Leadership Midterm

The value of team building:

The value of team building: -The establishment of goals and objectives -The allocation of the work to be performed -The mmaner in which a group works: it's processes, norms, decision making, and communication patterns -The relationships among the people doing the work

Affordable Care Act

Affordable Care Act Obama care-created in march 2010. The Affordable Care Act was intended to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare. It introduced mechanisms including mandates, subsidiesand insurance exchanges.[1][2] The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions or sex.[3] In 2011, the Congressional Budget Office projected that the ACA would lower future deficits[4] and Medicare spending.[5] Each measure how a hospital improves its performance based on baseline Empowers patients

Why teams are important in healthcare

Why teams are important in healthcare: As we experience changes such as cost cutting and quality and safety issues in health care, teamwork becomes critical. Nursing is accountable for patient outcomes that affect reimbursement for care and the institutional financial bottom line. -Interprofesional teams: collaboration

Forces that influence health care organizations:

economic, social, demographic

Emotional intelligence

¥ The ability to monitor emotions in a situation to guide actions and inform thought processes. ¥ Possession of social skills, interpersonal competence, psychological maturity, and emotional awareness devoted to helping people work well together. ¥ 5 domains: Having self-awareness, Managing emotions, Motivating self, Being empathetic, Handling relationships

¥ Manager

¥ The individual with accountability for a group of people ¥ The act of any individual who guides others through a series of routines, procedures, or practice guidelines.

¥ Follower

¥ The person who contributes to a group's outcomes by implementing activities and providing appropriate feedback. ¥ The optimal use of personal attributes in a team situation, while acquiescing to a peer who is leading or managing, to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes.

How healthcare is paid for CH 12

¥ Three major sources: 1. Government 2. Private health insurance 3. Out-of-pocket -Four sources 1. Government (45%) -Medicare: primary payer of health insurance -Part A (hospital, hospice, home health, skilled nursing) -Part B (provider, medical equipment, diagnostics) -Part D (drug benefit plans) -Medicaid -State level program -Medically indigent, blind, or disabled -Children with disabilities -50% to 83% paid by federal government 2. Private insurance companies (35.9%) 3. Individuals (15%) 4. Other (4%)

Questions to ask yourself as a member of the team

Questions to ask yourself 1. Am I in or out 2. Do I have any power or control 3. Can I use, develop, and be appreciated

What is prospective payment?

(Prospective payment) Flat-rate reimbursement is based on the payer's deciding in advance what the payment will be. If costs are greater, the provider absorbs the cost. If costs are less, the provider benefits. The third-party payer decides in advance what will be paid for a service or episode of care.

Not for profit organizations

-Controlled by voluntary boards or trustees -Provide care to a mix of paying and nonpaying patients -Excess revenue over expenses is redirected into the organization for maintenance and growth. -They don't pay taxes -Required to serve patients regardless of inability to pay

Health care reimbursement

-Cost based system: the cost of providing a service plus the mark up for profit. -Cost-based reimbursement: all allowable costs are calculated and used as the basis for payment. Amount of payment is determined after services are delivered. -Prospective payment system: method in which the third party payer decides in advance what will be paid for a service or episode of care -Medicare implemented a prospect payment system for hospital care that uses diagnosis-related groups (DRGs) as the basis for payment. -Value based purchasing: The premise of this payment is based on quality outcomes. Value based purchasing offering rewards and incentives to high performing organization.

2. Social:

-Focus of society that is changing from illness to health (wellness) -Increasing demand by individuals that they participate in designing their own customized care plans. -Seeking increase in the involvement of the providers Social is the next area. As the baby boomer generation retires, they are likely to become activists about the conditions and quality of services in healthcare. Patients in general are becoming more proactive and often come with a predetermined diagnosis and treatment plan. The issue of whether healthcare is a privilege or a right has not been resolved and will continue as a social issue.

