9/7/2015Carolyn Morse Jacobs, Rn, MSN, ONC1 Understanding and Working in Organizations

9/7/20152 Understanding Organizations Defined Organizations Formally constituted groups of people who work together Have identified tasks to achieve a specific purpose defined by the organization Defined by unique purpose and structure Organizational structure includes How the group is formed Chain of command Lines of communication How decision-making occurs Max WeberMax Weber, the Father of Organizational Theory!

9/7/20153 To understand organizations Organizational function: is it parallel to organization structure? Structure of organization Must accomplish its purpose in effective way…make money!

9/7/20154 Understanding Organizational Structure (know definitions/ advantages/ disadvantages) Tall or centralized structure Has “core” individuals; few in power “Narrow” area of responsibility Problems in communication Flat or de-centralized structure Decision-making “spread-out” Simplification of communication “Charge person” with broad span of control

9/7/20155 Understanding Organizational Charts cont Matrix Structure* Secondary lines of authority Typical of large organizational structures Characterized by having individuals with expertise as resources Team approach to problem solving! Involves a two directions for lines of authority, accountability and communication

9/7/20156 Understanding Organizations Adhocracy Bureaucracy and “adhoc” type structure using teams as specialists; has director Special projects Shared governance Professional practice model Increasing importance Various models, widely used in nursing, facilitates nursing input

9/7/20157 Understanding Organizational Charts Provides graphic description of roles and patterns of interactions among parts of the system Shows formal structure of organization Solid lines: communication relationships Vertical lines: lines of authority; chain of command Dotted lines: advisory Hospital Organizational Charts

9/7/20158 Organizational Chart

9/7/20159 Answer these questions What do the vertical lines represent on an organizational chart? What do the horizontal lines represent? A dotted (or broken) line in an organizational chart indicates what type of relationship among individuals? Lines of authority and accountability= chain of command Communication among individuals with similar levels of authority; no authority, same “work” level A communication relationship…not an authority relationship!

9/7/ More on understanding organizations…defining characteristics Authority Official power from top down; earned Responsibility Ethical and legal obligation Accountability Involves liability (Delegation)

9/7/ Answer this question! When the RN “delegates a task to a UAP…who is accountable for performance of that task?? (see p 48) When the nurse delegates (assigns) a task to a UAP (unlicensed assistive personnel) the nurse is still accountable/responsible for performance of that task!

9/7/ Relationships within Organizations Chain of Command Also known as “organizational hierarchy” Identifies path of authority and accountability ! Span of control Number of individuals a person is responsible for The greater the # the more authority and responsibility & greater span of control

9/7/ Channels of Communication Formal and informal pathways Think about advantages/disadvantages of each and effect on clinical work! Formal Informal

9/7/ Understanding Organizations Mission Statement “Why” of existence Describes what the organization plans to accomplish, aims or function Generally very brief Philosophy Results from “mission” statement Generally a listing of beliefs and values Promotes quality care Sets “Benchmark” to evaluate the organization’s performance

9/7/ Understanding Organizations Policy Plan or course of action for specific situation (such handling rape victims) Found in policy manual Procedure “How” a specific activity is to be carried out, the actual steps Found in a procedure manual Standard of Care Authoritative statement to describe acceptable level of care

9/7/ Relationships within Organizations Job Descriptions Written statements Provides general guidelines for function Outlines scope of authority, responsibility, and accountability Basis for evaluation Found in policy manual

9/7/ Consider these questions 1. Why would a nurse find it useful to understand organizational structure? 2. Give one example of a situation in which a nurse might find it helpful to understand organizational structure. 3. Give one example of how a nurse participates in shared governance..

9/7/ Review your answers: 1. Why would a nurse find it useful to understand organizational structure? 1.Work more effectively within organization 2. Give an example of a situation in which a nurse might find it helpful to understand organizational structure. 1.A nurse identifies a need to change a procedure; would need to know the organizational structure to determine “who” has authority to make changes and how change occurs.

9/7/ Review your answers: 3. Give one example of how a nurse participates in shared governance. Mary, RN, was elected as Medical-surg floor representative to the Shared Governance committee; nurses have complained that the new rotation schedule is not satisfactory; staff is dissatisfied and are leaving. What are the options besides everyone having to work every other weekend?

9/7/ Consider this question Which statement BEST describes a “Matrix” organization? 1. Decision-making by a few people “at the top” 2. Lines of communication and accountability highly structured 3. Authority and accountability widely dispersed within organization; not one person in charge 4. Involves a secondary structure with two directions for lines of authority, accountability and communication

9/7/ Consider this question Which statement BEST describes a “Matrix” organization? 1. Decision-making by a few people “at the top” 2. Lines of communication and accountability highly structured 3. Authority and accountability widely dispersed within organization; not one person in charge 4. Involves a secondary structure with two directions for lines of authority, accountability and communication

9/7/ Try another question! 1. As a recent graduate, you are seeking information on “criteria for promotion and advancement through the clinical ladder”. Where will you go to find this information? a. ask your charge nurse b. contact the hospital administrator c. ask another nurse d. consult the policy manual e. consult the procedure manual

9/7/ Try another question! 1. As a recent graduate, you are seeking information on “criteria for promotion and advancement through the clinical ladder”. Where will you go to find this information? a. ask your charge nurse b. contact the hospital administrator c. ask another nurse d. consult the policy manual e. consult the procedure manual

9/7/ Structuring Delivery of Nursing Care Case Method 1 st type; hired for individual patient; provide all care; “home health” Functional Method 1930’s model; task assignment such as one nurse do all medications or treatments; used in nursing homes Team Nursing 1950’s model; use of RN, LPN, UAP. Team leader gives assignments; have team conference Variation emerging today

9/7/ Structuring Delivery of Nursing Care cont Modular Care variation of team nursing Primary Nursing 1970’s-1980’s “Primary” nurse develops, update care plans, plan discharge. RN has 24 hour responsibility for patient’s care for duration of stay in hospital. Considered “too” expensive; required decision-making skills; need for BSN’s Total Patient Care 1980’s replacement for Primary Care Model. RN, LPN assigned to give all care to group of 4-6 patients. Assigned nurse has responsibility for care only during his/her shift.

9/7/ Structuring Delivery of Nursing Care cont Case Management Method Monitors individual patient needs to achieve best outcome Beyond primary care; works with multiple disciplines No “direct” care; education and experience required Partnership Model Also called “care pairs” Care provided by RN working with LVN or UAP (usually) to groups of patients RN has accountability and responsibility

9/7/ Culture and Climate of the Organization Informal organization and YOU! Social Needs Organizational goals met, even informally Communication Share information Job information Preserving group values Leadership development (skills and abilities; changing) Informal organization: why a risk? Undermine authority Have “outsiders” “Grapevine messages”

9/7/ Organizational Culture and Climate Organizational climate Perceptions held by employees Influenced by organizational culture Multiple factors influence Should be positive, compatible values Sum total of values, formal and informal communications Not static Your role as a new nurse within the organization

9/7/ Test Your Knowledge Which of these is a function of the informal organization? 1. Establishing lines of authority 2. Perpetuating cultural values and norms 3. Making organizational decisions 4. Evaluating performance Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system? 1. Primary nursing 2. Case method 3. Total patient care 4. Case management

9/7/ Test Your Knowledge Which of these is a function of the informal organization? 1. Establishing lines of authority 2. Perpetuating cultural values and norms* 3. Making organizational decisions 4. Evaluating performance Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system? 1. Primary nursing 2. Case method 3. Total patient care 4. Case management*