Organizational Structure and Nursing Leadership and Management - Essay Example

ORGANIZATIONAL STRUCTURE AND NURSING LEADERSHIP AND MANAGEMENT STEP 2: According to Bennis and Nanus (1986), the organization structure of an organization defines the task reporting relationship between the various members of an organization. There are usually two types of organizational structures, flat organizational structure and the tall organizational structure. The traditional approach was the taller one, the approach where there is very long chain of reporting relationships. The modern approach is the flat organizational structure. In the flat organizational structure, the chain of command is tried to be kept low, the team based approach is preferred. Employees are empowered with various decision making authorities, so as to reduce the path a report has to follow before certain decision is taken. (Handy 1991) The type of organizational structure followed at our hospital is the flat one. A flat structure has features such as, lesser number of reporting chains, team based working, employee empowerment, decentralization of the authority. (Hill, Charles and Jones 2001) Probably the first glance at the hierarchy might show a very long chain of reporting, however, the reality is quite different. Every person in the hierarchy is empowered with some set of authorities which they can exercise and in those matters, they are supposed to report only the matter that is out of routine. Thus, the decentralization of the authority is also an obvious phenomenon. Most of the work is done in form of teams. The team is led by the team leader. (Sullivan and Maureen, 1990) The flat structure has various advantages. For example, it is less time consuming, red Tapism is avoided, efforts in terms of man-hour is reduced, it creates a motivation in the empowered employees, it grooms the managerial skills of the employees and it creates a sense of responsibility among employees. (Schermerhorn 2004) Keeping in view the above advantages, the flat structure is the best suited in this setup. STEP 3 : Organizational Culture: Organizational or corporate culture is the system of shared actions, values, and beliefs that develops within an organization and guides the behavior of its members. (Hill and Jones 2001) For example, it is the shared value in our emergency department that when a new person is recruited, for example, a freshly graduated nurse is recruited, the senior staff goes to any length to help that new nurse and let her learn the skills along with getting used to with the emergency department environment. Thus, helping new comers has now become a culture of our department. Organizational Climate: It usually takes years or at times decades to change the organizational culture. However, if we look at the organizational climate, it seems to be something less permanent than the organizational culture. Thus, organizational climate is defined this very context by a number of authors. There are two major approaches on the basis of which the organizational culture is defined. The first approach is the cognitive schema approach, while the second one is the shared perception approach. According to the cognitive schema approach, climate of an organization is basically an individual’s perception or mental image of his work environment, thus it implies that the assessment of the climate of an organization should be done at the individual level. (Anderson, & West, 2001). For example, if the individuals working in the emergency department feel that the orders are imposed on them, the organizational climate is autocratic, according to cognitive schema approach. However, according to the shared perception approach, the climate of an organization is basically the shared perception of the environment of an organization or we can say that what is felt by all. Thus, in this context, we can imply that the climate must be assessed at the group level. (Reichers and Schneider, 1990) For example, the climate of the emergency department would be called, according to the share perception approach, would be called the climate promoting the team work, if the employees of the emergency department share this feeling that they working together and share responsibilities, displaying the group dynamics. If all the members of the emergency department share the feeling that the orders are imposed on them, then, according to this approach, the climate is autocratic one. The difference between the two; shared perception and cognitive approach, is that the feeling is the shared feeling in case of shared perception. The organizational climate in my department is the one that promotes teamwork, group dynamics and very motivational as well as very challenging too, in terms of the nature of work. Moreover, the organizational climate in my department is very helpful one, in terms of both the approach as individuals and overall group feels so. For example, if the staff assigned to one patient is very sick so the nurse who has relatively settled patient keeps on asking the nurse assigned to very sick patient, if she require any help. In this way, that individual nurse as well as overall group feels that the climate is helpful and supportive. Difference between Organizational Culture and Organizational Climate: The main point of difference between organizational culture and the organizational climate is the fact that it takes long to change the organizational culture, it is a gradual process. However, in case of organization climate, it just takes a day, a week or probably a month to change it. For example, if unannounced absences have become the routine in the organization, that shows the climate of irregularity and irresponsibility, only a stricit prohibition may change the climate. However, in case of culture, assume that it’s the culture within an organization that everybody helps each other, it takes long to let them change this habit. (Schermerhorn 2004) The Organizational Culture and Climate – A Reflection: Ultimately, it is the organizational culture that determines how the people would work in that organization. According to Schermerhorn (2004), if the culture of an organization is the aggressive one, the strategies of those organizations, such as marketing strategy etc. will also be the aggressive one. If the culture of an organization is more towards social responsibility, every action of that organization will be taken after considering its implications on the social image of the organization. At times, the nature of business also becomes the major factor of shaping the organizational culture. For example, an advertising agency would like to develop a culture that promotes creativity; an audit firm likes to develop the culture of honesty and integrity. Likewise, the hospital likes to promote the culture that creates its image as the hospital which considers the patient’s care as the service to humanity. As evident from the values I mentioned, the organizational culture of my hospital also reflects the concern for patient, since no patient is rejected on the basis of financial problems. Likewise, every step of our hospital is taken in keeping in view its impact on the community, which is also one of the values of my organization. The checklist also reflects that the organization (hospital) tries its level best to ease and support that patient as much as they can, through a diversified number of services and facilities. Same is the case with the mission statement of my organization, as the culture of research, innovation; help of the needy prevails in the organization. IMPACT OF ORGANIZATIONAL CULTURE ON: Communication Channel: Effective Communication is the lifeblood of any organization, if it wants to survive in the knowledge society that is evolving today. It is so because; in a knowledge society communication is the medium to transmit knowledge. In case of a hospital, communication is so essential that ineffectiveness in this aspect may lead to a number of causalities, despite the technological advancements. (McFarland et al. 1984) One of the best examples of the importance of communication in the field of nursing is reflected from the culture within our hospital to document every thing. For example, whatever the medication is given, that is recorded at the moment. Let us look at the areas, where the organizational culture is evident of the communication channels Documentation: It refers to the fact that within our hospital, it is essential for a nurse to write everything down and rely for nothing on the words. The nurses are supposed to document not only the medications given to the patients from time to time, but they are also supposed to check the vital signs (such as temperatures, blood pressure etc.) and document them on periodic basis, the duration of period may vary from patient to patient depending on its severity. Likewise, any order given by the doctor is also supposed to document every order. Thus, in this way the communication between the various stakeholders of the environment is maintained so as to avoid any misunderstanding that may cause serious consequences. (Monica 1983) Staff Handing Over Another channel of communication the patient by patient handing over of the staff assigned on that particular patient in the previous shift to the staff assigned for the next shift. Although every thing is documented, yet to avoid any misinterpretation out of those written words, the verbal communication is ensured through the process of handing over at the start of every shift. (Borkowski 2005) Team Leader’s Handing Over: Besides the handing over by the each staff about the patient he was assigned to, there is also the system of handing over the information of all the patients in the unit by the team leader of previous shift to the team leader of the shift that is going to be started. (Borkowski 2005) Paging System: The doctors present in the hospital are all connected through pagers. AS doctors are assigned to an area of specialty, rather than the physical unit (ward), thus it is not necessary that they are present all the time at the unit, in order to communicate to them in case of any difficulty, they are given the pagers, with the help of which they can be contacted and called to the unit within very short time. (Hill, Charles and Jones 2001) Integrated Information System Another great measure to avoid miscommunication is the use of integrated information systems. (Schermerhorn 2004) This can be understood through one example. For example, there may be the possibility that the doctor order drug X and somehow, it is communicated to the pharmacy department as drug Y. If all this is verbal, no body would be able to make out whom to blame. However, using the integrated system, as soon as the doctor enters the order for drug X through computer at the patient’s bed side, the pharmacy people will get the order at the same time