Effective Leadership and Management

Group 7 BSN-4 NA and ND November 16, 2011

Healthcare Organization

Organizing
includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery and grouping activities to meet unit goals

Organizational Theory
Max Weber, a German social scientist, is known as the father of organizational theory.
He developed the most comprehensive classic formulation on the characteristics of bureaucracy.

Characteristics of bureaucracies (as identified by Weber):

A clear division of labor A well-defined hierarchy of authority in which superiors are separated from subordinates Impersonal rules and impersonality of interpersonal relationships.

A system of procedures for dealing with work situations must exist.

A system of rules covering the rights and duties of each position must be in place.

Selection for employment and promotion based on technical

Organizational Culture
A system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common.

Shared Governance
An organizations governance that is shared among board members, nurses, physicians, and management. Thus, decision- making and communication channels are altered.

Components of Organizational Structure

Relationships and chain of command
The organization chart defines formal relationships within the institution. Formal relationships, lines of communication and authority are depicted on a chart by unbroken (solid) lines. Unity of command is indicated by the vertical solid line position on the organization chart.

One person/one boss: employees have one manager to whom they report and to whom they are responsible.

Components of Organizational Structure

Span of Control
The number of people directly reporting to any one manager represents that managers span of control and determines the number of interaction expected of him or her.

The number of people directly reporting to any one supervisor must be the number that maximizes productivity and worker satisfaction.
Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization.

Components of Organizational Structure

Managerial Levels
Top-level managers look at the organization as a whole, coordinating internal and external influences and generally make decisions with few guidelines or structures. Middle-level manager coordinate the effort of lower levels of the hierarchy and are the conduit between lower and toplevel managers. Middle-level managers carry out day to day operations but are still involved in some long-term planning and in establishing unit policies. First- level managers are concerned with their specific units work flow. They deal with immediate problems in the units daily operations with organizational needs, and with personal needs of employees.

Components of Organizational Structure

Centrality
Centrality refers to the location of a position on an organization chart where frequent and various types of communication occur.
Centrality is determined by organizational distance. Employees with relatively small organizational distance can receive more information than those who are more peripherally located. Middle manager often has a broader view of the organization than other levels of management. A middle manager has a large degree of centrality because this manager receives information upward, downward and horizontally.

Advantages of the Organization Chart

Maps lines of decision-making authority Helps people understand their assignments and those of their coworkers Reveals to managers and new personnel how they fit into the organization Contributes to sound organizational structure

Limitations of Organizational Chart

Shows only formal relationships Does not indicate degree of authority May show things as they are supposed to be or used to be rather than as they are

Possibility exists of confusing authority with

status

 Although it defines authority, it does not define responsibility and accountability.

Authority is defined as the official power to act/person to which responsibility is given. Responsibility is a duty, an assignment or an obligation. Accountability means that individuals agree to be morally responsible for the consequences of their actions/liability or

answerability.

Types of Organizational Structure

Line Structure

Types of Organizational Structure

Ad Hoc Design
The ad hoc design is a means of overcoming the inflexibility of line
structure and serves as a way for professionals to handle the increasingly large amounts of available information.

Ad hoc structures use a project team or task approach and are

usually disbanded after a project is completed. Disadvantage: decreased strengths in the formal chain of command and decreased employee loyalty to the parent organization.

Types of Organizational Structure

Matrix Structure

Types of Organizational Structure

Service Line Organization Service lines, sometimes called care-centered organizations are smaller in scale than a larger bureaucratic system. For example, in this organizational design the overall goals would be determined by the larger organization,

but the service line would decide on the processes to

be used to achieve the goals.

Types of Organizational Structure

Flat Design

Chief Nursing Officer

Nurse Manager

Nurse Manager

Nurse Manager

Staff

Staff

Staff

Modes of Organizing Patient Care

Total Patient Care Nursing or Case Method Nursing
Nurses assume total responsibility for meeting all needs of assigned patients during their time on duty Advantage: intensity of focus on the patient throughout that shift. Disadvantages: lack of communication and lack of continuity over time.

Modes of Organizing Patient Care

Functional Method
Functional nursing is done through work assignment by
functions or tasks, such as passing medicine, doing dressing changes, giving baths, or taking vital signs. Advantage: no role confusion; method is efficient and cheap; tasks are completed quickly. Disadvantage: client could not identify who their caretaker was, because there were so many caretakers; fragmented care.

Modes of Organizing Patient Care

Team Nursing
Team nursing - a team of RNs, licensed practical nurses (LPNs), and aides under the supervision of one nurse, called the team leader RN assigns work on team members expertise. Youre accountable for delegating things to people who are trained to do them.

