Leadership and management test 2

four basic steps in the delegation process

1. assess and plan 2. communication- expectations regarding the task 3. surveillance/supervision- in determining the level and nature of supervision 4. evaluation and feedback- monitor and evaluate the results

four elements of classical theory

1. division and specialization of labor 2. span of control- the number of works any one manager can manage is limited range 3-50 (ideal is 15-20) based on the manager abilities; maturity and task complexity. 3. scalar process- chain of command. the creation of levels is an organization. direct line of command from top to bottom 4. ordering of positions. arrangement of the work group. managers have authority. line positions- in the direct line of hierarchical authority, direct responsibility for accomplishing the objectives of a nursing dept. authority for decision making. solid lines- RN, LPN, CNA

3 elements of nursing not to be delegated

1. initial nursing assessment and subsequent ones requiring professional judgment 2. determination of nursing diagnosis, care goals, care plans 3. interventions that require professional knowledge and skills

three phases of Rogers

1. invention of the change 2. diffusion ( communication) of the information regarding the change 3. consequences (adoption or rejection) of the change. two key aspects: people must be interested in the change and committed to making it happen

Reasons for resistance for change

1. past experiences- favorable/unfavorable 2. misconceptions- communication problems and inadequate info 3. lack of trust- greatest factor contributing to resistance 4. attitudes/values/personality type- low tolerance to change. likes stability a. complacency-don't rock the boat b. resignation- why should we do this, it won't make any difference c. cynicism- no one cane make this work

5 factors which require decision making when delegating

1. potential for harm 2. complexity of task/care 3. need for problem solving and innovation 4. unpredictability of outcome 5. level of interaction wit the client

components of an organization

1. purpose 2. people 3. structure

5 rights of delegation

1. right tasks 2. right people 3. right direction/communication 4. right supervision 5. right circumstances

what delegation is not and not should be

1. the indiscriminate assignment of work to others "dumping" 2. giving orders in directing flow or work 3. abdication of control or responsibility

STEP

Assess the STATUS of the patient assess the level of TEAM member assess ENVIRONMENT assess PROGRESS towards goal

prerequisites to designing an organization: vision statement

FUTURE oriented, purposeful statements designed to identify the desired future of the organization. it conveys the core message of the mission. designd to inspire and motivate employees to achieve a desired state of affairs. should be brief, 1-2 sentences. an organization will never be greater than the vision that guides it. not critical.

Standards

Written value statements

Quality management

a PHILOSOPHY that defines a healthcare CULTURE emphasizing customer satisfaction, innovation and employee involvement. Everyone is involved

types of organizational structures: shared governance

a PROFESSIONAL PRACTICE MODEL that includes an accountability-based governance system for professional employees. philosophy- nursing practice is best determined by nurses. goal: to empoewr people within the system to increase the control over their practice. ACCOUNTABILITY: answerable for the outcomes Nurses have increased AUTONOMY authority- POWER/AUTHORITY to make decisions regarding all aspects of patient care the core of the structure is RN congressional model: nurses form committees or nursing councils and have a vote or say in the decision making process.

prerequisites to designing an organization: Mission statement

a brief statement of the organization's reason for being. identifies customers, services provided, and human resources. critical element. the mission influences development of the organization's functions, such as goals, policy/procedures, etc. All individuals should have input in creating the mission.

Definition of an organization

a collection of people working together under a defined structure to achieve predetermined outcomes using financial, human and material resources

delegation

a key strategy for the successful direction and function of the health care team. increases nurses' responsibility

change agent

a person skilled in the theory and implementation of planned change. hospitals and businesses.

Six Sigma

a quantitative data driven program that targets an ALMOST error free environment, empowers employees to improve processes and outcomes by measuring errors. Developed by Motorola

systems theory

a set of four elements that interact to achieve a specific goal: structure; technology, people, and the environment.