3. Demographic:

-Increasing percentage of society that is composed of elderly individuals (aging of population) -Increasing percentage of uninsured -Inability of communities to provide access to needed health services -Geographic distribution -Regional access to care -Incomes of population -Immigration trends Geographic distribution of the population and of services has long been an issue. The struggle of rural hospitals to survive and the intensity with which rural communities recruit a primary care provider are two examples of how geographic distribution is a force in healthcare delivery. Disparity of care based on income is well documented. The numbers of immigrants in the United States also poses challenges, especially in terms of providing culturally competent care. Increasing numbers of uninsured populations are clustered around particular healthcare provider organizations. Also, we already are aware of the influence of older adults, both from the numbers who will expect services and from their activism.

Networking

-Power strategy & political skill -Identify, value and maintain relationships with a system of individuals who are sources of information, support, advice -Support the empowerment of participants through interaction and the refinement of their interpersonal skills EX: having lunch with someone from another department including managers from non nursing departments -Participate in nursing organization -Join a civic, volunteer, and special interest group -Be care about mixing personal and professional life Network! Join nursing organizations and get to know nurses outside of where you work. Be proactive in sharing business cards with those in your professional network. Be a mentor (formally or informally).

Shred governance

-Sometimes referred to as professional practice model -Professional workplace rather than organizational hierarchy -Shared governance is focused on allowing professional nurses to manage their practice. It involves the responsibility for making decisions at the patient, unit, and organizational level. In this practice model, front-line nurses are accountable for making nursing care decisions that impact their patients. -Phase 1: Representative staff nurses are members of clinical forums. -Phase 2: Representative staff nurses belong to committees. -Phase 3: Representative staff nurses belong to councils with authority.

Nursing professional organizations and power

-The AACN-American Association of Colleges of Nursing-writes essentials for baccalaureate, graduate, and doctoral education. Identifies health policies too -Student Nurses Association (SNA) -ANA: American Nurses Association advocates for legislation

Stages of team development

1. Forming: In this stage, most team members are positive and polite. Some are anxious, as they haven't fully understood what work the team will do. Others are simply excited about the task ahead. As leader, you play a dominant role at this stage, because team members' roles and responsibilities aren't clear. This stage can last for some time, as people start to work together, and as they make an effort to get to know their new colleagues. Storming: Next, the team moves into the storming phase, where people start to push against the boundaries established in the forming stage. This is the stage where many teams fail. Storming often starts where there is a conflict between team members' natural working styles. People may work in different ways for all sorts of reasons but, if differing working styles cause unforeseen problems, they may become frustrated. Storming can also happen in other situations. For example, team members may challenge your authority, or jockey for position as their roles are clarified. Or, if you haven't defined clearly how the team will work, people may feel overwhelmed by their workload, or they could be uncomfortable with the approach you're using. Some may question the worth of the team's goal, and they may resist taking on tasks. Team members who stick with the task at hand may experience stress, particularly as they don't have the support of established processes, or strong relationships with their colleagues. 2. Norming: Gradually, the team moves into the norming stage. This is when people start to resolve their differences, appreciate colleagues' strengths, and respect your authority as a leader. Now that your team members know one another better, they may socialize together, and they are able to ask one another for help and provide constructive feedback. People develop a stronger commitment to the team goal, and you start to see good progress towards it. There is often a prolonged overlap between storming and norming, because, as new tasks come up, the team may lapse back into behavior from the storming stage. 3. Performing: The team reaches the performing stage, when hard work leads, without friction, to the achievement of the team's goal. The structures and processes that you have set up support this well. As leader, you can delegate much of your work, and you can concentrate on developing team members. It feels easy to be part of the team at this stage, and people who join or leave won't disrupt performance. 4. Adjourning: Many teams will reach this stage eventually. For example, project teams exist for only a fixed period, and even permanent teams may be disbanded through organizational restructuring. Team members who like routine, or who have developed close working relationships with colleagues, may find this stage difficult, particularly if their future now looks uncertain.

