assuming her current position due to her rank (PNO) without prior information and preparation. “Last year November, the lady here, the nurse manager who was here told me she wants to go and teach in Legon. So she told the DDNS. But nobody called me about it. So I went on leave in December came back in January and I was even called in the house that my name has been changed to this place. No prior notice from them. They only said I should come here because of my current rank. I was not prepared for this change at all”. 4.7.2 Mentoring Mentoring is an aspect of succession planning that most nurse managers were found to practice. Even though they had no clear cut lines of succession, they identified nurses with potential and mentored them for the future. NM4 explained that, even though they are supposed to mentor everyone on their team, she sometimes handpicks a few good ones and mentor them. “Ideally, you should mentor everybody. You are supposed to mentor everybody. But you know that each person has his or her own potential. There are some that are good. They have good managerial skills and such people, you pick them and then give them special mentoring so that they can take over from us when we are out of the system or if you are put to another place”. NM9 also explained that, he has people he mentor even though not everyone on his team know about this. “For me I am doing it (mentoring) but it is not known to all. There are some people when they make a mistake you don't talk about it. When you talk they don't accept their mistake. Some anytime you talk about one 62 University of Ghana http://ugspace.ug.edu.gh Succession planning practices thing, they realize it, and they accept it. There are people who ask questions, and who are ready to open up. So I identified some and then I’m mentoring them. Some too, they are not ready for me. They are bosses within themselves. But we are all working and there should be that cordiality”. NM3 also explained that, she believes that everyone has a potential and if they receive the right training and mentoring, it can help them be the best version of themselves . “I chose to mentor those I believe I can make an impact in. I can't make replicas of me that is why I chose those people. And then I believe that you can influence people to change their attitude to help them excel in what they do by training, by speaking to them, by counselling them, and then by maybe giving them advice on things that they can do that can enhance their skills and their knowledge”. 4.4 Summary of Findings The study explored the practice of SP among nurse managers at the KBTH. The views of twelve nurse managers were sought using a semi structured interview guide. Data was analysed using thematic content analysis. The objectives formulated for the study were underpinned by the theoretical framework of Leadership Succession Planning and Development (Rundio & Wilson, 2015). Some constructs of the framework were examined under the Strategies that can be used to enhance SP, in addition to other constructs like the importance, challenges and knowledge of SP, and these embodied the conceptual framework. The main themes for the analysis were thereby derived from the conceptual framework, namely; knowledge on succession planning, importance of succession planning, challenges associated with succession planning, strategies used to enhance succession planning and an emerging theme, current practice of succession planning. 63 University of Ghana http://ugspace.ug.edu.gh Succession planning practices The study brought to bear the fact that, most nurse managers do not explicitly practice SP but however, depend on the ranking system of progression to choose potential successors. Certain aspects of SP like mentoring and on the job training, were nonetheless, being practiced. Another finding of the study was that, most nurse managers have a fair knowledge about succession planning, its importance and the challenges associated with it. The key findings in the study are; 1. Succession Planning increases nurses’ sense of career planning, helps retain intellectual capital and also helps in organizational vision attainment. 2. The ranking system of progression is the main criteria nurse managers use in the appointment of potential successors. 3. The challenges encountered or perceived to be encountered by nurse managers in the practice of succession planning include; frequent reshuffling, lack of incentive, ranking system of progression and the tendency to generate conflict. 4. Strategies that can be used to enhance succession planning include; promotion with preparation, incentives, transparency in the succession planning process and talent identification. 5. The practice of SP is currently not explicit among nurse managers, however, certain aspects of SP like on the job training and mentoring are being practiced. 6. Nurse managers SP as a top managerial responsibility and hence expect the top management to come up with succession plans. 64 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 7. Nurse managers assert that, the ranking system of progression is not always reliable because, people pushed to the top by virtue of the ranking system are sometimes not the best for the job. 65 University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER FIVE DISCUSSION OF FINDINGS This chapter discusses the findings of the study. The major objective of the study was to explore the succession planning practices of nurse managers in KBTH. The qualitative approach was employed because, the theoretical framework, from which a conceptual model was derived, provided the strategies that nurse managers can use to enhance the practice of SP. The discussion follows the objectives of the study, which is in line with the main theme from the data: the knowledge on succession planning, the importance of succession planning, the challenges associated with succession planning and the strategies that can be used to enhance succession planning. An additional theme that emerged from the data; current practice of succession planning, was also discussed. 