Module 2: Leadership & Management; PART 2 (EXAM 1)

Strengths weaknesses opportunities threats The individual or team lists the strengths, weaknesses, opportunities, and threats related to the situation under consideration. > Strengths and weaknesses are internal factors and opportunities and threats are external factors > commonly used in strategic planning or marketing efforts but can also be used by individuals and groups in decision making.

+ What does SWOT stand for? What is a SWOT analysis?

Focus on the long-term

+ A final characteristic; concerned about what happens to the organization over long-term. Nurtures individuals and the organization with patients.

Satisficing: The nurse picked the rural hospital because the position provided an adequate salary and benefit package or because it was closest to home Optimizing: the nurse lists the pros and cons of each position being considered, such as salary, benefits, opportunities for advancement, career development, mentorship programs, and career goals.

+ A young nurse contemplates seeking employment in one of three places: an acute care hospital in the city; a community health organization; or a rural, comprehensive clinic or hospital. What decision would be satisficing? What decision would be optimizing?

Honesty courtesy; 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 human 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

+ What are additional personal power strategies for nursing leaders and aspiring leaders?

Defining objectives generating options identifying advantages and disadvantages of each option ranking the options selecting the option most likely to achieve the pre-defined objectives implementing the option evaluating the result

+ What are the phases of the decision making process?

Environmental scanning > explore the external, internal, and organizational environment to determine forces or changes that may affect the work of the organization or may be crucial to its survival. SWOT analysis > analyze the organizations strengths, weaknesses, opportunities, and threats benchmarking > establish and determine your benchmarks (The point of reference upon which things can be compared or assessed)

+ What is phase 1 in strategic planning process?

Strategic vision and mission > revise, as appropriate the organizations mission, vision, and values * then select strategic issues

+ What is phase 2 in the strategic planning process?

Decision making the hallmark of any type of decision making is the identification and selection of options or alternatives

+ ________ __________ is a purposeful and goal directed effort that uses a systematic process to choose among options.

Shared governance it provides a way to empower nurses to manage their professional practice And positively affects nurse retention and job satisfaction

+ _________ _________ is an organizational strategy that supports nurses to have ownership, autonomy, and input in their professional practice. It has been described as a professional practice model based on the principles of partnership, equity, accountability, and ownership.

Empowerment Empowerment emphasizes the notion that power grows when shared nurses who view power as infinite are strong collaborators who gain satisfaction by helping their colleagues expand their expertise and their power base

+ __________ is Authority or power given to someone to do some thing or the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights.

Satisficing this approach allows for quick decisions and may be the most appropriate when lack of time is an issue.

+ __________ is When the decision maker selects an acceptable solution, one that may minimally meet the objective or standard for a decision.

Consensus > this does not mean that the final decision will be all participants first choice > group members should be asked if they can "live" with the decision > achieving consensus requires considerable time and leads to both high-quality and high acceptance decisions reducing the risk of sabotage ** majority rule can be used to compromise when 100% agreement cannot be achieved. This method saves time, but the solution may only partially achieve the goals of quality and acceptance.

+ __________ requires that all participants agree to go along with the final decision.

Optimizing a better decision is more likely using this approach, although it takes longer to arrive at a decision.

+ ___________ is a decision style in which the decision maker selects the option that is best, based on an analysis of the pros and cons associated with each option.

Strategic plan The strategic planning process allows for an organization to take a realistic examination of its current state, where it needs to be, how to get to where it needs to be, and how people know how well they are doing.

+ a _______ _______ is a written plan of action that anticipates the future so that an organization can adapt and survive in a changing and competitive environment.

Lead with their heart and their minds

+ another characteristic; not afraid to show emotions, vulnerability. Connect with employees. Communicates problems in a direct manner; directness without being cruel.

Mission driven and focused on results

+ another characteristic; puts the organization ahead of their self interest. Pursues organizational results, not power, money, or ego.

Shared followers are generally more satisfied with a shared decision-making approach although this approach takes more time and is more appropriate when conflict is likely to occur , or when the problem is unstructured this model has been shown to increase employee satisfaction

+ in a _________ decision making style decisions are made through an interactive, deliberate process where the staffing manager may express and discuss options and preferences.

Paternalistic a.k.a. autocratic this results in more rapid decision making and is appropriate in crisis situations.

+ in general the various decision making styles can be split up into 3 categories. ____________ decision making style is when managers decide what is best for their team.

Informed

+ the _________ Decision making style offers the staff the ability to make a decision after information has been shared and without the active involvement of the manager.

Self-aware and genuine

+ this characteristic of authentic leadership to power and influence means that the person is self actualized, aware of strengths, limitations, and emotions. Recognizes that self actualization is forever ongoing. Behavior is consistent in private and public. Open about mistakes. Does not fear looking weak.

Self-confidence body language self image, including grooming, dress, and speech career commitment and continuing professional education attitudes, beliefs, and values

+ what are some of the power strategies for nursing leaders and aspiring leaders when it comes to developing a powerful image?

Build a working relationship with a legislator such as a state senator join and be an active member of the state nurses association affiliated with the ANA join a specialty nursing organization related to your specialty invite a legislator to a professional meeting or to spend the day with you at work vote in every election join legislative and political committees in your state nurses association be in touch with your federal and state legislators on healthcare issues such as specific bills, by writing letters and making phone calls or sending emails participate in nurse lobby day work on federal or state legislative campaigns visit US senators and member of Congress if visiting Washington DC get involved in the local group of your political party run for office enhance the image of nursing in policy efforts Etc....... (Box 9.2 page 146 - listed on study guide)

+ what are some things nurses can do to develop political skills?

Advantages: > quality outcome increases when individuals with different knowledge, skills, and resources collaborate > more ideas > followers have an increased sense of ownership and commitment > implementing solutions becomes easier challenges: > time may not be appropriate especially in a time sensitive situation requiring an immediate decision > unequal Power among group members influences the ability to collaborate > failure of group members to bring up options, explore conflict, or challenge the status quo results in ineffective group functioning and decision outcomes

+ what are the advantages and challenges of group decision making?

Strategic development > develop and evaluate the various strategies available to the organization to meet their weaknesses, opportunities, and threats * a plan is developed to guide the organization

+ what is phase 3 in the strategic planning process?

Implement the strategy > select the best strategic option that balances the organizations potential with the challenges of changing conditions * prepare the strategy and tactical plan to support the strategy then execute the plan

+ what is phase 4 In the strategic planning process?

Monitor progress > evaluate the strategy and set up monitoring and plan updating. * Revise the plan as appropriate

+ what is phase 5 in the strategic planning process?

(strategic planning provides members of the organization with the necessary tactical plans to achieve the organizational goals) encompass the organizations emphasis on mission, vision, and values environmental factors affecting the organization (both internally and externally) the development and execution of new strategies, goals, and tactical plans, which are continuously being evaluated.

+ what is the focus of strategic planning?

Internal factors > physical and emotional state, personal philosophy, biases, values, interests, experience, knowledge, attitudes, and risk seeking or risk avoiding behaviors. External factors > environmental conditions, time, and resources values > influenced by the persons cultural, social, and philosophic background > the resources that can facilitate ethical decision making include institutional policy, principles such as autonomy, nonmaleficence , beneficence, veracity, paternalism, respect, justice, Fidelity, personal judgment, trusted coworkers, institutional ethics committees such as the guide to the code of ethics for nurses risk-taking > influences effective decision-making and problem-solving personality factors > such as self-esteem and self-confidence The influence of work group, peers, and others

+ what kind of factors effect decision making?

Brainstorming nominal group technique's focus groups Delphi technique

+ what strategies can be used to minimize the problems encountered with group decision making and problem-solving?

Health maintenance organization (HMO)

A ________ _______ _______ plan aims to coordinate all patient care services through an approved primary care provider, who belongs to a provider network.

Quadruple aim

Economic, social, and demographic dynamics have placed emphasis on the development of organizations that strive to achieve the institute for healthcare improvements ________ _________ to: 1) improve the patient experience of care, 2) improve population health 3) reduce the per capita cost of care and 4) improve the experience of providing care

Critically effective critical thinkers are self-aware individuals who strive to improve their reasoning abilities by asking why, what, or how. > A Nursing questions why a patient is restless is thinking critically.

Effective decision-making and problem-solving are based on an individuals ability to think _____________

I.e. Estella has worked in a medical surgical unit for five years and is considering whether to request a transfer to the ICU ...

Example of SWOT analysis:

Guiding a novice nurse in exercising professional judgment empowers both the senior nurse and the novice clinician coaching a patient on how to be more assertive with a physician who is reluctant to answer the patient's questions is another form of empowerment

Give a couple of examples of empowerment:

Centers for Medicare and Medicaid services (CMS) US food and drug administration occupational health and safety administration US equal employment opportunity commission state licensing boards

Give some examples of regulatory agencies that monitor functions in healthcare organizations....

Public examples include - veterans/military - Native Americans - inmates of correctional facilities

Healthcare organizations have three basic ownership forms: public, private nonprofit, and for profit. __________ Institutions provide health services to individuals under the support and/or direction of local, state, or federal government. They answer directly to the sponsoring government agency or boards and are indirectly responsible to elect officials and taxpayers who support them.

Illness care wellness care Illness care services help the sick and injured. Wellness care services promote better health as well as illness and accident prevention.

Healthcare organizations provide two general types of services, _______ _______ (restorative) and , _______ _______ (preventative).

Acute care is a facility or hospital in which the average length of stay is less than 30 days chronic or long-term facilities provide services for extended period over 30 days

How does the AHA (American hospital association) define acute care versus long-term care?

Horizontal integration

Integration: when organizations that provide similar services come together, the arrangement is referred to as _______ _______. an example is a group of acute care facilities that come together to provide coverage for an expanded region.

Experts in communication estimated that 90% of the messages we communicate to others are nonverbal developing a network involves identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support one strategy to expand a workplace network is to have lunch or coffee with someone from another department, including managers from non-nursing departments, at least two or three times a month active participation in nursing organizations is the most effective method of establishing a professional network outside ones place of employment.

Notes:

Decision grids

Nurse leaders and managers can use a variety of decision making tools. _________ ________ Facilitate the visualization of the options under consideration and allow comparison of options using common criteria

Economic, demographic, technological, Sociocultural, educational, natural (natural disasters), views of the community, and political legal factors The institution of healthcare and a review of the effectiveness of the structure, size, programs, financial resources, human resources, information systems, and research and development * education and training of staff and public demands

Phase 1 is assessment of the external, internal, and organizational environment. What are some examples of the external environment? What about the internal environment?

The joint commission (TJC ) * which provides accreditation programs for ambulatory care and many more

Private organizations play significant roles in establishing standards and ensuring care delivery compliance by accrediting healthcare organizations. What is an example of this type of organization?

Shared decision making

SIMPLY put; what is shared governance?

Nominal Advantage is that it allows equal participation in minimizes dominant personalities

The _______ group technique allows group members the opportunity to provide input into the decision making process. Participants are asked to not talk while they write down their ideas to solve a predefined problem or issue. Then each member is asked to share an idea which is displayed on a flip chart. Comments and elaboration are not allowed during this phase - discussion is allowed after all ideas have been presented. > in the final phase ideas are ranked by priority. And group members can place colored stickers on the flip chart next to their first, second, and third choices.

Focus groups

The purpose of _______ _______ is to explore issues and generate information. The group meets face-to-face to discuss issues. The leader does not need to be the manager.

A mission statement will support the vision of the organization a vision statement reflects what the healthcare organization believes in and how it behaves; usually inspirational with a futuristic perspective on what the organization wants to achieve a value statement incorporates the priorities of the organizations culture, and emotional investment a statement of philosophy captures the belief system of the organization, which includes concepts as well as principles.

The second phase is review of mission, vision, and values statements, philosophy, goals, and objectives. What is a mission statement? Vision statement? Value statement? Statement of philosophy?

Strategic planning process

The term _______ ________ ________ is the development of a plan of action covering a defined few years of time, such as 3 to 5 years, although some organizations use a shorter timeframe. The initial phase is the most difficult and often when done correctly the most time consuming.

Primary care secondary care tertiary care

The term healthcare network refers to interconnected units that either are owned by the institution or have cooperative agreements with other institutions to provide a full spectrum of wellness and illness services. Community partnerships provide acute care services and also address risk factors for chronic disease such as obesity and tobacco use. The spectrum of care provided is typically described as _________ _______ (first access care), ______ _________ (disease restorative care), and _______ ________ (rehabilitation or long-term care)

Control of nursing practice perspective described an accountability-based government system that shares power, control, and decision-making with the professional nursing staff

This perspective describes shared governance as including the structure and processes by which organizational participants direct, control, and regulate the many goal oriented efforts of other members.

Ownership of nursing practice perspective define CNP in magnet hospitals as input, including access to and exchange of information, views and judgments, and decision making on issues of importance (practices, standards, policies, equipment) that affect the nursing profession, the practice of nursing, and the quality of patient care.

This perspective is professional control over nursing practice (CNP)

Theoretical perspective working to create a theoretical foundation to support systematic study and implementation of shared governance

This perspective is the theory based approach to Nursing shared governance

Accountability for practice perspective encouraged organizations to allow nurses to participate in decision making that affects the practice of nursing and in shaping the work environment where patient care occurs

This perspective shared governance model where decisions are made at the point of service. Shared governance has a dynamic way of conceptualizing empowerment and building structures to support it.

Human resources perspective initiated the idea that organizations could benefit from employee autonomy, growth, and investment

This shared governance perspective championed employees as the organizations most important asset, encouraging organizations to invest in employee motivation and growth.

Quality perspective created new forms of shared governance that were aligned with organizational quality improvement initiatives

This shared governance perspective introduced concepts of quality management and propose that an organizations work environment, value, and quality could be improved by empowering the employee to be more productive by solving problems by emphasizing teamwork and leadership.

Management perspective or structural power model describe the types of actions that express empowerment in practice such as ability of supervisors to give downward control, spreading of formal authority, decentralization, and distribution of decision making power.

This shared governance perspective provided the definition of shared governance as empowerment.

Appearance * clean and well groomed behavior * Micro: how you treat others macro: how do you spend your time communication * creating messages that inspire and influence others the good

Utilizing power strategies such as self image, grooming, good manners, body language, and speech is a type of power known as presence. What 3 strategies can be used to strengthen presence?

S- specific > Objective statement is properly constructed and describes exactly what is to be accomplished: simple, sensible, and significant M- measurable > The objectives are measurable; meaningful and motivating A- achievable > The objectives are agreed-upon by all parties; attainable R- relevant > The objectives must be created within the realm of possibility and a challenge; reasonable, realistic, resource, and results based T - Time bound > The objectives establish a timeframe for which the activity or improvement must be achieved

What are SMART goals?

Economic factors > healthcare organizations are being confronted daily with financial pressures associated with caring for uninsured patients, rapidly escalating drug costs, expensive new technology, and spiraling personnel costs > nurses have a major role to play in demonstrating that access to care and quality management are essential components of cost control social factors > increasing consumer attention to disease prevention and promotion of healthful lifestyles is redefining relationships of healthcare organizations and their patients demographic factors > Geographic dispersion, regional access to care, incomes of the population, aging of the population, and immigration trends are among the demographic factors influencing the design of healthcare organizations.

What are the 3 main forces that influence healthcare organizations and provide the input for future development driving the evolution of healthcare?

Salaries of physicians who supervise students care delivery and participate in educational programs such as teaching rounds and seminars duplicated tests or procedures delays in processing patients related to the teaching process ** teaching hospitals therefore tend to exhibit weaker economic performance

What are the economic inefficiencies with teaching hospitals?

In work settings, problems often fall under certain categories that have been described as the four M's... manpower > For example inadequate staffing or skill deficits methods > for example Communication problems or lack of protocols machines > for example malfunctioning equipment materials > for example inadequate supplies or defective materials

What are the four M's?

Strategies for developing a powerful image communication skills networking mentoring goal setting developing expertise high visibility

What are the main points of personal power strategies?

Know the facts separate the facts from interpretation be objective and descriptive determine the scope of the problem * The most common cause for failure to resolve problems is the improper identification of the problem or issue. * usually inadequate amount of time is allocated for defining the problem * "5 why,s" should be used to solve problems that keep resurfacing over time because asking "Why" gets to the actual root causes of the problem

What are the main principles for diagnosing a problem?

Time and resources integration leadership confidence morale change

What are the six core dilemmas of implementing strategic plans?

How nurses influence patients to improve their health status by providing teaching to them and their families Other examples include: > coaching other nurses to improve their performances > serving as the chief nursing officer at the hospital Or health related corporation * power depends on the ability to accomplish goals from your position * Sharing knowledge expands power and empowers others including colleagues and patients by giving them information or skills that they need to take action in a situation

What is an example of an exercise of power in nursing practice?