Types of organizational structures and characteristics

1. Functional: are those organized around specialities. Common in health care organizations. For EX: healthcare organization with a functional structure would have vice presidents for each major function: nursing, finance, human resources, and information technology. 2. Service line: (product lines)-functions necessary to produce a specific service or product are brought together into an integrated organizational unit under control of single manger/executive. EX: cardiology service line at acute care hospital might include all professional, technical and support personnel providing services to the cardiac patient population 3. Matrix structures: complex and designed to reflect both function and service in integrated organizational structure EX: director of pediatric nursing could report to both a VP for pediatric services (service line manager) and a VP of nursing (functional manager) 4.Flat 5.Shared governance

• Mission

: organization's reason for existence, influnces the design of the structure (eg to meet the healthcare needs ofa designated population, to provide supportive and stabilizing care to an actue care population, or to prepare patients for a peaceful death.)

Bureaucracy:

Bureaucracy: Initially referred to the centralization of authority in government departments. Now refers to an inflexible approach to decision making or an agency encumbered by red tape that adds little value to organizational processes. -at the top is president, down to vice presidents, down to associate director of nursing, to assistant directors, to nurse managers, to direct care nurses -Centralization of authority and decision making -Top-down communication

Capitation

Capitated payments are based on the provision of specified services to an individual over a set period, such as 1 year. The capitation (or per head [person] fee) is set, and the desire is to provide needed care at the lowest cost possible while meeting the standards for quality. Capitation: one fee is paid for all services provided, increasing the overall number of patients served and decreasing the volume of services used is desirable. Nurses must strive to accomplish more with each visit to decrease return visits and complications.

Centralization:

Centralization refers to where decisions are made. If everyone has to ask someone else, the organization is highly centralized. If the organization is highly decentralized, each employee is charged with decision-making authority to provide the best in patient care. Highly centralized organizations delegate responsibility without authority to act. Patient-side nurses are often frustrated with this approach because they see the decisions to be made evolving as care is being provided.

Transformational

Challenges the process Brings people together Empowers others Models the way Attends to personal things Effects of leadership on followers: Shares the vision Has increased self-worth Challenging and meaningful work Coaching and mentoring happen Feels valued Effects of leadership on organization: Increased loyalty Increased commitment Increased job satisfaction Increased morale Increased performance

Working in teams, communication, collaboration Creating teams: Commitment, communication, connectedness

Communication Communicate effectively -Stress: connection between stress and self worth can evolve as a result of a breakdown in communication. Stress is a threat to positive self-worth.. -Stress response model: when threat is identified: receiver uses 5 communication patterns: attribution of blame, placation, constrained, coolheadedness, immaterial irrelevance, or congruence. -Communication barriers -Communication pitfalls: giving advice, making others wrong, being defensive, judging the other person, patronizing, giving false reassurance, asking why questions, blaming others -Communication guidelines: approach each interaction as though the other person has no knowledge of effective communication, share your thoughts and feelings, use small talk, acknowledge praise and encourage the other person, present messages in a way that the other person can receive, take responsibility for problems or issues with one another, use appropriate level language. Communication is a reflection of self-worth. Stress results whenever self-worth is threatened and can lead to an angry reaction. Barriers: distractions, inadequate knowledge, poor planning, differences in perception, emotions and personality Working in the Foundations for creating team •Commitment: a passion for the project or mission of the team that allows team members to do whatever it takes to reach the objective. This can be seen in what is required to successfully achieve JCAHO accreditation or Magnet™ designation •Communication: the verbal and nonverbal interaction that occurs in the team. These interactions are respectful and honest, and members listen actively to the thoughts and feelings of other team members. Disagreements are handled in a way that honors each person and looks creatively for a win-win solution. •Connectedness: the positive supportive relationships that facilitate clear and effective communication.

Complexity

Complexity concerns the division of labor, how specialized that labor is, the number of hierarchical levels, and the geographic dispersion of the units. Division of labor and specialization refer to designation of processes into tasks. An organizational chart is a graphic representation of the work units and the reporting relationships. Hierarchy refers to the lines of authority and responsibility and how distant the patient-side nurse is from the chief nursing officer and the chief executive officer. Chain of command refers to the hierarchy and is the vertical view of organizational charts.

Covey's 8 characteristics of effective leaders:

Covey's 8 characteristics of effective leaders: 1. Engage in lifelong learning 2. Are service oriented 3. Are concerned with the common good 4. Radiate positive energy 5. Believe in other people 6. Lead balanced ievs and see life as an adventure 7. Are synergistic; that is, they see things as greater than the sum of the parts 8. Engage themselves in self-renewal

Decision making

Critical thinking Decision making Problem solving

Profit in healthcare and the nursing role

Revenues - Expenses = Profit Nursing role: patient centered care, employee centered Cost conscious nursing practice: ¥ Add "financial thinking" to nursing skill set ¥ Charge capture ¥ Time management ¥ Cost of care discussions with patients ¥ Evaluation of new technologies ¥ Efficient use of resources

Foundations of shared governance and the roles of leadership and nursing 1. What are the implications of flat organizational structures and shared governance on nursing managers?

Decentralized decision making. Provides staff with authority to make decisions at the place of interaction with patients. Shared governance improves nursing satisfaction and patient outcomes. IHI wants decisions made at the unit level because it improves patient safety and outcomes. An issue with decentralized structures is the potential for inconsistent decision making, loss of growth opportunities and the need to educate managers to communicate effectively and creatively. Shared governance increases participation of staff through giving them more autonomy and accountability. Nurses when they make decisions are supported by management and the administrative level.

Effective teams

Effective teams -decision by consensus -clear purpose -informatility and congeniality -commitment and high level of participation -memebrs will listen respectfully and give feedback -Roles and work assignments are clearly distinguished ahead of time -Role of leadership is shared -Each person's strengths are recoginized -Comfortable with disagreement and open and honestto discussing the disagreement -Information is distinguished in a comfortable and relaxed environment with focus in sharing discussing evenly

Flat structure:

Flat structure: vice president nursing to nurse managers (all on same level) to staff (all on same level) -Decentralization of authority and decision making -Delegation of decision making to the professionals doing the work -Found in Magnet hospitals -Flat structures focus on the delegation of decision making to the professionals doing the work. They have full authority to take action without seeking input from others.

Formalization:

Formalization refers to the amount of structure an organization has in terms of rules or policies. Often, highly specialized organizations with lots of professionals have little formalization.

Team roles

Googled: -Resource investigator: They use their inquisitive nature to find ideas to bring back to the team. -Teamworker: Help the team to gel, using their versatility to identify the work required and complete it on behalf of the team -Coordinator: Needed to focus on the team's objectives, draw out team members and delegate work appropriately -Plant: Tend to be highly creative and good at solving problems in unconventional ways -Monitor evaluator: Provides a logical eye, making impartial judgements where required and weighs up the team's options in a dispassionate way -Specialist: Brings in-depth knowledge of a key area to the team -Shaper: Provide the necessary drive to ensure that the team keeps moving and does not lose focus or momentum -Implementer: Needed to plan a workable strategy and carry it out as efficiently as possible -Complete finisher: Most effectively used at the end of tasks to polish and scrutinise the work for errors, subjecting it to the highest standards of quality control

1. Economics:

Increasing numbers of uninsured patients Decreasing reimbursement Regionalization Focus on pay for performance GDP With regard to economics, we read in the papers and in online news that the percentage of the gross domestic product devoted to health care continues to rise. We also see a growing population of people needing healthcare services, whether through survival of people who a century ago would have died, through increased population numbers, or through changes in employment benefits that limit the amount of coverage or direct the conditions under which a health benefit can be used. General factors such as inflation also make wages and products more expensive in health care and thus may influence people in their choices about spending. Finally, a direct reduction in governmental payments influences how organizations can operate.