5.1 Knowledge on Succession Planning Succession planning is a systematic process that is concerned with the development of potential leaders, through training, education and mentoring. This ensures that the potential leaders are well prepared to take up leadership positions in an organization. The study found out that, the knowledge of nurse managers on SP is centred on two sub-themes, which are; identifying and developing potential leaders and rising through the ranking system. A good number of nurse managers were of the view that, SP is associated with the identification and development of potential leaders through education and mentoring. This is consistent with a study conducted by Titzer and Shirey, (2013) on nurse manager succession planning, which concluded that, the fundamental principle of 66 University of Ghana http://ugspace.ug.edu.gh Succession planning practices succession planning is the identification of potential leaders internally and grooming them to take up key organization roles in the future. Bolton and Roy (2004) also asserted in a qualitative study that, the major components of a SP are the identification of key positions, identification of potential leaders, grooming of the potential leaders and allocating resources. The development or grooming of potential leaders is a major theme, which runs through almost all the various descriptions of SP in literature and this goes to support the perspectives of nurse managers on SP. Brunero, Kerr and Jastrzab (2009) in a qualitative study in Australia” concluded that, the SP program provides an opportunity for the organization to identify new leaders, who can then be groomed to take up leadership positions. Identification and Development of potential leaders is thence, a central theme in SP as asserted by majority of the nurse managers. Another theme that a few nurse managers linked to SP is the ranking system of progression in nursing. A few of the nurse managers were of the view that, the ranking system of progression that is seen in nursing, where a staff nurse, after three years of service rises to the senior staff nurse level, and after five years, to a nursing officer and then to a senior nursing officer, principal nursing officer and finally, deputy director of nursing services (DDNS), is synonymous to SP. Literature reviewed however, did not support this assertion. Literature predominantly, agreed with the majority of nurse managers who perceived SP as the development of potential leaders, but the notion that, it is synonymous to the ranking system, to the best of the researcher’s knowledge has so far not been considered in literature. Although in Ghana, most nurse managers get into their positions, through apprenticeship (Ofei, 2015), which consequently sees them 67 University of Ghana http://ugspace.ug.edu.gh Succession planning practices occupying the nurse manager role by rising through the ranks, this cannot be equated to SP which involves a series of process as outlined by Bolton and Roy (2014). 5.2 Importance of succession planning Importance of SP examined the perceived importance of SP to nurse managers. Three sub-themes were derived as the nurse manager’s perceived importance of SP, namely; organizational vision attainment, retention of intellectual capital and an increased sense of career planning. Nurse managers affirmed that, organizational vision attainment is an importance of practicing SP. Nurse managers further explained that, this is because, it creates the avenue for the next leader to be groomed by the current leader, with the vision of the organization as a guiding principle to the grooming process. With knowledge on the organizational vision and goals, the next leader is likely to develop her personal goals and vision for her unit in line with the organizational goals. This they explained will help in the attainment of organizational goals. This is consonance with a study conducted by Cross (2009) which found out that, succession planning increases the probability that, strategic vision of the organization will be maintained because, the next leader has been groomed by the current leadership of the organization. Seniwoliba (2015) also found out in a study that, organizational vision and mission are likely to be maintained with a SP program in place because, the next leaders with knowledge of the strategic mission and vision of the organization are most likely to come up with action plans, that are underpinned by the mission and vision of the organization. This goes to buttress the assertion by the nurse managers that, SP aids in 68 University of Ghana http://ugspace.ug.edu.gh Succession planning practices the attainment of organizational goals. When an organization’s vision is attained, there is satisfaction of staff, clients and management and this fosters growth and the pursuance of higher visions. Another importance of SP, nurse managers made mention of is its ability to aid in the retention of intellectual capital. Participants opined that, SP aids in the retention of intellectual capital. Additionally, participants explained that, when an organization invests in the grooming of potential leaders, they tend to have an allegiance to the organization, and this makes them stay in the organization to foster its growth. Others explained by saying that, when employees are previewed to the lines of succession, and they realize the plans of career progression the organization has for them, they are likely to stay and follow through with their career, consequently leading to the retention of intellectual capital. This is consistent with a study by Titzer, Phillips, Tooley, Hall and Shirey (2013), which revealed that, organizations that identify and develop internal human capital can improve role transition and reduce nurse manager turnover rates. Reduction in turnover rates results in the retention of intellectual capital. Kim & Thompson (2012) in a qualitative study also reported that, high performing healthcare organizations make use of SP programs to retain intellectual capital by identifying and supporting employees with potential for promotion. Employees after being supported through the promotion process with education and training, become more endowed intellectually, and their retention aids in improvement of the quality of care provided (Trepanier & Crenshaw, 2013). This is in line with the viewpoint of participants that SP aids in the retention of intellectual capital. 69 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Nurse managers were again of the view that, SP increases nurses” sense of career planning. Participants went on to explain that, when nurses are made aware of succession plans, it guides them in planning their career. It also guides them on the courses to pursue and the type of training they should acquire. This heightened sense of career planning, inadvertently affects their level of performance in a positive way, when they finally assume managerial roles. The quality of care rendered is improved, thereby aiding in the achievement of organizational goals. A study carried by Brunero et al. (2009) observed that, SP increased nurses’ sense of career planning and improved their comprehension on their career progression. Nurses are thereby, better positioned to undertake training and education that is in line with the succession plans of the organization. Titzer and Shirey, 2013 in a study on “nurse manager succession planning, a concept analysis”, noted that, a formal SP program prepares the organization to fill vacancies when the need arises. This is because the program creates a pool of qualified nurses who are ready to take up leadership positions, due to the right courses and training received. Leadership courses and other forms of training which build on the leadership and managerial qualities of the nurse manager is a prerequisite for every potential nurse manager. It aids them in making better decisions and planning better care for their clients as well as better workplace climate for their staff. When clients are content with the quality of care received, and the workplace climate is conducive for all staff, the organization’s goal is most likely to be achieved. The notion of nurse managers that, SP increases nurses’ sense of career planning is thence, supported by literature. 70 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 5.3 Challenges associated with succession planning The challenges associated with SP, were described by participants under four sub themes; frequent reshuffling, ranking system of progression, lack of incentives and the tendency to generate conflict. Nurse managers were of the notion that, frequent reshuffling of staff from one department to the other is a great challenge that hinders the successful implementation of succession plans. Time is of essence in every human relation, and getting to know the potential of staff, requires that, the nurse manager spends adequate time with them. Participants verbalized that, the staff they work with are reshuffled frequently, making it difficult for the nurse manager to build a relationship with them and also get to know their hidden potentials. Instances were cited, where nurse managers identified young nurses with potential, and started the grooming process but these staff were reshuffled to other units within the department without prior notice and consultation. This supports the assertion that, visible support and commitment of the top management is a cardinal element in SP, with some experts suggesting that, without the support and involvement of top management, even the best succession plans are headed towards failure (Clark & Lyness, 1991; Executive Knowledge Works, 1987; Friedman; 1986; Hall, 1984; Hall & Foulkes, 1990; Lee 1981). When top level managers are aware and in support of succession plans, a problem like reshuffling of staff is less likely to occur. Literature however, to the best of the researcher’s knowledge, did not make mention of “reshuffling of staff” as a single-handed challenge to SP. This the researcher believes is due to the fact that, SP has not been extensively studied in nursing. In the business sector where extensive studies have been done, reshuffling of staff is not likely 71 University of Ghana http://ugspace.ug.edu.gh Succession planning practices to be a challenge since staff are hired based on their skill set and knowledge base and placed where needed. The ranking system of progression in nursing is another challenge nurse managers explained can hinder the smooth implementation of SP. According to the participants, the ranking system puts people in management positions without taking into consideration their managerial potentials. Conners et al. (2007) also argued that, being a good clinical nurse does not guarantee that, an individual will be a good nurse manager. DeCampli et al. (2010), a study , discovered that, new nurse managers are usually promoted within direct care ranks, with limited or no formal training or preparation and this affects the efficacy of their work. This literally, supports the notion of nurse managers that, the ranking system of progression in nursing hinders the smooth implementation of SP. Participants again were of the view that, the nurse manager role in Ghana is not an attractive one. It comes with no incentives, despite the demanding nature of the role. This the participants explained makes the role unattractive to young potential nurse managers who see no reason to aim for managerial positions which comes with no added benefit, despite its demanding nature. Wieck, Dolls and Northam (2009) in a quantitative study on “What nurses want: the nurse incentive project”, reported that, nurses know what they want and over three quarters (78.5%) of their study population indicated that nurses were moderately to extremely unhappy with incentives. Wieck et al. (2009) further noted that, the two top issues that nurses enlisted as affecting their intention to leave or stay at a job are better working conditions and wages. The global health workforce alliance in 2008 reported that, incentives are important levers that organizations can use to attract, retain, motivate, 72 University of Ghana http://ugspace.ug.edu.gh Succession planning practices satisfy and improve the performance of staff. Young, Albert, Paschke and Meyer( 2007) found out in a study that, incentives such as innovative work schedules, have been effective for encouraging nurses to return to the workforce and to remain. The above studies support the assertion of nurse managers that, a lack of incentive for the nurse manager role, makes the role unattractive for the young nurses and they may hence not