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Nur 4112 class #3
- 1. ORGANIZATIONAL STRUCTURE/MAKING DECISIONS February 21, 2012
- 2. I N T E R R E L AT I O N S H I P O F M I S S I O N, VISION AND PHILOSOPHY Mission Statement: • Tells what the organization does • Defines the purpose and primary objectives • Internal- defines key measures of success for leadership Vision Statement: • Explains why; where it is aiming • Descriptive state of future • External- Shapes customers understanding Philosophy: • Values: How they will do that work- the talk they want to walk
- 3. GROUP PROJECT Search the web and define assigned organizations • Mission Statement • Vision Statement • Philosophy or Values Statement Post on Wallwisher at: http://www.wallwisher.com/wall/Missionvisionvalues
- 4. O RG A N I Z AT I O N A L C U LT U R E The reflection of the norms or traditions of the organization as exemplified through behaviors that illustrate the values and beliefs of the organization.
- 5. C H A R AC T E R I S T I C S O F O RG A N I Z AT I O N A L S T R U C T U R E S Complexity Formalization Centralization
- 6. T Y P E S O F O RG A N I Z AT I O N A L S T RU C T U R E S Functional Service Line Matrix Flat Shared governance
- 7. FUNCTIONAL
- 8. SERVICE LINE
- 9. MATRIX
- 10. FLAT
- 11. SHARED GOVERNANCE Promotes autonomy and accountability Also referred to a professional practice models Magnet hospitals Varies hospital to hospital • Forums • Committees • Councils with authority- organizational
- 12. MAKING DECISIONS AND S O LV I N G P RO B L E M S
- 13. CRITICAL THINKING Critical thinking is the mental process of analyzing or evaluating information • Reflects upon the meaning of statements, examines available date and uses reason to make informed decisions • Necessary to reflect and evaluate from a broader scope of view • more complex than decision making but is needed in order to make good decisions • Nurses us when making decisions, prioritizing and managing the care of clients.
- 14. BLOOM’S TAXONOMY
- 15. AT T I T U D E S O F C R I T I C A L THINKERS Intellectual Humility Intellectual Courage Intellectual Empathy Intellectual Integrity Intellectual Perseverance Faith in Reason Intellectual Sense of Justice
- 16. INTELLECTUAL HUMILITY Knowing what you don’t know Knowing your own personal bias or prejudices
- 17. INTELLECTUAL COURAGE Involves the ability to withhold judgments and conclusions until all the facts are in. Willing to be open to other ideas, beliefs, and concepts
- 18. INTELLECTUAL EMPATHY Being able to imagine yourself in the role of another in order to better understand comprehend and assist the other person in dealing with whatever it is they are face with
- 19. INTELLECTUAL INTEGRITY Hold yourself to the same standard that you hold others.
- 20. INTELLECTUAL PERSEVERANCE Involves taking the appropriate steps and persevering through to the conclusion because the end results is worth the time and trouble.
- 21. FAITH IN REASON The belief that people owe it to themselves and to their profession to develop, maintain and enhance critical thinking abilities and skills.
- 22. INTELLECTUAL SENSE OF JUSTICE The ability to fairly evaluate and reach conclusions based on what is known, not what you or someone else only perceive to be true.
- 23. CRITICAL THINKING Professional Judgment Creativity Decision Making Problem Solving
- 25. CREATIVITY Conceptualizing new and innovative approaches to a problem or issue.
- 26. DECISION MAKING Is a purposeful and goal-directed effort that uses a systematic process to choose among options The process by which a course of action is determined. The course of action may be in response to a problem or an issue.
- 27. DECISION MODELS Satisficing- good enough Optimizing – best possible
- 28. DECISION -MAKING STYLES Autocratic- decide and announce Democratic/participative- group input
- 29. DECISION MAKING TOOLS Decision Grids SWOT
- 30. DECISION GRID
- 31. SWOT Framework for situation analysis Encompasses both internal and external environment • Internal factor: Strengths & Weaknesses • External factors: Opportunities and Threats
- 32. C R E AT E A P L A N O F AC T I O N What steps can you take to: • Capitalize on your strengths • Overcome or minimize you weaknesses • Take advantage of some new opportunities • Respond to the threats • Set goals and objectives, like with any other plan
- 33. SWOT TEMPLATE SWOT Analysis Template Internal Strengths Weaknesses 1. 1. External Opportunities Threats 1. 1. SWOT Analysis Summary
- 34. PROBLEM SOLVING Includes a decision-making step, is focused on trying to solve and immediate problem, which can be viewed as a gap between “what is” and “what should be.”