Types of organizations

Institutional providers: acute care hospitals, long term care facilities, rehabilitation facilities ¬ Types of services: general vs specialized ¬ Length of direct care services: short term vs long term. Primary (first-access care), secondary (disease-restorative care), tertiary (rehabilitative or long term care). ¬ Teaching status: academic health centers (institutions that are affiliated with a school of medicine and at least one other health profession school) and affiliated teaching hospitals (those that provide only the clinical portion of a med school). Care is more costly, but usually better ¬ Accreditation: whether a health care organization has been accredited by an external body as having the structure and process necessary to provide high quality care. Joint commission and national committee for quality assurance ¬ Ownership: non for profit vs for profit. Public institutions provide health services to individuals under the support and/r direction of local, state, or federal government. Private non-profit (or not-for-profit) organizations-voluntary agencies-controlled by voluntary boards or trustees and provide care toa mix of paying and charity patients, excess revenue goes to organization. For profit organizations: operate with intent to earn a profit by providing healthcare services to individuals who can afford to pay. Accountable Care Organizations: In a desire to improve efficiency and effectiveness, many are organizing to become accountable care organizations or consolidated systems and networks. In these formats, organizations agree to provide a constellation of care to individuals and communities with careful attention to epidemiology, evidence-based care, and best practices that have been shown to result in high-quality outcomes. PPACA established ACOs to coordinate care and chronic disease management and improve the overall quality of care provided to Medicare patients. Consolidated systems and networks: 5 levels. 1st level: large national hospital companies, most are investor owned. 2nd level: voluntary affiliated systems which provide members with access to capital, political power, management expertise, joint venture opportunities and links to health insurance services or, as in Canada, to a national healthcare coverage program. 3rd level: regional hospital systems that cover a defined geographic area, such as an area of a state. 4th level: metropolitan-based systems. 5th level: composed of the special interest groups that own and operate units organized salong religious lines, teaching interests, or related special interest that drive their activities.

Key concepts of effective teams

Key concepts of effective teams • Conflict resolution • Singleness of mission • Willingness to cooperate • Commitment

Leadership within the workplace; how is it demonstrated by nursing?

Leadership 'levels' in the workplace Staff nurse Manager Nurse executive Nursing student Leadership within professional organizations Leadership in the community Leadership through appointed and elected office

Managed care: What is it? Why is it important? What is the goal?

Managed care is a health plan that brings together the delivery and financing function into one entity. The goal is to decrease unnecessary services, thereby decreasing costs. It is important because it can reduce the cost of health care which could then in turn allow more people to obtain better health care. What does this mean for nursing? Must advertise the value of nursing care -We must think of our practice within a context of organizational viability and quality of care. -We must be able to do "financial thinking." -We must think of our services in terms of value added for patients. -We must exercise cost-conscious nursing practices, including capturing all costs. -We must focus on patient needs, not provider needs or organizational practices. -We must provide evidence-based practices for the public we serve. -We must incorporate and evaluate new technologies. -We must use research to better our practices.

Qualities of a team player

Maxwell (2002) identified 17 characteristics that make a good team player: adaptable, collaborative, committed, communicative, competent, dependable, disciplined, enlarging, enthusiastic, intentional, mission conscious, prepared, relational, self-improving, selfless, solution-oriented, tenacious.

Transactional

Motivates through rewards for desired work Monitors performance and focuses on problems Reactive to problems Effects of leadership on followers: Fulfills the contract or gets punished Does the work and gets paid Errors are corrected in a reactive manner Effects of leadership on organization: Work is supervised and completed according to rules Deadlines are met Limited job satisfaction Low to stable level of commitment

Nursing role in political action and health policy

My thoughts: We need to support health care -Nurses must be a part of politics and political action-especially with our perspectives on critical issues for improving healthcare systems and how to help shape the policy agenda of the national's political leadership -Healthcare reform needs nurses to help things move forward -Nurses must exercise their power to create a strong voice for nursing in shaping and evolving healthcare -Political involvement is necessary -Nurses need to advociate for policies that improve health care -Healthcare reform offers new opportunities for nurses at the bedside and in the community Build a relationship with a legislator. Be an active member of an organization. Run for office in your organizations, your community, your legislature. Develop expertise in shaping policy. Seek appointed positions.

