Organizational Structure, Strategic Planning

Care Delivery Models, Safety Culture

Learning Objectives

Module I concentrates on the following course outcomes—

· Analyze how political arenas (government, workplace, professional organizations, and community) shape health care delivery.

o The concept of the organization is introduced to provide context to the planning component of nursing management. Mission, philosophy, vision and values are discussed as impacting the nurse’s practice. Planning patient care in specific team configurations is also discussed.

Federal and consumer directives have forced healthcare organizations to examine current practice models and both organizational structures and processes that account for increasing efforts to develop models and systems that contribute to patient safety. Patient safety is at the forefront of issues for organizations and efforts have begun to identify safety culture dimensions.

The importance of communication within the organization and specifically within structured work teams is discussed. Typical patterns of communication are identified.

Reading Assignment

Sullivan: Chapters 1, 2, 3

Supplemental Readings (See Resources Section)

Beyea, S. C. (2005). High reliability theory and high reliable organizations. AORN Journal. 81(6), 1319-1322.

Cooke, H. (2009). Theories of risk and safety: what is their relevance to nursing? Journal of Nursing Management. 17:256-264.

Air Safety Support International. (2006) Safety Culture. Available at: http://www.airsafety.aero/safety_development/sms/safety_culture/ (Links to an external site.)Accessed July 25, 2012

Overview

Understanding the organizational context of professional nursing practice is an important part of leadership and management. The nurse will participate in determining the most effective strategic plan for implementing care at the bedside or for an entire patient population of a facility. Other contextual factors include the mission, vision and philosophy and organizational culture of the organization. It is important for the nurse to know the mission and vision of the organization and have a philosophy that is consistent with that of the organization in order to support its efforts. Organizational structure relates to how work is organized and and provides for how work is communicated. Classic organizational structures include centralized, decentralized, matrix and combinations of these types. Centralized organizations (tall, with many layers) tend to have decision making at the “top.” While, decentralized organizations (flat) have decision making closer to the level of care. The military is an example of a centralized organization. Modern healthcare have moved toward a more type flat type of structure with decentralization and shared decision making. A concept appropriate to professional personnel. The organizational chart defines chain of command, line versus staff positions, and span of control. These are key concepts to know for this course. System’s Theory, Humanistic Theory, Chaos Theory, Contingency Theory and Complexity Theory are theoretical frameworks used to guide the processes within an organization. Cultural Diversity within organizations relates to both care provider and recipient. The changing demographics require non-biased understanding and appreciation of the difference of others.

Safety Culture has become a major issue for organizations since the IOM report in 1999 citing thousands of hospital errors and patient deaths and establishing a culture of safety has become a healthcare priority. Safety culture has its origin in high risk organizations such. Health care organizations are considered high risk organizations similar to aviation, nuclear plants and chemical process industry. Organizations that perform successfully under exigent conditions are termed high reliable organizations (HRO). Characteristics of high reliable organizations include for example: 1) preoccupation with failure, 2) reluctance to accept simplification and 3) deferring to expertise. Preoccupation with failure is an effort to avoid drifting into failure and becoming complacent. Safety culture is a central foundation of HROs and is measured with a variety of tools to assess communication, teamwork, frequency of error reporting. Expectations of manager behaviors to promote safety and more. The Agency for Health Research and Quality (AHRQ) published the Hospital Survey on Patient Safety Culture (HSOPSC) in 2004 and to date hundreds of hospitals with thousands of healthcare employees have reported perceptions of hospital safety culture with de-identified data reported in aggregate. See information about safety and the HSOPSC at http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Jones_29.pdf (Links to an external site.). Safety and safety culture information will be discussed again in Module V along with Quality improvement and literature related to healthcare errors.