Systems theory: environment

a set of objects, events or conditions that i snot part of the system but has bearing on system function. i.e. nursing shortage

characteristics of systems theory

a system is capable of maintain some degree of organization in the face of disturbing internal and external forces. ongoing process: -Closed system- limited or no interaction with the outside environment -open system- interactive with environment. the extent to which a system permits or not, new input into the system

Organizational chart

a visual display of what the organization says is their formal structure

steps of lippitt

a. diagnose the problem b. assess motivation and capacity for change c. assess change agent's motivation and resources d. develop action plan, evaluation criteria and strategies e. choose a change agent role- expert, cheerleader, facilitator (aide) f. maintain the change g. terminate the helping relationship

ways to handle resistance to change

a. understand resistance is to be expected and natural. Managers must resist the impulse to focus on blaming others when resistance to planned change occurs: 1. overt: out in the open, more constructive, can be heard and address 2. covert: hidden, a result of low trust and inadequate participation b. introduce the change gradually 3. allow participation in the process- feel responsible for the outcomes of change 4. provide education- constant communication 5. develop and maintain trust 6. provide rewards and incentives

key principles of TeamSTEP's: mutual support

ability to anticipate and support other team members' needs through accurate knowledge about their responsibilities and workload

restraining forces

against change- lead participants in other direction. if driving forces= restraining forces, status quo remains

intensity 3rd level

alterations in behavior- change style to democratic

intensity 2nd level

alterations in feelings/attitude- results making managers more aware than authoritarian style

intensity 1st level

alterations in knowledge, survey, satisfaction

TeamSTEPs

an evidence-based framework to optimize team performance across the healthcare delivery system

Quality Improvement

an ongoing PROCESS of innovation, prevention of error, and staff development that is used by institutions that adopt the quality management philosophy. Focus is on the prevention of problems.

Lewin

any present state is a dynamic equilibrium of simultaneous driving and restraining forces. keeping things in balance may not be linear

Human responses to change: active

attacks the idea; refuses to change; argues agains the idea

knowledge

awareness or knowledge is presented to the group, showing that the innovation is available. start to understand

accountability

being answerable for the actions or omissions of self or others in the context of delegation. accepting ownership for the results or lack thereof. the nurse who delegates retains accountability for the task delegated.

intensity 4th level

complex alterations of focus altering an entire social system, resurvey- encourage others to change style

Pattern

continuous, occasional, rare- needs to be a balance

Scientific management

contributed to the classical theory. Four principles: 1. standardize the work 2. select the right workers 3. carefully train these workers. 4. support workers by planning their work and removing obstacles

types of organizational structures: flat structures

decentralization. aka: participatory management. attempt to flatten the chain of command, removing hierarchical layers. a. primary characteristic is the delegation of decision making to the professionals from doing the work. places authority at the action level b. removal or hierarchical layers- low level of formalization. less formal, decrease in rules and policies. nurses on the units can make changes

general characteristics of organizational designs: formalization

degree to which an organization has rules that define a member's function.

types of organizational structures: functional structures

departments and services are arranged according to their specialty. common. departments providing similar functions report to a common manager or executive. disadvantage: delays in decision making can occur

Rogers

diffusion of innovations focused on the reversible nature of change

four characteristics of bureacracy

division of labor hierarchy of authority rules and regulations emphasis on technical competence

general characteristics of organizational designs: complexity

division of labor, specialization of that labor, number of hierarchical levels, and geographical dispersion of units- one building or several clinics

Classical theory

efficiency through design

Background of quality

emphasis has shifted from quality assurance to quality improvement and its management. moved from a focus on provider's values to a focus on customer's values

Lippitt

focus on what the change agent must DO than on the process of change itself

quality management (3)

focuses on the patient, not the provider focuses on prevention, not inspection focuses on the process, instead of person

driving forces

for change. push participants in desired direction

organizational chart: formal structure

formal relationships between and among the positions on the chart. roles and functions are defined.

Human responses to change: passive

ignores; avoids; agrees but does not assist or act

implementation

implementation occurs- put to use

Moving

implementing the change process. PLANNING AND IMPLEMENTATION. plans, set goals, develop strategies, implements gradually, overcome resistance, evaluate and modify.

persuasion

interest in the innovation begins. + or - attitude

general characteristics of organizational designs: centralization

location where a decision is made

bureaucracy

max weber, 1947- ideal, intentionally rational, most efficient form of organization. Father of organizational theory. German social scientist. developed the organizational chart. he wanted actions of management to be fair and predictable.

assigning

may be different than delegating. assignment describes the distribution of work that each staff member is to accomplish in a given time period. I.E. One RN assigns a pt. to another RN

management component of controlling

measuring performance against standards

definitions of change

naturally occurring phenomenon, it's a pat of everyone's lives, natural and continuous process, an alteration to make something different

responsibility

obligation to accomplish work reliably and dependably. LPNs are licensed nurses and CAN delegate in Montana.

