Leadership final

TYPES OF DECISION MAKING

- recurrent and routine problem solving - satisficing - maximizing or optimal mode

One of the most commonly used tools in health-care organizations is SWOT analysis (identification of strengths, weaknesses, opportunities, and threats):

-Strengths are those internal attributes that help an organization to achieve its objectives. -Weaknesses are those internal attributes that pose barriers to an organization achieving its objectives. -Opportunities are external conditions that promote achievement of organizational objectives. -Threats are external conditions that challenge or threaten the achievement of organizational objectives.

Authentic leadership is not easy

. It takes great courage to be true to one's convictions when external forces or peer pressure encourages an individual to do something he or she feels morally would be inappropriate.

EI consists of Three Mental Processes:

1) Appraising and expressing emotions in the self and others 2) Regulating emotion in self and others 3) Using emotions in adaptive ways

McNally's (1980) classic work identified the following four characteristics that determine a true value:

1. It must be freely chosen from among alternatives only after due reflection. 2. It must be prized and cherished. 3. It is consciously and consistently repeated (part of a pattern). 4. It is positively affirmed and enacted.

Two Aspects That Carry the Most Weight When Making Hiring Decisions

1.The requirements of the job oQualified versus overqualified 2.Personal bias oExamine any negative feelings occurring in the interview for personal bias.

Implications of Knowles's Work for Trainers and Educators

A climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn. Adults enjoy taking part in and planning their learning experiences. Adults should be involved in the evaluation of their progress. Experiential techniques work best with adults. Mistakes are opportunities for adult learning. If the value of the adult's experience is rejected, the adult will feel rejected. Adults' readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem). Adults need the opportunity to apply what they have learned very quickly after the learning. Assessment of need is imperative in adult learning.

Budget

A plan that uses numerical data to predict the activities of an organization over a period of time

Illegal Interview Inquiries

Age Marital status Children Race Sexual preference Financial or credit status National origin Religion

Nursing Portfolio

All nurses should maintain a professional portfolio (a collection of materials that document a nurse's competencies and illustrate the expertise of the nurse) to reflect their professional growth over their career.

Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks

Allowing nurses to exchange hours of work among themselves

Chunking refers to presenting two independent items of information and grouping them together into one unit.

Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses.

Agile leaders have the ability (and agility) to think in many ways so that they can be flexible, adaptable, & fast in their decision making

Are inclusive, democratic leaders who exhibit a greater openness to ideas & innovations. Have a passion for learning, a focus on developing people, & a strong ability to define & communicate a desired vision, They possess the tools necessary to inspire others & become an agent for change within any organization. Listen deeply & ask powerful questions to gain insights & make the right decision to help the organization move forward through problems. Quickly adapt to situations as they come along, are flexible & open to change & growth Show how much they value their team's contribution by understanding & being what they need, productivity & engagement wise

What happened in the early 1930s that changed how we pay for healthcare?

Birth of "The Blues"Blue Cross (1929) and Blue Shield (1939)

Managed Care

Broadly defined as a system that attempts to integrate efficiency of care, access, and cost of care

Capitation: A Hallmark of Managed Care

Capitation is a prospective payment system that pays health plans or providers a fixed amount per enrollee per month to provide a defined set of health services based on enrollee needs.

Critical Pathways Provision of service no longer guarantees reimbursement.

Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement.

The learning organization (LO) promotes a shared vision and collective learning in order to create positive and needed organizational change.

Collective learning goes beyond the boundaries of individual learning and releases gains for both the individual and the organization.

Cost-Effectiveness

Cost-effective means producing good results for the amount of money spent. Expensive items can be cost-effective and inexpensive items may not. Cost-effectiveness then must take into account factors such as anticipated length of service, need for such a service, and availability of other alternatives.

DECISION-MAKING TOOLS

DECISION GRIDS PAYOFF TABLES DECISION TREES CONSEQUENCE TABLES LOGIC MODELS PROGRAM EVALUATION & REVIEW TECHNIQUES

Minimum Staffing Criteria

Decisions made must meet state and federal labor laws and organizational policies. Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests. Patient care must not be jeopardized.

