N242 Davis Nursing roles in an organization
3.) structural audits:
assume that a *relationship exists between quality care and appropriate structure*
*Quality Control as a Process*: Steps 4
basic steps: 1.) criterion or *standard must be determined* 2.) information is collected to *determine if the standard has been met* 3.) education or *corrective action is taken if the criterion has not been met* 4.) *benchmarking* measuring how well you do vs. the highest standard. ex: LACCON vs. Yale/Harvard/MIT
organizational theory: *Bureaucracy*
bureaucracy 1.) *clear divisions of labor* 2.) *clearly established vertical hierarchy and roles and rules* within each step 3.) systematic rules and procedures, nothing left unaccounted for. 4.) *employment and promotion based on technical competency.*
1.) philosophy:
describes the *beliefs, values*, assumptions, *and goals of the institution.*
1.) overcome audits:
determine what results occur as a *result of the specific nursing interventions.*
stakeholders:
internal or external stimulus who *may or may not feed money or political favors* or moral merit into the system in order *to have their interests benefit.*
1.) authoritarian:
strict schedules, get the job done, *strong control*
*Quality Control*: def/characteristics
that are used to evaluate, monitor, or *regulate services rendered to consumers*. *Hallmarks of effective Quality Control programs* 1.) *support from top-level* administration 2.) *commitment* by the organization 3.)goals reflect search for excellence 4.) ongoing process
*Quality Improvement theories* (TOM/CQI/TPS)
the focus of all thee methods is continuous quality *improvement* s opposed to just meeting a standard. 1.) TOM: total quality management 2.) CQI: continuous quality improvement 3.) TPS: Toyota Production system
external quality control
the joint commission: monitoring and evaluation process 1.) QA program 2.) sentinel events 3.) ORYX 4.) core measures 5.) national patient safety goal
interactional theories
1.) *leadership behavior is generally determined by the relationship between the leader's personality and specific situation.* 2.) leader and follower contributing to the working relationship and both receiving something from it 3.) leadership is a dynamic two-way process. 4.) there are 3 types of leadership interactions: X, Y , and Z
leader: *characteristics* 3
1.) *no delegated authority*, given authority by followers. 2.) emphasizes the interpersonal relationships to build rapport with followers 3.) *goals that may or may not reflect those of the organization*
interactional theories: *Theory y*
1.) *the employee is intrinsically motivated* 2.) seeks responsibility: asks "is there anything more i can do" 3.) *works hard to get rewards* 4.) self direction and self control
*Full-Range leadership*
1.) *using leadership skills from both the transformational theory and the transactional theory* as the situation arises. 2.) good problem solvers 3.) *reward those that behave properly.*
*great man theory / trait theory*
1.) Trait like congenital, you're *born* with it. born to lead or born to be led 2.) personality traits such as that develop early in life make the person a better leader 3.) *the leader arises when the situation demands it.*
*Development of Standards*
1.) a *predetermined level of excellence that serves as a guide for practice* 2.) used as measurement tools, they must be *objective, measurable, and achievable* 3.) ANA scope and standards of practice and standards of professional performance
the three basic elements of a leadership
1.) a leader 2.) a group to lead 3.) situation to work on
*Risk Management*: def
1.) attempts to *analyze problems and minimize losses after a patient care error occurs* 2.) directed towards identifying, evaluating and *fixing risks that could injure the pt or the staff.* 3.) report it so that the factors that caused the error might be corrected. ex: drug labels that are written very tiny or are all the same color.
interactional theories: *theory z*
the newest theory "Japanese" 1.) *consensus decision making* 2.) strong bonds of responsibility 3.) *lifetime employment and slower promotions* 4.) *holistic concerns for workers.* modification of theory y
decision making: 3 kinds-*Centralized/Decentralized/Stakeholders*
1.) centralized: *managers at the top of the hierarchy make all the decisions.* 2.) decentralized: *diffuses decision making throughout the organization* 3.) stakeholders: internal or external stimulus who *may or may not feed money or political favors* or moral merit into the system in order *to have their interests benefit.*
risk management: functions
1.) define situations that place the system at *financial risk* 2.) determine *frequency of occurrences* 3.) *intervene* and investigate identified events 4.) identify potential risk or opportunities to *improve care*
relationships and chain of command: *Horizontal Lines/Vertical Lines/Dotted Lines*
1.) horizontal lines: communication *between people of the same level but with different roles* 2.) vertical lines: formal paths of communication and authority up the *"chain of command"* 3.) dotted or broken lines: represent *staff positions*
*Transactional leader*
1.) is a caretaker 2.) *does not identify shared values* 3.) *minimizes errors* 4.) examines causes 5.) *punishes deviation* from the norm with impunity 6.) *will bribe you to do more labor*
*Law of situation* and *contingency approach* theories
1.) leadership styles should vary according to the situation or the individuals involved. 2.) follows *law of situation*: The *situation should determine the directives* given after allowing everyone to know the problem. 3.) contingency approach:* no one leadership style is ideal for every situation.*
organizational structures: 5 of them-*Line Structure/Ad Hoc Design/Matrix Structure/Service Line Organization/Flat Design*
1.) line structures: *authority and responsibility are clearly defined* 2.) ad hoc design: *facilitate completion of a project*, disband after. 3.) matrix structure: *focus on product and function* 4.) service line organization: *address the shortcomings* 5.) flat designs: *remove hierarchical layers*
*Centrality*
1.) location of a *position on an organization chart where frequent and various types of communication occur.* 2.) a *middle manager* often has a large degree of centrality because they are dealing with orders from the top and bullshit from the bottom. 3.) middle manager needs good people skills to handle everyone
Joint Commission: *hospital accreditation*
1.) offers an objective *evaluation of an organization's performance* 2.) stimulates the *organization's quality improvement efforts* 3.) *enhances professional recruitment* 4.) *influences liability insurance* 5.) influences managed care contracts
*organizational culture & organizational climate*
1.) organization culture: how we split our duties *how we behave within the hierarchy* ex: how we behave with the doctors. 2.) organizational climate: *how we think the workplace is*. our perception of it. "fair" "friendly"
leader: def 3
1.) outgoing, risk takers, goal oriented, inspire others 2.) has *willing* followers 3.) influences and guides direction, opinion, and course of action.
Audits: *Overcome audits/Process audits/Structural audits*
1.) overcome audits: determine what results occur as a *result of the specific nursing interventions.* 2.) process audits: *measure how nursing care is provided* 3.) structural audits: assume that a *relationship exists between quality care and appropriate structure*
meeting the clients and agency goals-*Philosophy/Policies/Procedures*
1.) philosophy: describes the *beliefs, values*, assumptions, *and goals of the institution.* 2.) policies: are *general descriptions of the agency approach to achieve goals* in an expedient manner. 3.) procedures: describe a *specific process needed to complete a task.*
organizational structure: *Formal/Informal*
1.) refers to a way in which the group is formed, its line of communication and its means for channeling authority and making decisions. 2.) formal: *provides a framework* for defining managerial authority, responsibility, and accountability. 3.) informal: is generally a *naturally forming social network* of employees
components of organizational structure
1.) relationships and chain of command 2.) span of control 3.) managerial levels 4.) centrality
*medical errors*: how to minimize
1.) reporting and analyzing errors 2.) the leapfrog group: like yelp but for hospital safety. 3.) a six sigma approach: like a *rating system* for the amount of errors an institution has as a whole. the less the better. 4.) reforming the medical liability system
auditing quality control
1.) set the rules higher in the chain of command"establishing control criteria" 2.) *make judgement about how the quality has been controlled to meet the standards based on collected data* 3.) take corrective action and reevaluate 4.) *root cause analyses: a reactive plan to get rid of the culprit of errors*
interactional theories: *Theory x*
1.) the *employee dislikes work and will avoid it* 2.) takes no responsibility 3.) only wants money/security 4.) *must be controlled and threatened*
*Span of Control*
1.) the *number of people that directly report to the manager* 2.) the ideal amount is anywhere from 3 to 50 employees
managerial levels: *top, middle, first*
1.) top-level managers: *CEO or district manager*. coordinates internal and external influences. needs experience 2.) middle-level managers: *coordinate the efforts of the lower level of the hierarchy* and are the channels between the lower and top level managers 3.) first-level managers: are concerned with their *specific unit's work flow.*
*leadership theories* 5
1.) trait theory/great man theory 2.) behavioral 3.) situation and contingency 4.) interactional 5.) transactional & transformational 6.) full-range
Characteristics of a nurse manager: 5
1.] assigned position but not necessarily a leader* 2.] responsible for your schedule 3.] hires and fires 4.] directs willing and unwilling subordinates 5.] *accountable* for what may happen in the unit that is under their direct control.