Defined the problem, issue, or situation gather data * should be objective and subjective; should be valid, accurate, relevant, and timely analyze data develop solutions * consider other viewpoints: am I jumping to conclusions? If I were ________, How would I approach the issue? How are my beliefs and values affecting my decision? select a solution and implement the solution evaluate the results

What is the main problem solving process?

Fishbone diagram a.k.a. cause-and-effect diagram This tool encourages problem solvers to focus on the content of the problem and not be sidetracked by personal interests, issues, or agendas of team members. The "effect "is generally the problem statement such as decreased morale and is placed at the right end of the figure. > The major categories of causes are the main bones, and those are supported by smaller bones, which represents issues that contribute to the main causes

What is this model used for categorizing the possible causes of a problem?

Problem definition model a series of questions provided to help the nurse leader or manager increase the likelihood of successfully defining a problem and finding the best solution

What type of model is this?

Vertical integration Benefits of vertical integration include enhance coordination of services, efficiency, and customer services.

When organizations align to provide a full array or continuum of services, the arrangement is referred to as _________ _______. organizations brought together in this way may include an acute care facility, a rehabilitation facility a home care agency, an ambulatory clinic, and a hospice.

Private nonprofit (a.k.a. not-for-profit) examples include : churches communities industries special interest groups such as the Shriners

______ ________ organizations are often referred to as voluntary agencies and controlled by voluntary boards or trustees to provide a mix of paying and charity patients. Excess revenue is redirected into the organization for maintenance and growth rather than returned to its stockholders. They are usually exempt from paying taxes because they provide an important community service.

Accountable care organization's (ACO's) The Medicare shared savings program is the most prevalent ACO program.

_______ ______ ______ emerged as a result of the patient protection and affordable care act of 2010 as a mechanism to meet the challenges of value based payment models. They coordinate care and chronic disease management and improve the overall quality of care provided to Medicare patients.

Connection power for example at a national nurses week celebration nurses take advantage of the opportunity to have extended, informal conversations with those who report to the chief nursing officer.

_______ _______ is gained by association with people who are powerful or who have links to powerful people.

Position power for example: the dean of the college of nursing is viewed on campus as powerful, because frequently this dean leads the fastest growing or largest academic unit on campus.

_______ _______ is possessed by virtue of one's position within an organization or status within a group.

Purposeful inaction

_______ _______ is to "do nothing " which might be indicated when other persons should resolve problems or when the problem is beyond one's control

Information power for example: 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

_______ _______ stems from one's possession of selected information that is needed by others.

Persuasion power for example a nurse is able to persuade an organization to change a policy to better serve a group of patients.

_______ ________ is based on the ability to influence or convince others to agree with one's opinion or agenda. It involves leading others to a viewpoint with data, facts, and presentation skills.

Referent power for example: a senior nursing student asks a well respected nurse manager to be her preceptor for the senior leadership course. The student wants to work in this agency upon graduation.

_______ ________ is granted by association with a powerful person

Reward power for example an instructor is perceived positively by a nursing student who received an "A" for a clinical course

_______ ________ is when One is perceived as being able to provide rewards or favors

Chaos theory 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.

________ ________ Is defined by the universe being chaotic and requiring organizations to be self organizing and adaptive in order to survive. It is viewed as unpredictable and made up of random events. There is constant change resulting in little long-term stability.

Independent practice association's (IPAs) preferred provider organization's (PPOs)

________ ________ ________ are a form of group practice in which physicians in private offices are paid on a fee for service basis by a prepaid plan to deliver care to enrolled members. ________ _______ _______ contracts are developed with private practice physicians , but fees are discounted from their usual and customary charges. In return, physician's are guaranteed prompt payment.

Expert power for example the SNA president has always delivered ON promises of support and provided useful information to legislatures on matters of health policy.

________ ________ is based on one's reputation for expertise and credibility. The knowledge and skills the nurse possesses that are needed by others.

For profit organizations such as private or public insurers who provide healthcare insurance coverage are known as third-party payers

________ ________ organizations Are also referred to as proprietary or investor owned organizations. They operate with a specific intent of earning a profit by providing healthcare services to individuals who can afford to pay for the services.

Coercive power * for example a nurse who lacks confidence in her performance in a new position is worried about an upcoming review with the nursing director

________ ________ stems from fear of someone's real or perceived fear of another person

Problem solving

_________ _________ includes the decision making step, focused on trying to resolve an issue that can be viewed as the gap between what currently is and the best available option.

