Organizational Delivery

Question 1

Focus: organizations are structured or organized to…

Answer 1

Assist individuals to work together to achieve a common purpose

Question 2

4 Characteristics of an organization **

Answer 2

1: Common Goal
2: Coordination of Effort
3: Division of Labor
4: Established delegation of authority

Question 3

An organizational structure is…

Answer 3

the framework for the working relationships among members of the system. Each organization has a formal and informal structure.

Question 4

Structure refers to…

Answer 4

refers to how a group is formed and is the formal relationship within each organization

Question 5

Goal of an organization

Answer 5

to seek a structure that is efficient and provides maximum cost effectiveness

Question 6

Goal of the Structure

Answer 6

to achieve the mission, vision, and philosophy of the organization

Question 7

Organizational Charts show:

Answer 7

only formal relationships, show what should be happening not necessarily what is happening

Question 8

5 Characteristics of Organizational Structures

Answer 8

Complexity
Size
Geographical dispersion
Formalization 
Centralization

Question 9

Organizational charts DO *

Answer 9

Show authority
Show positions
Accountability
Division of labor
Relationship of individuals

Question 10

Organizational charts DO NOT

Answer 10

Show informal communication
Goals of org.
Culture
Degree of authority

Question 11

What is a Mission? *

Answer 11

is the purpose of the organization. It outlines the organizations primary plans or driving forces. They can often incorporate statements of philosophy.

Question 12

What is a Vision ?

Answer 12

provides a conceptual view of what the future of the organization desires to look like

Question 13

What is a Philosophy?

Answer 13

general imbedded into mission statement

Question 14

Organization Values…

Answer 14

largely descriptive the organizations boundaries while pursing the vision

Question 15

Organizational Theories

Answer 15

Classic
Humanistic
Modern

Question 16

Classic (Bureaucratic) *

Answer 16

GOAL: high production, efficiency and profit. communication always top to bottom, impersonal,
Key features: centralized control, well defined superior subordinate, rewards accomplishments, promoted on bases of competency. Division of labor was on bases of skills and each worker did one task, very clear division of labor, very rule governed the organization for this theory is VERY important, focus is on task and worker is of little importance

Question 17

Humanistic (individual)

Answer 17

1930’s goal was economic, productivity, profit job satisfaction led to improved production. Communication was vertical, participation of workers
more of a social organization, people wanted to have equal value, and individuals had goals that were different from the organization
Key Features: informal organization was recognized and improved job satisfaction, felt they had higher productivity d/t job satisfaction, if they involve the workers in planning and decision making then better, FOCUS is on individual more so than on the organization than the work, although the organization still remains important

Question 18

Modern

Answer 18

1950’s goal interdependence of individuals to meet a common goal, communication was horizontal and vertical. Organization and worker are seen as a whole
communication can be both ways, continues to evolve, an open system, team concept arose from here. Focus; individuals and organizations as well as roles, status and context is important, organization and worker seen as whole

Question 19

Focus of Classic is on…
Focus of Humanistic is on…
Focus of Modern is on…

Answer 19

Classical: focus is on the organization

Humanistic: focus is on the organization and individual

Modern: focus is on the organization and individual, environment, role arrangements, status etc.

Question 20

Types of Structures

Answer 20

Centralized (tall)
Decentralized (flat)
Matrix

Question 21

Centralized (Tall)

Answer 21

Location where decisions are made. Usually by a few individuals at the top of the organization I.e. major decisions made by the vice president of patient care

Decisions made at top, made by very limited number of people, and are communicated downward, authority is clear and formalized allows for close coordination, control of workers, highly productive, works well were close coordination and rapid change is occurring

Question 22

Disadvantages of Centralized

Answer 22

communication can be slow and difficult d/t number of levels it goes through, workers get very boss oriented d/t close contact with supervisors, very little individual thinking, adjustment to change is very slow and implementation can be very very difficult, extremely expensive structure because there are so many managers

Question 23

Decentralized (flat)

Answer 23

decisions are made by the professionals that are doing the work i.e. Unit Manager, head nurse
don’t have a number of layers and levels, decisions are made by the people who are working, decision making is more delegated, more spread out, easier to work, very short administration distance, school of nursing is a good example, or private healthcare facilities
Advantages: worker is the one receiving the advantages, more authority and less supervision, communication is shorter, messages you get are less confusing or distorted, workers are happier and work is smoother

Question 24

Disadvantages of Decentralized

Answer 24

less contact with supervisor, some managers may have trouble letting go, want to be more hands on. Lack of knowledge in operations in which you are responsible, workers need education on how to make good decisions, larger organizations find it difficult coordinating and getting consensus, communication not top to bottom

Question 25

Matrix

Answer 25

may combine a tall and flat. There are often two directions for authority, accountability and communication i.e. financial services, quality assurance, etc
not clear lines of communication, more opportunity for everybody to engage and everybody to be involved in decisions, interconnected clusters that tend to move decision making up and down, allows people to break free of limits of a beurocratic design
Advantages: increased flexibility, autonomy of, get assistance and expertise from experts, get a lot of creativity, can offers creative solutions to problems, teams supervise and manage themselves

Question 26

Disadvantages of Matrix

Answer 26

turf wars, not one clear boss, can get people who have a great need for control who don’t like teams, personality conflict, can be time consuming some may not feel the need to push forward, can be hard to control because no clear lines of leadership

Question 27

Organizational Designs

Answer 27

Org. designs are classified by their characteristics of complexity, formalization and centralization
How the labor is organized will have a direct bearing on how the mission of the organization is achieved.
Must consider the complexity of an organization and the division of labor.(May be geographic area such as O.R. or Amb Care or Program i.e. cardiology or oncology)
There must be a clear division of labor (work undertaken by individuals or groups for specific groups of people).
A system of procedures to deal with work situations must exist– i.e. what must be accomplished in a day or shift.

