Class 4 Health Care Organizations & Care Delivery Models Flashcards
A purposefully designed, structured social system developed for the delivery of health services by specialized workforces to defined communities, populations or markets.
(Keller, 2017)
HEALTH CARE ORGANIZATION
three defining attributes of health care organizations
- Purpose
- Specialized workforce
- Public trust
- T]structure
- Organizational environmemt
Minor attributes: formal rules & policies, integration of diverse functions and activities accross organization
• Closed system
• Like a machine
• Authority & control gets results
Bureaucracy
• Affected by outside
forces
• A social system
• Employees innovate & are engaged
Complex Adaptive System
What is the nurses’ role in a health care organization?
What needs to be known an analyzing organizations?
• Organizational structure • Reporting relationships • Recruitment practices • Method of selecting individuals for
positions • Organizational culture
What is a functional organizational structure?
*in exam
- it is an organizational structure
- dept according to specialty
- managed by one person
service line structure
A set of shared mental assumptions that guide interpretation and action in organizations by defining appropriate behavior for various situations (Ravasi & Schultz,
2006)
ORGANIZATIONAL CULTURE
•Should reflect mission, vision, values • Reflects norms & traditions of unit or HCO • Socially constructed • Difficult to change • Can promote harmony or disharmony
ORGANIZATIONAL CULTURE
What is flat structure?
Matric structurez/
An interactive process that provides guidance and direction
Leadership
What do we consider in selecting a model of an organization?
Pt population
Size of organization and/or unit
Staffing mix and numbers
Budget
Types of Nursing Care Modeks
- Total patient care (case method)
- Functional nursing
- Team nursing
- Primary nursing
A case method where the registered nurse plans, organizes, and performs all care
Total Patient Care
What is functional nursing?
Team nursing?
What are major attributes of HCO
- Purpose
- Specialized Helthcar Workforce
- Public trust
Minor attributes of HCO
Structure,
Ornabizarional environemnts
- arrange departments and services according to specialty
- departments providing similar functions report to a common manager or executive
Benefits:
- support professional expertise and encourage advancement
Limitations:
- may result in discontinuity of patient care services
- delays in decision making can occur if a silo mentality develops within groups
- communication among groups is raised to senior management level
FUNCTIONAL STRUCTURE
Functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager or executive
Benefits:
- coordination of services, an expedited decision-making process, and clarity of purposes
Limitations:
- increased expense associated with duplication of services, loss of professional or technical affiliation, and lack of standardication
SERVICE LIVE STRUCTURE
Complex and designed to reflect both function and service in an integrated organizational structure
The manager of a unit respinsible for a service reports to both a functional manager and a service or product line manager
Combines both bureaucratic structure and a flat structure, and teams are used to carry out specific programs or projects
Horizontal program management
Creates interdisciplinary system
Line manager and project manager collaborate
Benefits
- enables timely response to the forces in the external environment that demand continual programming, and it facilitates internal efficiency and effectiveness through the promotion of cooperation among disciplines
- can be designed to cover both cimprehensive patient-focused care and a specialty service
Limitations
- well developed collaboration and coordination skills are required
- required nurses with high levels of knowledge and skill in Interprofessional collaborative practice
MATRIX STRUCTURE
Delegation of decision making to the professionals doing the work.
Places authority at action level.
Decentralized decision making.
Less formalized.
Goal is tro improve pt safety and outcome,
Benefits:
- decrease in strict adherence to rules and policies allows individualized decisions that fit specific situations
- nurses on a clinical unit can make changes in real time
Limitations:
- inconsistent decision making, loss of growth opportunities, and the need to educate managers
- managers are unsure of what needs to be controlled, how much control is needed, and which mechanisms can replace control
FLAT STRUCTURE
Facilitate nursing staff having more autonomy to govern their practice.
Accountability is the foundation.
Decentralized/diminish hierarch*
Management and administrative level serves to coordinate and facilitate the work of the practicing nurses.
ex. Magnet hospitals
Benefits: Higher levels of staff satisfaction, enhanced productivity, and improved retention
Limitations:
- chnaging nurses’ positions from dependent employees to accountable professionasl
- requires administrators, managers, and staff to abandon traditional notions
- require new behaviour
SHARED GOVERNANCE
One nurse provides total care for one pt during the entire work period.
Staff Nurse: No aspect of nursing care is delegated to another, thus eliminating the need for supervision of others.
Manager Role: Consider the expense of the system; weight expense of RN vs. LPN vs. UNP.
Benefits: One nurse provides total patient cafd for one pt during the entire work period. Consistent care from one nurse. Subtle changes in the patient status are easily noticed.
Limitations: holistic perspective is lost. Very expensive. May not be enough resources or nurses to use this model.
CASE METHOD (Total Patient Care)
- a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients
-tasks are determined by the scope of practice - similar to manufacturing
Staff Nurse: - RN must be responsible for all assessments, admissions
- charge nurse assigns
- policies and procedures to complete care
- charge nurse coordinates care and assignments and may ultimately be the only person familiar with all the needs of any individual patient
Manager Role: - see quality of pt care and budgetary constraints
- responsible for pt outcomes
(staff may view this as autocratic)
- with effective management and leadership -> staff’s independence
- rotate assignments among staff
Benefits: - each person becomes efficient at specific tasks, and much work can be done in a short time
- unskilled workers can be trained to perform one or two specific tasks
- financial benefit
Limitations: - disadvantages may outweigh savings
- fragmentation of care
- psychological and spiritual needs may be overlooked
- staff may not have enough time to communicate with each other
- critical changes of the pt may be unnoticed
- not holistic
- fragmented care and ineffective communication -> pt and fam dissatisfaction
- nurse feel frustrated from task-oriented role
FUNCTIONAL NURSING
- Each unit typically has several teams, with patient assignments made by each team leader
- charge nurse provides support for the teams on a shift-by-shift basis
STAFF NURSE: - nursing uses strength for each caregiver
- Some members become known for their expertise in the
psychomotor aspects of care
- (x. If a nurse is skilled at IV lines, she would start all IV lines for the team)
MANAGER ROLE: - determine which RNs are competent in becoming a charge nurse or team leader
- adequate staff mix and orient team members to the team nursing system by providing continuing education about leadership, management techniques, delegation, and team interaction
BENEFITS: - improved patient satisfaction, organizational decision making occurring at lower levels, and cost- effectiveness
- works with an expected ratio of unlicensed to licensed personnel
- RN, is responsible for coordinating a group of licensed and unlicensed personnel to provide patient care to a small group of patients
- collective efforts of the team become greater than the functions of the individual caregivers
LIMITATIONS: - if leader has poor leadership skills
- When the team leader is not prepared for this role, the team method becomes a version of functional method, and the potential for fragmentation of care
- leader must have excellent communication skills,
positive delegation and conflict management, strong clinical skills, and effective decision- making
TEAM NURSING
- one RN functions autonomously as the patient’s primary nurse throughout the hospital stay
- nsg process
- all RN staff
Staff Nurse: - primary nurse collaborates,
communicates, and coordinates all aspects of patient care with other nurses as well as other
disciplines
MANAGER ROLE: - functions as a role model, advocate, coach, and consultant
BENEFITS: - pt and families develop a relationship with nurse and are typically satisfied
- decrease in the number of unlicensed personnel
LIMITATIONS: - RN may not have the experience or
educational background to provide total care
- ineffective in nsg shortage.. Primary nurse rely heavily on feedback from associates, which defeats the purpose of primary nursing
PRIMARY NURSING
