Quiz #1 Manager of Care

Bureaucratic leaders

-Influence the behavior of the organization through organizational policies and rules.

Leadership

-ability to influence people to work toward the meeting of stated goals -can be defined as the use of individual traits and personal power to influence and guide strategy development -leaders need to "do the right thing", be future oriented, be visionary, focus on purposes, and empower others to set and achieve organizational goals

Leadership Produces Change and Movement

-establishing direction -creating a vision -clarifying the big picture -setting strategies -aligning people -motivating and inspiring -inspiring and energizing

Levels of Management

•Different levels of patient care management in most institutions •Organizational structure determines titles and span of authority of the various levels of patient care management •The role of a nurse manager is to guide and lead the frontline nurses while contributing to an organization's success.

Vertical

- affiliation of a particular health care facility with the health maintenance organization

Horizontal

- shared services or reciprocal services across two or more institutions

Accreditation

-"Continuously improve health care for the public in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value" -Originally designed to set a minimum standard of care

Permissive or Laissez-Faire leaders

-Assume that people are able to make their own decisions and complete their work without any facilitation of the leader

Autocratic leaders

-Change behaviors within the organization through the use of coercion, authority, punishment, and power

Team Nursing

-Diversity of skills, education, licensure team members that collectively care for a group of patients -RN is team leader -Usually doesn't provide direct care -Charts a lot -Needs strong communication skills -Group work and productivity model -this model supports group work and productivity

Advantages of Team Nursing

-Facilitation and overseeing of novice nurses -Smaller group of patients allows for a higher quality of care than with functional nursing -Team leader has knowledge of patient needs and can provide coordination of care -Fixed teams relate to higher quality patient care

4 core components of transformational leadership

-Idealized influence -Inspirational motivation -Intellectual stimulation -Individualized consideration

Primary Nursing Advantages

-Improved quality and continuity of care -Simplified communication -Increased nurse satisfaction in nurses prepared for the role -Patients perceive care to be more personalized

Democratic leaders

-Leaders influence change within the organization through participation, involvement of staff in goal setting, and collaboration

Care Delivery Systems

-Method used to deliver care to patients. -Multiple care delivery models, dependent on many factors: financial, staffing capability, patient population, organizational mission, and philosophy. -Care delivery system delineates the nurses' authority and accountability for clinical decision making and outcomes. -Combination of: clinical decision making, work allocation, communication, management, coordination, accountability

Case Management

-Mixes process and care delivery -Collaboration with all members of team (physician, therapies, social workers, nurses, pharmacy, etc.) -Follows patient throughout entire hospital stay and coordinates for post-hospitalization needs -Also in nursing homes, rehab facilities, home health, community care (i.e. reservation), chronically ill patients -Prevent readmissions -Advantages: professional practice model, cost effective -Disadvantages: fragmented communication; needs to be integrated into care delivery model -The manner in which patient care is delivered to patients and families is reflective of the nursing philosophy of the organization. Each model of patient care delivery has advantages and disadvantages for both the patient and the nurse. The role of the nurse in each type of model differs according to the delivery system. It is important to acknowledge your role and responsibilities in the model being used in your institution. -New models of patient care delivery and professional practice are being developed and used across the United States. Some of the newer models combine aspects of the models already in existence. As research and evidence concerning the successes and challenges of the new models evolve, care delivery will change.

Total Patient Care

-Oldest method of providing care to a patient -Until 1930s then again in 1990s -Type of primary nursing, but does not extend beyond that particular shift whereas primary nursing is 24/7/365 -Florence Nightingale's model of care -Usually assigned 4 patients, depending on shift and acuity of patients

Primary Nursing Care

-One-to-one approach to care -24 hour coordination of care -Care plans big part of this role -Flexible model, care delegated to others -Works in NICU or Level II nursery

Advantages of patient centered care

-Quality of care -Continuity of care -High patient satisfaction -Decreases communication time between staff -Reduces need for supervision -Allows one person to perform more than one task -All care is given by RN's

The 3 major health care organization accrediting agencies are the:

-The Joint Commission (TJC) -Det Norske Veritas (DNV) -American Osteopathic Association (AOA) Healthcare Facilities Accreditation Program