stay to follow through with it. This inadvertently affects the SP program since identified potential nurse managers may not be interested in assuming the role. Participants lastly mentioned that, succession planning carries the tendency of generating conflicts in the unit. This is because, it may be perceived as favouritism by other staff on the ward. Nurse managers explained that, choosing a potential successor who does not fall within the direct care ranks, regardless of the person being the best fit for the job, may be perceived as favouritism by other staff on the ward. Mehrtak et al. (2014), in a study on “succession planning in the Iranian health system discovered that, perceived favouritism is a challenge that affects the succession planning process. Mehrtak et al. (2104) also said that leaders who select their favourite employee to succeed them, hinder the purpose of SP. The study is in line with the assertion of nurse managers that, SP carries the tendency of generating conflicts in the unit. It is therefore, necessary to ensure that, succession plans are transparent enough and all staff on the unit are aware of it. The support of top management in the SP process is also important to foster transparency and also the acceptance of the plan by staff. 73 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 5.4 Strategies used to enhance succession planning Participants made mention of some strategies that can be used to enhance SP under four sub-themes namely; promotion with preparation, incentives, transparency and talent. Nurse managers were of the view that, promotion with preparation is a strategy that can be used to enhance succession planning. Nurse managers believed that young nurses should be groomed through in-service training as they climb the promotional ladder. This will aid bring up a pool of talented young nurses who are ready and prepared to fill the leadership pipeline. Prestia, Dyess and Sherman (2014), reported that, a successful succession plan promotes an emerging leader with sufficient leadership preparation developed over years of training, education and practical experience. Wilson (2015) also observed that, promoting an emerging leader without preparation could produce years of inefficient performance as the leader becomes educated and acclimated to their new role. Years of productivity are rather used to learn and develop leadership skills. It is therefore imperative that, potential leaders are given adequate preparation through further education, training, and mentoring. Literature accordingly is in consonance with the view of nurse managers that, promotion with preparation is a strategy that can be used to enhance SP. This ensures outright productivity on assuming managerial roles, as well as improved patient otcomes and staff satisfaction. Another strategy participants made mention of, which in their view can be used to enhance SP is incentives. Nurse managers explained that, incentives in the form of better conditions of service and better remuneration are strategies that can be adopted to increase staff retention rates which consequently will aid in the success of succession 74 University of Ghana http://ugspace.ug.edu.gh Succession planning practices plans. A study by Sherman, Saifman and Schwartz (2015) on “Factors that lead Generation Y nurses to consider or reject nurse leader roles”, found out that, nurses required better conditions of service in the form of opportunities for personal and professional development as well as better remuneration. Wieck et al. (2009) in a study also reported that, nurses know what they want and over three quarters (78.5%) of their study population indicated that they were moderately to extremely unhappy with incentives. Wieck et al. (2009) further reported that, the top two issues that nurses generally identify as affecting their intention to leave or stay at a job are better working conditions and wages. Previous studies are thus, in accordance with the assertion of nurse mangers that, incentives can be used as a strategy to enhance SP. The nurse manager role especially in Ghana needs to be given the importance it deserves. Challenging as it is, it comes with no added incentive for the nurse manager. Nurse managers are seen joining queues, to seek healthcare for themselves and their families. Some take loans in order to cover the cost of healthcare in the same health facilities they work in. Most nurse managers in the study reported living in privately rented apartments and struggle to get to work on time with public transport. These are demotivating factors to the young nurse and leaves the young nurse with very little to desire about the nurse manager role. Incentives in the form of better remuneration and better conditions of service can be used to enhance the attractiveness of the nurse manager role to young nurses. Transparency in the succession planning process is another strategy nurse managers presumed, can be used to enhance the SP process. Participants explained further that, transparency in SP helps to prevent conflicts, build trust, increase retention and 75 University of Ghana http://ugspace.ug.edu.gh Succession planning practices prevent favouritism in the unit. This in turn fosters growth and unity between staff. Campbell & Smith (2014), reported that, transparency in SP has an influence on potential leadership candidates. Tucker (2017), asserted that, transparency in SP is central to building trust and retaining talented individuals and intellectual capital within the nursing organization. Transparency within the nursing organization culture requires easy access to SP information, consistency in what constitutes success in development, honesty in the promotion process and upward mobility (Balogh-Robinson, 2012; McCallin et al., 2009; Wilson, 2015). Literature above concurs with the notion of nurse managers that, transparency in the succession planning process can be used to enhance succession planning. Lines of succession need to be made clear enough for every staff to understand. This will debunk notions of favouritism and foster unity among staff. Talent management is a central theme in SP and participants enumerated it as one of the strategies that can be used to SP. Nurse managers explained that, the identification and nurturing of potential nurse managers who have the skill and knowledge required of good leaders is important in ensuring the success of succession plans. Tucker (2017) reported that, talent management in SP involves identifying, developing and managing high potential emerging candidates to develop the organization’s future leaders. She further stated that, talent management is a strategy that can benefit the organization by ensuring that, there is a pool of qualified candidates to fulfil succession plans. An organization’s intellectual capital can be lost in a short period of time with unplanned retirements, sudden illness, or exodus of talented leaders (Sherman, Chiang-Hanisko & Koszalinski, 2013; Wilson, 2015). It is therefore of outmost importance that, talented young individuals are identified, mentored and trained to fill up the leadership pipeline 76 University of Ghana http://ugspace.ug.edu.gh Succession planning practices (Charan, 2005). The above literature supports the assertion that, talent management is a strategy that can be used to enhance succession planning. Harnessing the talent of staff aids in making informed decisions on the kind of preparation young people with potential will need as they move ahead in their career. This consequently improves staff retention rates and also intensifies the commitment of staff to the organization. 5.5 Current practice of succession planning Current practice of succession planning is a theme that emerged from the data gathered. On their current practice of SP, most nurse managers were found not to have an existing succession plan in place. They however, practiced other aspects of SP like on the job training and mentoring. Leadership development through SP is a business strategy, which has gained recent attention in nursing (Cadmus, 2006; Kim & Thompson, 2012; United states Department of Labour: Bureau of Labour, 2013; Westphal, 2009). This recent attention in nursing has however been focused much in the developed countries. Developing countries like Ghana, to the best of the researcher’s knowledge are yet to incorporate SP for nurse managers into the developmental strategy for nurses. Mariotti (2014) in her study on the “Development and Implementation of a Succession Plan for the Nursing Department in a Community Hospital”, discovered that SP for nurse managers is a practice that is mostly seen in high ranking healthcare facilities, found in developed countries. The utilization of succession planning by these high ranking healthcare facilities aided in the retention of intellectual capital by identifying and supporting employees with potential for promotion. The non-existent succession plans of nurse managers in the KBTH, which is in Ghana, a developing country hence comes as no surprise as literature has observed. 77 University of Ghana http://ugspace.ug.edu.gh Succession planning practices Mentoring is an aspect of succession planning most nurse managers were found to engage in. Mentoring of a novice manager by a more experienced nurse manager creates an environment of trust and helps the novice nurse manager navigate through the difficulties of role transition (Lindsey, 2012). Moran et al., (2002) acknowledged that, mentoring is an aspect of succession planning, most nurse managers have been found to engage in. This is consistent with the findings in this study, as most nurse managers were found to engage in mentoring. Dennison (2010) describes mentoring as an educational strategy, where a practiced individual supports a novice individual, helping to close the gap between organizational procedures and policies. Practiced nurse managers need to identify people early in their career and mentor them both administratively and practically. Taking time to guide, share experience and knowledge, as well as provide emotional support for the novice can increase job satisfaction, competency and optimize health (Mijares, Baxley & Bond, 2013). 5.6 Summary of Discussion The study found out that, the knowledge of most nurse managers on succession planning is centred on the identification and development of potential leaders, which is consistent with literature. A few nurse managers were however of the view that, SP is synonymous with the ranking system of progression in nursing, which was not supported by literature, to the best of the researcher’s knowledge. The study also revealed that, succession planning aids in organizational vision attainment, retention of intellectual capital and also increases nurses’ sense of career planning. Literature supported the study findings. The study again found out that, the 78 University of Ghana http://ugspace.ug.edu.gh Succession planning practices challenges associated with SP for nurse managers include; frequent reshuffling of staff, the ranking system of progression in nursing, a lack of incentive and the tendency of SP to generate conflict among staff. These findings were supported by literature however, frequent reshuffling of staff, to the best of the researcher’s knowledge was not mentioned in literature as a challenge to SP. The study additionally discovered that, strategies that can be used to enhance SP include; promotion with preparation, the provision of incentives, transparency in the SP process and talent identification /management. Studies reviewed acknowledged that, these strategies can be used to enhance the SP process. Current practice of SP among nurse managers was found to be predominantly absent. Most nurse managers were found to have non-existent succession plans. This was in line with various studies reviewed which viewed succession planning for nurses as a reserve for health facilities in the developed world, despite its numerous benefits. Mentoring, an aspect of succession planning, was found to be a common practice among nurse managers and previous studies asserted to that. 79 University of Ghana http://ugspace.ug.edu.gh Succession planning practices CHAPTER SIX SUMMARY, CONCLUSION AND RECOMMENDATION This chapter presents the summary of the study and the implications of the findings of the study to nursing administration, education, research and practice. It also presents the lessons learnt by the researcher from the study, the limitations of the study, draws conclusions and offers recommendations. 6.1 Summary of the study Nurse managers play a notable role in the delivery of healthcare, ensuring both patient and staff satisfaction. They also serve as a conduit between the top management and staff, conveying information from the top management to the staff and vice versa. Their indispensable role requires a great deal of knowledge and skill to aid in the achievement of both staff and client satisfaction, as well as the organizational goals of the health facility. Their appointment therefore, needs to be well thought out, following due process. In Ghana however, the appointment of nurse managers is based on the number of years one has spent in service. When a vacancy is created, the next person in line with the highest rank or years in service automatically takes over without much consideration of how prepared they are for their new role. The ill preparedness of nurse manages for this role however, continues to be documented. The study therefore sought to explore the succession planning practices of nurse managers at the Korle Bu Teaching Hospital. The exploratory descriptive research design was used to explore the practice of succession planning among nurse managers at the KBTH. The knowledge, importance and challenges associated with succession planning were also explored. A purposive sampling technique was used to recruit twelve (12) nurse managers who have been in 80 University of Ghana http://ugspace.ug.edu.gh Succession planning practices their current positions for not less than three years. A semi-structured interview guide based on the constructs of the conceptual framework adapted from the Leadership Succession Planning and Development Model, 2015, was designed to elicit responses from participants. The interview guide was pilot-tested at the Greater Accra Regional Hospital. Ethical clearance was sought from the Noguchi Memorial Institute for Medical Research Institutional Review Board (NMIMR, IRB) and Korle Bu Teaching Hospital Institutional Review Board. The Scientific and Technical Committee of Korle Bu Teaching Hospital also reviewed the study protocol and granted approval for the study. The researcher was then introduced to the human resource department of the hospital, where commencement date was discussed, and researcher was introduced to the Deputy Directors of Nursing of the various departments used for the study. The DDNS’ in turn introduced the researcher to the heads of the units the researcher used for her study. The purpose of the study was explained to the selected unit heads and they were also told of their right to confidentiality, anonymity and voluntary participation. Contact numbers of nurse managers who volunteered to be part of the study were taken. They were contacted later, and a convenient day was scheduled for the interviews. Participants were again informed that, participation in the study is purely voluntary and that, they can decline to be interviewed even after consenting initially. Permission was sought to have the interview sessions recorded. A field notebook was used to record nonverbal cues. Interview sessions lasted between 45 minutes and 1 hour. Verbatim transcription of the recorded interviews was done. The data was managed by separating demographic data from transcripts and filed using pseudonyms to maintain confidentiality. Data was analysed using Braun & Clarke’s six phases of thematic 81 University of Ghana http://ugspace.ug.edu.gh Succession planning practices analysis. The data was read to familiarize self with data and coding done according to the themes and sub-themes of the framework. Data safety was electronically ensured with pseudonyms and passwords and printed copies kept under lock and key. The main themes that were derived from the objectives of the study and data collected were; Knowledge on succession planning, Importance of succession planning, Challenges associated with succession planning and Strategies that can be used to enhance succession planning. In the course of data analysis, an emerging theme that was discovered is the Current practice of succession planning among nurse managers. These five themes were broken down into a total of fifteen sub-themes. The theme; Knowledge on succession planning, had the sub-themes; Developing potential leaders and Rising through the ranking system. Nurse managers explained their knowledge on succession planning under these two sub-themes. Majority of them were of the view that, succession planning is centred on the development of potential leaders. Literature agreed with “the majority” of nurse managers because, studies found on the knowledge of succession planning had the “development of potential leaders” as the main theme. A few nurse managers were however of the view that, succession planning is synonymous with the ranking system of progression in nursing. This to the best of the researcher’s knowledge, was not found in literature. The theme; Importance of succession planning was described under three subthemes namely; Organizational vision attainment, Retention of intellectual capital and Increased sense of career planning. Nurse managers asserted that, succession planning helps the organization achieve its vision and also helps the organization retain its intellectual capital. They also explained that, with succession planning in place, nurses’ 82 University of Ghana http://ugspace.ug.edu.gh Succession planning practices tend to have an increased sense of career planning and they take courses and engage in various forms of training that are in line with the progress of their career. Several studies were found to agree to this assertion. The theme, Challenges associated with succession planning had the sub-themes; frequent reshuffling, ranking system of progression, lack of incentive and tendency to generate conflict. Participants explained that, some of the challenges nurse managers face or perceive to face in the practice of succession planning include frequent reshuffling of staff on their wards, which thwarts their efforts at planning succession. They additionally explained that, the ranking system of progression puts nurses in certain positions which inadvertently makes them potential successors, without