The Human Relations Era

Developed the concepts of participatory and humanistic management Emphasizing people instead of machines. Attempted to correct what was perceived as the major shortcoming of the bureaucratic system—a failure to include the "human element." Time consuming and often resulted in unmet organizational goals

Elton Mayo (1953) :

Discovered that when management paid special attention to workers, productivity was likely to increase, regardless of the environmental working conditions. Indicated that people respond to the fact that they are being studied, attempting to increase whatever behavior they feel will continue to warrant the attention. Found that informal work groups and a socially informal work environment were factors in determining productivity Recommended employee participation in decision-making

Responsibility Accounting

Each of an organization's revenues, expenses, assets, and liabilities is someone's responsibility. As a corollary, the person with the most direct control or influence on any of these financial elements should be held accountable for them, usually the leader-manager

Training may be defined as an organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job.

Education is more formal and broader in scope than training. Whereas training has an immediate use, education is designed to develop individuals in a broader sense.

Rath and Conchie (2008):

Effective leaders are always investing in strengths but that they consciously & consistently work to use their key strengths to their advantage rather than putting significant effort into being better rounded The most effective leaders surround themselves with the right people (people who have different strengths than they do) & maximize their team Effective leaders understand their follower's needs, strengths & engages them in activities that allow these strengths to grow and for employees to be empowered and successful.

Medicare

Established in 1965 Primary populations are elderly, disabled, and renal dialysis patients. Two parts: A and B Part A funded by Social Security tax and federal taxes. Part B subsidized 75% by federal government and 25% by subscribers.

Trait Theories assume that some people have certain characteristics or personality traits that make them better leaders than others

Even with obvious shortcomings (e.g., they neglect the impact of others or the situation on the leadership role) these theories are worth examining

Luther Gulick (1937)

Expanded on the management functions with the introduction of the seven activities of management.

Queen Bee Syndrome

Female-dominated professions often exemplify the queen bee syndrome. The queen bee is a woman who struggled to become successful, but once successful, she refuses to help other women be successful.

Medicare Part B

Financed largely from federal general funds Is a supplementary medical insurance, which covers primary care provider services, outpatient diagnostics tests, certain medical supplies and equipment, and (since 1998) home health care (previously Part A) Is optional for beneficiaries, although most elderly pay the premiums

Medicare Part A

Financed primarily through employee payroll deductions and employer contributions Covers inpatient hospital care, limited skill nursing facility care, home health, and hospice care, although beneficiaries pay a deductible for each inpatient benefit period as well as coinsurance for hospital and skilled nursing facility stays

Float pools

Float staff must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers.

Strength-Based Leadership grew out of the positive psychology movement

Focuses on the development or empowerment of strengths as opposed to weaknesses or areas of needed growth. Is part of the development of positive organizational scholarship that focuses on successful performance that exceeds the norm and embodies an orientation toward strengths and developing collective efficacy. Has a profound impact on the ability of individuals to self-manage and to regulate their emotions.

Forecasting involves trying to estimate how a condition will be in the future

Forecasting takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes.

informal: the focus is on the employees, their relationships, and the informal power that is inherent within those relationships

Has its own leaders and communication channel (grapevine)

Types of Managed Care Organizations

Health maintenance organization (HMO) oPoint of service (POS) oExclusive provider organization (EPO) Preferred provider organization (PPO)

Henri Fayol (1925):

Identified management functions as planning, organization, command, coordination, and control

In centralized staffing, staffing decisions are made by personnel in a central office or staffing center

In decentralized staffing, each department is responsible for its own staffing.

A review of the literature consistently demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase. This includes:

Increased medication errors Patient falls Decreased patient satisfaction with pain management

Phases of Employee Indoctrination

Induction: includes all activities that educate the new employee about the organization and employment and personnel policies and procedures Orientation: teaches activities that are more specific to the position Individual orientation to each department: Specific departments are responsible for developing their own orientation program.

CHARACTERISTICS OF A CRITICAL THINKER

Insight Intuition Empathy Willingness to take action

The interviewer may have poor communication skills and be unable to generate a discussion. Physical appearance often contributes substantially to an interviewer's opinion about an applicant.