Question 28

Features of Organizational Chart structures:

Chain of command – path of authority

Answer 28

Scalar Process the vertical growth ( the more steps there are the more centralized the decision making is.)
Functionalization horizontal growth (different kinds of duties at the same level)

Question 29

Features of Organizational Chart Structures:

Span of control

Answer 29

– refers to # of people a manager is supervising.
Narrow/short – few people/tasks 3-5 subordinates. Allows for more control (tall structure)
Broad/wide – many people and tasks, decreased control (flat structure.

Question 30

Features of Organizational Chart Structures:

Service-Line Features

Answer 30

Line function – hierarchy of personnel that is from executive to workers at bottom. Involves direct responsibility to meet objectives. Have authority for decision making. Line positions use solid horizontal & vertical lines
Staff function – may assist line positions, provide support, advise and counsel (do not confuse with specific jobs such as ‘staff nurse’ etc.). Staff positions are recognized through broken lines

Solid vertical lines – line position
Solid horizontal lines – line position
Broken lines – staff position

Question 31

Models of Care Delivery

Answer 31

1: Total patient care or Case Method *
2: Functional method *
3: Team method *
4: Primary method *
5: Nursing Case Management*

6:Emerging models -not tested on this one (partnership or collaborative methods)

five most well known methods of organizing nursing care for pt care delivery

Question 32

Patient Care Model

Advantages

Answer 32

Oldest known model - Nurse: patient ratio 1:1
Is the predominant model of care in high acuity settings.
ADVANTAGES
consistent, holistic care
subtle changes noted quickly
Very useful with complex patients

Question 33

Patient Care Model Disadvantages

Answer 33

expensive

not ideal with nursing shortage

Question 34

Functional Model

Advantages

Answer 34

Each employee has a designated set of tasks, skills and activities
ADVANTAGES (Figure 14-3)
efficiency
unskilled workers can be trained to do specific tasks
give care to large numbers of patients (cost effective

Question 35

Functional Model

Disadvantages

Answer 35

fragmentation of care
confusion for patients
Critical changes may go unnoticed
poor communication lines

Question 36

Team Model

Advantages

Answer 36

This model of care is based on the basis that each unit will have 2 or more teams to provide care to a geographic location of patients. Each team has variously educated care providers i.e. RN, LPN, Care Aid etc.
ADVANTAGES
improved pt. satisfaction
cost effective
Works with multiple levels of health care ie RN, LPN, HCA

Question 37

Team Model

Disadvantages

Answer 37

ifteam leader has poor communication/leadership skills
Duplication of care
Need time for conferencing

Question 38

Primary Model

Advantages

Answer 38

One nurse functions as the patient’s primary care giver throughout their entire length of stay. The RN plans and delivers all the care.
ADVANTAGES (Figure 14-6)
noted increased quality of care. Nurses further their education and knowledge to provide optimal care of their patients.
Increased job satisfaction
establish relationship with pt and family
Decreases # of unlicensed personnel

Question 39

Primary Model

Disadvantages

Answer 39

Lack of experience or education of RN; shorter stays, large # of part time RN’s
RN are held accountable even if not physically present for 24 hour responsibility of care
Costly

Question 40

Nursing Case Management

Advantages

Answer 40

Refers more to a system in which health care services are controlled and monitored. Key to this model is the identification of a critical pathway for care and treatment. RN’s most often act as the case managers. (Figure 14-7)
ADVANTAGES
Pt receive more services & have fewer unmet needs
cost effective
Better pt. monitoring, decreased complications
Nurse satisfaction

Question 41

Nursing Care Management

Disadvantages

Answer 41

Duplication of services,

Turf wars b/t services i.e. RN and social worker etc

Question 42

Emerging Models

Advantages

Answer 42

New models today are generally a hybrid of the traditional models. There is a growing trend towards partnership or collaborative practice models. Primary Nursing Hybrid partnership Model and Primary Nursing Hybrid: Patient-Focused Care.
The goal is to ensure delivery of the right care by the right provider. Care may be provided by an RN, LPN or UCA. Need to ensure effective and efficient utilization of all health care team members
ADVANTAGES
Cost effective
Using innovative approaches with new technology

Question 43

Emerging Models

Disadvantages

Answer 43

Roles of RN and LPN are not clear; LPN must have pt. who is stable with predictable outcomes.
Both groups focus on tasks and activities blurring their roles

Question 44

The Synergy Model

Answer 44

This model is based on patient characteristics and nurse competencies.
Synergy between patient characteristics and nurse competency helps optimize patient care.
This model is just beginning to emerge in Canada.