in their system. This will not only save the time but also make the communication smooth. Nursing Leadership A typical definitions of leadership is: A leader shapes and shares a vision which gives point to the work of others., defined by Handy (1991) John Brown (1996) evolved the concept that the leader is the one who move the members of his team into unison so as to achieve their common goal. Thus he offered a cyclical process of leadership and motivation which can be represented by following diagram. leadership promotes commitment encourages change ideas needs leadership requires consultation generates involvement and trust enhances leadership etc. etc. To sum up, we can say that leadership is basically the ability to get the team together to achieve the common goal. Now we will try to look at it in the perspective of nursing. According to Handy (1991) the common goal of the team is to provide the holistic care. Thus the nursing leader is the one who can drive all his team to ensure that the holistic care is provided to all the patients. In order to achieve this goal, a leader is supposed to perform the following tasks; each of them prevails within the culture in my organization. According to Bennis and Nanus (1986) these tasks are defining the task, planning, briefing, controlling, evaluating, motivating, organizing and setting an example. Leaders here are always well planned and organize their resources, material as well as human, through motivation so as to achieve the purpose of the team, providing the holistic care to the people. (Mcfarland, Gertrude, Martha 1984) Nursing Care Delivery System For any of the organization, its value chain plays the key role in determining its overall efficiency. The nursing care delivery system refers to the model employed so as to provide the nursing care to the patient. The term model may be called as the arrangement of the resources as well as the stake holders in the process of delivering the care to the patients. (Monica, 1983) Before looking into the Nursing Care Delivery System used by the organization, let’s look at its importance and various common systems like that. First of all we need to understand that why should we model the resources? It should be done on account of a number of reasons. First reason is the nursing staffing issue. The demand for nurses is greater than the supply, thus it is essential to employ optimal level of nurses in various areas. Another reason is the achievement of efficiency and effectiveness. Organizational resources are the basis through which the revenue is generated, thus they should be optimally used and not wasted, in order to acquire the efficiency. These models do take into account the changes in social setup. However, it is important to mention that there is no single good or bad model. Historically, there are four important nursing care delivery systems. (Bennis and Nanus 1986) Case Method: It refers to the idea that one nurse should take care of all the needs of the patient. At our hospital, this model is still in use at critical care units, labor and delivery unit etc. or any other unit where the patient’s condition demands very vigilant care. This model has various advantages, such as the response to the patient’s need is quick. A relationship develops between the patient and the nurse, thus ensuring the holistic care. However, the operational cost increases too much, as greater number of nurses are required. (Monica 1983) Functional Method: This is also known as the task oriented working. It refers to the fact that a nurse can not do all the things, specially if she has to look after a number of patients. Thus, the nurse is assigned the tasks, rather than patients. Or they are assigned the patient but she is supposed to do only some specific task like medication, less risky tasks such as taking vital signs are done by the nursing assistants. (Monica 1983) Team Method: It refers to the model where a team is supposed to do all the tasks of the patients and the team leader directs them. Among the team, the working is task oriented, but all the team members are answerable to the team leader. In our hospital, it is the most prevalent model. (Monica 1983) Primary Method: It is the model in which there is the primary nurse, who is 24-hours responsible for the group of patients assigned to her. She prepared the individualized nursing care plan for all of them and in her absence, the associate nurses help to implement the plans. (Monica 1983) STEP 4: According to Crainer (1995)As it is a well known fact that the organization’s climate is the determinant of its performance, at least in the short run. Keeping this in view, it becomes essential to first of all identifying the relation of the existing climate to the performance of the organization the whether the climate is fostering the organizational performance or hindering it. In both the cases, what factors of the climate have still the room of improvement? Lastly, we need to determine how to improve those factors. If I look at the overall climate of my organization, I can confidently say that the climate in my organization is playing a positive role in improving the performance of my organization. However, there is always a room of improvement. So is in the case of the climate of my hospital. The most important factor in the climate of my organization is the motivation of the employees to work for the service of humanity. However, motivation itself