N419 Exam 1 Unit 3: Organizational Structures and Healthcare Environment
T or F. Centrality refers to the location of a position on an organization chart where frequent and various types of communication occur.
T
T or F. Current research suggests that changing an organization's structure in a manner that increases autonomy and work empowerment for healthcare employees will lead to more effective patient care.
T
T or F. In general, the larger the organization, the greater the need to decentralize decision making.
T
T or F. Organizational structure refers to the way in which a group is formed, its lines of communication and its means for channeling authority and making decisions.
T
T or F. The informal structure also has its own leaders. In addition, it also has its own communication channels, often referred to as the grapevine,
T
The following are components of the healthcare ______: · Providers o Physicians/LIP § Hospitalists · Nurses, PT, OT, other healthcare professionals (everyone that lays a hand on the patient) · Hospitals · Insurers and payers · Education and research · Suppliers · Professional associations/organizations o AMA is very powerful · Regulatory bodies/agencies (ex: TJC, CMS, etc.)
system
We have 2 different organizational structures: tall and flat. Which of these is described below: o Complex organizations o Numerous departments that are highly specialized and differentiated o Authority is centralized o _____ organizational structure with many small work groups § So big that they have to have multiple teams § Several middle managers o Really big hospitals that have women and children services, oncological services, cardiovascular services, etc.
tall
accountability, responsibility, or authority? is the moral responsibility for the consequences of their actions
accountability
Characteristics of a ________ includes: 1. There must be a clear division of labor (ex all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks). 2. A well-defined hierarchy of authority must exist in which superiors are separated from subordinates; based on this hierarchy, remuneration for work is dispensed, authority is recognized, privledges are allotted, and promotions are awarded. 3. There must be impersonal rules and impersonality of interpersonal relationships. in other words, bureaucrats are not free to act in a way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism. 4. A system of procedures for dealing with work situations (ex regular acitivites to get a job done) must exist. 5. A system of rules covering the rights and duties of each position must be in place. 6. Selection for employment and promotion is based on technical competence.
bureaucracy
________ has somewhat taken on a negative connotation in healthcare, but the reality is that we have to have some form of ________ in healthcare to provide structure · Selection of employment must be based on technical competence o Otherwise, somebody would show up and if you liked the way they looked you would hire them and they could be totally incompetent for the job o ___________ on some level creates some form of objectivity when running an organization
bureaucracy
________ has somewhat taken on a negative connotation in healthcare, but the reality is that we have to have some form of ________ in healthcare to provide structure · There must be system for dealing with work situations o There has to be some formal procedure or policy when this particular situation happens, this is how we generally handle it generally speaking. There are some exceptions to certain situations · There must be a system of rules for covering the rights and duties of each position o Have to know what your rights are in your position and what duties are expected of you
bureaucracy
________ has somewhat taken on a negative connotation in healthcare, but the reality is that we have to have some form of ________ in healthcare to provide structure · There must be a clear division of labor - who is responsible for what · A well-defined hierarchy of authority must exist - who do you go to when you have a problem · There must be impersonal rules - otherwise emotions would rule the organization
bureaucracy
When talking about organizational charts we have a _______ _____ ______. · It is indicated by the vertical solid line between positions on the organizational chart · This concept is best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible o You know who that one person is and that is who you report to and they are responsible for you; that is the unity of command · Difficult to maintain in some large healthcare organizations because the nature of health care requires a multidisciplinary approach o While you may be a nurse responsible for some of the respiratory care for the patient, there is a respiratory department and respiratory therapist who also has a piece of that system and that they are responsible (multidisciplinary approach) § Obviously the respiratory director is going to have some say in the way care is rendered within the hospital organization, not just the nurse director
unity of command
______ ____ _____ is indicated by the vertical solid line between positions on the organizational chart. This concept is best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible. This greatly simplifies the manager-employee relationship because the employee needs to maintain only a minimum number of relationships and accept the influence of only one person as his or her immediate supervisor.
unity of command
Each organization has a ___1__ and an ____2_____ organizational structure. In the ___1__ organization, the the emphasis is on organizational positions and __1__ power, whereas in the ____2_____ organization, the focus is on the employees, their relationships, and the ___2_____ power that is inherent within those relationships. In addition, the __1___ structure is generally highly planned and visible, whereas the ____2______ structure is unplanned and often hidden.