Healthcare organizations economic, social, and demographic factors affect the purpose and structuring of the system, which in turn interact with the mission, philosophy, and structure of healthcare organizations

_________ __________ are systems composed of people, institutions, and resources designed to address the healthcare needs of a target population.

Brainstorming Effective brainstorming is that all ideas are stated without critique or discussion. Ideas should not be judged, nor should the relative merits or disadvantages of the ideas be discussed during brainstorming.

_________ can be in effective method for generating a large volume of creative options.

Influence Coaching a new graduate to complete a complicated nursing procedure successfully demonstrates the ability of the experienced nurse to influence that Orientee

_________ is the process of using power.

Accreditation * the CMS (centers for Medicare and Medicaid services) is responsible for the enforcement of its standards through its certification activities * for a healthcare organization to participate in and receive payment for either Medicare or Medicaid, the organization must be certified as complying with the CoP (conditions of participation). * healthcare organizations accredited by an organization with CMS deeming authority are therefore deemed as meeting Medicare and Medicaid certification requirements (to obtain deeming authority an organization must undergo a comprehensive evaluation by the CMS to ensure that standards are being met)

_________ refers to the approval, recognition, or certification by an official review board that an organization has met certain standards.

Systems in systems theory, a system is described as comprising four elements: structure, technology, people, and their environment The open system approach 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 organization development Closed system views a system as being sufficient unto itself and untouched by what happens around it

_________ theory is that organizations evolve in a pleasant manner. It attempts to explain productivity in terms of a unifying whole as opposed to a series of unrelated parts.

Power Nurses must exercise their power to shape the continuing development of the profession of nursing and the future of the healthcare system and manage the efforts of medicine and others to control nursing practice. Power may be defined as the capacity or ability to direct or influence the behavior of others or the course of events. This definition demonstrates the essential nature of power to Nursing.

__________ is the ability to influence others in an effort to achieve goals.

Empowerment for example the chief nurse executive develops a model of shared governance to enable nurses to have a stronger voice in patient care decisions.

__________ is when the nurse is a source of shared power to build the exercise of power by others

Medicaid In contrast to Medicare, Medicaid is administered by states, under federal requirements, and is funded by state and federal funding.

___________ offers government funded coverage to eligible low income adults, children, pregnant women, older adults, and people with disabilities.

A: inpatient hospital stays - skilled nursing facility stays - hospice care - home health care B: some doctor services - outpatient care - medical supplies - primary prevention care C: gives patients the option to enroll in a health plan offered by a private company that contracts with Medicare to coordinate coverage services offered by parts A and B D : prescription drug coverage ** patients can have more than one plan

note: the Medicare program is not limited to individuals over 65. People with certain permanent illnesses such as end-stage renal disease can also receive Medicare benefits. What are the benefits of Medicare part A through D?

Institutional providers major characteristics that differentiate institutional providers from other healthcare organizations are the types of services provided, length of direct care provided, ownership, teaching status, and accreditation.

Acute care hospitals, long-term care facilities, and rehabilitation facilities have traditionally been classified as _________ ________

Managed care systems Retail clinics aim to offer convenient care access to patients in retail stores with an aim to also increase store retail business.

Ambulatory based organizations: Prepaid group practice plans, are referred to as ________ _______ ________ and they combine care delivery with financing and provide comprehensive services for a fixed prepaid fee. The goal is to reduce the cost of expensive acute hospital care by focusing on out of hospital preventative care and illness follow up care

Delphi technique An advantage is that you can involve a large number of respondents , it eliminates the off the subject discretions typically encountered in face-to-face meetings , it prevents the negative or unproductive verbal and non-verbal interactions that can occur with group meetings A disadvantage is that it may lower the sense of accomplishment and involvement of group members

Another group decision making strategy is the _______ _________ Which involves systematically collecting and summarizing opinions and judgments on a particular issue from respondents, such as members of expert panels, through interviews, surveys, or questionnaires.

Is it important? Do I want to do something about it? Am I qualified to handle it? Do I have the authority to do anything? Do I have the knowledge, interest, time, and resources to deal with it? Can I delegate it to someone else? What benefits will be derived from solving it? > If the answers are no; why waste time, resources, and personal energy? > If the answers are yes, the nurse leader or manager chooses to accept the problem and assume responsibility for it

Before attempting to solve a problem, the nurse must ask what key questions (seven)?