“Nursing work” is organized according to different models for care delivery. Functional, Team Leading, Differentiated Practice, Primary Nursing and Care Management Method are common delivery models. Differentiated practice is a model more commonly seen within Magnet hospitals systems and includes provision for the different levels of educational preparation and skill of the Registered Nurses with different job descriptions for each. The type of delivery system depends on a number of factors, including availability of staff, staff mix, type of patients and organizational philosophy. The ultimate goal is a safe environment with quality and financially sound outcomes.

Strategic planning is vital to any organization and is carried out in a systematic process. It includes identifying the organization’s strengths and weaknesses through assessment of the internal and external environment. The process screens for influencing markets, competition, technology, healthcare trends, financial resources and information systems to name a few.

Assignment questions: Post answers in Forums Module I. See calendar for due date.

1. Discuss one of the organizational theories from the readings and how you see this theory used or could be used in an organization. What are the merits of the theory?

2. Discuss what is meant by the terms, organizational span of control and chain of command.

3. Describe three types of organizational structures and some characteristics. Which type of organizational structure have you seen used in an organization and what are its advantages and limitations.

4. Which type of organizational structures do we see most frequently in acute care hospitals?

5. Cite common factors used for strategic planning and how nurses are involved in the process.

 

Interview a professional nurse with a BSN who could be a mentor to you and who exemplifies the type of nurse you want to become.

Write a 1- to 2-page interview report. In your report, include the following:

• Identify and describe the attributes that make this nurse a role model for you.
• Explain the beliefs, values, attitudes, and philosophies this nurse demonstrates and relate it to your long-term goals.

• Describe the role of the nurse based on beliefs, values, attitudes, and philosophies.

 

As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess all system components, as some may be relatively healthy while others are problematic.

For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)

To prepare:

Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).

Reflect on your organization or one with which you are familiar ( Refer to the first discussion you did for me, My organization is a hospital University of Maryland Medical center) . Within a particular department or unit in this organization, identify a problem the staff is encountering.

Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.

Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.

Research professional standards that are pertinent to your identified problem.

Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

To complete:

Write a 4- to 5-page paper (page count does not include title and reference page) that addresses the following:

(1) Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.

(2) Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).

(3) Based on this information, explain how you would address the problem as follows:

(a) Formulate a desired outcome.

(b) Identify goals and objectives that would facilitate that outcome.

(c) Translate those goals and objectives into policies and procedures for the department or unit.

(d) Describe relevant professional standards.

(4) Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

Guidance for Application Assignments:

Application Assignments require a title page, introduction, body of the paper, conclusion, and reference page. The title page needs to follows APA style and includes a title, student name, course number and section, and date. An abstract is not required. APA style headings are to be used appropriately to separate and organize sections of the paper. The use of direct quotes is discouraged and should only be used when the source material uses language that is particularly striking or notable. The introduction should provide an overview of the topic, the purpose of the paper, and topics that will be addressed. The body of the paper needs to address all required topics. The conclusion ought to provide closure for the reader, synthesize the content, and tie everything together to help clarify the main points of the paper. The reference page should include all references cited in the assignment in correct APA format.. Credible sources include scholarly peer-reviewed journal articles, evidence based resources, and professional (.org), educational (.edu), and government websites (.gov). Commercial websites (.com) are not considered credible sources. Please note: When selecting articles for course assignments, you are advised (unless you are referencing seminal information) to focus on work published within the past five years.

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Review Chapter 7, “Strategic and Operational Planning”

See especially Figure 7.1 on page 147.

Chapter 8, “Planned Change”

Organizational Change Associated With Nonlinear Dynamics (pp. 172–176)

Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.

Chapter 12, “Organizational Structure”

“Organizational Culture” (pp. 274–276)

There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.

Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.

Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4 (1) [2].

Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.

Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
Retrieved from the Walden Library databases.

In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

Optional Resources

Glennister, D. (2011, July). Towards a general systems theory of nursing: A literature review. Paper presented at the 55th Annual Meeting of the International Society for the System Sciences, Hull, United Kingdom. Retrieved from http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569

Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf