N242 Davis Nursing roles in an organization

3.) structural audits:

assume that a *relationship exists between quality care and appropriate structure*

*Quality Control as a Process*: Steps 4

basic steps: 1.) criterion or *standard must be determined* 2.) information is collected to *determine if the standard has been met* 3.) education or *corrective action is taken if the criterion has not been met* 4.) *benchmarking* measuring how well you do vs. the highest standard. ex: LACCON vs. Yale/Harvard/MIT

organizational theory: *Bureaucracy*

bureaucracy 1.) *clear divisions of labor* 2.) *clearly established vertical hierarchy and roles and rules* within each step 3.) systematic rules and procedures, nothing left unaccounted for. 4.) *employment and promotion based on technical competency.*

1.) philosophy:

describes the *beliefs, values*, assumptions, *and goals of the institution.*

1.) overcome audits:

determine what results occur as a *result of the specific nursing interventions.*

stakeholders:

internal or external stimulus who *may or may not feed money or political favors* or moral merit into the system in order *to have their interests benefit.*

1.) authoritarian:

strict schedules, get the job done, *strong control*

*Quality Control*: def/characteristics

that are used to evaluate, monitor, or *regulate services rendered to consumers*. *Hallmarks of effective Quality Control programs* 1.) *support from top-level* administration 2.) *commitment* by the organization 3.)goals reflect search for excellence 4.) ongoing process

*Quality Improvement theories* (TOM/CQI/TPS)

the focus of all thee methods is continuous quality *improvement* s opposed to just meeting a standard. 1.) TOM: total quality management 2.) CQI: continuous quality improvement 3.) TPS: Toyota Production system

external quality control

the joint commission: monitoring and evaluation process 1.) QA program 2.) sentinel events 3.) ORYX 4.) core measures 5.) national patient safety goal

interactional theories

1.) *leadership behavior is generally determined by the relationship between the leader's personality and specific situation.* 2.) leader and follower contributing to the working relationship and both receiving something from it 3.) leadership is a dynamic two-way process. 4.) there are 3 types of leadership interactions: X, Y , and Z

leader: *characteristics* 3

1.) *no delegated authority*, given authority by followers. 2.) emphasizes the interpersonal relationships to build rapport with followers 3.) *goals that may or may not reflect those of the organization*

interactional theories: *Theory y*

1.) *the employee is intrinsically motivated* 2.) seeks responsibility: asks "is there anything more i can do" 3.) *works hard to get rewards* 4.) self direction and self control

*Full-Range leadership*

1.) *using leadership skills from both the transformational theory and the transactional theory* as the situation arises. 2.) good problem solvers 3.) *reward those that behave properly.*

*great man theory / trait theory*

1.) Trait like congenital, you're *born* with it. born to lead or born to be led 2.) personality traits such as that develop early in life make the person a better leader 3.) *the leader arises when the situation demands it.*

*Development of Standards*

1.) a *predetermined level of excellence that serves as a guide for practice* 2.) used as measurement tools, they must be *objective, measurable, and achievable* 3.) ANA scope and standards of practice and standards of professional performance

the three basic elements of a leadership

1.) a leader 2.) a group to lead 3.) situation to work on

*Risk Management*: def

1.) attempts to *analyze problems and minimize losses after a patient care error occurs* 2.) directed towards identifying, evaluating and *fixing risks that could injure the pt or the staff.* 3.) report it so that the factors that caused the error might be corrected. ex: drug labels that are written very tiny or are all the same color.

interactional theories: *theory z*

the newest theory "Japanese" 1.) *consensus decision making* 2.) strong bonds of responsibility 3.) *lifetime employment and slower promotions* 4.) *holistic concerns for workers.* modification of theory y

decision making: 3 kinds-*Centralized/Decentralized/Stakeholders*

1.) centralized: *managers at the top of the hierarchy make all the decisions.* 2.) decentralized: *diffuses decision making throughout the organization* 3.) stakeholders: internal or external stimulus who *may or may not feed money or political favors* or moral merit into the system in order *to have their interests benefit.*

risk management: functions

1.) define situations that place the system at *financial risk* 2.) determine *frequency of occurrences* 3.) *intervene* and investigate identified events 4.) identify potential risk or opportunities to *improve care*

relationships and chain of command: *Horizontal Lines/Vertical Lines/Dotted Lines*