1. formal 2. informal
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o 1971- National Health Insurance Program, known as Medicare (not to be confused with US Medicare)- it is a govt. run insurance system covering entire population o Single payer systems are not "socialized medicine" but "socialized insurance" systems § Physicians are in the private sector; hospitals are controlled by private boards & regional authorities o Universal Program o Consumer co-payments are negligible o Physician choice unlimited unlike the US o Physician receives payments on a negotiated fee for service o Hospital receives global budget payments (get one large lumpsum to manage their budget) o Private HI (health insurance) for covered services are illegal § You cannot have private insurance in Canada o Supplemental private insurance for uncovered services is allowed -prescription drugs and dental o Patients do not participate in reimbursement process unlike in the US; sometimes we have to get involved with insurance company to make sure something is paid o Cost control because of the: § Fixed global budget § Predetermined fee for physicians o Key element: controlled-regionalization of high-tech services (may have a high-tech service such as an MRI for a certain region and there is a limited number—aren't multiple high tech services within that locale) § Govt. makes resource allocation decisions · If you have a sudden growth in population in an area, it is up to the government to decide if they want to allocate further resources to the particular area o Deficits in several areas—such as angioplasty, cardiac Cath, MRI, CT scans o Waiting list for certain surgeries and diagnostic tests—waiting list as long a 16.2 weeks (2002) § "line jumping" by affluent and well connected people (those who know people) o Most Canadians support this healthcare system o Works relatively well
Canada
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Deficits in several areas—such as angioplasty, cardiac Cath, MRI, CT scans o Waiting list for certain surgeries and diagnostic tests—waiting list as long a 16.2 weeks (2002) § "line jumping" by affluent and well connected people (those who know people) o Most Canadians support this healthcare system o Works relatively well
Canada
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Key element: controlled-regionalization of high-tech services (may have a high-tech service such as an MRI for a certain region and there is a limited number—aren't multiple high tech services within that locale) § Govt. makes resource allocation decisions · If you have a sudden growth in population in an area, it is up to the government to decide if they want to allocate further resources to the particular area
Canada
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Supplemental private insurance for uncovered services is allowed -prescription drugs and dental o Patients do not participate in reimbursement process unlike in the US; sometimes we have to get involved with insurance company to make sure something is paid o Cost control because of the: § Fixed global budget § Predetermined fee for physicians
Canada
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Universal Program o Consumer co-payments are negligible o Physician choice unlimited unlike the US o Physician receives payments on a negotiated fee for service o Hospital receives global budget payments (get one large lumpsum to manage their budget) o Private HI (health insurance) for covered services are illegal § You cannot have private insurance in Canada
Canada
What does a solid (unbroken) line on an organizational chart mean?
Solid vertical lines between positions denote the official chain of command, the formal paths of communication and authority.
T or F. Organizations are necessary because they accomplish more work than can be done by individual effort. Because people spend most of their lives in social, personal, and professional organizations, they need to understand how organizations are structured--their formation, methods of communication, channels of authority, and decision making processes.
T
T or F. Unity of command is difficult to maintain in some large healthcare organizations because the nature of healthcare requires an inter-professional approach.
T
T or F. When talking about span of control too many people reporting to a single manager delays decision making, whereas too few results in an inefficient top heavy organization.
T
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Most insurance have some type of UR (utilization review) § Preadmission criteria that you have to meet in order to qualify for admission into a hospital or qualify for a certain procedure § Concurrent review of LOS—constantly looking at medical necessity and the reason you have to stay in the hospital (do you meet the criteria for remaining hospitalization) § Mandatory 2nd opinion for surgery o Greatest strength—both of these things are part of the reason why our healthcare is so expensive § Advanced state of technology § Pharmaceutical innovation
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o No single payor—there is a multitude of insurance companies or different ways that providers and hospitals are paid o Health insurance is purchased in private market place or provided by the govt. to certain groups (disabled, Medicaid population, etc.) § If you have a health insurance that is a private marketplace that you go in and purchase OR it is something that the government has offered o Large majority of people with health insurance is through employment related benefits o There are Self-insured/partially self-insured programs (employers) § If an employer offers health insurance all the money is put into one pot and then claims are paid from that one put (so it is possible that an organization could get into trouble and run out of funds) § Partially self-insured programs—they will cover up to a certain amount then they have a third party who picks up the remaining amount once they hit their cap o Most insurance have some type of UR (utilization review) § Preadmission criteria that you have to meet in order to qualify for admission into a hospital or qualify for a certain procedure § Concurrent review of LOS—constantly looking at medical necessity and the reason you have to stay in the hospital (do you meet the criteria for remaining hospitalization) § Mandatory 2nd opinion for surgery o Greatest strength—both of these things are part of the reason why our healthcare is so expensive § Advanced state of technology § Pharmaceutical innovation o Weaknesses § Litigation influences practice - 350% more lawsuits in US than Canada · Malpractice lawsuits cost over $28 billion, plus defensive medicine consumes 9% of HC expenses (they are covering themselves—they want to order that extra diagnostic just to make sure its not the worst-case scenario—ex: HA could be a migraine or an aneurysm but the doctor is going to want to get a head CT because if you diagnose wrong then you fear a lawsuit) § US has twice the administrative costs d/t government mandates & diversity of insurers § Spend more on technology and duplication of services · Everyone wants to have the greatest and latest; well, it is a supply and demand thing and if you are in an area that does not need, for example MRI machines, some machines may be sitting and not used a lot. You will pay millions and millions of dollars for this type of technology. It is wasteful costs § Cost of drugs higher in US (Canada has a review board to set reasonable prices on patented products) · In Canada they set prices. In the US, until a drug becomes generic that pharmaceutical company charges a prime price since they "put a lot of research into it" which is not necessarily true
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o There are Self-insured/partially self-insured programs (employers) § If an employer offers health insurance all the money is put into one pot and then claims are paid from that one put (so it is possible that an organization could get into trouble and run out of funds) § Partially self-insured programs—they will cover up to a certain amount then they have a third party who picks up the remaining amount once they hit their cap
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Weaknesses § Cost of drugs higher in US (Canada has a review board to set reasonable prices on patented products) · In Canada they set prices. In the US, until a drug becomes generic that pharmaceutical company charges a prime price since they "put a lot of research into it" which is not necessarily true
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Weaknesses § Litigation influences practice - 350% more lawsuits in US than Canada · Malpractice lawsuits cost over $28 billion, plus defensive medicine consumes 9% of HC expenses (they are covering themselves—they want to order that extra diagnostic just to make sure its not the worst-case scenario—ex: HA could be a migraine or an aneurysm but the doctor is going to want to get a head CT because if you diagnose wrong then you fear a lawsuit)
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Weaknesses § Litigation influences practice - 350% more lawsuits in US than Canada · Malpractice lawsuits cost over $28 billion, plus defensive medicine consumes 9% of HC expenses (they are covering themselves—they want to order that extra diagnostic just to make sure its not the worst-case scenario—ex: HA could be a migraine or an aneurysm but the doctor is going to want to get a head CT because if you diagnose wrong then you fear a lawsuit) § US has twice the administrative costs d/t government mandates & diversity of insurers § Spend more on technology and duplication of services · Everyone wants to have the greatest and latest; well, it is a supply and demand thing and if you are in an area that does not need, for example MRI machines, some machines may be sitting and not used a lot. You will pay millions and millions of dollars for this type of technology. It is wasteful costs § Cost of drugs higher in US (Canada has a review board to set reasonable prices on patented products) · In Canada they set prices. In the US, until a drug becomes generic that pharmaceutical company charges a prime price since they "put a lot of research into it" which is not necessarily true
US
When talking about the comparison of healthcare in the US and Canada, which of these countries is described below when talking about healthcare? **do not need to memorize specifics; more of comparison to help understand how healthcare systems differ** o Weaknesses § US has twice the administrative costs d/t government mandates & diversity of insurers § Spend more on technology and duplication of services · Everyone wants to have the greatest and latest; well, it is a supply and demand thing and if you are in an area that does not need, for example MRI machines, some machines may be sitting and not used a lot. You will pay millions and millions of dollars for this type of technology. It is wasteful costs
US
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: **a modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization. The ___ ___ structure is a means of overcoming the inflexibility of line structure and serves as a way for professionals to handle the increasingly large amounts of available information. ___ ____ structures use a project team or task approach and are usually disbanded after a project is completed. This structure's disadvantages are decreased strength in the formal chain of command and decreased employee loyalty to the parent organization.
ad hoc
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: · Modification of the bureaucratic structure o ___ _____ meaning "adding to" · Sometimes used temporarily to facilitate project completion within a formal line organization o Maybe EHR implementation · Overcomes the inflexibility of line structure · Serves as a way for professionals to handle increasingly large amounts of information o So if suddenly have a project that has a ton of information, you may need this ad hoc team that becomes part of the ad hoc design · Uses a project team or task approach and is usually disbanded after a project is completed · May result in decreased employee loyalty to the parent organization o Bring in this external company and the staff start working the external company and you could risk losing them to that type of work
ad hoc
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: · Uses a project team or task approach and is usually disbanded after a project is completed · May result in decreased employee loyalty to the parent organization o Bring in this external company and the staff start working the external company and you could risk losing them to that type of work
ad hoc
The following are ______ of the organizational chart: · Maps lines of decision-making authority o You know who to go to for that decision · Helps people understand their assignment and those of their coworkers (clarifies things) · Reveals to managers and new personnel how they fit in the organization · Contributes to sound organizational structure · Shows formal lines of communication
advantages
accountability, responsibility, or authority? is the official power to act and direct the work of others Official power is the formal power
authority
In organizations with ______ decision making, a few managers at the top of the hierarchy make the decisions and the emphasis is on top down control. In other words, the vision or thinking of one or a few individuals in the organization guides the organization's goals and how those goals are accomplished. Execution of decision making in _____ organizations is fairly rapid because role conflict is minimized and role expectations are clarified.
