Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Designing Organizations 2

Effective Leadership and Effective Leadership and Management in NursingManagement in Nursing

CHAPTER

EIGHTH EDITION

Designing Designing OrganizationsOrganizations

2

Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan

Learning OutcomesLearning Outcomes

1. Discuss how organizational theories differ.

2. Describe the different types of health care organizations.

3. Explain how health care organizations are structured.

4. Discuss various ways that health care is provided.


Learning OutcomesLearning Outcomes

5. Demonstrate how strategic planning guides the organization's future.

6. Discuss how the organizational environment and culture affect workplace conditions.


Organizational TheoriesOrganizational Theories

• Were unexplored until the Industrial Revolution

• Include the following theories:– Classical– Contingency– Humanistic


Organizational TheoriesOrganizational Theories

• Include the following theories:– Chaos– Systems– Complexity


Classical TheoryClassical Theory

• Built around four elements:– Division and specialization of labor– Chain of command; hierarchy, line

authority, staff authority – Organizational structure describe the

arrangement of the work group– Span of control


Figure 2-1 Chain of authority.


Humanistic TheoryHumanistic Theory

• Focuses on social aspects of organizational design

• Views social relationships, group pressure, and search for personal fulfillment as motivators

• Says formal authority only works with willing participants


Systems TheorySystems Theory

• A system is interrelated parts arranged in a unified whole.

• Systems can be open or closed.• Organization is a recurrent cycle of

input-throughput-output.• The manager is the catalyst for the

process.


Contingency TheoryContingency Theory

• Performance is enhanced by matching the organization's structure to its environment.

• Environment includes people, objects, and ideas outside the organization that influence it.

• Optimal form of the organization depends on the environment in which it operates.


Chaos TheoryChaos Theory

• Organizations are living, self-organizing systems that are complex and self-adaptive.

• Creativity and flexibility are necessary to adapt to change.

• The leader's role is to build resilience, maintain balance, and encourage creativity.


Complexity TheoryComplexity Theory

• Random events interfere with expectations.

• No linear cause and effect to explain outcomes.

• The system interacts and adapts to change.

• Managers must encourage the flow of information in all directions, not just top to bottom.


HospitalsHospitals

• Most are acute care facilities• May be classified as general or special-

care facilities (e.g., pediatric)• Many are teaching institutions

– Role of nurse may differ from teaching to nonteaching hospital

• New groups in hospitals include hospitalists and intensivists


Long-Term Care FacilitiesLong-Term Care Facilities

• Provide professional nursing care and rehabilitative services

• May be freestanding or part of hospital• Limit length of stay• May be residential care facilities

(nursing homes) where care is supervised by RNs and LPNs


Home Health AgenciesHome Health Agencies

• Provide intermittent, temporary health care in the home by skilled or unskilled providers

• May offer services other than nursing such as physical therapy or medical equipment

• May offer hospice care


Temporary Service AgenciesTemporary Service Agencies

• Provide nurses and other health care workers to hospitals

• Provide private duty nurses to patients in the hospital or at home


Health Care NetworksHealth Care Networks

• Deliver a continuum of care• Provide geographic coverage for buyers

of health care services• Accept risk in taking a fixed payment

for providing health care for all persons in selected group


Interorganizational RelationshipsInterorganizational Relationships

• Horizontal integration– Organizations in a network provide the

same or similar services; e.g., all hospitals provide comparable services


Figure 2-6 Horizontal integration.



• Vertical integration– Dissimilar but related organizations in a

network provide a continuum of services


Figure 2-7 Vertical integration.



• Corporate health care network


Figure 2-8 Corporate health care network.


DiversificationDiversification

• Organization expands into new arenas• Two common types

– Concentric diversification and conglomerate diversification

• Joint venture– Partnership in which each partner

contributes different areas of expertise, resources, or services to create a new product or service


Accountable Care OrganizationsAccountable Care Organizations

• Contract with Medicare to provide care to a group of Medicare recipients

• More flexible than Health Maintenance originations because consumers can choose providers outside the network


Traditional Organizational Traditional Organizational StructuresStructures

• Functional– Employees grouped in departments by

specialty

• Hybrid– Contains both self-contained and

functional units


Traditional Organizational Traditional Organizational StructuresStructures

• Matrix– Integrates product and functional

structures in one overlapping structure– Different mangers, its appropriate in

highly uncertain environment.

• Parallel– Unique to health care; involves two lines

of authority—the authority of the organization and the authority of its medical staff


Figure 2-3 Service line structure.


Different Types of Health Care Different Types of Health Care OrganizationsOrganizations

• Private or government• Voluntary (not for profit) • Investor owned (for profit)• Sectarian or nonsectarian


RedesignRedesign

• Patient-centered care model– E.g., medical home

• Focus on specific service lines• Lean thinking• Flat, decentralized organizational

structure


Strategic PlanningStrategic Planning

• Philosophy• Vision statement• Mission• Goals


Organizational EnvironmentOrganizational Environment

• System-wide conditions that contribute to a positive or negative work setting

• Positive environment has a positive effect on patient outcomes

• Nurse manager plays a key role in maintaining a positive environment


Healthy Work EnvironmentHealthy Work Environment

• Skilled communication• True collaboration• Effective decision making• Appropriate staffing• Meaningful recognition• Authentic leadership


Organizational CultureOrganizational Culture

• Encompasses basic assumptions and values held by members of the organization


Organizational CultureOrganizational Culture

• Varies among institutions, subcultures, and countercultures– Consonance occurs when the

subculture's norms and traditions agree with the organization's

– Dissonance occurs when they are not in agreement

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Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Designing Organizations 2