Modular Nursing

-Variation of team nursing -Based on layout of nursing unit "Pod nursing" -Less footsteps! -Possible downfall - if you end up with the open beds in your pod you might get two admits instead of other people getting one and you getting one •Advantage: Ease of working in environment •Disadvantage: Need to have consistent numbers of staff members in each group

Functional nursing

-Work allocated according to specific tasks and technical skills. -Popular in 1800s to end of WWII -Charge nurse identified tasks to be done during shift -Work was then divided amongst personnel - for example - med passes by a medication nurse and dressing changes by a wound nurse, etc. -One challenge with this model is there needs to be a great deal of communication between staff members to ensure quality care •Large number of tasks can be completed in a shift •Staff classifications mixed •Financially efficient •Staff can become masters at a certain task -this model of care delivery is oriented to the accomplishment of tasks -it is efficient in times of staff shortages, and you will see patient care units reverting to this delivery mode in times of staff shortage -everyone is accountable for a portion of care -the challenge is that all aspects of patient care needs to be communicated to the next shift, and the charge nurse must make sure that all pertinent information is known by them and that they are then able to communicate it to the next shift -this can lead to fragmented patient knowledge and lack of holistic care

Transformational Leadership 5 basic practices

-challenging the process, questioning the ways that things have always been done, and creatively thinking of new ways of doing things -motivating and inspiring shared vision or bringing everyone together, moving toward the shared goal -empowering others to act -modeling the change -praising the employee for the work done

Care coordination

-function that helps ensure that the patients needs and preferences for health services and information sharing across people, functions, and sites are met over time

Management Produces Order and Consistency

-planning and budgeting -establishing agendas -setting timetables -allocating resources -organizing and staffing providing structure -making job placements -establishing rules and procedures

Management

-the act of planning, organizing, staffing, directing, and controlling for the present; process of coordinating actions and allocating resources to achieve organizational goals -management can be taught, whereas leadership is usually a reflection of personal experience -leaders show the way, although management labor to produce the day-to-day outcomes -leaders focus on effectiveness, and management deal with effieciences

Leader vs. Manager

-the competencies of a nurse manager need to be developed, and the process of manager development occurs through education, mentorship, and professional growth

Professional Practice Model

-the driving force of nursing care -it is a schematic description of a theory, phenomenon, or system that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest level of care for those served by the organization

Functional Structures

Defined by departments, similar departments report to common leader Can lead to "silo" effect, but supports professional expertise •In such a structure, nursing units would report to the larger nursing services. Other services in support of patient care, such respiratory and dietary, might report to a non-nursing manager or VP. --Arrange services and departments according to what they do --Departments with similar functions report to a common manager or vice president •Advantage: Supports professional expertise •Disadvantage: Departments become separate entities with little interaction •Discuss the advantages and disadvantages of this structure using examples from students' experience respiratory wouldn't report here, only nursing - thus silo effect -arrange services and departments according to what they do -nursing units would report to larger nursing services -other services in support of patient care, such as respiratory and dietary, might report to a non nursing manager -this type of structure supports professional expertise but can result in the "silo" effect, in which departments become separate entities with little interaction

Care delivery system

a system for the delivery of care that delineates the nurses' authority and accountability for clinical decision making and outcomes; it is integrated with the professional practice model and promotes continuous, consistent, efficient, and accountable nursing care

US Department of Health and Human Services

•115 programs •11 divisions •Examples: -Head Start -Child abuse and domestic violence prevention -Home delivered meal services -Emergency management preparedness

CDC

•Agency within the USDHHS •Promotion of health and quality of life by preventing and controlling diseases Ebola COVID Overdose Chemical exposures Rattlesnakes

Patient Care Manager

•Also known as charge nurse, who is a staff nurse with managerial responsibility •Key tasks -Assist in shift coordination and personnel issues. -Create patient assignments for the shift. -Make patient care rounds during shift. -Trouble-shoot problems that occur during shift. -Assist staff members with making decisions and prioritizing care. -Use resources efficiently. -Serve as liaison between staff of off-shift and first-line management. •The role of charge nurse may be a permanent position or it may be a rotating one.

