exam 2 Flashcards
organizational design
The arrangement of authority, responsibility, and flow of information within an organization, resulting in an organizational structure
relation to management activities
- Statement of mission
- Strategy development
- organization design
- Information needs
- Rewards
- Performance evaluation
- Feedback loop (change)
form (3) follows function (mission and strategy)
twin structural issues
differentiation and integration
Because we have so much differentiation (medical specialties) in the org, we need to integrate
continuum of structures
functional
direct contact
integrators and liaisons
-long-term point of contacts for each department to communicate across departments
task forces
- limimited in time and focused
- often interdepartmental
committees
- the “parallel organizatin”
- continue overtime and interepartmental
teams
programs/service line
- Centers of excellence
- Mini org within org for high volume and complex specialties
- So large and so complex, you may have a specific program
- Cancer and heart care
programming approaches to coordination of work
Standardization of work processes (Clinical pathways) (sometimes protocols): standardized way of going about your work
- Benefits of standardization
- Often protocols (same thing)
- Pathway from admissions to discharge
Standardization of skills
Standardization of outcomes
feedback approaches to coordination of work
Supervision: exchange of information in hierarchical relationships
Mutual adjustment: not in hierarchical relationships; one-on-one relationships that occur to get jobs done; informal interactions between MDs and RNsd
Group coordination: more formal and typical done in morning rounds
-Get the whole team across disciplines together
responsbility matrix
fixes accountability
Assign task and responsibilities to primary owner, supper, coordination, decision
communication
the creation of exchange of understanding between sender(s) and receiver(s)
Repeat back in your own words so you understand what i meant
channels of communication
Face-toface
- need to be face-to-face to solve a problem
- If not possible, can do virtual
Virtual
Correspondence
Phone
defensive communication to open communication
defensive communication is a barrier to open communication
Evaluating ——> descriptive
Controlling ——> supporting
Making statements ——> asking questions
Acting parent-child ——> acting adult-adult
how do we communication
Non-verbal 55% (why in-person is best)
Tone of voice 38%
Verbally 7%
communicating with stakeholders
stakeholder mapping
-Map out people with stake (interest in org) in org to determine stakeholders and then find out 4 things from them
Stakeholder analysis
- Needs
- Expectations
- Challenges
- recommendations
tools for managing organizational communication
Interviews
Nominal group technique; silent brainstorm then group together
Focus groups
- Limited to 5-7 people; focus on a specific issue
- Surveys or questionnaires will show up as a problem so you run a focus group to drill down on that problem
Questionnaires
-Less effective; bad response rate
Delphi techniques
- Delphi technique used to reach out to people who cannot be there
- Do this if you have geographically dispersed people
- Survey, synthesize, send back out (see what others are saying and piggy back on those ideas), survey back again
key communication hints
Eye contact Voice, non-verbal Consistency of message Paraphrasing Watch filters and barriers Simple and focused Enough time Right channel
power
ability/potential to exert actions that either directly or indirectly cause a change in the behavior and/or attitudes of another individual or group
Often characterized by coercion
You have the ability but not the influence to take action
influence
actions, either directly or indirectly, cause a change on the behavior and/or attitudes of another individual or group
Influence is power turned into action
politics
ongoing process of managing influence, characterized by its hidden nature
This is a process whereby participants attempt to influence organizational decisions and activities in ways that are not sanctioned by the organization
power abuse
use of power in ways that are not acceptable, often involves self-interest and not the organizations best interest
Often inflicts negative outcomes on workers, customers and other stakeholders
sources of power
Structural
-hierarchical (you have power because you are the boss)
Structurally derived (ex. Support services) -We have the power because we have the important services that you need
Cultural (ex. informal/peer leaders)
Knowledge-based
-someone with the knowledge to lead a project; specialties in medicine
Network centrality
-Being close to power
preventing abuse of power
Transparency
Board and advisory boards
-important to make sure things are done correctly
External auditors
-Check the books
Code of ethics
-guidelines for how we behave in an organization
Appraisal systems
Personal integrity in hiring
Conflict can be good but it can be detrimental if there’s too much and you don’t manage it well
Why we need conflict
- Can stimulate productivity and creativity
- Can unearth differences
- Serves as an antidote to groupthink
Why we don’t need conflict
- High levels can be detrimental and destructive
- Diverts attention away from mission
- Increases stress
- Reduced well-being
- Loss of trusting, supportive relationships
3 types of conflict
Task conflict (what to do) -Disagreement about the actual job/task
Administrative conflict (how to do it) -Disagreement on how task is to be done
Relationship conflict (ways to work together) -Interpersonal conflict
conflict management; each have tradeoffs for self/others
Pressing: assertive and uncooperative (win/lose)
-Times to do this such as urgency and patient safety
avoiding: unassertive and uncooperative (lose/lose)
- Need time to cool off or you don’t have enough info to resolve the conflict
Collaborating: assertive and cooperative (win/win)
-Trying to meet the needs of 2 people
Accommodating: unassertive and cooperative (lose/win)
-Needs of other more important than own
Compromising: no winners or losers
-Resolve by splitting the difference
learning
Involves the acquisition of knowledge and skills through study, instruction, or experience. We take action, we gather info about the effects of our actions and then we revise our understanding of our world and ourselves. It is a balanced feedback loop
Gain skills, apply them, learn from that application, adjust as necessary