Systems theory: input

operating material: information, $, equipment, energy, time, effort, raw material. receives the operating material from the environment or from another system. importation of energy. ex. nursing process data.

Chaos Theory

originated from quantum physics. chaos actually has an order- changes that seem to occur at random are the result of a complex order. fluid organizations must be able to self-organize, adapt readily and must accept that change is inevitable. give up the idea that a permanent organizational structure is possible

Empirical-rational-assumption

people are rational and will make change if it's rationally presented and perceive benefits. provide knowledge and information. used when little resistance to change is expected. does not deal with emotional response to it

normative-reeducative-assumption

people will change if actively engaged in the process. group problem solving, participation, collaboration. More time-consuming- norms, attitudes, feelings and commitment are important to take into account when change is planned. easier to change knowledge than attitude

Power-coercive-assumption

people with less power will comply with directives for change from someone with increased power. lack of time; very little participation needed. great resistance is expected

as a manager you never delegate

personal accountability, discipline of employees, giving recognition or praise- morale issues

key principles of TeamSTEP's: communication

process by which information is clearly and accurately exchanged among team members

key principles of TeamSTEP's: situation monitoring

process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team

confirmation

seek reinforcement that the decision was correct. May reverse original decision

standards: process standards

standards connected with the actual delivery of care and whether the activities are being appropriately conducted. Focus on the BEHAVIOR OF THE NURSE. activities interventions, timeliness and sequence of caregiving events. assessed by audit. adherence to critical pathways. ex. nursing assessment will be done every 24 hours for each pt.: vital signs will be taken every four hours

standards: outcome standards:

standards that reflect the desired result or outcome of care and whether the services provided make any difference. focus is on the CLIENT. physical health status and function, utilization of services, client's perception of care. ex. breath sounds are clear. patient has no infection

standards: structure standards

standards that relate to the PHYSICAL ENVIRONMENT- the internal characteristics of the organization, its personnel and management. Resources: human resources, organizational resources, physical resources, standards of practice, and environmental characteristics. examples: nursing dept provides inservice for staff development, staffing: at least one RN for every six patients. one intensivist for every unit. Omnicell for each unit.

Key Principles: Leadership

the ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the necessary resources

Organization structure

the arrangement of the work group

decision

the decision to use and evaluate the innovation is made. adopt or reject.

LEAN

the elimination of wasteful processes and waste within processes. A set of concepts, principles and tools used to create and deliver the most value from the customers' perspective while consuming the fewest resources

Systems theory: output

the final outcome of systems throughout. exportation of products

types of organizational structures: Service-line structures

the functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager.

organizational chart: informal structure

the network or pattern of social relationships and friendship circles that are outside the formal structure. not on the chart

Refreezing

the new method must be integrated into familiar events until it becomes routines. support others so the change remains.

prerequisites to designing an organization: Goals and Objectives

the philosophies should be translated into goals and objectives- action plans. they should motivate people to a specific end

prerequisites to designing an organization: philosophy

the philosophy should flow from the vision and mission. the VALUES and BELIEFS that guide all actions in the organization.

Systems theory: throughput

the process by which input flows through the system in its original state or is transformed so the system can use it. transformation of energy. ex. nursing process

Systems theory: feedback

the processing of providing a circular loop so the system can respond to its own output. info used at any point.

supervision

the provision of guidance or direction, evaluation and follow-up by the licensed nurse for accomplishment of a nursing task

Systems theory: function

to convert information, energy or materials into a planned outcome or product for use within the system, outside the system or both.

purpose

to create a stable future that is more desirable than the present state

Unfreezing

weakening the bonds that support the present systems. creating the motivation or readiness for change. awareness for change occurs. assessment and diagnoses- father data, dx the problem. must increase driving forces of decrease restraining forces. build trust and recognition for the need to change. get members to agree that the status quo is not beneficial. Stage is complete when people understand and accept the need for change.