Modes of Organizing Patient Care

Primary Nursing
Primary nursing is an approach in which a nurse has responsibility and accountability for the

continuous guidance of specific clients from

hospital admission through discharge Hallmark to this is that you have autonomy/accountability 24 hours a day.

Modes of Organizing Patient Care

Case Management
Case management in acute care hospital nursing has been defined as a system of client care delivery that focuses on the achievement of client outcomes within effective and appropriate time frames and resources.

Focus is on individual patients, not populations of

patients

Factors to consider when organizing committees and making appointments

composed of people who want to contribute in terms of commitment, energy, and time variety of work experience and educational backgrounds should have enough members to accomplish assigned tasks task and responsibilities should be clearly outlined assignments should be given ahead of time

Delivery of Nursing Care

Staffing
Recruitment is the process of actively seeking out or attracting applicants for existing positions. Selection is the process of choosing from among applicants the bestqualified individual or individuals for a particular job or position. Placement is the process when the astute leader is able to assign a new employee to a position within his or her sphere of authority where the employee will have a reasonable chance for success. Indoctrination refers to planned, guided adjustment of an employee to the organization and the work environment through induction and orientation.

Factors Affecting Staffing-External

Nature of Competition for Human
Resources

Legal factors
Socio-culture Factors External influences

Factors Affecting Staffing-Internal

Size of Organization
Organizational Image Technology Used

Staffing Computation
Step 1: Determine the type of hospital (primary, secondary, or tertiary).
Step 2: Categorize patients according to levels of care.

Staffing Computation
Step 3: Find the total number of NCH needed by patients at each level of care.

Staffing Computation
Step 4: Find the total NCH per year(x 365 days) Step 5:Find the actual working hours rendered by each Nursing Personnel per year.
40 h/week- 1,728 work hours/year (locality of > 1 million populations) 48 h/week- 2, 144 work hours/year (locality of < 1 million populations)

Staffing Computation
Step 6: Find the total number of nursing personnel needed.
a. b. (NCH/year) Actual working hours/year # of relievers needed (nursing personnel needed * 0.095) c. Total nursing personnel needed: (sum of A & B)

Staffing Computation
Step 7: Categorize into professional and non-professional.
Primary 55:45 Secondary 60:40 Tertiary 65:35

Step 8: Distribute by shifts.

AM 45%
PM 37% Night 18%

Evaluation of Staff Performance

Using the Performance Appraisal to Motivate Employees

Performance appraisal implies an appraisal of how well employees perform the duties of their job as delineated by the job description. Factors influencing effective performance appraisal

Appraisal should be based on a standard.

Employee should have input into development of the standard.

Employee must know the standard in advance. Employee must know the sources of data gathered for the appraisal.

Appraiser should be someone who has observed employees work.

Appraiser should be someone who the employee trusts and respects.

Strategies to Ensure Accuracy and Fairness in the Performance Appraisal

Develop self-awareness regarding own biases and prejudices. Use appropriate consultation. Gather data adequately over a period of time. Keep accurate anecdotal records for the length of appraisal period. Collect positive data and areas where improvement is needed. Include employees own appraisal of his or her performance. Guard against the halo effect, horns effect, central tendency trap and Matthew effect.

Strategies to Ensure Accuracy and Fairness in the Performance Appraisal

The halo effect occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employees performance. The horns effect occurs when the appraiser allows some negative aspects of the employees performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded. The manager who falls into the central tendency trap is hesitant to risk true assessment and therefore rates all employees as average. The Matthew effect is said to occur when employees receive the same appraisal results, year in and year out.

Performance Appraisal Tools

Trait Rating Scales

Rates an individual against some standard

Job Dimension Scales Rates the performance on job requirements Behaviorally Anchored Rating Scales (BARS) Rates desired job expectations on a scale of importance to the position Checklists Rates the performance against a set list of desirable job behaviors

Performance Appraisal Tools

Essays

A narrative appraisal of job performance

Self-Appraisals An appraisal of performance by the employee

Management by Objectives
Employee and management agree upon goals of performance to be reached

Peer Review
Assessment of work performance carried out by peers

Overcoming Appraisal Interview Difficulties

Be calm,

courteous

and prepared.

Performance Management
Experts believe that annual performance appraisals should be replaced by ongoing performance management.

In performance management, appraisals are

eliminated and the manager places his or her

efforts into ongoing coaching, mutual goal setting

and the leadership training of subordinates.

Coaching
Coaching is a mechanism for informal performance appraisal that promotes improved work performance and team building. To become an effective coach, one must be:
Be specific, not general. Be descriptive, not evaluative. Be certain that the feedback is not self-serving but meets the needs of the employee. Direct the feedback toward behavior that can be changed.

Use sensitivity in timing the feedback.

Make sure that the employee has clearly understood the feedback and that the employees communication also has been clearly heard.

Thank You for Listening.