Organizational culture

Organizational culture ¥ Reflection of norms or traditions ¥ Expressed through MVP, job descriptions, and policies and procedures ¥ Congruent vs. incongruent -Do the decisions that are made consistently demonstrate that the organization values its patients and keeps their needs at the forefront? -Are employees treated with trust and respect? -An organization's mission, vision, and philosophy both shape and reflect organization culture. EX: rituals and customary forms of practice, such as celebrations of promotions, degree attaminet etc. Characteristics of people who are recognized as heroes by the organization. Organizational culture is formally written and is represented in the day-to-day experience of staff and patients -The reflection of the norms or traditions of the organization as exemplified through behaviors that illustrate the values and beliefs of the organization

Personal power strategies and exercising power in the workplace

Power strategies for nursing leaders and aspiring leaders: Developing a powerful image: -Self-confidence -body language -self-image, including grooming, dress, and speech -Career commitment and continuing professional education -Attitudes, beliefs, and values -be confident -Self-image: Present a poised and positive image to oneself and to the rest of the world. - Grooming and dress are critical to a powerful image. Wrinkled scrubs and messy hair do not contribute to a powerful image. -Hair, makeup, and jewelry should be appropriate to the situation. -Clothing must look professional and appropriate to the setting. -Business casual is not an invitation to wear jeans. -Speech is a powerful aspect of image. ¬ Pay attention to tone of voice, pace of speech, and volume. ¬ The words one says are important; how those words are spoken is even more important. - Body language is critical to a powerful image. -Gestures, posture, and body position contribute to the image one projects. -That power is a positive force for nurses -That being a powerful nurse is a professional asset and is critical to one's positive professional image -It is critical to value nursing as a profession, not just a job, and to view nursing as one's career, not just a job. -Never think of oneself as "just a nurse." -Never discourage others from considering nursing as a career; be a nursing booster! - Value continuing education in nursing to grow as a professional. -Commit to lifelong learning in nursing. -Be honest; it is a critical professional behavior. -Be courteous even when others are not. -Greet patients, family members, and colleagues with a handshake and eye contact. - Smile when appropriate. Smiling puts people at ease, especially when they are under stress. -Accept responsibility for your own mistakes and learn from them. This is professional accountability, and it is powerful. -Be a risk taker. -Expand your horizons in nursing. Join a nursing organization, then run for office or volunteer for a committee. -Network! Join nursing organizations and get to know nurses outside of where you work. -Be proactive in sharing business cards with those in your professional network. -Be a mentor (formally or informally). -Take constructive criticism gracefully. -Learn to let destructive or unwarranted criticism "roll off your back." Additional personal power strategies -Be honest -Be courteous; it makes other people feel good! -Smile when appropriate; it puts people at ease -Accept responsibility for your own mistakes, and then learn from them -Be a risk taker -Win and lose gracefully -Learn to be comfortable with conflict and ambiguity; they are both normal states of the humand condition -Give credit to others where credit is due -Develop the ability to take constructive criticism gracefully; learn to let destructive criticism "roll off your back" -Use business cards when introducing yourself to new contacts, and collect the business cards of those you meet when networking -Follow through on promises Exercising power requires the nurse to feel powerful and to think of oneself as powerful. Nervous Nellies and Disorganized Dans do not project images related to power. Exercising power: -Know how the system works -Be respectful and collaborate -Empower attitude -Develop coalitions (a group of people who come together around a common goal) -Negotiate Exercising power: -Building political skills Ð Taking action to influence policy -Are you politically astute? (see pages 179-180) Ð I am registered to vote Ð I know where my voting precinct is located Ð I know the names of my senators in Washington Ð I know the name of the state center from my district Ð I know which senators are supportive of nursing