Experience is the best way to learn
importance of non-stop learning
types of organizational learning
Adaptive (single loop) : patient shows up late, you work them in
- Whack a mole
- Adapt to circumstances then move on
Generative (double loop): what caused that patient to be late or what caused us to be behind schedule
- Looking at underlying root causes
- Fixes system
disciplines of the learning organization
System thinking: how 1 thing affects another
Personal mastery
Mental models: challenge your own assumptions of people, things
Shared vision
Team learning
5 building blocks of learning organizations
- Systematic problem solving
- Learning from own experience and past history
- Learning from the experiences and practices of others
- Transferring knowledge quickly and efficiently throughout the organization
- Experimenting with new approaches (innovation)
the innovative process (5th step of learning organizations
Genesis (generate ideas and narrow down)
- Generation, exploration of multiple ideas (brainstorming)
- Convergence of ideas (pros/cons)
- Trigger for concentrated effort
- Vague goals, optimistic projections
- Development (develop a few ideas)
- Multiple paths/approaches
- adaptation/change based on experience/testing
- evolving/changed goals
- Sponsor involvement/influence on change - Termination (decide which one to adopt)
- Final adaptation.change to local or unique situation
- Implementation or termination
- Lessons learned
characteristics of complex systems
Interconnected (change in one area affects another area)
Non-linear (small changes can produce big effects)
Dynamic (constant change, prior conditions influence current events)
lewin’s change model
Unfreezing —> moving —> refreezing
managing change
- Establishing urgency (unfreezing)
- Creating a guiding coalition (unfreezing)
- Developing a vision (unfreezing)
- Communicating the change vision (moving)
- Empowering broad-based action (moving)
- Creating short-term wins (moving)
- Consolidating gains (refreezing)
- Anchoring new approaches into the culture (refreezing)
productivity
rate of outputs to inputs
Ex. number of admissions to ER nurses
efficency
cost per unit of output
Ex. average labor costs per admissions
effectiveness
degree to which goals and objectives are met
Ex. reduction in mortality or infections
quality improvement
organized approach to planning and implementing continuous improvement in performance
3 categories of quality measures
Structural: based on organizational features or participant characteristics (ex. % of doctors board certified)
Process: activities in carrying out work (ex. Number of patients seen, number of nurses trained)
-If you need a knee replacement, you might pick a doctor who does a lot of knee replacement every year (that doesn’t necessarily mean they’re good at it, but they have done a lot so maybe you want them more)
Outcome: evidence of degree that ultimate objective is met (ex. Health status)
- Effectiveness
- Hard to measure so structure and process often used as surrogate
QI approaches
Clinical practice guidelines: recommendations for treatment for specific clinical conditions based on a synthesis of the evidence in literature
-Specify protocol; outline what needs to get done based on best practices
Crew resource management training: a technique from aviation industry to address errors from communication and decision making in teams
-Simulate stressful situations and give feedback
Benchmarking: process of comparing (and then enhancing) an organization’s performance to those of “best practices”
- Know your operation; assess strengths and weaknesses
- Know the industry leaders and competitors
- Incorporate the best
- Gain superiority
Lean: an improvement approach that focuses on improving efficiency and eliminating waste (excess inventory, duplicate steps, etc)
-eliminating waste (make things more efficient)
Six sigma: a data-drive methodology for eliminating defects in any process by applying a consistent framework of DMAIC (define, measure, analyze, improve, control) to minimize variation, improve processes, and enhance quality
-eliminate problems in the system (ex. Infection rates)
Total quality management: a participative, systematic approach to planning and implementing QI
models of organization
traditional
-top –> bottom (think triangle) is leadership, management, labor (workforce)
total quality organization: servant leadership
-top –> bottom (think upsidedown triangle) is customers, labor (workforce), management, leadership
common QI approaches
patient/customer focus
Employee involvement
Teamwork, QI teams
measurement/tracking
process/systems improvement
Use of problem solving tools
Management action/leadership
Improvement though
- Eliminating defects
- Meeting customer needs and preferences
Proactive risk assessment
High standards
Use of IT
improving quality of care
- Develop a participative, team-oriented organizational culture that encourages input from professionals and other workers from all levels of the organization
- Establish high standards and expectations
- Develop information systems that provide relevant, timely, and accurate data for purposes of taking corrective action and reaching ever-higher standards
- Use statistical thinking and tools to identify desired performance levels, measure current performance, interpret it, and take action when necessary - Look for opportunities to improve quality by detecting and preventing potential problems in the process
- Design work to reduce complexity and increase standardization
- Develop reward systems that reinforce participation and high performance
- Recruit the best available talent
Improving productivity and efficiency of care
- Develop accurate, timely, and useful management information systems
- Concentrate productivity improvement program in large departments where payoff will result
- Consider streamlining and consolidating departments and functions
- Develop scheduling systems consistent with professional values
- Focus on areas where quality can be maintained or even enhanced through better scheduling of staff and support resources - Cross train staff to gain greater flexibility
- Develop productivity based incentives based on work activities under the control of organizational members
- Set high standards by establishing “best practices” in one’s own organization as well as using comparison from competitors and industry leaders
- Involve organizational members, particularly professions, in the development, implementation