what is at the bottom of hierarchy
theory x
what theory has slower promotions
theory z
we need this amount of nurses for the floor 3 for morning and two for evening and i clerk .. what type of leadership
transactional
what leadership focuses on day to day
transactional
4.) service line organization:
*address the shortcomings
1.) line structures:
*authority and responsibility are clearly defined
Behavioral Theory-*authoritarian/democratic/laissez faire*
*based on how the leader/manager chooses to set the tone of the work environment* analyzed in the perspective of behavior. 3 general paths: 1.) authoritarian: strict schedules, get the job done, *strong control* 2.) democratic: *decision making involves the group in helping shape the goals/rules* to an extent. 3.) laissez faire: *permissive, very little control* exercised from superiors. "let do" french translation.
2.) democratic:
*decision making involves the group in helping shape the goals/rules* to an extent.
2.) decentralized:
*diffuses decision making throughout the organization*
2.) ad hoc design:
*facilitate completion of a project*, disband after
3.) matrix structure:
*focus on product and function*
organizational climate:
*how we think the workplace is*. our perception of it. "fair" "friendly"
TOM (*Total Quality Management*)/CQI (*Continuous quality improvement*)
*interchangeable systems*. very similar. 1.) the individual customer is the focal element on which production and service is dependent. *satisfying the customer is the hallmark* of a good product. 2.) *empowerment of employees* 3.) *quality is more important than profit*
1.) centralized:
*managers at the top of the hierarchy make all the decisions.*
3.) laissez faire:
*permissive, very little control* exercised from superiors. "let do" french translation.
5.) flat designs:
*remove hierarchical layers*
*transformational leadership*
1.) *both leaders and followers have the ability to raise each other* to higher levels of motivation and morality 2.) the manger i committed, has a vision, and is able to empower others with his vision. 3.) lead followers to levels of higher morals
TPS (*Toyota Production System*) quality improvement
1.) *eliminate problems at their root* (root cause) 2.) *decentralized problem solving*. solve the problem yourself, no need to take it to management if it's within your power to fix. 3.) can be summarized as: wringing water out of a wet towel. efficiently eliminating "waste" (oversupply, waste of effort, waiting, defective products)
*Transactional leadership*
1.) *focused on finishing the goal at all costs. goal comes first.* 2.) focused on the task of management and the *goal to reward system* 3.) management-by-exception: *handling any deviations from the norm quickly and efficiently*
Management
1.) *handles resource distribution, manipulating the environment and subordinate job duties, and money.*
*transformational leader characteristics*
1.) *identifies common values* 2.) is committed 3.) inspires others with vision 4.) has long-term vision 5.) looks at effects 6.) *empowers others*
*limitation of organization charts*
1.) *informal structure* 2.) authority: *nsg manager is actually the one who has the highest authority over the individual RN.* 3.) responsibility 4.) accountability: *might not be as clear who is responsible* or accountable for the situation
2.) policies:
: are *general descriptions of the agency approach to achieve goals* in an expedient manner.
3.) procedures:
: describe a *specific process needed to complete a task.*
*Audits*
A systematic and official examination of a record, process, structure, environment, or an account to *evaluate performance* 1.) retrospective audits 2.) concurrent audits 3.) prospective audits
process audit
Review how care was provided and assume a relationship exist between nurses and the quality of care provided
2.) follows *law of situation*:
The *situation should determine the directives* given after allowing everyone to know the problem.
1.) organization culture:
how we split our duties *how we behave within the hierarchy* ex: how we behave with the doctors.
who knows everything about you leader or manger
leader
3.) contingency approach:*
no one leadership style is ideal for every situation.*