Types of power; Empowerment

Power: Ability to influence to achieve goals -Expert power: based on one's reputation for expertise and one's credibility. The knowledgea dn skills the nurse posseses that are needed by others. EX: The leader of SNA may have access to the leaders of the state legislature based on the elader's expert power, which has enabled years of work with members of the legislature. -Position power: possessed by virtue of one's position within an organization or status within a group. EX: The dean of a college of nursing is viewed on campus as powerful because this dean leads the fastest growing academic unit on campus. -Information power: stems from one's possession of selected information that is needed by others. EX: A direct care nurse demonstrates great skill in teaching patients difficult self care activities and is sought out by colleagues to help them teach their patients -Connection power: gained by association with people who are powerful or who have links to powerful people. EX: At a nurse's week,. Nurses take advamtage of the opportunity to have extended, informal conversations with those who report ot he chief nursing officer. -Referent power: granted by association with a powerful person. EX: A graduating nursing student asks a well respected nurse manager to be her preceptor for the seior leadership course. The student wants to work in this agency upon graduation. -Coercive power: stems from fear of someone's real or perceived fear of another person. EX: A nurse who lacks confidence in her performance in a new position is worried about an upcoming review with the nurse director. -Reward power: one is perceived as being able to provide rewards or factors. EX: AN instructor is perceived positively by a nursing student who receieved an A for a clinical course. -Empowerment: the nurse is a source of shared power to build the exercise of power by others. EX: The chief nurse executive develops a model of shared governance to enable nurses to have a stronger voice in patient care decisions. -Influence: process of using power. Can range from punitive power of coercion to the interactive power of collaboration. -Empowerment: Sharing power with others in decision making and taking action process of exercising one's own power to facilitate the participation of others in decision making and taking action so they are free to exercise power

• Vision:

articulated goal to which the organization aspires. A vision statement conveys an inspirational view of how the organization wishes to be described at some future time. It suggests how far to strive in all endeavors. -Future-oriented, purposeful statements designed to identify the desired future of an organization

• Philosophy:

expresses the values and beliefs that members of the organization hold abou thte nature of their work, about the people to whom they provide service and about themselves and others providing the services -Written statement that articulates the values and beliefs held about the nature of the work required to accomplish the mission

¥ Leader

¥ A person who demonstrates leadership. Using personal traits to constructively and ethically influence patients, families and staff through a process in which clinical and organizational outcomes are achieved through collective efforts. ¥ The use of individual traits and abilities to interpret an emerging situation and to address the situation in the absence of a script or defined plan. ¥ A leader is an individual who works with others to develop a clear vision of the preferred future and to make that vision happen.

Political astuteness

¥ Are you politically astute? (see pages 179-180) Ð I am registered to vote Ð I know where my voting precinct is located Ð I know the names of my senators in Washington: Dick Durbin and Mark Kirk Ð I know the name of the state center from my district: Bill Foster Ð I know which senators are supportive of nursing: Build a relationship with a legislator. Be an active member of an organization. Run for office in your organizations, your community, your legislature. Develop expertise in shaping policy. Seek appointed positions.

Hierarchy

¥ Hierarchy and Chain of Command -connotes lines of authority and responsibility. Vests authority in positions on an ascending line away from where work is performed and allows control of work. -staff members are often placed on a bottom level of organization, and those in authority who provide control are placed in higher levels. -Lines of authority and responsibility depicted on organizational chart -Staff members are at bottom level of organization -Those in authority are placed in higher levels

Characteristics of organizational structure

¥ Organizational chart: Horizontally, the graphic representation of work units and reporting relationships, relates to the division and specialization of labor functions attended by specialists. ¥ Hierarchy: connotes lines of authority and responsibility. Vests authority in positions on an ascending line away from where work is performed and allows control of work. staff members are often placed on a bottom level of organization, and those in authority who provide control are placed in higher levels. ¥ Chain of command: term used to refer to the hierarchy and is depicted in vertical dimensions of organizations charts. ¥ Span of control: refers to the number of subordinates a supervisor manages. For budgetary reasons, span of control is often a major focus for organizational restructuring. Although cost implications are presnt when a span of control is too narrow, when a span of control becomes too large, supervisison can become less effective. ¥ Bureaucracy: Initially referred to the centralization of authority in government departments. Now refers to an inflexible approach to decision making or an agency encumbered by red tape that adds little value to organizational processes.

