LM Organizing

8/12/2019 LM Organizing

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ORGANIZING

Module 7: ORGANIZING

Mind Set: NETWORKING

1. Define key terms.2. Discuss organizational concepts.3. Identify the different modes of organizing patients care.4. Discuss the roles and functions in staffing.5. Stress the importance of staffing needs and scheduling policies.

COMPONENTS OF ORGANIZATIONAL STRUCTURE:

ORGANIZATIONAL CHART- to depict an organizations structure. Because the organizational chart is a picture ofan organization.

The organizational chart defines formal relationships within the institution, areas of responsibility, persons towhom is accountable & channels of communication.

1. RELATIONSHIPS AND CHAIN OF COMMAND Solid Lines (unbroken) shows the formal relationships, lines of communication and authority. Line position can be shown by solid horizontal or vertical lines.


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Vertical linesare referred to as lines of authority and accountability. Lines of authorityrepresent the responsibility of individuals to supervise others officially and are

identified by moving downward on the chart.

Lines of accountability also calledreporting relationships, represent a responsibility to report toanother person.

The level of position on the chart also signifies status and power. Dotted or broken lines on the organizational chart =represent staff position. These positions are advisory, a staff

member provides information and assistance to the manager but has limited organizational authority.

Advisory (staff) position do not have inherent legitimate authority and staff position often lack the authorityand staff position often lack the authority that accompanies a line relationship.

2. SPAN OF CONTROL = can be determined from the organizational chart. The number of people reporting to any one manager represents that managerss span of control and

determining the number of interactions expected of him or her.

When determining the span of control in an organization, the managers abilities, the employees maturity, taskcomplexity geographic location, and the level in the organization at which the work occurs must be considered.

3. MANAGERIAL LEVELS TOPLEVEL MANAGER: coordinate internal and external influences and generally make decisions with few with

few guidelines or structures.

MIDDLE-LEVEL MANAGER: coordinates the efforts of lower levels of the hierarchy and are the channelsbetween lower and top-level managers.

FIRST-LEVEL MANAGER: concerned with their specific units work flow. Deals with immediate problems in theunit daily operation, with organization needs and personal needs of employees.

4. CENTRALITY = refers to the location of a position of an organizational chart where frequent and various types ofcommunication occurs.

Centrality = is determined by organizational distance.DECISION-MAKING WITHIN THE ORGANIZATIONAL HIERARCHY

DECISION MAKINGHierarchy or Pyramid is often referred to as Scalar Chain CENTRALIZED DECISION MAKING- decisions are made by a few managers at the top of the hierarchy DECENTRALIZED DECISION MAKINGdiffuses decision making throughout the organization and allows

problems to be solved by the lowest practical managerial level. (Problem are solved at the level to which they

occur)


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LIMITATION OF ORGANIZATION CHARTS

ADVANTAGES LIMITATIONS

1. Maps lines of decision-makingauthority.

2. Helps people understand theirassignments and those of their

coworkers

3. Reveals to manages and new personnelhow they fit into the organization

4. Contributes to sound organizationstructure

5. Shows format lines of communication

1. Shows only formal relationship2. Does not indicate degree of authority3. May show things as they are supposed

to be or used to be rather than as they

are

4. Possibility exists of confusing authoritywith status.

FIVE MAJOR CHARACTERISTICS OF AN ORGANIZATIONAL CHART

DIVISION OF WORKeach box represents the individual or sub-unit responsible for a given task oh theorganizations work load.

CHAIN OF COMMANDlines indicates who reports to whom and by what authority.

TYPE OF WORK TO BE PERFORMEDindicated by labels or descriptions for the boxes. GROUPING OF WORK SEGMENTSshown by the clusters of work groups (departments or single units) LEVELS OF MANAGEMENT- indicate individual and entire management hierarchy.

HIERARCHY= refers to a body of persons or things organized or classified in a pyramidal fashion according to rank,

capacity or authority assigned to vertical levels with offices ranked in grades, orders or classes one above the other.

AUTHORITY= the right to act or make decisions without approval of higher administrators.

LINES AND STAFF RELATIONSHIPS

LINE AUTHORITY- simplest and most direct type; each position has general authority over the lower positions in thehierarchy in the accomplishment of the main operations of the organization

RESPONSIBILITY- obligation to perform the assigned tasks; it is a duty or an assignment; it is the implementation ofa job.

ACOUNTABILITY- taking full responsibility for the quality of work & behavior while engaged in the practice of theprofession;

INTERNALIZED RESPONSIBILITY to be accountable means that the individuals agree to be morally responsiblefor the consequences of their actions;

POWER- the ability to influence another to behave in accordance with ones wishes. STATUS- the rank a group bestows on a person in accord with the groups estimation a of the persons valueand

significance to group goals.

