Think of a healthcare organization that you are most familiar with and think of its organizational structure. Describe this structure or use of combinations of structure (line, matrix, service line, ad hoc, or flat).
Give an example of how decision making occurs and identify if this is centralized or decentralized. Is this best practice?
Organizations have many task forces, councils, and committees that are designed to contribute to the success of the organization and improve its function.
Describe one of these groups, discussing the formal and informal leadership, how decisions are made, and what the role of those that are most influential have on the final product or outcome of the group’s efforts.
Scholarly references to support your response are required.
Welcome to Week 2!
During Week 2, you will identify how organizations are structured and function and how this structure and function impacts organizational outcomes. Organizational structure and function affects how leaders behave and interact through impacting communication patterns, problem solving, decision making, and creating change. People in organizations, regardless of the type of structure and function and mandated communication patterns, also establish informal communication patterns that are demonstrated through frequent interactions that lead to development of strong and powerful relationships. The formal and informal structure and functions within the organization are noted in leader assignments such as task forces and committees, as well as through volunteering to work on new projects and organization-sponsored social events. This week, you will have an opportunity to examine organizational structure and function and consider how leaders behave through formal and informal avenues to achieve leader and organizational goals and objectives.
Examine how a systems-approach can contribute to achieving quality health outcomes characterized by high quality, safe, patient-centered care (PO1, PO2)
Compare methods of conflict resolution that respect cultural diversity and promote a caring environment for staff and patients (PO2, PO3)
Identify various team strategies for problem-solving that enhance patient-centeredness and value-added care. (PO 1)
Week 2: Reading
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Battilana, J. & Gasciaro, T. (2013, Jul-Aug). The network secrets of great change agents. Harvard Business Review. link (Links to an external site.)Links to an external site.
Jayanthi, A. (2013). Using an input-throughput-output model to minimize cost, increase value. Becker’s Control & Clinical Quality [online]. link (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.
Johnson, V., Wessel, T., & Johnson, K. (2013). Building collaboration between CNOs and direct-care nurses. American Nurse Today [online], 8(1). link (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.
Krueger, D. L. (2013). Informal leaders and cultural change. American Nurse Today [online], 8(8). link (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.
Lee, T. H., & Hall, K. W. (2010). Turning doctors into leaders. Harvard Business Review, 88(4), 50-58. link
Several systems theories discovered in the literature, including open systems, chaos, and multiple types of adaptive theories, may assist in leading nursing services (Rose, 2013). The open systems approach will be our focus here, as we look at how healthcare organizations meet their needs in various areas. Some of the areas that leaders deal with daily are finance, quality, and regulatory requirements.
Systems can be closed or open. A closed system has inputs and outputs within distinct barriers; most often, these barriers are from the internal organizational environment. The closed system is seen as an entity wherein all the components for functioning are within the system; there are no inputs or outputs from the external environment. Historically, healthcare has been considered a closed system.
An open system is seen as an entity that is interactive with its environment, being sustained by the inputs and outputs of the system. In open systems, there is a hierarchy in which smaller systems interact with each other dynamically to support goals or accomplish tasks (Sullivan, 2011). Some of the smaller units of the healthcare system include highly specialized areas such as the emergency department and the intensive-care unit; the laboratories and central processing; and human resources and financial management. An open organization becomes more complex as more specialized units are developed and function within it. In an open system, all the units are interdependent. Leaders have a broad overview and understanding of the system within which they work as well as a detailed view of the areas within their sphere of influence. The healthcare open system functions to create patient care, diagnosis, and treatment for patients, and provide all the intricacies to support this goal.
In NSDT, there are four main components that nurse leaders must consider in their daily work; these are inputs, throughputs, outputs, cycles of events, and negative feedback. The inputs are the people, materials, resources, and information. The people are all those who are internal and external to the system, including staff and patients. Materials mean those items that are required to complete the organizational goals of care delivery, such as supplies and devices. The resources are related to funding sources such as insurance, government, grants, loans, and donations. Information is vast, ranging from the overall climate of the external environment to the details related to a specific patient (Meyer & O’Brien-Pallas, 2010).
Throughput is what is manipulated and changed to affect us reaching our goal. Throughputs can be as simple as a nursing intervention and other provisions of services (Meyer & O’Brien-Pallas, 2010). Outputs are those things that include any products generated (perhaps through research), materials created (such as a new device or drug), and services provided. One clear service that is provided as an output is the volume of patients that are cared for. One product is the revenue that is generated within the organization.
Systems cycles are those regular and periodic events that ensure best practices, highest quality, and patient safety such as adherence to regulatory demands (Meyer & O’Brien-Pallas, 2010). Other cycles include infection-control data and monitoring, review and updating of policies and procedures, and addressing patient-satisfaction surveys.
Negative feedback has high appreciation from nursing leaders because this is a mark of the degree to which their sphere of influence is meeting organizational expectations (Meyer & O’Brien-Pallas, 2010). Negative feedback occurs through evaluation of performance indicators for the organization and those people and specific units functioning within it.
An example of how the NSDT works within the organization is seen by observing a nursing unit’s activity. The patient arrives for care, leading nursing staff to input the delivery of services to promote the output of improved patient health. Along this path, there may be necessary changes in room assignment or areas of care; these changes would be throughput, and during this change, there may be negative feedback if the patient and family do not appreciate the change.