Factors contributing to increased healthcare costs

¥ Price inflation ¥ Administrative inefficiency or waste ¥ Consumer attitudes and behaviors ¥ Third-party payer reimbursement ¥ Demographics (changing population) ¥ Unecessary care (stomach ache in ER?) ¥ Health care financing ¥ Pharmaceutical usage ¥ Disease patterns

Chaos Theory

• Definition: The universe is chaotic and requires organizations to be self-organizing and adaptive to survive • Viewed as unpredictable and random events • Constant change resulting in little long term stability Chaos Theory Unfortunately, health care as an industry is not always as predictable and orderly as systems theorists would have us believe. In contrast to the somewhat orderly universe described in systems theory, in which an organization can be viewed in terms of a linear, cause-and-effect model, chaos theory sees the universe as filled with unpredictable and random events. According to the proponents of chaos theory, organizations must be self-organizing and adapt readily to change in order to survive. Organizations, therefore, must accept that change is inevitable and unrelenting. When one embraces the tenets of chaos theory, one gives up on any attempt to create a permanent organizational structure. Using creativity and flexibility, successful managers will be those who can tolerate ambiguity, take risks, and experiment with new ideas that respond to each day's unique situation or environment. They will not rest upon a successful transition or organizational model because they know the environment within which it flourished is fleeting. The successful nurse leaders will be those individuals who are committed to lifelong learning and problem solving.

Systems Theory

• Definition: a system comprises four elements (structure, technology people, and environment) forming a unified whole • Viewed as inputs, throughputs, and outputs • Closed systems-self-contained • Open systems-interacting with internal and external forces Systems Theory Systems theory attempts to explain productivity in terms of a unifying whole as opposed to a series of unrelated parts. Systems can be either closed (self-contained) or open (interacting with both internal and external forces). In systems theory, a system is described as comprising four elements: structure, technology, people, and their environment. Systems theorists focus on the interplay among these elements in a framework of (1) inputs—resources such as people, money, or materials; (2) throughputs—the processes that produce a product from the inputs; and (3) outputs—the product of inputs and throughputs. The theoretical concepts of systems theory have been applied to nursing and to organizations. Systems theory presents an explanation of organizational evolution that is similar to biological evolution. The survival of an organization depends on its evolutionary response to changing environmental forces; it is seen as an open system. The response to environmental changes brings about internal changes, which produce changes that alter environmental conditions. The changes in the environment, in turn, act to bring about changes in the internal operating conditions of the organization. This open systems approach to organizational development and effectiveness emphasizes a continual process of adaptation of healthcare organizations to external driving forces and a response to the adaptations by the external environment, which generates continuing inputs for further healthcare organization development. This open system is in contrast to a closed system approach, which views a system as being sufficient unto itself and thus is untouched by that which happens around it. Nurses need to aware of how they interact with their organization as an open system and what components of that system they can influence to achieve the best patient outcomes.

Leadership and influence

• Englightened leadership: ability to elicit a vision from people and to inspire and empower those people to do what it takes to bring the vision into reality. -Influence: process of using power. Can range from punitive power of coercion to the interactive power of collaboration.

Differences between groups and teams

• Group: a number of individuals assembled together or having some unifying relationship o Group is a number of individuals assembled around some unifying purpose or relationship, such as the PTA or students in the SON. • Team: number of persons associated together in specific work or activity. o Team is a group of people with a high degree of interdependence and a focus on a specific goal or objective. It includes ongoing positive relationships and a supportive environment.