centralized decision making
When talking about decision making within the organizational hierarchy we have centralized decision making and decentralized decision making. Which of these is described below: o A few managers at the top of the hierarchy make all the decisions o Handful of people are responsible for most of the decision making
centralized decision making
The following are some _______ of the healthcare system: · Center for Medicare and Medicaid Services (CMS) o Government agency that manages and clarifies policies that regulate Medicare and Medicaid · Healthcare is now a competitive, market-based enterprise o Transformed health care from an industry with a service orientation to one with a business orientation o Businesslike now which is not always in the best interest of the patient
considerations
The following are some _______ of the healthcare system: · Roles of providers, payers, and suppliers · Health care is a unique patchwork of diverse components o Fragmented and complex o Not like one day someone said "I am going to create the US healthcare system" and it is well thought out and linear. No it just keeps happening. · No central oversight agency o There are too many players that have a lot of power (it's a political tug-of-war) · Complicated rules and regulations · Government has major role in health care finance and delivery o A large percent of hospitalized patients are Medicare patients (all the insurance providers have to follow suit of what Medicare does) o 70% of hospitalized patients are Medicare patients and as long as that is a fact and the government controls Medicare all the insurance providers will follow suit in what Medicare does
considerations
The following are some _______ of the healthcare system: · U.S has one of the most complex organizational systems in the world. PERIOD. o Everyone contributes to the dynamics of it from the buyers, to the providers, to the payers, to the suppliers; all influence how healthcare is rendered
considerations
The following are some _______ of the healthcare system: · U.S has one of the most complex organizational systems in the world. PERIOD. o Everyone contributes to the dynamics of it from the buyers, to the providers, to the payers, to the suppliers; all influence how healthcare is rendered · Roles of providers, payers, and suppliers · Health care is a unique patchwork of diverse components o Fragmented and complex o Not like one day someone said "I am going to create the US healthcare system" and it is well thought out and linear. No it just keeps happening. · No central oversight agency o There are too many players that have a lot of power (it's a political tug-of-war) · Complicated rules and regulations · Government has major role in health care finance and delivery o A large percent of hospitalized patients are Medicare patients (all the insurance providers have to follow suit of what Medicare does) o 70% of hospitalized patients are Medicare patients and as long as that is a fact and the government controls Medicare all the insurance providers will follow suit in what Medicare does · Center for Medicare and Medicaid Services (CMS) o Government agency that manages and clarifies policies that regulate Medicare and Medicaid · Healthcare is now a competitive, market-based enterprise o Transformed health care from an industry with a service orientation to one with a business orientation o Businesslike now which is not always in the best interest of the patient
considerations
When talking about decision making within the organizational hierarchy we have centralized decision making and decentralized decision making. Which of these is described below: o Diffuses decision making throughout the organization - allows for decision making at the lowest managerial level (managers at lower levels) o Allows problems to be solved at the level at which they occur (at the bedside in the hospital setting) o As a rule, larger organizations benefit from decentralized decision making § If have really large organization and only a handful of people making the decisions, you are going to have way more decisions that need to be made than the number of people making the decisions
decentralized decision making
The following are ______ of the organizational chart: · Does not show the informal structure of the organization o Not going to know who the informal leaders are by the organizational chart · Does not indicate the degree of authority held by each line position o All you know is that that is a direct report but you don't know how much authority that person has · May show things as they are supposed to be or used to be rather than as they are o The organization chart (ORG Chart) is one of the hardest things to keep up to date because things are always changing. Because healthcare is so dynamic, we are having to reorganize or move units under different directors or managers or change processes and procedures. A lot of times nobody is thinking about the ORG chart. So when Joint Commission shows up the first thing they want is a copy of the ORG chart to know who reports to who. You need to make sure that ORG chart is updated. · Possible existence of confusing authority with status o Can be some confusion because someone has a particular title, you assume that they have authority that they don't
disadvantages
The following are ______ of the organizational chart: · Possible existence of confusing authority with status o Can be some confusion because someone has a particular title, you assume that they have authority that they don't · Does not indicate the degree of authority held by each line position o All you know is that that is a direct report but you don't know how much authority that person has
disadvantages
The organization chart defines formal relationships within the institution. ______ or broken lines on the organization chart represents ***staff positions.**** Because these positions are advisory, a staff member provides information and assistance to the manager but has limited organizational authority. Used to increase his or her sphere of influence, staff positions enable a manager to handle more activities and interactions than would otherwise be possible. These positions also provide for specialization that would be impossible for a manager to achieve alone. Although staff positions can make line personnel more effective, organizations can function without them.
dotted
What major type of healthcare organization (federal government and non-federal) is described below: o VA hospital o Military hospitals o Federal Prisons o Indian Health (part of DHH)
federal government
What are the 2 major types of healthcare organizations?
federal government and non-federal
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? Examples: charge nurse, team leader, primary nurse Scope of Responsibility: focus primarily on day to day needs at unit level Primary planning focus: short range, operational planning Communication flow: more often upward; generally relies on middle level managers to transmit communication to top level managers
first-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? o Focus on a specific unit's work flow -- Daily operations like Case manager, primary care nurse for a set of patients, team leader, charge nurse
first-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? these managers are concerned with their specific unit's workflow. they deal with immediate problems in the unit's daily operations, with organizational needs, and with personal needs of employees. these managers need good management skills. because they work so closely with patients and healthcare teams, ___ ____ managers also have an excellent opportunity to practice leadership roles that will greatly influence productivity and subordinates' satisfaction. Examples include primary care nurses, team leaders, case managers, and charge nurses. In many organizations and RN is considered a ____ ___ manager.
first-level managers
We have 2 different organizational structures: tall and flat. Which of these is described below: o Less complex organization o Authority is decentralized meaning spread out amongst the employees of the organization o Several managers supervising large work groups so not top heavy o "When I was at Heart Hospital in a VP role, I had a lot of different departments reporting to me since it was a small organization and the authority was decentralized. We could not afford to be top heavy since our organization was not large enough"
flat
We have 2 different organizational structures: tall and flat. Which of these is described below: · Remove hierarchical layers by flattening the scalar chain and decentralizing the organization o Scalar chain - decision-making hierarchy, or pyramid of decision that we visualize, the way decisions are made · Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out · Despite being very ______, often retain many characteristics of a bureaucracy o While it is decentralized and flattened on an organizational structure, you are still going to have a lot of the policies and regulations that organizations need (bureaucracy part of business) · One person at the very top with 3 directors or VPs
flat
The _______ point for care is primary care rather than the hospital setting (this is not the way it used to be). The goal is to keep patients healthy by treating them in the setting that incurs the lowest cost and thereby reducing expensive hospital treatments. o Trying to reduce expensive hospital treatments · The former goal - to keep hospital beds full - has been replaced with a new goal:****** to keep patients out of the hospital!***** o Used to be able to charge and be reimbursed regardless—now if the patient is not meeting medical necessity and criteria for the utilization review board of a particular insurance then you do not get reimbursed and paid
focal
Formal or informal organizational structure? _____ structure provides a framework for defining managerial authority, responsibility, and accountability. In a well-defined _____ structure, roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident.
formal
Formal or informal organizational structure? · The emphasis is on organizational positions and _______ power (organizational positions within a company or _______ power or chain of command) o Provides a framework for defining managerial authority, responsibility, and accountability for specific jobs, tasks, and processes § Have to have a framework otherwise organizations would be in chaos o ______ power or chain of command § Every organization has a framework in order to define this chain of command to define who has authority, responsibility, and accountability for specific jobs/tasks/processes
formal
What provider is described below: (physician, hospitalists, nurse practioner) o Physician providing medical care to acutely ill hospitalized patient o Main focus is for caring for the acutely ill in the hospital setting
hospitalists
Formal or informal organizational structure? The ____ structure even has its own communication network, known as the grapevine and grapevine communication is at the heart of ______ organization: it is the conversations that occur in the break room, down the halls, during the carpool, and in between work that allows the relationships of _____ groups to develop. In addition, social media sites and electronic communication such as email and text messages are also used to facilitate communication among _____ group members.
informal
Formal or informal organizational structure? _____ structure is generally a naturally forming social network of employees. This type of structure fills in the gaps with connections and relationships that illustrate how employees' network with one another to get work done. Because ______ structures are typically based on camaraderie, they often result in a more immediate response from individuals, saving people's time and effort. People also rely on ____ structure if the formal structure has stopped being effective which often happens as an organization grows or changes but does not reevaluate its hierarchy or work groups.