Upper Level

•Also known as executive-level manager, senior vice president of patient care, vice president for nursing, chief nurse executive, or chief nursing officer (CNO) •Responsibilities -Establishing organizational goals -Establishing strategic plans for nursing -Integrating work units to achieve the organization's mission -Buffering the effects of the external environment on nurses within the organization •The CNO spends the least amount of time in direct supervision and more time in planning to move the organization forward. -middle management reports to the Vice President for nursing -most of the time is spent planning and working with key stakeholders to move the organization forward -the CNO is responsible for influencing change beyond the scope of nursing to provide for continued excellence -they are responsible for establishing organizational goals and strategic plans for the patient care department and driving leadership development and the continued path toward excellence

First Level

•Also known as first-line manager, nurse manager, or head nurse •Responsibilities -Clinical nursing practice -Patient care delivery -Use of human, fiscal, and other resources -Personnel development -Compliance with regulatory and professional standards -Fostering interdisciplinary, collaborative relationships -Strategic planning •A first-level nurse manager must work between the worlds of staff and upper management. •Discuss specific duties that often fall within the job description of the first-level nurse manager • Nurse Managers exert substantial influence on the work environment at the bedside. -Nurse manager -responsible for supervising the work of non managerial personnel and the day-to-day activities of a specific work unit or units -preparing orientation and transition to practice schedules in collaboration with nursing education department -submitting time schedules for nursing shifts -assigning staff for patient care during shifts

Middle Level

•Also known as supervisor, director, assistant director, or associate director of nursing •Responsibilities -Actions of people and activities within the departments they supervise -Liason between upper management and first-level management -also known as supervisor, director, assistant director, or associate director of nursing, supervises a number of first-level managers •A middle-level nurse manager supervises a number of first-level managers and may spend more time planning, evaluating, and coordinating and less time with direct patient care supervision than the first-line manager. •Key tasks include assessment of whether unit policies are meeting needs of patients and staff, setting and revising appropriate goals for patient care, using delegation and shared governance to put plans into action, and analyzing/revising plans in order to facilitate growth of staff. -they are positioned on the organizational chart between the nurse manager and the chief nursing officer (CNO)

Other Accrediting Agencies

•American College of Surgeons •Commission on Accreditation of Rehabilitation Facilities •Institute for Medical Quality •National Dialysis Accreditation Commission •American Association for Accreditation of Ambulatory Surgery Facilities •The Intersocietal Accreditation Commission •National Committee for Quality Assurance •National Commission for Correctional Health Care

Centers for Excellence

•American Nurses Credentialing Center (ANCC) •Malcom Baldrige Award for Performance Excellence •U.S. News and World Report •J.D. Power and Associates -As if that isn't enough...... other groups are responsible for health care performance and excellence -Bariatric center for excellence -Pain management center for excellence -ANCC - evidence-based practice -US News and World Report - Top ranked hospitals, physicians, etc. -J.D. - Distinguished Hospital Program - notable level of patient satisfaction (like cars are given awards from consumer satisfaction) -Magnet award - additional lecture -The Joint Commission accreditation standards, the Malcolm Baldrige National Quality Award, and the ANCC's Magnet Award contain many parallels. All three share the following characteristics: • Developed using a consensus-building approach. • Built upon a core set of values and principles. • Use a framework of important functions (patient care) that cross internal structures (departments) of an organization. • Recognize the "systemness" of organizations. • Focus on continuous improvement and organizational performance. • Are not prescriptive. • Promote the use of organizational self-assessment. (The Joint Commission [2014]. Comparison Between Joint Commission Standards, Malcolm Baldrige National Quality Award Criteria, and Magnet Recognition Program Components. p. 1.)

Theories of Leadership (Behavioral Theory)

•Behavioral theory: Leaders are characterized by how they behave, not what they do. -Autocratic -Democratic -Permissive -Bureaucratic •Behaviorists characterize leaders by their style of practice.

Integrated Structures

•Care across the continuum for a patient population •Preventive care is inherent •Goal to keep people healthy •Hospitals, delivery systems, and health care workers are brought together under one umbrella •Disadvantages: high overhead and potential internal power struggles -Example: single specialty group practice - physicians and physician services - varies depending on specialty - may be owned by hospitals or health plans which may manage part of it or provide oversight of practices -Multispecialty group practice - various physician specialties in one office - may facilitate referrals amongst them to improve care coordination and management of care - share governance and infrastructure; might have tighter management control;

Disadvantages of Functional Nursing

•Charge nurse is only one with total view of patient •Decreased patient satisfaction •Decreased nurse satisfaction •Fragmented communication •Fragmented accountability •Lack of holistic care •The charge nurse is responsible for communicating all aspects of patient care to the next shift.

Matrix Structures

•Combination of function and service line into an integrated service structure •Manager of unit reports to multiple leaders -Director of Trauma, Director of Nursing, Emergency Department Manager, Chief of Nursing, Chief of Trauma •Requires collaboration between service line and functional leaders •The nurse is responsible to the nurse manager and vice president of nursing for nursing care and to the program director when working within the matrix. •Ex. Cardiovascular services or trauma services, surgical services, women and children services -the manager of a unit responsible for a service reports both to a functional manager (Vice President for nursing) and a service manager (directors of the service) -the nurse is responsible to the nurse manager and Vice President of nursing for nursing care and to the program director when working within the matrix

Leadership Structure

•Complex web of health care facilities •Chief goal of providing safe, cost-effective patient care •Three aims: -Improve patient experience -Improve overall health of population -Reduce per capita costs •Focus on oversight, efficiency and stakeholder satisfaction •Improving the US healthcare system requires the pursuit of three aims: improving the experience of care, improving the health of the population, and reducing per capita costs (Berwick, Nolan, & Whittington, 2008). •The health care industry is complex made up of patient care facilities & workers and the chief goal of caring for patients, in a safe, cost -efficient manner. an be centralized or decentralized -structures are defined as centralized or decentralized depending on the degree to which the organization has spread its lines of authority

Theories of Leadership (Contingency Theory)

•Contingency theory: Leaders adjust leadership style depending on the situation. •Newer concepts of leadership: -Charismatic -Connective -Shared -Servant •The contingency theory is also called "situational leadership." For example, a leader may use an autocratic style in a disaster management situation, but a democratic style in strategic planning. •Newer concepts of leadership are a combination of prior work and study in the field. -A leader may use an autocratic style in a disaster management situation but use a democratic style in strategic planning -This ability to adjust ones approach to the situation is called situation leadership or contingency theory

Modular Nursing

•Each module consists of a group of staff members and a group of patients. •Patients are grouped by spatial or floor plan clustering. •Nurse/patient assignment is standardized by cluster

Nurse Role in Survey

•Ensuring patient safety and delivering quality care •Participate in committees to improve evidence-based practice and core nursing processes •Safe reporting of any events that cause harm or are near misses •Keep current with new standards and recommendations for care in industry •Answer questions asked by surveyor -Common topics: pain management, patient rights (what if they refuse treatment), procedures, patient confidentiality, medication passing, policies and procedures

Transactional Leadership

•Exchange between leader and employee •Needs of employees are identified •Leader provides rewards to meet needs in exchange for performance •Usually in a hierarchal organization •Decision making occurs at the top and is communicated down to employees -Needs of the employees are identified and rewards are given to those who meet the needs in exchange for performance. -Found in Hierarchical type of organization which that's where thedecision making occurs top and is communicated to the employees

Leadership characteristics

•Future oriented •Visionary •Focus on purposes •Empowers others to set and achieve organizational goals •Healthcare leaders help others adapt to the demands of a value-driven health system. •Help to establish direction for a long range plan •Focus on people or empower them to help achieve set goals •They innovate for change , their originators

The Joint CommissionCovers.....

•General, psychiatric, children's and rehabilitation hospitals •Critical access hospitals •Health care networks •Home care organizations •Nursing homes and other long-term care facilities •Assisted living facilities •Behavioral health care organizations •Ambulatory care providers •Clinical laboratories

Benefits of TJC?