considering their actual performance. Denying them the right to be potential successors even though the ranking system has put them in that light, creates conflicts and misunderstandings. Another hindrance to SP participants made mention of was lack of incentive, which they explained makes the nurse manager role unattractive to potential nurse managers. Literature supported these assertions of nurse managers on the challenges associated with SP. Reshuffling of staff was however not found in literature to the best of the researcher’s knowledge as a challenge to SP and this the researcher believes is as a result of SP being an emerging area in nursing. Strategies that can be used to enhance SP were described under four sub-themes namely; promotion with preparation, Incentives, Transparency and Talent. Nurse managers explained that, when potential leaders are prepared adequately before promotion, success of the SP process can be greatly assured. They also said that, ensuring transparency in the SP process, giving incentives to nurse managers to make their roles 83 University of Ghana http://ugspace.ug.edu.gh Succession planning practices attractive and identifying talented individuals for grooming and training are sure ways to enhance SP. Studies reviewed were found to agree with the stance of the participants. The emerging theme that was derived from data, “current practice of succession planning” was described under two sub-themes by participants namely; ranking system of succession and mentoring. Participants explained that the ranking system of succession is what they currently use in choosing potential leaders. Other aspects of SP like mentoring was also discovered to be practiced by nurse managers. Studies reviewed were consistent with the current practice of nurse managers, where promotion is done through direct care ranks. Mentoring is also an aspect of SP, which was found to be in practice. 6.2 Implications of the Study The findings of the study have implications for nursing practice, nursing research and nursing education. 6.2.1 Implications for Nursing Practice Findings of the study indicate that, the ranking system of progression in nursing is what is currently being used as the determinant of potential successors and nurse managers assert to the fact that, it has failed them to some extent. It is therefore imperative that, potential nurse managers are identified early in their career and given the necessary grooming and education as per the succession planning process. The commitment of top management to the succession planning process is also very crucial to the success of the process. 84 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 6.2.2 Implication for Nursing Research The need for further research on succession planning is evident from the study. This will aid in a deeper understand of succession planning in nursing. The study revealed that, succession planning is an emerging area in nursing and research on it pertaining to nursing is quite limited. Further research is therefore needed on succession planning for nurse managers in Ghana and its impact on the competency level of potential nurse managers. The succession planning process also needs to be researched into to help create a better understanding of the process. 6.2.3 Implication for Nursing Education Nursing education has been found to prepare nurses to become good clinicians and not good managers (Conners et al., 2007). Leadership and management concepts relevant to the nursing profession would hence be needed to be incorporated into the curriculum for nursing education. The Ministry of Health in partnership with accredited universities can also run leadership programs for nurses in their various health facilities. 6.3 Lessons Learnt from the Study Carrying out this study to a successful end with such experienced nurse managers has broadened my scope of experience. Researching into this new area has given me another insight into the nurse manager role, and the role succession planning plays in it. The study has also helped me gain additional insight into how in-depth interviews are conducted and also the qualitative approach to research. 85 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 6.4 Limitations of the Study The overall goal of every research work is to produce findings that can be applied to other areas with similar challenges. It is however, extremely difficult for behavioural or social science research to achieve universal generalization (Coughlan, Cronin & Ryan, 2007). The study was conducted at the Korle Bu Teaching Hospital in the Greater Accra Region to explore the succession planning practices of nurse managers. Their practice and perceptions may not holistically reflect that of other nurse managers in Ghana. KBTH, notwithstanding, is the largest hospital in Ghana and the third largest hospital in Africa, with a large number of nurse managers. The researcher purposely chose participants from different departments within the hospital and this to an extent positively affects the generalizability of the study. Another limitation of the study is that, it is reductionist in nature because, it reduced the strategies that can be used to enhance succession planning to the few concepts under study (pilot & Beck, 2010). The researcher however examined additional concepts as per her conceptual framework. 