informal
Formal or informal organizational structure? · The focus is on the employees, their relationships, and the ______ power that is inherent within those relationships. o Has its own leaders and communication channel (grapevine) o If want to get something done in an organization, approach the _____ leaders and get buy in from them first because they will sway the staff around them. Every organization has its own _______ leaders and this is that grapevine or communication channel that we refer to
informal
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: **a _____ organization structure is designed to focus on both product and function. Function is described as all the tasks required to produce the product and the product is the end result of the function. For example, a good patient outcomes are the product and staff education and adequate staffing may be the functions necessary to produce the outcome.
matrix organizations
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: · Can produce confusion and frustration for workers because of dual-authority hierarchical design o Ex: may have the cath lab that reports to cardiovascular services and surgical services (because this is procedural), so might have someone managing all of the procedural services, it is also a cardiovascular department so the director of the cardiovascular component of the organization may also have some say in the running of the cath lab
matrix organizations
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: · Designed to focus on both the product and the function · Have a formal vertical line and horizontal chain of command o Like you are reporting to 2 different bosses · Have fewer formal rules and fewer levels of the hierarchy · Can cause slow decision making due to information sharing o Slow decision making if you have 2 different managers involved, that can complicate things · Can produce confusion and frustration for workers because of dual-authority hierarchical design o Ex: may have the cath lab that reports to cardiovascular services and surgical services (because this is procedural), so might have someone managing all of the procedural services, it is also a cardiovascular department so the director of the cardiovascular component of the organization may also have some say in the running of the cath lab
matrix organizations
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? Examples: unit supervisor, department head, director Scope of Responsibility: focus is on integrating unit level day to day needs with organizational needs Primary planning focus: combination of long and short range planning Communication flow: upward and downward with great centrality
middle-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? o Conduct day to day operations o Conduit between lower and top-level managers -- Nursing Supervisor, Unit manager, Department heads -- They are middle management
middle-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? these managers coordinate the efforts of lower levels of the hierarchy and are the conduit between lower and top level managers. These managers carry out day to day operations but are still involved in some long term planning and in establishing unit policies. Examples include nursing supervisors, department heads, coordinators, directors, and unit managers.
middle-level managers
What major type of healthcare organization (federal government and non-federal) is described below: o Acute Care Facilities § Specialty - Children's, Surgical, Heart, Ortho/Spine, Women's, Rehab, Oncology, etc. o Behavioral Health o Long Term Acute Care (LTAC) o Critical Access Hospitals (important tin the outlying small communities—need a place that they can be stabilized then transferred to a higher level of care) § If you have a heart attack and you are an hour away from a major metropolitan city, you need a place that you can be stabilized at and possibly transferred to a higher level of care o Ambulatory Surgery Centers (ACS)—have taken a lot of revenue from acute care hospitals § Very profitable
non-federal
What provider is described below: (physician, hospitalists, nurse practioner) o Master's degree; nowadays have doctorate programs so will have DNP o Specializes in specific area of practice **component of the healthcare system · Providers o Physicians/LIP § Hospitalists · Nurses, PT, OT, other healthcare professionals (everyone that lays a hand on the patient)
nurse practitioner
The following are other major types of healthcare _______: · Home Health (very important part of healthcare continuum) · Hospice o Follow the growth and you will know where the money is in healthcare; there are so many Hospice companies that have popped up o Reimbursement is good because we know patients dying in the hospital is not smart use of healthcare dollars. We do end of life very poorly in the US so that is an opportunity for us o There is some abuse out there with people opening Hospice companies and patients get discharged from Hospice and this should be rare · Dialysis Centers · Nurse Managed Clinics · Outpatient Clinics - Public Health · Physician Offices
organizations
The following are other major types of healthcare _______: · Home Health (very important part of healthcare continuum) Hospice · Dialysis Centers · Nurse Managed Clinics · Outpatient Clinics - Public Health · Physician Offices
organizations
What component of the healthcare system is described below: · Different types of educational preparation leads to confusion for public o LPNs, RNs (associate and BSN), diploma programs o This is very confusion for average person to figure out; in there mind a nurse is a nurse but we all know that is not true · ________ practice in all types of health care settings · Largest group of health care professionals o If we really band together and use our power wisely we could significantly influence the direction of healthcare but unfortunately through the years we have not claimed our powers · Nursing Shortage o Always an issue for us; in general very serious and get more serious especially after COVID o One of the most serious issues facing health care delivery o Estimated nursing shortage of 340,00 by 2020 o Contributing factors § Lack of qualified faculty (top of list) · To have a _______ with an advanced degree and teaching the academic arena, they could make more money in the acute care arena which is tough competition. You have to have a desire to teach. Until the academic arena is paid better, we will have trouble with faculty § Expanded career opportunities · Maybe selling medical equipment, selling drugs, there are a lot of things § Aging workforce · Bulk of population is still age 50 and older