Interviewers frequently ask questions that demonstrate a self-fulfilling prophecy regarding their first impression of the applicant

Suggested Interview Format

Introduce yourself and greet the applicant. Make a brief statement about the organization and position and clarify the position for which the person is applying. Discuss the information on the application and seek clarification or amplification as necessary. Discuss employee qualifications and proceed with structured interview format. If applicant is qualified, discuss the position further. Explain hiring procedures Terminate the interview.

Career Coaching

Involves helping others to identify professional goals and career options and then designing a career plan to achieve those goals In short-term career coaching, the manager regularly asks employees questions or challenges them to refocus their perspective or improve their performance.

Why Is Scheduling So Difficult in Nursing?

It does not fit traditional business cycle. There is an erratic and unpredictable health-care demand. High-level expertise is required 24/7. Stress of job requires balanced work-recreation schedule. Staffing mix varies with acuity.

Vision statements are used to describe future goals or aims of an organization.

It is a description in words that conjures up a picture for all group members of what they want to accomplish together. An organization will never be greater than the vision that guides it.

Ethics is a system of moral conduct and principles that guide a person's actions in regard to right and wrong and in regard to oneself and society at large.

It is concerned with doing the right thing, although it is not always clear what that is. The study of what a person's life and relationships should be, not necessarily what they are.

Confidentiality

Keeps privileged information private

ADMINISTRATIVE MAN

Knowledge is fragmented Is impossible to accurately predict future consequences Considers multiple alternatives but not all Makes decisions that are good enough Final choice is satisficing

LEADERS

Leadership has many meanings and there is no single definition broad enough to encompass the total leadership process. Leaders are those individuals who take risks, attempt to achieve shared goals, and inspire others to action. Those individuals who choose to follow a leader do so by choice, not because they have to. The impact of leadership depends on the ability to influence people, not the ability to command, coerce, or manipulate. A job title alone does not make a person a leader; only the person's behavior determines who holds a leadership role. A leader is the person who influences and guides direction, opinion, and course of action. A leader can be out in front, in the middle or following behind. You recognize a leader by the response of their followers

The ACA experienced successes as well as failures.

Legislative efforts in late 2017 to repeal the ACA failed, but recent executive orders, including elimination of the individual mandate, have undermined many of its key elements.

Criticisms of Managed Care

Loss of existing physician-patient relationships Limited choice of physicians for consumers Less continuity of care Reduced physician autonomy Longer wait times for care Consumer confusion about the many rules to be followed

Harvest Commences in late career

Milestones: elevating mastery to sage practice for advancing the profession and positioning as a professional statesperson and establishing a legacy

Momentum Is the middle career phase and typically reflects the nurse with 11 to 29 years of experience

Milestones: further building confidence in one's competence; developing experience, gaining mastery, and establishing a professional track record; and finding a voice through aligning strengths with passion

Promise Generally reflects the first 10 years of employment; making wise career choices is important

Milestones: socialization to the nursing role; building knowledge, skills, abilities, credentials, and an education base; gaining exposure to a variety of experiences; identifying strengths and building confidence; and positioning for the future

Subjectivity can never be totally eliminated. High interview assessments do not necessarily correlate with high-level performance on the job.

Mixed reliability and validity Intrarater reliability high Interrater reliability low in unstructured interviews Interrater reliability is better if interview is structured and same interview format is used by all interviewers.

Negative information about the applicantis weighed more heavily than positive information, and the earlier in the interview, the greater the negative effect.

Most decisions about the applicant are made in the first 30 to 60 seconds.

Greenleaf (1977) -Servant Leadership is leading from the ground up

Most successful managers lead in a different way from traditional managers. Put serving others as the number one priority. Choice between personal advantage & organizational advantage Speaks to the heart of servant leadership. "'Win-win' is challenging when YOU win later & OTHERS win sooner" Foster a service inclination in others that promotes collaboration, teamwork, & collective activism. Values are the pillars that uphold the entire structure of servant leadership. Honesty, truth, compassion, & acceptance are some of the intrinsic core values shared by servant leaders

INNOVATION & CREATIVITY: CRITICAL ASPECTS OF PROBLEM-SOLVING & DECISION-MAKING

New research suggests that gender also plays a role in how individuals make decisions

FREQUENT ERRORS MADE IN DECISION MAKING

No clear objective or goal for decision #2- Faulty data gathering Failure to use science, logic & empirical evidence in making decisions Not considering enough alternatives Faulty logic or "crooked thinking" 6- Not assessing or ignoring the quality of the decision making that is required Lack of self-awareness Too much time spent identifying the problem 9- Refusal to act Using outcome only for the evaluation It is not enough to gather adequate information, think logically, select from may alternatives, & be aware of the influence of one's values. In the final analysis, one must act.

Fiscal Planning

Not intuitive; a learned skill that improves with practice An important but often neglected dimension of planning Should reflect the philosophy, goals, and objectives of the organization A skill increasingly critical to nursing managers because of increased emphasis on finance and "big business" of health care

Resocialization

Occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes in the type of work they do, in the scope of responsibility they hold, or in the work setting itself

Coaching

One person helping another to achieve an optimal level of performance Tool for empowering subordinates, changing behavior, and developing a cohesive team Emphasis on assisting the employee to recognize greater options, to clarify statements, and to grow

Role Change

Organizations often fail to address socialization problems that occur in job, position, or status changes. Role overload occurs when the demands of the role are excessive

PROBLEM-SOLVING

Part of decision-making; a systemic process focusing on analyzing a difficult situation involving higher order reasoning & evaluation

Adult learning theory (Knowles, 1970):

Pedagogy versus andragogy

Long-Term Coaching

Planned, systematic management action that occurs over the duration of an employee's employment Should occur at least annually in addition to performance appraisal Includes data gathering, assessing what is possible, and performing coaching interview

Interactive or Proactive planning.

Planners who fall into this category consider the past, present, and future and attempt to plan the future of their organization rather than react to it.

Seven Activities of Management:

Planning, Organizing, Staffing, Directing, Coordinating, Reporting, and Budgeting—as denoted by the mnemonic POSDCORB. Theorist began to refer to these functions as the Management Process

A third planning mode is pre-activism.

Pre-active planners utilize technology to accelerate change and are future oriented. Pre-activists do not value experience and believe that the future is always preferable to the present.

Critical Pathways

Predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery Strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care

Medicaid -Established in 1965

Primary population is the financially indigent. The majority of Medicaid recipients are women and children. Administered by the states under broad federal guidelines Covers about 17% of the US population

Formal: the emphasis is on organizational positions and formal power

Provides a framework for defining managerial authority, responsibility, and accountability

EXPERIENTAL LEARNING

Provides mock life experiences to learn from Allows learners to apply leadership & management theory Promotes whole brain thinking & improve problem-solving skills

Thought leadership applies to a person who is recognized among his or her peers for innovative ideas & who demonstrates the confidence to promote those ideas.

Refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things. Challenges the status quo & attracts followers not by any promise of representation or empowerment but by their risk taking & vision in terms of being innovative. Generally problem oriented, increasing their value to both individuals & organizations.

Moral Hazard

Refers to the propensity of insured patients to use more medical services than necessary because their out of pocket cost is so small (insurance covers most of the cost)

Recruitment is not the key to adequate staffing in the long term.

Retention is, and it occurs only when the organization is able to create a work environment that makes staff want to stay.

WHAT IS YOUR RISK QUOTIENT IN DECISION-MAKING?

Right Brain vs. Left Brain Dominance #1 Right Brain vs. Left Brain Dominance #2 Some people fail to use any type of systematic examination of the problem or its alternatives for solution. Right Brain vs. Left Brain Dominance #3 Instead, they rely on discrete, often unconscious processes known as heuristics Heuristics refers to using a "trial-and-error" or "rule-of-thumb" approach to problem solving

SUCCESSFUL DECISION MAKERS

Self-aware Courageous Sensitive Energetic Creative

Changed by Drift is accidental change

Some of the forces driving change include: •rising health-care costs, declining reimbursement, new quality imperatives, workforce shortages, emerging technologies, the dynamic nature of knowledge, and a growing elderly population.

Turnover

Some turnover is normal and in fact desirable. It infuses the organization with fresh ideas and reduces the probability of groupthink. However, excessive or unnecessary turnover reduces the ability of the organization to produce its end-product and is expensive.

Mary Parker Follett (1926)-

Suggested basic principles of what today would be called participative decision making or participative management. Belief that managers should have authority with, rather than over, employees.

The Great Man Theory asserts that some people are born to lead, whereas others are born to be led.

Suggests that great leaders will arise when the situation demands it.

Chris Argyris (1964):

Supported McGregor & Mayo by saying that managerial domination causes workers to become discouraged and passive. Believed that if self-esteem and independence needs are not met, employees will become discouraged and troublesome or may leave the organization. Stressed the need for flexibility within the organization and employee participation in decision making.

Key Characteristics of Senge's Model of LOs

Systems thinking Personal mastery Team learning Mental models Shared vision

Medicare and Medicaid Managed Care

The Centers for Medicare & Medicaid Services is now the largest purchaser of managed care in the country. MCOs receive reimbursement for Medicare-eligible patients based on a formula established by the CMS, which looks at age, gender, geographic region, and the average cost per patient at a given age. Then, the government gives itself a 5% discount and gives the rest to the MCO.

The quality of ethical problem solving should be evaluated in terms of both outcome AND the process used to make the decision.

The best possible decisions stem from: •structured problem solving, adequate data collection, and examination of multiple alternatives

Behavioral Sanctions

The bestowing of rewards and punishments Used to show employees what behavior is rewarded or eschewed in an organization Rarely carried out on a systematic and planned basis

In unstructured interviews, the interviewer generally does most of the talking. In structured interviews, the interviewer talks less.

The environment is artificial, and it is difficult for many interviewees to relax and be natural.

Centrality

The extent to which an employee is integrated into the network of interpersonal relationships within the work system The middle manager often has centrality because he or she has a broader view of the organization and communicates in many directions.

Group Norms

The manager should know what the group norms are and should be observant of the sanctions used by the group to make newcomers conform. The manager should take appropriate intervention if group norms are not part of the organizational culture.

Interviewing as a Selection Tool

The most common method for employee selection used by managers Also the most time-consuming and thus one of the costliest selection tools It generally requires an interviewer to use judgments, biases, and values to make decisions based on a short interaction with an applicant in an unnatural situation. Thus, reliability and validity are always suspect

Applied ethics requires application of normative ethical theory to everyday problems

The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, provide the foundation and filter from which ethical decisions are made.

Nursing Management Ethics are distinct from Clinical Nursing Ethics in that a nurse manager has a different ethical responsibility than the clinical nurse

The nurse manager's ethical obligation is: Tied to the organization's purpose, whereas the purpose of the organization is linked to the function that it fills in society and the constraints society places on it; responsibilities of the nurse-manager emerge from a complex set of interactions. Distinct from other areas of management; requires the nurse-manager to deal with unique obligations and ethical dilemmas that are not encountered in non-nursing management.

Health care is labor-intensive.

The personnel budget accounts for the majority of most health-care organization's expenses.

CRITICAL THINKING

The process of actively & skillfully conceptualizing, applying, analyzing, synthesizing, & evaluating information to reach an answer or conclusion

The critical indicator PCS uses broad indicators such as bathing, diet, intravenous fluids, medications, and positioning to categorize patient care activities.

The summative task PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient. At the national level, the use of a PCS is a condition for participation in Medicare and is required by The Joint Commission for certification

Douglas McGregor (1960):

Theorized that managerial attitudes about employees (how managers treat the employees) can be directly correlated with employee satisfaction.

Management is "the organization and coordination of the activities of a business in order to achieve defined objectives"

This implies that management is the process of leading and directing all or part of an organization through the deployment and manipulation of resources. The manager is the person who brings things about—the one who accomplishes, has the responsibility, and conducts. The manager is the person who brings things about—the one who accomplishes, has the responsibility, and conducts.

Some nurses lack a career focus and instead view nursing as a job.

This viewpoint limits opportunities for professional advancement and personal growth because what cannot be imagined rarely becomes a reality.

Three Reasons for Staff Development

To establish competence To meet new learning needs To satisfy interests the staff may have in learning in specific areas

Unfreezing - when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited.

To make a change effort successful, the leader must clear away the competing priorities and shine a spotlight on the need for a change to happen.

If a value does not meet all four criteria, it is a value indicator

True values require that the person to take action, whereas value indicators do not.

TO MAKE BETTER DECISIONS:

Use a systematic decision-making process whenever possible

Overcoming Interview Limitations

Use a team approach. Develop a structured interview format for each job classification. Use scenarios to determine decision-making ability. Conduct multiple interviews. Provide training in effective interviewing techniques.

Reliability and Validity Issues of the Selection Process

Validity increases with a team approach. Negative information tends to be weighed more heavily than positive information. The same standards should be used for all applicants. Selection should be based on established criteria, not value judgments. Personal bias should be minimized because negative feelings likely have no relation to the criteria necessary for success in the position.

Values clarification includes examining values, assigning priorities to those values, and determining how they influence behavior so that one's lifestyle is consistent with prioritized values.

Values can change as a result of life experiences or newly acquired knowledge. Most of the values we have as children reflect our parents' values. Later, our values are modified by peers and role models. Although they are learned, values cannot be forced on a person because they must be internalized.

Schein (1970) :

Was the first to propose a model of humans as complex beings whose working environment was an open system to which they responded. A system defined as a set of objects, with relationships between the objects and between their attributes.

Historically, when the economy improves, nursing shortages occur

When the economy declines, nursing vacancy rate decline as well.

In mandatory overtime, employees are forced to work additional shifts, often under threat of patient abandonment.

While mandatory overtime is neither efficient nor effective in the long term, it has an even more devastating short-term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity.

Theory Z-

an expansion of McGregor's Theory Y that supports democratic leadership

ACOs

are groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings with the expectation that efficiency as well as quality of care will result in shared savings.

Health insurance marketplaces, also called exchanges

are online insurance supermalls, created for individuals without access to health insurance through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace.

Diagnosis-related groups (DRGs)

are predetermined payment schedules that reflect historical costs for the treatment of specific patient conditions.

Theory X managers-

believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs.

Theory Y managers-

believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

Multiple types of transition-to-practice programs exist

but all are focused on helping nursing students bridge from school into employment.

In decentralized decision making

decision making is diffused throughout the organization, and problems are solved at the lowest practical managerial level.

In centralized decision making

decisions are made by a few managers at the top of the hierarchy.

Ethical frameworks guide individuals in solving ethical dilemmas.

do not solve the ethical problem but assist the in clarifying personal values and beliefs. Self-awareness is a vital leadership role in ethical decision-making; aspect of management

Management

emphasizes control—control of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies—whereas leadership increases productivity by maximizing workforce effectiveness.

Third-party payment for health care escalated

from <20% pre-WWII to 70% by the early 1960s.

Goals and objectives are the ends toward which the organization is working. All philosophies must be translated into specific goals and objectives if they are to result in action.

goals and objectives "operationalize" the philosophy.

California is the only state in the U.S. that has enacted legislation requiring mandatory staffing ratios

in hospitals and long-term care facilities. The answer as to whether mandated ratios have improved care or created new cost burdens for California is still unclear.

Utilization review

is a process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care.

Inactivism

is another type of conventional planning. Inactivists seek the status quo, and they spend their energy preventing change and maintaining conformity. When changes do occur, they occur slowly and incrementally.

Proactive planning

is dynamic, and adaptation is considered to be a key requirement because the environment changes so frequently. Adaptability is a key requirement for proactive planning. Proactive planning occurs, then, in anticipation of changing needs or to promote growth within an organization and is required of all leader-managers so that personal as well as organizational needs and objectives are met.

Responsibility

is related to job assignment and must be accompanied by enough authority to accomplish the assigned task.

Accountability

is the moral responsibility that accompanies a position.

Organizational culture

is the total of an organization's beliefs, history, taboos, formal and informal relationships, and communication patterns. Much of an organization's culture is not available to staff in a retrievable source and must be related by others.

Quantum Leadership

is used by leader-managers to better understand dynamics of environments, such as health care.

Leadership

is viewed by some as one of management's many functions.

Lewin (1951) and White and Lippitt (1960)

isolated common leadership styles: authoritarian, democratic, and laissez-faire.

Social learning theory (Bandura, 1977):

learning from interactions with others in a social context Other learning concepts: readiness to learn; motivation to learn; reinforcement; task learning; transfer of learning; span of memory; chunking; knowledge of results

Benner (1982) suggests that in the transition from novice to expert

nurses develop skills and an understanding of patient care over time through a sound educational base as well as experience. Thus, the new nurse moves from reliance on past abstract principles to the use of past concrete experience and changes his or her perception of situations to whole parts rather than separate pieces.

