Organizational Structures Flashcards
Understand the implications of a decentralized organizational structure versus a centralized structure
Centralized (tall) -decisions are made by a few individuals at the top of the organization I.e. major decisions made by the vice president of patient care. Kelly, pg 272 example (poor+slow communications, expensive)
Decentralized (flat) – decisions are made by the staff that are closest to the action ie Unit Manager, head nurse (less layers, decisions are made more at the levels where it is needed with the people with the expertise. Workers are happier and has more freedom) Disadvantage – has a hard time letting go, some lack knowledge, difficult to coordinate and get consensus from people)
Matrix - may be either tall or flat. There are often two directions for authority, accountability and communication ie financial services, quality assurance, etc. Kelly pg 273 (created to allow people to enable team and organziational structure, increase flexibility, offers experts from expert opinions, people who need control do not do well in matrix, turf issues)
Describe the common features that define organizational structures
DEFINITION: An organizational structure is the framework for the working relationships among members of the system. Each organization has a formal and informal structure.
Characteristics of an organization include:
- Common Goal
- Coordination of Effort
- Division of labor
- Established delegation of authority
Compare and contrast the various types of organizational theories
Classic (Bureaucratic) – 1900’s goal was high production, efficiency and profit. Communication – top to bottom (clear division of labour, one person does one task, focus is on the task, workers is of very little importance)
Humanistic – 1930’s goal was economic, productivity, profit job satisfaction led to improved production. Communication was vertical, participation of workers (people work together, workers had more to say on the decision maker. More ownership of the job)
Modern – 1950’s goal interdependence of individuals to meet a common goal, communication was horizontal and vertical. Organization and worker are seen as a whole (team effort, individuals and organization as well as roles and status are important)
Classical: focus on the organization
Humanistic: focus on the organization and individual
Modern: focus’s on the organization and individual, environment, role arrangements, status etc.
Analyze the elements of organizational structure
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What are the features of a organizational structure
Chain of command – path of authority
Scalar Process the vertical growth ( the more steps there are the more centralized the decision making is.) vertical growth
Functionalization horizontal growth (different kinds of duties at the same level) horizontal growth
Span of Control – refers to # of people a manager is supervising.
Narrow/short – few people/tasks, allows for more control (tall structure)
Broad/wide – many people and tasks, decreased control (flat structure)
Channels of communication
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 (advisory staff position)
Explain the purpose of healthcare care delivery models
The purpose is to achieve optimal use of the health workforce, strengthen the provision of safe and high quality care, improve retention, and enhance client and staff satisfaction
Healthcare care delivery models are developed in the growing shortage of health professional, and the concurrent underutilization of many health care providers.
Many organizations are exploring the implementation of new service delivery models based on the principles of collaborative practice. Collaborative practice is defined as an interdisciplinary process for communication and decision making that enables the separate and shared knowledge and skill of the care providers to synergistically influence the client/patient care provided
Compare and contrast the advantages and disadvantages of various nursing care delivery system
Total Patient Care or Case Method
Oldest known model : Nurse: patient ration 1:1 Nurses assume total responsibility on one patient.
Is the predominant model of care in high acuity settings.
ADVANTAGES
-consistent, holistic care
-subtle changes noted quickly
-patients needs met very quickly
DISADVANTAGES
Expensive
Not ideal with nursing shortage
Functional Model
Each employee has a designated set of tasks, skills and activities Highly efficient and competent on task Nursing home model ADVANTAGES -efficiency -unskilled workers can be trained to do specific tasks (1-2) -give care to large numbers of patients (cost effective) DISADVANTAGES -fragmentation of care -confusion for patients Critical changes may go unnoticed -poor communication line
Team Model
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 ie RN, LPN, Care Aid etc.
Increase cooperation, increase morale, less fragmentation of care, decisions are made at a lower level
ADVANTAGES
-improved pt satisfaction
-cost effective
Works with multiple levels of health care ie RN, LPN, HCA
DISADVANTAGES
If team leader has poor communication/leadership skills
-duplication of care
Need time for conferencing
-legal concerns
Primary Model
Also known as relationship based nursing. The RN is brought back to the bedside to establish a plan of care that guides the patient’s entire length of stay.
ADVANTAGES
-noted increased quality of care. Nurses further their education and knowledge to provide optimal care of their patients. Increased continuity of care.
Increased job satisfaction
-establish relationship with pt and family
Decreases # of unlicensed personnel
DISADVANTAGES
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
New grads becomes anxious, and cannot handle the new accountability and responsibility
Modular Model notpod
Uses a mini-team (2-3 nursing staff with minimum of one RN, LPN and Care aids) Each module has own linens, med and supplies
Nursing units are divided into modules/districts and assignments are given on the geographical location of patients. Shift reports typically take place in patient rooms, and patients are assigned to one nurse.
Advantages
Offers continuity of care, as same team cares for same group everyday
RN plans & coordinates care
Efficient communication
Disadvantages
Increased cost of stocking each unit and the architectural design of most hospitals
Less direct nurse to nurse accountability
Case Management Method homecare
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.
ADVANTAGES
Pt receive more services & have fewer unmet needs
-cost effective
Better pt monitoring, decreased complications
Nurse satisfaction
DISADVANTAGES
Duplication of services,
Turf wars b/t services ie RN and social worker etc