•Improved patient care •Organization's commitment to safety and quality •Educational on-site survey •Safety and quality improvement efforts •Recruitment and retention efforts •Substitution for federal certification surveys (Centers for Medicare and Medicaid Services) •Secures managed care contracts •Organization's business strategies (center of excellence, stroke center, etc.) •Competitive advantage •Public image with Gold Seal of Approval •State licensure requirements met •Insurance companies and third-party payors recognize •Community confidence •Accreditation by The Joint Commission is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards. ​

Primary Nursing disadvantages

•Increased number of hours of care per day •Overall patient satisfaction results are inconclusive •Can be difficult to implement if patient has multiple unit transfers

Disadvantages of Team Nursing

•Increased time needed to communicate with team members •High labor costs •Increased time required to supervise, coordinate, and delegate •Communication breakdown possible •Most educated staff in role of supervisor, not direct patient care delivery

Leader vs. Manager

•Leader operates under evidence-based management tenets: -Balance efficiency and patient safety -Promote trust -Create and manage change -Implement shared decision-making around work design and flow -Establish a learning environment •Management is a complex process of coordinating and directing the actions of others to accomplish an organization's objectives. •Management also involves the assignment of resources to these groups so that the objectives can be met. -Leadership is mission driven, whereas management is task driver

Regulatory Agencies

•Licensing of health care agencies occurs through state departments of health. •Compliance with regulatory standards on both national and state levels is mandatory. •Fines can be levied against organizations for non-compliance. •Accrediting agencies evaluate health care organizations against a set of standards that have been validated as best practice. -Accreditation is voluntary, although without it some insurances, including the Centers for Medicare and Medicaid Services (CMS) will not allow payment for services provided to patients. •State departments of health usually oversee outcomes of care within health care facilities, investigate consumer complaints, and deal with issues of importance to the public health. ​

Leadership Versus Management (Cont.)

•Management can be taught. •Leadership is usually a reflection of personal experience. •Leaders show the way. •Managers labor to produce day-to-day outcomes. •Leaders focus on effectiveness. •Managers deal with efficiencies. •Leadership involves establishing direction, aligning people, and motivating and inspiring others. It has the potential to produce useful change (Kotter, 1996). • •Management is planning and budgeting, organizing and staffing, and controlling and problem solving. It produces a degree of predictability and order. Management also has potential to consistently produce short-term results (Kotter, 1996).

Leader Versus Manager

•Manager administers; leader innovates. •Manager maintains; leader develops. •Manager focuses on systems and structure; leader focuses on people. •Manager asks how and when; leader asks what and why. •Manager has eye on the bottom line; leader has eye on the horizon (future). •Manager accepts status quo; leader challenges it. •The process of manager development occurs through education, mentorship, and professional growth. •Management is a part of leadership.

Leader Versus Manager (Cont.)

•Manager coordinates and directs the actions of others to accomplish an organization's objectives by -Planning -Staffing -Organizing -Directing -Controlling -Decision making •Organizing is a fluid activity requiring knowledge of the organization and people and having the ability to alter the plan, staffing, and organization if the goals are not being met. •Key steps of decision making are identification of the problem, establishment of criteria to evaluate potential solutions, consideration of alternative solutions, and selection of the best option based on the organization's mission and values. -management is a complex process of coordinating and directing actions of others to accomplish an organization's objectives -it also involves the assignment of resources to these groups so that the objectives can be met

Disadvantages of total patient care

•May not be cost effective because of the number of registered nurses needed to provide care •Less job satisfaction due to patient care activities that can be delegated

Transformational Leadership

•More consultative and collaborative •Finding new ways of doing things •Motivating and inspiring shared vision •Empowering others to act •Modeling the change •Praising the employee for accomplishments •Four components of transformational leadership include idealized influence, inspirational motivation, intellectual stimulation, and individual consideration. •This is seen more frequently now .. •Where leaders are more collaborative and consult with staff and other leaders

Det Norske Veritas (DNV)

•More hospitals moving to this accreditation •364 health care institutions currently •Annual survey required -used with Honor Health - new approach away from TJC - focuses on quality, innovation and continual improvement. ISO9001 standards moving towards continual improvement. Annual surveys required. Also offers disease specific certifications, such as stroke center or management of infection risk certification.

Comparing the Nursing Process with the Management Process

•Nursing process focuses on assessing analyzing, planning, implementing, and evaluating. •Management process meets client needs in efficient and effective manner with available resources and consists of five phases: -Identification of needs -Identification of resources -Planning -Organizing and direction -Controlling -Discuss how managers influence the nursing process. •Quality of care, patient safety, patient experience, patient outcomes, nurse outcomes, job satisfaction, retention, nurse engagement, promote autonomy and professional development.