Patient Protection and Affordable Care Act (PPACA) Put in place comprehensive insurance reforms that were to be phased in over a 4-year period:

oNew Patient's Bill of Rights oBundled payments oAccountable care organizations oHospital value-based purchasing oThe medical home oHealth insurance marketplaces

Reactive planning

occurs after a problem exists; planning efforts are directed at returning the organization to a previous, more comfortable state.

Moral uncertainty or moral conflict:

occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is.

Moral outrage

occurs when an individual witnesses the immoral act of another but feels powerless to stop it

Moral distress:

occurs when the individual knows the right thing to do, but organizational constraints make it difficult to take the right course of action. morally distressed nurses often demonstrate and/or experience: biological, emotional, and moral stress because of this intrapersonal conflict (Edmonson, 2015). anger, loneliness, depression, guilt, powerlessness, anxiety, and even emotional withdrawal. this then leads to turnover as the nurse leaves the stressful situation for a less stressful environment one of the main ethical problems affecting nurses; is a threat to nurses' integrity and to the very essence of quality of patient care.

Closed-unit staffing

occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census.

The structured interview is a much better predictor

of job performance and overall effectiveness than the unstructured interview.

Capital budgets

plan for the purchase of buildings or major equipment. This includes equipment that has a long life (usually greater than 5 years), is not used daily, and is more expensive than operating supplies.

With bundled payments

providers agree to accept a discounted payment either retrospectively or prospectively, which represents a coordinated plan of care for patients over the course of a single episode of an illness.

In value-based purchasing

providers are held accountable for the quality and cost of the health-care services they provide by a system of rewards and consequences, conditional upon achieving prespecified performance measures.

Four Planning Modes

reactive planning, inactivism, pre-activism, or proactive planning

In staffing, the leader-manager

recruits, selects, orients, and promotes personnel development to accomplish the goals of the organization.

The operating budget

reflects expenses that flex up or down in a predetermined manner to reflect variation in volume of service provided

The Medical Home

relies on a team of providers to integrate all aspects of health care through well-developed health information technology, including electronic health records.

Mandatory overtime

should be a last resort, not standard operating procedure because an institution does not have enough staff.

Career planning

should include, at minimum, a commitment to the use of evidence-based practice, learning new skills or bettering practice through the use of role models and mentors, staying aware of and being involved in professional issues, and furthering one's education.

The major defect of the interview is

subjectivity.

As a result of the PPS and the need to contain costs

the length of stay for most hospital admissions has decreased.

Fiscal accountability

to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a staffing budget and meet the needs of patients and staff.

Lewin (1951) identified three phases through which the change agent must proceed before a planned change becomes part of the system:

unfreezing, movement, and refreezing

With DRGs, hospitals join the prospective payment system (PPS

whereby they receive a specified amount for each Medicare patient's admission regardless of the actual cost of care.

Proactive change is generally less emotional than mandated change

yet the lines often blur between the two because proactive change launched by one group may be perceived as mandated change by another

DECISION-MAKING

•A complex, cognitive process of choosing a particular course of action; the thought process of selecting a logical choice from available options

Nonmaleficence

•Actions are taken in an effort to avoid harm

Beneficence

•Actions are taken in an effort to promote good

People maintain a state of status quo or equilibrium by the simultaneous occurrence of both driving forces (facilitators) and restraining forces (barriers) operating within any field.

•Driving forces advance a system toward change; restraining forces impede change. •It suggests that people like feeling safe, comfortable, and in control of their environment. For change to occur, driving forces must be increased or restraining forces decreased.

Planned change results from a well-thought-out and deliberate effort to make something happen.

•It is the deliberate application of knowledge and skills to bring about a change.