It is through the use of the NSDT and consideration of healthcare as an open system that leaders gain information and insight into how to respond to daily events that bring barriers and challenges to the organization’s function and meeting the goals for patient-care delivery.
Leaders must keep the organizational goals firmly in mind as they work within the organization creating changes (throughput) to improve the output. Daily staffing of the organization in which staff assignments are adjusted across units is a keen example of how throughput is used, demonstrating the interdependence of systems units on each other. Consider the oncology unit with the need for two registered nurses due to high patient volume. The goals of the organization must be met, including delivery of high-quality, safe patient care to all patients on the oncology unit. Leaders evaluate staff competencies and change (throughput) the nursing care assignments of two registered nurses from one area to another. If this shortage of nursing personnel becomes an ongoing situation, the organization will adapt by hiring additional registered nurses in a supportive role for the oncology patient population. Leadership will evaluate the department performance, and should the number of patients decrease, the oncology registered-nurse staff would shift to accommodate the needs in another area (throughput). A cycle of events for this particular oncology unit may occur seasonally if there is an influx of population such as in a college town or a city where the weather is pleasant during a harsh winter. Feedback will be obtained from staff and patients and, if negative, additional adjustments will be made by the leadership team. Thus nursing services delivery is a dynamic interplay of inputs, throughputs, outputs, cycles of events, and negative feedback.
Although the use of the NSDT seems to organize the work within the environment, there continue to be many variables that impact the ability to ensure consistency in delivery of nursing services. These variables include the patients who are different ages, genders, cultures, degrees of illness, and degrees of needs. Some tools are available to leaders who strive to create the steady state for patients and employees, but often there is more chaos than consistency.
Using the NSDT as a foundational component, leaders can focus on both the global and sub-units of the organizational system. The NSDT allows leaders to measure and evaluate nursing services through observing the actual work completed rather than using data that may not offer both quantitative and qualitative perspectives. Unlike the closed system, open systems described through the use of the NSDT are energetic, innovative, and dynamic in the approach to nursing services. Applying the NSDT with nurse-sensitive indicators supports leaders to lead and manage the process of nursing within the organization (Meyer & O’Brien-Pallas, 2010).
As leaders use the NSDT to gain information and insight within their organizations, it becomes important for these leaders to manage their behaviors and communication in a manner that is appropriate for their roles. In order to ascend to the highest levels of leadership, individuals must be able to view, know, and reflect on their behaviors and communication patterns related to the impact on others. There are five components to emotional intelligence. These are (a) self-awareness, (b) self-regulation, (c) motivation, (d) empathy, and (e) social skills (Taft, 2013).
Self-awareness is the component that identifies the degree to which the leader knows him- or herself. This is the ability to know what you are feeling and how these feelings may translate in facial expression, body language, and verbal communication and how others in the environment will interpret and respond to you. Leaders with high self-awareness demonstrate humility and appreciation. They are keenly aware of their strengths and weaknesses. How can you achieve high self-awareness? Keep a journal of your thoughts and interactions during the day that includes reactions of others to you. Find a method that will allow you to respond rather than react. Some techniques to encourage responding include counting to 10, excusing yourself for a moment, or asking for a meeting or the opportunity to give an answer at a later time.
Self-regulation requires establishment of acceptable response patterns that include (a) careful and measured non-emotional responses (no cynicism or sarcasm); (b) making measured decisions; never rushed or with an emotional response; (c) universal or neutral approach to all people regardless of status, race, gender, etc.; and (d) never compromising personal, organizational, or professional values. How can you achieve high self-regulation? Leaders must draw the line designating where they can and cannot compromise; to do this, leaders must clarify their values and those of their profession. A good way to do this is to ask yourself what your code of ethics is. Knowing where you stand ethically will support ethical and moral decision making. Another way to achieve self-regulation is through self-accountability. Leaders must be accountable for their actions; stop blaming others, the organization, and the situation. Facing errors, challenges, and barriers earns respect and admiration from others. Lastly, practice calmness. Monitor your behavior the next time you feel yourself becoming anxious. How are you acting? Do you get quiet or do you scream? Practice breathing. This may seem silly, but often we do not take full, even breaths in situations that are difficult; breathing helps to keep you calm. To relieve stress, express it in a manner that is acceptable. An acceptable manner is to write down everything that you would like to say, then file it away, never to be read by anyone but you.
Motivation can come from others or can be created within yourself. The best leaders have high standards and clear goals. These people are focused on achievement. How do you get yourself more motivated? To get more motivated, you need to reexamine what you love about your job. If you are struggling with even one thing, begin with something concrete such as “I love that I get paid for the job I do”; “I love that I receive a great insurance plan”; “I love that I earn vacation time”; and so on. If you are a leader, recall the whys that led you to originally apply for the position. The use of the whys is a valuable technique to reevaluate performance. Completing this process helps to find the issues that are creating problems and discover possible solutions.
Why I am unhappy?
Why was the deadline missed?
Why did the project take longer?
Why did I underestimate the complexity?
Why didn’t I look all the steps?
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