NR 446 Edapt Week 5 Leading in an Organisation

NR 446 Edapt Week 5 Leading in an Organisation

Student Name

Chamberlain University

NR-446 Collaborative Healthcare

Prof. Name:

Date

Leadership in Healthcare Organizations

Formal and Informal Leadership

Healthcare organizations operate using both formal and informal leadership structures. Formal leadership follows a hierarchical model, where authority, accountability, and responsibility are clearly delineated through a structured chain of command. Informal leadership, however, relies on interpersonal relationships and the influence that emerges from those connections. Each type employs distinct channels of communication to achieve organizational goals.

Top-Level Healthcare Management

Top-level healthcare executives are accountable for the overall performance of their organizations. These include the Board of Directors, Chief Executive Officer (CEO), and Chief Nursing Officer (CNO). Middle-level managers such as nursing supervisors and department heads report to top-level management and oversee lower-tier managers, playing a critical role in daily operations.

Medicare and Healthcare Delivery Systems

Medicare Coverage Breakdown

Medicare, a federally funded program, provides health insurance primarily to individuals over 65 and those with specific chronic conditions. The program is divided into the following parts:

Private and Public Insurance Funding

Healthcare systems receive funding from both private insurance and public programs. Employers typically transfer part of insurance costs to employees. Individuals also contribute via premiums, deductibles, and copayments. Medicaid, a state-funded program, assists low-income individuals and those with disabilities, while Medicare covers elderly and certain chronically ill populations. Both are tax-funded.

Shared Governance and Organizational Models

Shared Governance in Nursing

Shared governance structures empower nurses by including them in decision-making processes. This decentralized approach enhances collaboration, fosters leadership development, and integrates staff input into policies, procedures, and quality improvement. This model embodies servant leadership, where communication and accountability flow across all levels.

Magnet Recognition

An exemplary model of shared governance is Magnet recognition, which signifies excellence in nursing and healthcare leadership. It reflects a commitment to empowering nurses and optimizing patient care through collaborative leadership.

Organizational Structure and Management Roles

Hierarchical Structure and Chain of Command

Healthcare systems use organizational charts to outline lines of authority and communication. These charts clarify decision-making authority and reporting relationships:

Chain of command is fundamental, ensuring information flows efficiently. For example, staff nurses report to the nurse manager, who in turn reports to the CNO.

Centralized vs. Decentralized Decision-Making

Centralized structures restrict decision-making to upper management, while decentralized structures allow unit-level managers and staff to tailor decisions to meet specific client needs.

Functional Roles of Managers

Manager vs. Leader

Managers are assigned roles with explicit responsibilities, including accountability, authority, and responsibility. Leaders, on the other hand, influence and inspire others. For example, a charge nurse demonstrates responsibility by ensuring care delivery and coordination. The nurse also exercises authority and is morally accountable for their duties.

Organizational Planning and Strategy

Top-level managers undertake strategic planning and stakeholder engagement. Meanwhile, department heads focus on organizing resources and personnel to provide quality care.

Organizational Chart Advantages and Disadvantages

Managed Care Models

Collaborative Care and Leadership

Barriers to Care Coordination

Barriers in collaborative care include language and cultural differences, limited interdisciplinary staff, communication breakdowns, medical errors, and poor transition processes.

Organizational Models

Case Study: Chamberlain Health Care (CHC)

CHC is a large, not-for-profit system operating multiple facilities and recognized with Magnet status. Recent challenges such as staff retirements, pandemic-related pressures, and a lack of emerging leaders led to the formation of the “Chamberlain Healthcare Emerging Leaders” task force. Goals included increased participation in leadership development and shared governance implementation.

Application of the Nursing Process in Organizational Planning

Organizational planning mirrors the ADPIE nursing process:

1. Assessment: Identify site needs through stakeholder input.
2. Diagnosis: Recognize practice gaps.
3. Planning: Search for evidence-based interventions.
4. Implementation: Apply interventions in practice.
5. Evaluation: Measure intervention outcomes.

Collaborative Care Models

Case Scenario Example

A charge nurse divides a 24-bed unit into two teams with assigned RNs, LPNs, and UAPs. The described model closely aligns with modular nursing due to the small team setup and geography-based assignments.

Leading and Managing in Practice

Nurse managers lead by applying policies and governance models aligned with the organization’s mission and vision. Effective leadership involves evaluating existing structures, advocating for safe and quality care, and allocating resources efficiently.