ECONOMIC MAN

•Makes decisions in rational manner •Has complete knowledge of problem or situation •Considers all alternatives •Has systematic ordering of alternatives •Selects maximizing choice

Fidelity

•Need to keep promises

Veracity

•Obligation to tell the truth

Right to Die Laws only apply to those patients:

•Older than 18 •With the capacity to make medical decisions •Have a terminal illness resulting in death within 6 months

Paternalism

•One individual assumes the right to make decisions for another

Short-term planning:

•Operational planning that focuses on achieving specific tasks. •Can involve a period of 1 hour to 3 years and are usually less complex than strategic or long-range plans. •May be done annually, quarterly, monthly, weekly, daily, or even hourly. Mental health often improves when we can take some action to resolve the challenges facing us. When we lack the time to resolve those challenges, we feel overwhelmed → leading to increased errors, the omission of important tasks, general feelings of stress and ineffectiveness.

A professional code of ethics is a set of principles, established by a profession, to guide the individual practitioner.

•Professional codes of ethics function as a guide to the highest standards of ethical practice for nurses. However, they are not legally binding.

Autonomy:

•Promotes self-determination and freedom of choice

Justice

•Seeks fairness; treats "equals" equally and treats "unequals" according to their differences

The last phase is refreezing:

•The change agent assists in stabilizing the system change so that it becomes integrated into the status quo. •For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change •If refreezing is incomplete, the change will be ineffective and the pre-change behaviors will be resumed. •Change agents must be patient and open to new opportunities during refreezing, as complex change takes time and several different attempts may be needed before desired outcomes are achieved. •Change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed.

The second phase of planned change is movement:

•The change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces. •Because change is such a complex process, it requires a great deal of planning and intricate timing. •Recognizing, addressing, and overcoming resistance may be a lengthy process, and whenever possible, change should be implemented gradually. •Any change of human behavior, or the perceptions, attitudes, and values underlying that behavior, takes time. •Helping others to change is not just about being nice or nagging; instead, inspiration, goal setting, building trust, and making change a priority are what matter.

Rational-empirical strategies:

•The change agent using this set of strategies assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given information documenting the need for change. •This type of strategy is used when there is little anticipated resistance to the change or when the change is perceived as reasonable. •with the most appropriate strategy for any situation depending on the power of the change agent and the amount of resistance expected from the subordinates.

Utility

•The good of the many outweighs the wants or needs of the individual

Chaos Theory considered by some to be a subset of complexity science; emerged from the early work of meteorologist Edward Lorenz in the 1960s to improve weather forecasting techniques

•about finding the underlying order in apparently random data. •tiny changes in variables often dramatically affected outcomes. •chaotic changes appeared to be random, when they were not; deterministic sequences and physical laws •suggests that even small changes in conditions can drastically alter a system's long-term behavior (commonly known as the Butterfly Effect). •Chaos and complexity theories have great application within the health-care arena.

Moral or Ethical dilemma:

•being forced to choose between two or more undesirable alternatives. (ie: caring for a patient with a treatment that conflicts with religious beliefs)

Complexity Science suggests that the world is complex as are the individuals who operate within it.

•control and order are emergent rather than predetermined, and mechanistic formulas do not provide the flexibility needed to predict what actions will result in what outcomes. •suggests that the actions of any agent within the system affect all other agents in the system; context and action are interconnected. •suggests that there are always hidden or unanticipated elements in systems that make linear thinking almost impossible. •suggests that most powerful change processes occur at the microlevel, where relationships, interactions, and simple rules shape emerging patterns.

Power-coercive strategies:

•features the application of power by legitimate authority, economic sanctions, or the political clout of the change agent. •include influencing the enactment of new laws and using group power for strikes or sit-ins. •assume that people often are set in their ways and will change only when rewarded for the change or when they are forced by some other power-coercive method. •Resistance is handled by authority measures; the individual must accept it or leave.

Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies),

•if actions taken are not grossly negligent, and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services.

Moral indifference:

•occurs when an individual questions why morality in practice is even necessary.

Time management can be defined as making optimal use of available time. Optimizing time management must include:

•priority setting, managing and controlling crises, and balancing work and personal time. •All these activities require some degree of both leadership skills and management functions. Good time management skills allow an individual to spend time on things that matter.

Normative-re-educative strategies:

•use group norms and peer pressure to socialize and influence people so that change will occur. •The change agent assumes that humans are social creatures, more easily influenced by others than by facts; does not require the change agent to have a legitimate power base; gains power by skill in interpersonal relationships, focusing on noncognitive determinants of behavior, such as people's roles and relationships, perceptual orientations, attitudes, and feelings, to increase acceptance of change.