Organizations are characterized as flat, rather than tall, structures in which unit-based decision-making prevail. Nursing departments are decentralized, with strong nursing representation evident in the organizational committee structure. The nursing leader serves at the executive level of the organization, and the Chief Nursing Officer reports to the executive level.

FORCE 2Organizational Structure

EXECUTIVE SUMMARY FORCE 2: ORGANIZATIONAL STRUCTURE Organizations are characterized as flat, rather than tall, structures in which unit-based decision-making prevails. Nursing departments are decentralized, with strong nursing representation evident in the organizational committee structure. The nursing leader serves at the executive level of the organization, and the Chief Nursing Officer reports to the executive level.

Massachusetts General Hospital (MGH) is a complex, tertiary facility with over 4000 nurses

practicing throughout the hospital, within and outside of the Department of Nursing. The Senior

Vice President for Patient Care Services and Chief Nurse has positioned herself strategically in the

organization and has created an infrastructure that empowers nurses to take the lead in promoting

and enhancing innovative, high quality patient care.

The Chief Nurse reports directly to the President of the MGH. Although not a voting

member, the Chief Nurse is invited to attend all meetings of the MGH Board of Trustees, the

highest governing body at MGH. Attendance at Trustees meetings positions her to have extensive

input in the strategic planning and decision-making process for the Hospital. Annually, she presents

an executive report to the Board about Nursing, depicting both the Department’s successes as well

as challenges. Topics presented during her last presentation included chaos in the health care

environment, quality of care, nursing shortage, staff satisfaction, and quality and safety. Following

her presentation, priorities were established and funding released.

As a key member of the Hospital’s senior leadership team, the Chief Nurse oversees the

development and implementation of programs to fulfill the patient care, research, and educational

missions of the organization. As stated in her position description she directs the activities of all sections

of the institution responsible for direct patient care and assures that competent, compassionate patient care is uniformly

provided to patients in ambulatory, inpatient and community settings. Using the Patient Care Services Strategic

and Annual Operating Plan and the Professional Practice Model (including Collaborative

Governance) as a framework, the Chief Nurse has organized her management team structure to

create streamlined operational relationships throughout the organization. This operational structure

clearly supports unit-based decision-making, giving nurses a strong voice in the decision-making

process. As a result, robust nursing representation is evident throughout the organizational

committee structure.

In addition to the personnel structures, the Chief Nurse has actively addressed and revised

programmatic structures within the organization to meet the needs of patients and staff including

the recent establishment of The Institute for Patient Care, a new interdisciplinary structure within

Patient Care Services centered on meeting patients’ needs; advancing care delivery systems; and

fostering, studying, and promoting innovations in the care environment. Four Centers constitute

The Institute for Patient Care: The Norman Knight Nursing Center for Clinical & Professional

Development, The Maxwell and Eleanor Blum Patient and Family Learning Center, The Yvonne

Munn Center for Nursing Research and The Center for Innovations in Care Delivery. Center

descriptions and impact on practice are detailed in the Forces.

In addition to the Chief Nurse’s contributions at the Trustee’s and other executive-level

meetings, key information is disseminated through departmental and unit-based retreats to ensure all

levels of nurses participate in decision-making. Open forums as well as the Collaborative

Governance meetings are also used to begin a dialogue with staff, engaging them in the fact-finding

and decision-making process.

Collaborative Governance is embedded in the MGH culture. It is the critical element within

the practice model that describes communication and decision-making processes and places the

authority, responsibility and accountability for patient care with the practicing clinicians. In place

since 1997, it has been and continues to be the structure that sets the standard for nursing staff

involvement, both formally and informally in both program and unit activities. Its mission is to

integrate multidisciplinary clinical staff into the formal decision-making structure of Patient Care

Services to stimulate, facilitate and generate knowledge that will improve patient care and enhance the environment in

which clinicians shape their practice. More than 250 clinicians within and outside of the Department of

Nursing participate in the seven Collaborative Governance Committees. Committee descriptions

and operational examples are articulated throughout the Forces.

In addition to the Collaborative Governance Committees, the Chief Nurse uses the Staff

Perceptions of Professional Practice Environment Survey (SPPPE) as a way to involve all nurses in

the decision-making process. The SPPPE gives the nurses the opportunity to share their concerns

with the Chief Nurse to start a dialogue about issues. The results from the survey inform decisions

about the strategic direction for Patient Care Services and Nursing, thus aligning leadership and staff

in attainment of specified strategic initiatives.

TABLE OF CONTENTS Volume 2

Force 2: Organizational Structure

Sources of Evidence 2.1

2.2

2.3

2.4

2.5

2.6

Pages 1-43

Pages 44-64

Pages 65-86

Pages 87-101

Pages 102-115

Pages 116-138