Governmental Agencies

•OSHA •USDHHS •CDC

Regulatory and Advisory Agencies

•Occupational Safety and Health Administration (OSHA) •Centers for Disease Control and Prevention (CDC) •Food and Drug Administration (FDA) -OSHA - regulates workplace safety standards (example - floor, chemical use, etc.) -CDC - multiple infection control standards (example - COVID, ebola, chicken pox, measles, etc.) -FDA - regulates drugs, medical devices, and radiation-emitting products, which form the basis of the medication management standard of accreditors.

Organizational Structures

•Organizational chart •Centralized - top-down leadership •Decentralized - higher job satisfaction •The more decentralized an organization, the greater the opportunity for shared governance and therefore, the greater the level of job satisfaction. -a centralized organization is a typical hierarchy that follows a chain of command and is characterized by a top-down decision making -the more decision making is "pushed down" through the organizational levels, the more decentralized the organization becomes -a flat organizational structure signifies the removal of hierarchical layers, demonstrating that the authority of action occurs at the point of service -in a more decentralized organization, lower-level managers and staff have an increased opportunity for shared governance and often report greater job satisfaction

Shared Governance

•Organizational structures that allow nursing staff autonomy to govern their practice •Shared decision-making •Shared accountability •ANCC shared leadership/participative decision-making is a model in which nurses are formally organized to make decisions about clinical practice standards, quality improvement, staff and professional development, and research (American Nurses Credentialing Center [ANCC], 2013, p. 74). •Shared Governance is very common in facilities especially those achieving Magnet Status -this is a democratic, dynamic process resulting from a shared decision making and accountability -is a structure and process for partnership, equity, accountability, and ownership

Licensing Bodies

•Perform surveys to evaluate wide range of quality topics •Investigate complaints •Provide report cards to consumers •Nurses are often called to assist hospital administrators regarding complaints lodged with the state department of health. ​ •Health care organizations are licensed to perform services by the state department of health​ •State departments of health:​ a. Regulate a variety of health care settings for quality of care​ b. Investigate complaints received from patients, other consumers, and other state and federal agencies​ c. Provide consumer information in the form of report cards and other performance information​

Survey

•Performance reviewed •Standards set for performance expectations •Right performance = good outcomes •Citations •"Dinged" -Constant readiness -"Right of passage" -Every three years - unannounced visits Interview staff, patients, families -Review hospital policies and procedures, protocols, employee files, annual competencies, etc. -Page 58-59 in book - examples are infection control, emergency management, life safety, medication management, national patient safety goals, quality, patient rights, etc.

Management characteristics

•Planning •Organizing •Staffing •Directing •Controlling the present •Managers labor to produce the day-to-day outcomes. •Controlling & solving current issues while foreseeing possible future issues. •They are to produce short-term results for current problems Leaders focus on effectiveness, and managers deal with efficiencies.

OSHA

•Preventing back injuries •Preventing needle sticks •Infection control training annually •Fire safety training annually -Mission of OSHA - ensure safety and health of workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual involvement in workplace safety and health -Examples of their work: -Did you know they are part of the US Department of Labor?

The American Osteopathic Association (AOA)

•Recognized as an alternative accreditation agency •Primarily deals with osteopathic hospitals and institutions •Can also do certifications for specialties, such as primary or comprehensive stroke centers -Osteopathic hospital - medical practice based on a theory that disease are due chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by therapeutic measures (such as use of drugs or surgery) -Homeopathic - medicine, not surgery -Naturopathy - waste products accumulated in body

Comparison of Leadership and Management

•Role of manager is to achieve: -Desired outcomes of quality care - Fiscal responsibility -Customer satisfaction by coordinating care using technology, resources, information, and systems •Role of leader is to: -Establish direction of care -Align people -Motivate and inspire to produce change •Some health care agencies will differentiate between the level of academic preparation of the nurse and the expected competency of the manager. •A manager does things right, and a leader does the right thing.