Nursing Care Delivery Models

Primary Nursing Model

In the described scenario, the care model in use is the primary nursing model, also known as relationship-based nursing. This approach emphasizes continuity of care, where the primary nurse is accountable for the client’s care from admission to discharge. The primary nurse provides total care during scheduled shifts and establishes a care plan for associate nurses to follow when off-duty. This ensures consistent care delivery and reinforces the nurse-client relationship.

Team Nursing Model

Another situation highlights the team nursing model, where a charge nurse assigns team leaders to oversee client care. Under the team leader’s direction, registered nurses and unlicensed assistive personnel (UAP) collaborate to deliver direct care. For example, in a 12-bed ICU, the charge nurse assigns each RN to two clients, while a unit secretary supports with administrative tasks. This collaborative model enhances efficiency by distributing care tasks according to team roles and expertise.

Total Patient Care Model

The total patient care model is evident when each nurse assumes complete responsibility for assigned clients during their shift. This traditional model involves the nurse providing all aspects of care without delegation. It is ideal for situations requiring high levels of accountability and individualized attention.

Case Management and Functional Nursing

Case Management

Case management involves coordinating individualized, cost-effective care through multidisciplinary action plans. Case managers, often nurses or social workers, are adept at navigating community resources. For instance, in a 30-bed telemetry unit, the charge nurse coordinates staff such as the RN, UAP, unit secretary, and telemetry technician to meet client needs efficiently.

Functional Nursing

In the functional nursing model, care is delivered by task assignment rather than by client assignment. This model emphasizes task specialization, making nurses managers of care. Staff members are delegated specific functions, such as hygiene, medication administration, or monitoring, rather than comprehensive patient care.

Power and Authority in Nursing

Types of Power in Nursing

Nurses possess various types of power, each influencing staff behavior and workplace dynamics.

Queen Bee Syndrome and Power Misuse

“Queen Bee Syndrome” occurs when experienced nurses avoid mentoring novices, often in female-dominated professions. This behavior fosters workplace toxicity. Similarly, misusing coercive power, such as threatening staff for unmet goals, may lead to high turnover and organizational loss. New managers must develop self-awareness, practice ethical leadership, and build trust to prevent widening the authority gap.

Authority Gap and Managerial Responses

An authority gap arises when staff distrust leadership. This may result from inconsistent leadership, fear of retaliation, or lack of support. Leaders who foster transparency, listen actively, and support quality care help bridge this gap. Conversely, coercion expands it, resulting in communication breakdown and turnover. Leaders must use power wisely, informed by self-awareness and emotional intelligence.

Quality Management in Healthcare

Characteristics of Quality Care

According to the Institute of Medicine (2001), high-quality healthcare should be:

• Safe: Prevents client harm.
• Effective: Based on scientific evidence.
• Timely: Reduces delays in care.
• Efficient: Minimizes resource waste.
• Equitable: Uniform across demographics.
• Client-centered: Respects client preferences.

Quality Improvement vs. Assurance

DMAIC Process in Quality Improvement

The DMAIC (Define, Measure, Analyze, Improve, Control) model is used in quality projects. For example, a committee addressing client falls:

• Define: Recognize fall rates as the issue.
• Measure: Assess frequency of incidents.
• Analyze: Identify poor communication as a cause.
• Improve: Implement and refine new protocols.
• Control: Sustain changes and evaluate results.

Medication Safety and Reconciliation

Medication reconciliation is vital during transitions of care, such as admissions or transfers. It involves comparing current and new prescriptions to avoid omissions or errors. Nurses use electronic drug guides, pharmacist consultations, and package inserts—not outdated texts—for safe medication administration.

Global Health Workforce Transformation

The WHO’s High-Level Commission on Health Employment and Economic Growth (2016) proposed strategic actions to address global health workforce shortages:

• Invest in healthcare education and lifelong learning.
• Support gender equality and women’s participation.
• Promote universal health coverage with people-focused care.
• Incorporate technology into training and practice.
• Ensure health worker protection and fair migration.
• Collect and analyze data for accountability.
• Treat health workers as investments, not costs.

These global efforts aim to reduce the projected 18 million health worker shortfall by 2030 and to strengthen healthcare systems worldwide.

References

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.

World Health Organization. (2016). Working for health and growth: Investing in the health workforce. High-Level Commission on Health Employment and Economic Growth.

Yoder-Wise, P. S. (2019). Leading and Managing in Nursing (7th ed.). Elsevier Health Sciences.

NR 446 Edapt Week 5 Leading in an Organisation