1.) horizontal lines: communication *between people of the same level but with different roles* 2.) vertical lines: formal paths of communication and authority up the *"chain of command"* 3.) dotted or broken lines: represent *staff positions*

*Transactional leader*

1.) is a caretaker 2.) *does not identify shared values* 3.) *minimizes errors* 4.) examines causes 5.) *punishes deviation* from the norm with impunity 6.) *will bribe you to do more labor*

*Law of situation* and *contingency approach* theories

1.) leadership styles should vary according to the situation or the individuals involved. 2.) follows *law of situation*: The *situation should determine the directives* given after allowing everyone to know the problem. 3.) contingency approach:* no one leadership style is ideal for every situation.*

organizational structures: 5 of them-*Line Structure/Ad Hoc Design/Matrix Structure/Service Line Organization/Flat Design*

1.) line structures: *authority and responsibility are clearly defined* 2.) ad hoc design: *facilitate completion of a project*, disband after. 3.) matrix structure: *focus on product and function* 4.) service line organization: *address the shortcomings* 5.) flat designs: *remove hierarchical layers*

*Centrality*

1.) location of a *position on an organization chart where frequent and various types of communication occur.* 2.) a *middle manager* often has a large degree of centrality because they are dealing with orders from the top and bullshit from the bottom. 3.) middle manager needs good people skills to handle everyone

Joint Commission: *hospital accreditation*

1.) offers an objective *evaluation of an organization's performance* 2.) stimulates the *organization's quality improvement efforts* 3.) *enhances professional recruitment* 4.) *influences liability insurance* 5.) influences managed care contracts

*organizational culture & organizational climate*

1.) organization culture: how we split our duties *how we behave within the hierarchy* ex: how we behave with the doctors. 2.) organizational climate: *how we think the workplace is*. our perception of it. "fair" "friendly"

leader: def 3

1.) outgoing, risk takers, goal oriented, inspire others 2.) has *willing* followers 3.) influences and guides direction, opinion, and course of action.

Audits: *Overcome audits/Process audits/Structural audits*

1.) overcome audits: determine what results occur as a *result of the specific nursing interventions.* 2.) process audits: *measure how nursing care is provided* 3.) structural audits: assume that a *relationship exists between quality care and appropriate structure*

meeting the clients and agency goals-*Philosophy/Policies/Procedures*

1.) philosophy: describes the *beliefs, values*, assumptions, *and goals of the institution.* 2.) policies: are *general descriptions of the agency approach to achieve goals* in an expedient manner. 3.) procedures: describe a *specific process needed to complete a task.*

organizational structure: *Formal/Informal*

1.) refers to a way in which the group is formed, its line of communication and its means for channeling authority and making decisions. 2.) formal: *provides a framework* for defining managerial authority, responsibility, and accountability. 3.) informal: is generally a *naturally forming social network* of employees

components of organizational structure

1.) relationships and chain of command 2.) span of control 3.) managerial levels 4.) centrality

*medical errors*: how to minimize

1.) reporting and analyzing errors 2.) the leapfrog group: like yelp but for hospital safety. 3.) a six sigma approach: like a *rating system* for the amount of errors an institution has as a whole. the less the better. 4.) reforming the medical liability system

auditing quality control

1.) set the rules higher in the chain of command"establishing control criteria" 2.) *make judgement about how the quality has been controlled to meet the standards based on collected data* 3.) take corrective action and reevaluate 4.) *root cause analyses: a reactive plan to get rid of the culprit of errors*

interactional theories: *Theory x*

1.) the *employee dislikes work and will avoid it* 2.) takes no responsibility 3.) only wants money/security 4.) *must be controlled and threatened*

*Span of Control*

1.) the *number of people that directly report to the manager* 2.) the ideal amount is anywhere from 3 to 50 employees

managerial levels: *top, middle, first*

1.) top-level managers: *CEO or district manager*. coordinates internal and external influences. needs experience 2.) middle-level managers: *coordinate the efforts of the lower level of the hierarchy* and are the channels between the lower and top level managers 3.) first-level managers: are concerned with their *specific unit's work flow.*