6.5 Conclusion of the Study The study explored the succession planning practices of nurse managers in a tertiary level hospital in the Greater Accra region of Ghana. Data was collected using in- person interviews with a sample size of 12 nurse managers. Nurse managers play a critical role in ensuring both staff and patient satisfaction in the hospital setting and this role requires a great deal of knowledge and skill. Their appointment therefore, needs to be well thought out and executed using a planned process. Succession planning has been 86 University of Ghana http://ugspace.ug.edu.gh Succession planning practices found to prepare potential leaders for their task ahead through the identification and development of potential leaders. The study found out that, the knowledge of majority of nurse managers on SP is centred on the development of potential leaders. It was also found that SP aids in the achievement of organizational goals, the retention of intellectual capital and also increases nurses’ sense of career planning. Challenges nurse managers’ face or perceive to face in the implementation of succession plans were found to include frequent reshuffling, ranking system of progression, lack of incentives for nurse managers and the tendency to generate conflict. Some strategies nurse managers perceive can be used to enhance succession planning include promotion with preparation, incentives for nurse managers, transparency in the succession planning process and talent identification. Nurse managers were found to currently practice the ranking system of progression which they asserted has failed them to an extent due to the ill preparedness of potential leaders before attaining the nurse manager role. It is consequently imperative that, succession planning is given the needed attention in the nursing fraternity to aid in the development of leaders who are knowledgeable and skilled at their work. 6.6 Recommendations of the Study Based on the findings of the study, the following recommendations have been made with the aim of helping in the development of nurse managers through a well thought out succession plan. 87 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 6.6.1 Recommendation to Korle Bu Teaching Hospital (KBTH) 1. A structured succession planning system should be put in place to ensure that, potential nurse managers are given the needed education and training before attaining the nurse manager role. 2. Commitment from the top management of the hospital to the succession planning process is essential in ensuring the success of the program. 3. The in-service training department of the hospital should be well equipped to identify the training needs of staff, as well as offer regular experiential training on leadership and management. 6.6.2 Recommendation to Nursing Administration 1. A structured job description for nurse managers should be developed for evaluating performance and identifying training needs. 2. The appointment criteria for nurse managers should be reviewed, paying less attention to ranks, and focusing more on the knowledge, skill and managerial education or experience the candidate has. 3. Every nurse manager should be mandated to identify potential nurse leaders and mentor them officially, to fill up the leadership pipeline. 4. Experiential learning training sessions, in the form of conferences should be held at regular intervals to update existing nurse managers on the current trends in nursing. 88 University of Ghana http://ugspace.ug.edu.gh Succession planning practices REFERENCES Aroian, J. 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V., & Valpuesta, D. (2010). Examining human resources' efforts to develop a culturally competent workforce. The health care manager, 29(2), 117-125. Wilmot, H. (2006). Seagull management and the control of nursing work. Work, Employment and Society, 20(2), 223–243. Wright, K., Rowitz, L., Merkle, A., Reid, W. M., Robinson, G., Herzog, B., … Baker, E. (2000). Competency development in public health leadership. American Journal of Public Health, 90(8), 1202. 96 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX A INTERVIEW GUIDE UNIVERSITY OF GHANA SCHOOL OF NURSING INTERVIEW GUIDE SECTION A Gender: Age: Educational Qualification: Department/ Unit: Place of Residence: Marital Status: Number of Children: Religion: Languages Spoken: Nationality: SECTION B Knowledge and Perception of Succession Planning 1. What is your understanding of “succession planning? “ 2. Do you think Succession Planning is an applicable practice for nurse managers? 97 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 3. What is the required level of education and or experience for nurse managers in the Korle Bu Teaching Hospital (Probe: what set of experience, skills, abilities, and traits is required of nurse managers?) 4. How did you get into your current position? 5. Do you have acceptable candidates who can succeed you on a short or long term basis? If yes, how well do you know them, and what criteria did you use in selecting them as potential successors? If No………. what happens, if you should leave for a new job or retire? Importance of succession planning 1. Do you think succession planning increase nurses’ sense of career planning? If yes….how? 2. How do succession planning programs help to retain intellectual capital in the health facility? 3. Does succession planning bring about stability of climate in the organization? If yes…….how? 4. To what extent does succession planning help an organization to achieve its vision? Challenges associated with succession planning 1. What barriers do you think nurse managers and leaders face in the development of succession plans? 98 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 2. What challenges have you encountered or perceive to encounter with implementing succession planning in your facility? Strategies for enhancing succession planning 1. How can potential nurse leaders be given the knowledge and experience required to maximize their potential as nurse managers? 2. What measures can be put in place to ensure that young nurses are attracted and motivated to aim for managerial positions in the organisation? 3. How can the tendency on the part of nurse managers to hoard talent be overcome? 4. How can we ensure that every nurse manager identifies potential nurse leaders in her unit or department that can add up to our leadership pipeline? 99 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX B CONSENT FORM 100 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 101 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 102 University of Ghana http://ugspace.ug.edu.gh Succession planning practices 103 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX C LETTER OF INTRODUCTION FROM SONM 104 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX D NOGUCHI CLEARANCE 105 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX E KBTH CLEARANCE 106 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX F KBTH STC/IRB APPROVAL 107 University of Ghana http://ugspace.ug.edu.gh Succession planning practices APPENDIX G LETTER OF INTRODUCTION FROM KBTH 108