nurses
What component of the healthcare system is described below: · Nursing Shortage o Contributing factors § Lack of qualified faculty (top of list) · To have a _______ with an advanced degree and teaching the academic arena, they could make more money in the acute care arena which is tough competition. You have to have a desire to teach. Until the academic arena is paid better, we will have trouble with faculty § Expanded career opportunities · Maybe selling medical equipment, selling drugs, there are a lot of things § Aging workforce · Bulk of population is still age 50 and older
nurses
What component of the healthcare system is described below: · ________ practice in all types of health care settings · Largest group of health care professionals o If we really band together and use our power wisely we could significantly influence the direction of healthcare but unfortunately through the years we have not claimed our powers
nurses
The following is decision making within the _______ hierarchy: · Centralized decision making o A few managers at the top of the hierarchy make all the decisions o Handful of people are responsible for most of the decision making · Decentralized decision making o Diffuses decision making throughout the organization - allows for decision making at the lowest managerial level (managers at lower levels) o Allows problems to be solved at the level at which they occur (at the bedside in the hospital setting) o As a rule, larger organizations benefit from decentralized decision making § If have really large organization and only a handful of people making the decisions, you are going to have way more decisions that need to be made than the number of people making the decisions
organizational
_________ charts reflects the formal structure of the organization; this is the formal power, this is who reports to who, this is who is responsible for what. · A drawing that shows how the parts of an organization are linked · Line positions = solid lines = represents flow of authority
organizational
_________ charts reflects the formal structure of the organization; this is the formal power, this is who reports to who, this is who is responsible for what. · Increased layers of management help the organization cope with increasing work complexity and extended time lines o If trying to take care of a patient and having a lot of issues (not enough supplies, disruptive physician issues, etc.), you don't have the time or the resources to deal with that because you are taking care of the patient so you need management's help to step in and to cope with these problem areas § Managers are really just paid problem solvers § If you sign up for a management position because in your head you are thinking "this makes me somebody and is an important position." It is an important position but at the end of the day you are just a professional problem solver.
organizational
_________ charts reflects the formal structure of the organization; this is the formal power, this is who reports to who, this is who is responsible for what. · Informal structures do not appear on an organizational chart so the people with informal power will not be found on an organizational chart o Does not mean that they do not have tremendous power · Number of management layers in the hierarchy (this is what we call the scalar chain)
organizational
_________ charts reflects the formal structure of the organization; this is the formal power, this is who reports to who, this is who is responsible for what. · Staff positions or advisory bodies = dotted lines to show consultative relationships o Every organization at one time or another brings in a consultant. It doesn't mean that the group or that person doesn't have power. Think about if you have a project (EHR implementation) and you may bring in one of the major companies like Cerner or Epic and they will have a certain amount of power within the organization because they are running the show of implementing that EHR but it is usually temporary
organizational
What provider is described below: (physician, hospitalists, nurse practioner) o Medical degree o Typically specializes in specific area of practice
physician
The following are different ______: · Physicians o Medical degree o Typically specializes in specific area of practice · Hospitalists o Physician providing medical care to acutely ill hospitalized patient o Main focus is for caring for the acutely ill in the hospital setting · Nurse Practitioner o Master's degree; nowadays have doctorate programs so will have DNP o Specializes in specific area of practice
providers
· On March 23, 2010 The Patient Protection and Affordable Care Act became law · The Health care ________ act has been the single thing in the last decade that has impacted our healthcare system the most
reform
What does a dotted or unsolid line in an organizational chart mean?
represents staff positions
accountability, responsibility, or authority? is a duty or assignment; implementation of a job
responsibility
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: **like the matrix design is, ____ ____ organization which can be used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations. ______ ____, sometimes called care-centered organizations, are smaller in scale than a large bureaucratic system. For example, in this organizational design, the overall goals would be determined by the larger organization, but the service line would decide on the processes to be used to achieve the goals.
service line organizations
Traditionally, organizations have used one of the following structural patterns: bureaucratic, ad hoc, matrix, flat, or various combinations of these. Which structural pattern is described below: · Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations · Sometimes called care-centered organizations · Smaller in scale than *****large bureaucratic systems**** · If have really big organization, you will hear about service lines o Ex: Lafayette General has a service line of women and children, service line of critical care medicine (includes ICUs, ED, cath lab maybe), etc.