Product Line Structure

•Service Lines •Centers of Excellence •Similar focus and vision •Possible duplication of services -For instance ... orthopedic service line or cardiac service line Ortho ambulatory care, operating rooms, ortho trauma center, rehab centers -Disadvantage would be duplication of services at another sister facility. -functions necessary to produce a specific service are brought together into an integrated unit under the control of a single manager -for example, the orthopedic service line at a hospital would include all personnel providing services to the orthopedic service population -this might include the orthopedic ambulatory care service, the orthopedic operating rooms, the orthopedic trauma center of the ED and the orthopedic rehab center -benefits of this model include coordination of all services within the specialty and a similarity of focus -a limitation would be increased expense caused by duplication of services

What is a Regulatory Agency?

•Set -Set standards for the operation of health care organizations •Ensure -Ensure compliance with federal and state regulations developed by government administrative agencies •Investigate -Investigate and make judgments regarding complaints brought by consumers of the services and the public

Integrative Structures in Health Care

•Short-term acute care hospital has home-health agency •Long-term acute care hospital has hospice beds •Short-term acute care hospital has rehab hospital •Behavioral health contracts with short-term hospital for lab and x-ray services -Can be vertical or horizontal -Increased efficiency and financial stability of services -Vertical - affiliation of a particular health care facility with the health maintenance organization -Horizontal - shared services or reciprocal services across two or more institutions

The Joint Commission

•TJC - JCAHO - JAYCO - Joint Commission •Started in 1951 •Not-for-profit •Every 3 years •Laboratories every 2 years -TJC - JCAHO - "JAYCO" - most common - Formally known as Joint Commission on Accreditation of Healthcare Organizations. Started in 1951. Accredits more than 25,000 health care organizations in US. Not-for-profit organization. Comprehensive accreditation process to evaluate an organizations compliance with their standards and other requirements. Hospitals, Nursing Homes, Long-term care facilities, home health and hospice agencies, psychiatric and behavioral health facilities, outpatient facilities, laboratories and plasma/blood donation center are all examples of covered entities. Recognized nationwide as a symbol of quality. Gold seal of approval. Surveys every three years, except laboratories which are every two years.

Accrediting Agencies

•The Joint Commission (TJC) •Det Norske Veritas (DNV) •American Osteopathic Association Healthcare Facilities Accreditation Program (AOA)

Magnet Presentation

•The Magnet Award is the highest level of recognition that the ANCC can award to organized nursing services •ANCC recognizes nursing-sensitive outcomes as a predictor of quality of patient care ANCC values the retention and recruitment of highly competent nurses

Competencies of Patient Care Managers

•Time management •Interdisciplinary collaboration •Leadership characteristics •Ability to prioritize client needs and related care •Flexibility and creativity •Critical thinking skills •Conflict resolution •Ability to delegate •The client care manager has more limited authority and a limited span of control when compared with a first-level nurse manager. •A resource nurse is usually a nurse with recognized clinical expertise (clinical ladder position, certification, and experience) who is able to mentor less experienced nurses as they grow within the profession.

The following are the models associated with nursing practice:

•Total Patient Care •Functional Nursing •Team Nursing •Modular Nursing •Primary Nursing •Case/Care Management -These models are associated with nursing practice -The choice of a model within an organization is dependent on several factors : financial, staffing, capability, patient population, organizational mission and philosophy

Theories of Leadership (Trait theory)

•Trait theory: Leaders possess certain traits: -Drive -Persistence -Initiative -Ability to influence others •According to the trait theory, when leaders put their traits into practice, positive outcomes result.

Educational Accreditation

•Why is this necessary for a hospital? •Examples of these agencies: -Accreditation Commission of Education Nursing -Commission on Collegiate Nursing Education -Liaison Committee on Medical Education -American Osteopathic Association -Commission on Accreditation in Physical Therapy -Who would this apply to? Physicians? Respiratory? Radiology? Therapies? Nursing? Pharmacy? Every part of healthcare, actually. -Hospitals who participate in the education of health care personnel, nurses, and physicians are subject to visits by the accrediting agencies used by the schools working with it. -If your hospital participates in the education of health care personnel, nurses, and physicians, nurses will also be exposed to visits by the accrediting agencies used by the schools working with your hospital. The schools are usually responsible for the compliance with standards in these situations. Your role will be to respond to the role of the students in the provision of care on your unit.