COMMUNICATION- the transmission of information between personsTYPES OF ORGANIZATION CLASSIFIED BY NATURE OF AUTHORITY

1. LINE ORGANIZATIONthe simplest and most direct type or organization in which each position has generalauthority over the lower position in the hierarchy.

In these structures, authority and responsibility are clearly defined, which leads to efficiency andsimplicity of relationships.


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DISADVANTAGES:

Often produce monotony, Alienate workers Make adjusting rapidly to altered circumstances difficult Chain of command restricts upward communication

2. INFORMAL ORGANIZATIONrefers to horizontal relationships rather than vertical. It is composed of smallgroups of workers with similar interest.

3. STAFF ORGANIZATION- purely advisory to the line structure with no authority to put recommendations intoaction.

Eg. Training and research

4. FUNCTIONAL ORGANIZATION is one where each unit is responsible for a given part of the organizationsworkload. There is clear delineation of roles & responsibilities which are actually interrelated.

Eg. All standing and ad hoc committees

5. AD HOC DESIGNa modification of the bureaucratic structure and is sometimes used in a temporary basis tofacilitate completion of a project within a formal line organization.

DISADVANTAGES:

- Decreased strength in the formal chain of command and decreased employee loyalty to the parentorganization.

6. MATRIX ORGANIZATION STRUCTURE- it is designed as all the tasks required to produce the product, and theproduct is the end result of the function.

7. SERVICE LINE ORGANIZATION- is used in some large institutions address the shortcoming that are endemic totraditional large bureaucratic organizations

-It is sometimes called Car-centered organization

8. FLAT ORGANIZATIONAL DESIGNS - designed to remove hierarchical layers by flattening the chain of commandand decentralizing the organization

- Many managers resist this type of organization as it increases their work load


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- Flat or (decentralized structure)decentralized organization, the chart of relationship shows fewerlevels and a broad span of control.

- Decentralized organization have an opportunity to develop their own abilities and autonomy and oftensee the organization as more humanistic.

- Results greater job satisfaction for the majority of individuals.- Strength: is the simplification of communication patterns, which flow easily from lower levels to higher

levels in direct manner.

SHARED GOVERNANCE:

ORGANIZATIONAL DESIGN OF THE 21ST

CENTURY

One of the most innovative and idealistic of organization structures Developed in mid-1980s as an alternative to the traditional bureaucratic organizational structure. Often describe as a flat type of organizations. Organizations governance is shared among board members, nurses, physicians, and management Decision-making & communications channels are altered Aim: empowerment of people within the decision-making system. In healthcare system is directed at increasing nurses authority and control over nursing practice by being

accountability based governance system for professional workers.

Participatory mgt. lays the foundation for shared governance they are not the same. Participatory managementimplies that the others are allowed to participate in decision making over which someone has control.

PRINCIPLES OF ORGANIZING

1. UNITY OF COMMANDindicated by the vertical solid line between positions on the organizational chart; Best describe as one person/boss in which employees have one manager to whom they report and

to whom they report and whom they are responsible,Responsible to only one superior

2. SCALAR PRINCIPLE or HIERARCHY- authority and responsibility flows in clear unbroken / solid lines from thehighest executive to the lowest; formal paths of communication and authority

Chain of Command a military term, proper definition and delegation of authority andresponsibility facilitate the accomplishment of work;

THINGS TO BE OBSERVED AND MADE TO UNDERSTAND:

When responsibility for a particular job is delegated to a subordinate , the subordinate shouldhave authority over resources needed to accomplish the task;

When a particular function is delegated to as subordinate, the superiors own responsibility is inno way decreased;

When a person is given authority for action, he is accountable and responsible for his actions tothe person who gave him such.

3. HOMOGENOUS ASSIGNMENT OR DEPARTMENTATIONworkers performing similar assignments are grouptogether for a common purpose;

4. SPAN OF CONTROL- the number of people directly reporting to any one manger represents that managers spanof control and determines the number of interactions expected of him.

5. FLATTENING THE ORGANIZATION- reduction in numbers of administrative levels.6. EXCEPTION PRINCIPLE- recurring decisions are handled in a routine manner by lower-level managers whereas

problems involving unusual matters are referred to the higher levels;

MODES OF ORGANIZING PATIENT CARE

1. TOTAL PATIENT CARE NURSING or CASE METHOD NURSING Oldest mode of organizing patient care. The nurse assumes total responsibility for meeting all

the needs of assigned patient during their time on duty.