service line organizations
The organization chart defines formal relationships within the institution. Formal relationships, lines of communication, and authority are depicted on a chart by unbroken (_______) lines. These line positions can be shown by ______ horizontal or vertical lines. ________ horizontal lines represent communication between people with similiar spheres of responsibility and power but different functions. ________ vertical lines between positions denote the official chain of command, the formal paths of communication and authority. Those having the greatest decision making authority are located at the top; those with the least are at the bottom. The level of position on the chart also signifies status and power.
solid
_____ _____ _____ also can be determined from the organization chart. The number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. Thus, there is an inverse relation between the ____ ____ ____ and the number of levels in hierarchy in an organization, that is, the narrower the span, the greater is the number of levels in an organization.
span of control
· Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her o If my span of control is 10 people or 30 people, I can be overextended with 30 people reporting to me depending on what the job is · Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization o If you have a boss for every 30 people, you will have a very top heavy organization
span of control
Those entities that play a role in the organization's health and performance, or affected by the organization. These may be both internal and external, they may include individuals and large groups, they may have shared goals or diverse goals.
stakeholders
The following is talking about the _____ of an organization: o Have to know what your job is and then how that fits into the entire organization § If I know that I am responsible for this then I also need to know who is responsible for the other pieces of the puzzle so that we are not infringing on other people's territories § Ex of nurse and respiratory therapist (RT) again: the nurse has to be competent in the use of the mechanical ventilator in the ICU setting because she has overall care of the patient but the RT is the expert in the respiratory care of the patient and the daily operation of the ventilator so what do you do if the ventilator is malfunctioning but the RT is not the in the room? You have to be able to know what to do even though the RT is the expert. Need to respect each other's knowledge and trust that if patient is in trouble that the nurse would intervene if the patient is in trouble since that is what is in the best interest of the patient. They would work together for the best outcome of the patient instead of being a tug-of-war. § That is part of why ________ of an organization and understanding it is so important. Who truly has power over the ventilator? Who has the knowledge? That is just one silly example but not so silly since there will be a number of things about whose job is it anyways.
structure
The following is talking about the _____ of an organization: · Organizational _______ defines how work is divided and coordinated o Purpose: Divide the labor into distinct tasks · _______ influences the flow of information, resources, and power o Have to know what your job is and then how that fits into the entire organization § If I know that I am responsible for this then I also need to know who is responsible for the other pieces of the puzzle so that we are not infringing on other people's territories § Ex of nurse and respiratory therapist (RT) again: the nurse has to be competent in the use of the mechanical ventilator in the ICU setting because she has overall care of the patient but the RT is the expert in the respiratory care of the patient and the daily operation of the ventilator so what do you do if the ventilator is malfunctioning but the RT is not the in the room? You have to be able to know what to do even though the RT is the expert. Need to respect each other's knowledge and trust that if patient is in trouble that the nurse would intervene if the patient is in trouble since that is what is in the best interest of the patient. They would work together for the best outcome of the patient instead of being a tug-of-war. § That is part of why ________ of an organization and understanding it is so important. Who truly has power over the ventilator? Who has the knowledge? That is just one silly example but not so silly since there will be a number of things about whose job is it anyways.
structure
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? Examples: chief nursing officer, chief executive officer, chief financial officer Scope of Responsibility: look at organization as a whole as well as external influences Primary planning focus: strategic planning Communication flow: more often top down but receives subordinate feedback both directly and via middle level managers
top-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? Some _____ _____ managers may be responsible for non-nursing departments. For example, a ____ ____ nurse manager might oversee the respiratory, physical, and occupational therapy departments in addition to all nursing departments. Likewise, the CEO might have various titles such as president and director. It is necessary to remember only that the CEO is the organization's highest ranking person and the _____ ____ nurse manager is its highest ranking nurse.
top-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? o The "C suite" o Look at the organization as a whole -- Strategic minded managers o Coordinate internal/external influences o CEO, CNO, President, VP, Director, Board of Directors -- Chief executive officer of the hospital, chief nursing officer, President, VPs, Board of directors o They are not just concerned about the operations of the hospital within the organization but also concerned about the market chair, attracting certain physicians, supply chains, who they do business with, the economic viability of a community- all of this impacts the hospital business
top-level managers
In large organizations, several levels of managers often exist. We have 3 managerial levels: top-level managers, middle-level managers, and first-level managers. Which of these managers is described below? these managers look at the entire organization, coordinating internal and external influences, and generally make decisions with few guidelines or structures. Examples include the organization's CEO and the highest level of nursing administrator. Current nomenclature for ___ ____ managers include vice president of nursing, nurse administrator, director of nursing, chief nurse, assistant administrator of patient care services, or chief nurse officer (CNO).
top-level managers