Healthcare Organizations Understanding and Designing Organizational Structures Cultural Diversity in Healthcare

Chapter 7 2

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 3 Objectives  Identify and compare characteristics that are used to differentiate healthcare organizations.  Classify healthcare organizations by major types.  Analyze economic, social, and demographic forces that drive the development of healthcare organizations.  Describe the impact of the evolution of healthcare organizations on nursing leadership and management roles.

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 4 Characteristics and Types of Organizations  Institutional providers  Types of services  Length of direct care services  Teaching status  Accreditation  Ownership

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 5 Not-for-Profit vs. For-Profit Healthcare Organizations  How does ownership impact healthcare organizations?

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 6 Not-for-Profit Healthcare Organizations  Controlled by voluntary boards or trustees  Provide care to a mix of paying and nonpaying patients  Excess revenue over expenses is redirected into the organization for maintenance and growth.

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 7 For-Profit Healthcare Organizations  Operate with the specific intent of earning a profit by providing healthcare services to individuals who can afford to pay

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 8 Characteristics and Types of Organizations (Cont.)  Accountable Care Organizations  Consolidated systems and networks

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 9 Characteristics and Types of Organizations (Cont.)  Other organizations Community services Subacute facilities Home health Long-term care and residential facilities Hospice Nurse-owned and nurse-organized services Self-help voluntary organizations

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 10 Characteristics and Types of Organizations (Cont.)  Supportive and ancillary organizations Regulatory agencies Accrediting bodies Third-party financing organizations Pharmaceutical and medical equipment Professional, educational, and training

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 11 Characteristics and Types of Organizations (Cont.)  Organizational relationships Integration Acquisitions and mergers

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 12 Forces That Drive Organizations  Economic  Social  Demographic

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 13 Theoretical Perspective  Systems theory Structure Technology People Environment  Chaos theory Universe filled with unpredictable and random events

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 14 Economic Forces Influencing Health Care  Increasing numbers of uninsured patients  Decreasing reimbursement  Regionalization  Focus on pay for performance

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 15 Social Factors Influencing Health Care  Focus of society that is changing from illness to health (wellness)  Increasing demand by individuals that they participate in designing their own customized care plans

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 16 Demographic Factors Influencing Health Care  Increasing percentage of society that is composed of elderly individuals  Increasing percentage of uninsured  Inability of communities to provide access to needed health services

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 17 The Spectrum of Health Care  Primary Care Purpose  Early detection and prevention of disease  Maintenance of health and wellness  Management of common health problems and chronic illnesses Examples of Organizations  Healthcare provider practices  Community and neighborhood clinics  School and occupational health offices

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 18 The Spectrum of Health Care (Cont.)  Secondary (Acute) Care Purpose  Diagnosis and treatment of disease and injury Examples of Organizations  Acute care hospitals  Long-term care facilities

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 19 The Spectrum of Health Care (Cont.)  Tertiary Care Purpose  Diagnosis and treatment of complex disease and injury Examples of Organizations  Acute care hospitals with specialty units such as coronary care or transplant units  Specialty hospitals such as psychiatric facilities

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 20 The Spectrum of Health Care (Cont.)  Respite Care Purpose: To provide caregivers of chronic care patients a short-term period of relief  Restorative Care Purpose: To provide routine follow-up for acute conditions (e.g., nursing home care), or for conditions such as drug rehabilitation (e.g. half-way house)  Continuing Care Purpose: To provide ongoing care for those who need assistance with activities of daily living (e.g., geriatric care centers)

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 21 Understanding the type of healthcare organization in which you practice helps you understand the populations served, the availabilities of healthcare providers, the concerns of owners or taxpayers, and how forces are likely to change the organization in the future.

Chapter 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.

Objectives  Analyze relationships among mission, vision, philosophy, and organizational structure.  Analyze factors that influence the design of organizational structure.  Compare and contrast types of organizational structure.  Evaluate reengineering of organizations. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 23

Organizational Theory  Systematic analysis of how organizations and their component parts act and interact All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 24

Interrelationship of Mission, Vision, and Philosophy All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 25

Types of Organizational Structures Shared governance is focused on allowing professional nurses to manage their practice. It involves the responsibility for making decisions at the patient, unit, and organizational level. In this practice model, front-line nurses are accountable for making nursing care decisions that impact their patients. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 26

Mission Statement  Sets the stage by clearly defining the intent and goal of the unit or organization. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 27

Example of Mission Statement “This unit’s purpose is to provide high- quality nursing care for neurosurgical patients during the acute phase of their illness that facilitates their progression to the rehabilitation phase. We strive to cultivate a multidisciplinary approach to the care of the neurosurgical patient and provide multiple educational opportunities for the professional development of neurosurgical nurses.” All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 28

Vision Statements  Future-oriented, purposeful statements designed to identify the desired future of an organization All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 29

Example of Vision Statement  “To be the premier neurosurgical nursing unit in the state” All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 30

Philosophy  Written statement that articulates the values and beliefs held about the nature of the work required to accomplish the mission All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 31

Factors Influencing Philosophy  Views and beliefs (management, staff, patients)  Stage of professional development  Education  Technology All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 32

Organizational Culture  The reflection of the norms or traditions of the organization as exemplified through behaviors that illustrate the values and beliefs of the organization All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 33

Characteristics of Organizational Structures  Complexity  Formalization  Centralization All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 34

Factors Influencing Organizational Development  Consumerism  Change  Competition  Legal/Regulatory All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 35

Shared Governance Structure Evolution  Phase 1: Representative staff nurses are members of clinical forums.  Phase 2: Representative staff nurses belong to committees.  Phase 3: Representative staff nurses belong to councils with authority. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 36

Types of Organizational Structures  Functional  Service line  Matrix  Flat  Shared governance All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 37

Types of Organizational Structures (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 38

Types of Organizational Structures (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 39

Types of Organizational Structures (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 40

Types of Organizational Structures (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 41

Conclusion Numerous options exist for the way in which nursing services can be organized. It is important to think about the characteristics of each type and how those fit with the way in which you wish to enact your professional career. Organizations do change; however, it is a slow and deliberate process. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 42

Chapter 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.

 Evaluate the use of concepts and principles of acculturation, culture, cultural diversity, and cultural sensitivity in leading and managing situations.  Analyze differences between cross- cultural, transcultural, multicultural, and intracultural concepts and cultural marginality. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 44

 Two perspectives to think about: Patients Workforce All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 45

 Enhancing efforts to increase the recruitment, retention, and subsequent graduation of minority nurses  Promoting leadership development for minority nurses  Developing a practice environment that promotes diversity  Promoting the preparation of all nurses so that culturally competent care can be provided All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 46

 Shape the culture of an organization. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 47

 The ANA Code of Ethics for Nurses with Interpretive Statements, Provision 8. “The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs” All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 48

 Linked to social strata  Patient Protection and Affordable Care Act of 2010 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 49

 National League for Nursing (2005) Core Competencies of Nurse Educators with Task Statements Competencies 1, 2, and 4. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 50

 Competency 1 – Facilitate Learning All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 51

Competency 2 – Facilitate Learner Development and Socialization All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 52

 Competency 4 – Participate in Curriculum Design and Evaluation of Program Outcomes 53All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.

 Causes in Health Care  Related to?  Examples All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 54

 Effectively manage and treat disease processes. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 55

 Greater productivity!! All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 56

 Ethnic background  Socioeconomic status  Family rituals All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 57

 Develops over time  Members learn it and share it  Essential for survival  Difficult to change All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 58

 Range of differences All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 59

 Affective behaviors All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 60

 Adapting All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 61

 Change All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 62

 Positive outcomes for entire team! All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 63

 Negative Outcomes for the Team! All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 64

 Foster respect for differences. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 65

 Multiculturalism  Cross-culturalism  Transculturalism All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 66

 Leaders and Managers Long-term vision Financial commitment Healthcare-provider commitment All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 67

 Mentoring  Continuing Education  Internet All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 68

 Understanding is key…and appreciation! All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 69