is affected by various factors. Let us look at what can be done to improve them. Employee Retention: It is a well accepted phenomenon in the world of organizational behavior that the higher the employee turn over, the lower is the employee’s motivation to work. It is therefore essential to ensure employee retention so as to increase the motivation. Following measure can be taken for this purpose such as Retention Allowances, Senior Employee Benefits and to Link promotion with experience. Knowledge Management: Knowledge management is the relatively newer phenomenon in the industry. Previous strategy was focused on retaining the employees and marinating their motivation. This strategy focuses on sustaining the same organizational climate, in case of the situation when some key member leaves the organization. According to Borkowski (2005), this concept tells that we need to store the best practices, the experiences and the tacit knowledge of the members of the organization. These things shape the organizational culture and climate. For example, if best practices of a successful sales person are stored with the organization and then shared to all other salesman, it may help in improving the overall organizational climate as well as the culture. CONCLUSION: To sum up, the organizational culture prevailing at the hospital where I work is one of the major factors of enabling it to reflect its mission and values in its performance. Furthermore, the organizational structure, climate and culture have encouraged the communication level among the various parts of the environment of the organization. The leadership practices prevailing here are also an offshoot of the culture prevailing here. As a result, the nursing care delivery system and climate of the organization keep on impacting each other. Last but not the least, it is also essential that the organization keep on working the principle of continuous improvement with the special focus on areas like motivation through employee retention and the protection, preservation and sharing of the knowledge asset of the organization. References Schermerhorn, John 2004, Organizational Behavior, Wiley, New York. Hill, Charles, and Gareth Jones, 2001 Strategic Management Theory, Houghton Mifflin, Boston. Burbank, Douglas and Robert Anderson 2001, Tectonic Geomorphology, Blackwell Science, Oxford. Bennis W. and Nanus B. 1986, Leaders. Harper and Row, New York. Handy C. 1991, The age of unreason. Century, London. Brown J. 1996, Chance favours the prepared mind. The Managing Change Through, Innovation Project, HMSO. Crainer S. 1995, Handbook of management: the state of the art. Pitman Publishing. Monica, Elaine. Nursing Leadership and Management. Sudbury: Jones & Bartlett Publishers, 1983. Mcfarland, Gertrude and Martha Morris 1984, Nursing Leadership and Management, Wiley, New York. Sullivan, Maureen and Judy Carlson-Catalano, 1990, Nursing Leadership and Management, Springhouse Corp, Springhouse. Borkowski, N. 2005, Organizational Behavior in Health Care, Jones and Bartlett Publishers, Inc, London. APPENDICES THE HEALTH CARE ENVIRONMENTAL CHECKLIST Directions: Check yes” or ‘no” to the list of attributes to determine to what extent your organization/complex is consistent with the stated priorities for today’s health care. ATTRIBUTE YES NO Wellness and prevention programs are offered to the public.  Patients are discharged in a timely manner.  Case management is the system of nursing care delivered for inpatient and outpatient care.  Home care services are provided.  Ambulatory or outpatient surgery services are offered.  Opportunities exist for Advanced Practice Nurses.  Standardization of medical and nursing care plans are in effect using critical paths and evidence-based care  Skilled nursing units are available.  Staffing requirements are based on acuity levels and optimum staffing models.  Supervision of non-licensed personnel is by professional nurses.  Information systems are in place.  Efficiency methods are sought in departments.  Opportunities exist for nurses.  Nursing leadership and management roles are prominent.  The extent to which your current work environment reflects these elements is the degree to which it is congruent with current health care delivery systems. Your desire for continued participation in an organization depends on your personal priorities in the practice of nursing, and how well your priorities fit within the organization. Mission Statement: The mission of the hospital is embodied in a summary statement which is as follows: To provide exemplary care to patients; To develop and test innovations in care, education, and research; To support the teaching and research missions of the Faculty of Health Sciences; To contribute to the development of a system encompassing primary, secondary, and tertiary care, and not geographically confined to the existing Hospital facility; To provide access for needy patients who may not, on account of financial difficulties, be able to afford normal Hospital charges, and to reach out to those who might not otherwise present themselves at the Hospital; To develop new services in response to public expectations as resources permit on an economically viable and sustainable basis; and To carry out programmes and assigned missions in a manner that would demonstrate the ability of the institution to attain self-support in a developing nation environment. Values: Quality Relevance Impact Read More