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To date: used in hospitals and home health agencies Provides nurses with high autonomy and responsibility

2. FUNCTIONAL NURSING or CARE THROUGH OTHERS History: functional nursing care evolved primarily as a result of world war II and the rapid

construction of hospitals as a result of the Hill Boston Act.

MAJOR ADVANTAGE OF FUNCTIONAL

NURSING:

LIMITATIONS:

Efficiency- tasks are completedquickly with little confusion

regarding responsibilities

A. May lead to fragmented care and thepossibility of overlooking priority

patients needs.

B. Some workers may feet unchallengedand under stimulated in their roles; itmay result in Low Job Satisfaction.

C. Functional nursing may not be costeffective due to the needs for many

coordinators Employees often

focus only in their own efforts with

less interest in overall results.

3. TEAM NURSING/ MODULAR NURSING Was developed in the 1950s in an effort to decrease the problems associated with the functional

organization of patient care.

In team nursing, ancillary personnel collaborate in providing care to a group of patient under thedirection of a professional nurse.


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TEAM NURSING ORGANIZATION STRUCTURE

ADVANTAGES DISADVANTAGES

Group members are given as muchautonomy as possible when performing

assigned tasks although the team shares

responsibility and accountability

collectively.

Team nursing allows members tocontribute their own special expertise or

skills;

High job satisfaction= if given theautonomy and recognizing individual

worth

Improperly implementation rather than with thephilosophy itself

Insufficient time is allowed for team careplanning and communication

Can lead to blurred lines of responsibility errorsand fragmented patient care.

4. PRIMARY NURSING Developed in the early 1970s uses some of the concepts of total patient care and brings the registered

nurse back to the bedside to provide clinical care.

Primary nursing- requires a nursing staff-RNs This method is quite difficult to implement because of the degree of responsibility and autonomy

required of the primary nurse.

PRIMARY NURSING STRUCTURE

CHARGE NURSE

TEAM LEADERTEAM LEADER TEAM LEADER

NURSING STAFF

PATIENTS

NURSING STAFF

PATIENTS

NURSING STAFF

PATIENTS

PRIMARY NURSE

PATIENT

PHYSICIAN CHARGE NURSE

HEALTHCARE

ORGANIZATIONS

RESOURCES

ASSOCIATE NURSE

(EVENINGS)ASSOCIATE NURSE

(NIGHTS)

ASSOCIATE NURSE

(AS NEEDED)

(DAYS)


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5. CASE MANAGEMENT Latest work design prepared to meet patients needs. Defined as collaboration process that assesses, plans, implements, coordinates, monitors & evaluates

options and services to meet an individualshealth needs through communication & available resources to

promote quality cost-effective outcomes

Focus of case management=is an individual clients Case management handles each case individually. DOWELL (1996) IDENTIFIES THREE BASIC MODELS OF CASE MANAGEMENT

BROKERAGE CASE MANAGEMENT MODELS: The case manager identifies needed services and makes referrals to various sources but does not

directly provide the services.

SERVICE MANAGEMENT MODEL: The case manager manages both the clients service budget and directly provides most if not all

services.

MANAGED CARE MODEL:

Providers are paid for services prospectively. Thus, services provided are cost centers, not revenueproducers.

In all these models, the case manager works to see that client receives appropriate resources in a time- andcost effective manner and ensures continuity of care.

3 TYPES OF ORGANIZATIONAL CULTURE:

1. COOKE AND LAFFERTY (1989) POSITIVE CULTURE= constructive culture in which members are encourage tointeract with others and to approach tasks in proactive ways that will help them to meet their satisfaction

needs.

2. PASSIVE AGGRESSIVE3. AGGRESSIVE DEFENSIVE = members interact in guarded and reactive ways and approach tasks in forceful ways

to protect their status, and security.

These 2 cultures are based on approval, conventional, dependent and avoidance norms andoppositional, power, competitive and perfectionistic norms.

Discuss the structure and relationships of an organization by using an organizational chart; include typeof structure, span of control, chains of command, channels of communication and lines of authority and

accountability.

ADVANTAGES DISADVANTAGES

The primary nurse assumes 24 hoursresponsibility for planning the care of one

or more patients from admission or the

start of treatment to discharge or the

treatment ends.

During work hours, the primary nurseprovides total direct care for the patient.

When the primary nurse is not on duty,associate nurses who follow the care plan

established by the primary nurse provide

care.

Improper implementation (same in team nursing) Inadequate in preparation or incompetent

prepared nursing-may incapable of coordinating

a multidisciplinary team or identifying complex

patient needs and condition changes.

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