Organizational Structure, Strategic Planning Care Delivery Models, Safety Culture

Understanding the organizational context of professional nursing practice is an important part of leadership and management. The nurse will participate in determining the most effective strategic plan for implementing care at the bedside or for an entire patient population of a facility. Other contextual factors include the mission, vision and philosophy and organizational culture of the organization. It is important for the nurse to know the mission and vision of the organization and have a philosophy that is consistent with that of the organization in order to support its efforts. Organizational structure relates to how work is organized and and provides for how work is communicated. Classic organizational structures include centralized, decentralized, matrix and combinations of these types. Centralized organizations (tall, with many layers) tend to have decision making at the “top.” While, decentralized organizations (flat) have decision making closer to the level of care. The military is an example of a centralized organization. Modern healthcare have moved toward a more type flat type of structure with decentralization and shared decision making. A concept appropriate to professional personnel. The organizational chart defines chain of command, line versus staff positions, and span of control. These are key concepts to know for this course. System’s Theory, Humanistic Theory, Chaos Theory, Contingency Theory and Complexity Theory are theoretical frameworks used to guide the processes within an organization. Cultural Diversity within organizations relates to both care provider and recipient. The changing demographics require non-biased understanding and appreciation of the difference of others.

Safety Culture has become a major issue for organizations since the IOM report in 1999 citing thousands of hospital errors and patient deaths and establishing a culture of safety has become a healthcare priority. Safety culture has its origin in high risk organizations such. Health care organizations are considered high risk organizations similar to aviation, nuclear plants and chemical process industry. Organizations that perform successfully under exigent conditions are termed high reliable organizations (HRO). Characteristics of high reliable organizations include for example: 1) preoccupation with failure, 2) reluctance to accept simplification and 3) deferring to expertise. Preoccupation with failure is an effort to avoid drifting into failure and becoming complacent. Safety culture is a central foundation of HROs and is measured with a variety of tools to assess communication, teamwork, frequency of error reporting. Expectations of manager behaviors to promote safety and more. The Agency for Health Research and Quality (AHRQ) published the Hospital Survey on Patient Safety Culture (HSOPSC) in 2004 and to date hundreds of hospitals with thousands of healthcare employees have reported perceptions of hospital safety culture with de-identified data reported in aggregate. See information about safety and the HSOPSC at (Links to an external site.). Safety and safety culture information will be discussed again in Module V along with Quality improvement and literature related to healthcare errors.

“Nursing work” is organized according to different models for care delivery. Functional, Team Leading, Differentiated Practice, Primary Nursing and Care Management Method are common delivery models. Differentiated practice is a model more commonly seen within Magnet hospitals systems and includes provision for the different levels of educational preparation and skill of the Registered Nurses with different job descriptions for each. The type of delivery system depends on a number of factors, including availability of staff, staff mix, type of patients and organizational philosophy. The ultimate goal is a safe environment with quality and financially sound outcomes.

Strategic planning is vital to any organization and is carried out in a systematic process. It includes identifying the organization’s strengths and weaknesses through assessment of the internal and external environment. The process screens for influencing markets, competition, technology, healthcare trends, financial resources and information systems to name a few.

Assignment questions: Post answers in Forums Module I. See calendar for due date.

1. Discuss one of the organizational theories from the readings and how you see this theory used or could be used in an organization. What are the merits of the theory?

2. Discuss what is meant by the terms, organizational span of control and chain of command.

3. Describe three types of organizational structures and some characteristics. Which type of organizational structure have you seen used in an organization and what are its advantages and limitations.

4. Which type of organizational structures do we see most frequently in acute care hospitals?

5. Cite common factors used for strategic planning and how nurses are involved in the process.


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