*leadership theories* 5

1.) trait theory/great man theory 2.) behavioral 3.) situation and contingency 4.) interactional 5.) transactional & transformational 6.) full-range

Characteristics of a nurse manager: 5

1.] assigned position but not necessarily a leader* 2.] responsible for your schedule 3.] hires and fires 4.] directs willing and unwilling subordinates 5.] *accountable* for what may happen in the unit that is under their direct control.

what is at the bottom of hierarchy

theory x

what theory has slower promotions

theory z

we need this amount of nurses for the floor 3 for morning and two for evening and i clerk .. what type of leadership

transactional

what leadership focuses on day to day

transactional

4.) service line organization:

*address the shortcomings

1.) line structures:

*authority and responsibility are clearly defined

Behavioral Theory-*authoritarian/democratic/laissez faire*

*based on how the leader/manager chooses to set the tone of the work environment* analyzed in the perspective of behavior. 3 general paths: 1.) authoritarian: strict schedules, get the job done, *strong control* 2.) democratic: *decision making involves the group in helping shape the goals/rules* to an extent. 3.) laissez faire: *permissive, very little control* exercised from superiors. "let do" french translation.

2.) democratic:

*decision making involves the group in helping shape the goals/rules* to an extent.

2.) decentralized:

*diffuses decision making throughout the organization*

2.) ad hoc design:

*facilitate completion of a project*, disband after

3.) matrix structure:

*focus on product and function*

organizational climate:

*how we think the workplace is*. our perception of it. "fair" "friendly"

TOM (*Total Quality Management*)/CQI (*Continuous quality improvement*)

*interchangeable systems*. very similar. 1.) the individual customer is the focal element on which production and service is dependent. *satisfying the customer is the hallmark* of a good product. 2.) *empowerment of employees* 3.) *quality is more important than profit*

1.) centralized:

*managers at the top of the hierarchy make all the decisions.*

3.) laissez faire:

*permissive, very little control* exercised from superiors. "let do" french translation.

5.) flat designs:

*remove hierarchical layers*

*transformational leadership*

1.) *both leaders and followers have the ability to raise each other* to higher levels of motivation and morality 2.) the manger i committed, has a vision, and is able to empower others with his vision. 3.) lead followers to levels of higher morals

TPS (*Toyota Production System*) quality improvement

1.) *eliminate problems at their root* (root cause) 2.) *decentralized problem solving*. solve the problem yourself, no need to take it to management if it's within your power to fix. 3.) can be summarized as: wringing water out of a wet towel. efficiently eliminating "waste" (oversupply, waste of effort, waiting, defective products)

*Transactional leadership*

1.) *focused on finishing the goal at all costs. goal comes first.* 2.) focused on the task of management and the *goal to reward system* 3.) management-by-exception: *handling any deviations from the norm quickly and efficiently*

Management

1.) *handles resource distribution, manipulating the environment and subordinate job duties, and money.*

*transformational leader characteristics*

1.) *identifies common values* 2.) is committed 3.) inspires others with vision 4.) has long-term vision 5.) looks at effects 6.) *empowers others*

*limitation of organization charts*

1.) *informal structure* 2.) authority: *nsg manager is actually the one who has the highest authority over the individual RN.* 3.) responsibility 4.) accountability: *might not be as clear who is responsible* or accountable for the situation

2.) policies:

: are *general descriptions of the agency approach to achieve goals* in an expedient manner.

3.) procedures:

: describe a *specific process needed to complete a task.*

*Audits*

A systematic and official examination of a record, process, structure, environment, or an account to *evaluate performance* 1.) retrospective audits 2.) concurrent audits 3.) prospective audits

process audit

Review how care was provided and assume a relationship exist between nurses and the quality of care provided

2.) follows *law of situation*:

The *situation should determine the directives* given after allowing everyone to know the problem.

1.) organization culture:

how we split our duties *how we behave within the hierarchy* ex: how we behave with the doctors.

who knows everything about you leader or manger

leader

3.) contingency approach:*

no one leadership style is ideal for every situation.*