- 35. P RO B L E M S O LV I N G P RO C E S S Define problem, issue, situation Gather and analyze data All possible solutions are identified and evaluated Select and Implement a solution Evaluate results
- 36. CAUSE & EFFECT DIAGRAMS Also called CEDAC, Fishbone diagram, Ishikawa diagram Identifies many possible causes Can be used to structure a brainstorming session Sorts ideas into useful categories
- 38. PRIORITIZATION Requires decisions be made regarding the order in which • Clients are seen • Assessments are completed • Interventions are provided • Steps in client procedure are completed • Components of client care are completed
- 39. PRIORITIES BASED ON Shift reports and other communications with members of the healthcare team Through careful review of documents By continuously and accurately collecting data
- 40. AT I P R I O R I T I Z AT I O N P R I N C I P L E S Prioritize systemic before local (life before limb) Prioritize acute before chronic Prioritize actual problems before potential future problems Listen carefully to clients and don’t assume Recognize and respond to trends versus transient findings Recognize signs of medical emergencies and complications versus “expected client findings.” Apply clinical knowledge to procedural standards to determine the priority action
- 41. PRIORITY SETTING FRAMEWORKS Maslow’s Hierarchy of Needs Airway Breathing Circulation (ABC) Framework Safety/Risk Reduction Assessment First Survival Potential Least Restrictive
- 42. M A S L OW ’ S H I E R A RC H Y
- 43. ABC FRAMEWORK An open airways is necessary for breathing, so it is highest priority • Identify airway concern • Establish airway if indicated Breathing is necessary for oxygenation of the blood to occur • Assess effectiveness of breathing • Intervene as appropriate (reposition, Narcan etc.) Circulation is necessary for oxygenate blood to reach tissues Disability_ Assess for current or evolving disability
- 44. SAFETY/RISK REDUCTION Look first for a safety risk. Next ask, “What’s the risk to the client?” and “How significant is the risk compared to other posed risks?” Give priority to responding to whatever finding poses the greatest (or most imminent) risk to the client’s physical well-being
- 45. ASSESSMENT FIRST Use the nursing process to gather pertinent information prior to making a decision regarding a plan of action.
- 46. SURVIVAL POTENTIAL Use this framework for situations in which health resources are extremely limited (mass casualty, disaster triage) Give priority to clients who have a reasonable chance of survival with prompt intervention. Clients who have a limited likelihood of survival even with intense intervention are assigned the lowest priority.
- 47. LEAST RESTRICTIVE Select interventions that maintain client safety while posing the least amount of restriction to the client.
- 48. TIME MANAGEMENT Good time management • Facilitates grater productivity • Decreases work-related stress • Helps ensure the provision of quality and appropriately prioritized client care • Enhances satisfaction with care provided Poor time management • Impairs productivity • Leads to feelings of being overwhelmed and stressed • Increases omission of important tasks • Creates dissatisfaction with care provided
- 49. H OW T O O RG A N I Z E C A R E What must be done immediately? What must be done by as specific time to ensure client safety, quality care , and compliance with facility policies and procedures? What must be done by the end of the shift? What can be delegated?
- 50. CYCLIC PROCESS Time initially spent developing a plan will save time later and help to avoid management by crisis Set goals and plan care based on established priorities and thoughtful utilization of resources Complete one client care task before beginning the next, starting with the highest priority task Reprioritize remaining tasks based on continual reassessment of client care needs At the end of the day, perform a time analysis and determine if time was use wisely .
- 51. T I M E M A N AG E M E N T A N D T E A M WO R K Be cognizant of assistance needed by other health care team members Offer to help when unexpected crises occur Assist other team members with provision of care when experiencing a period of “down time.”
- 52. T I M E M A N AG E M E N T & SELF-CARE Take time for oneself Schedule time for breaks and meals Take physical and mental breaks from work/unit
Editor's Notes
- 5 factors that influence an organizational structure Types of service performed or product produced characteristics of the employees performing the service Beliefs and values held by people delivering the service, receiving the service and the employees The technologies used The needs desires and characteristics of the consumers
- Distinguish between Vision and Mission VisionARY- Someone who sees what is possible, who sees potential (Jesus) MissionARY- Someone who carries out that work (Disciples)Your organization’s vision is all about what is possible, all about that potential. The mission is what it takes to make that vision come true.Values: Shared beliefs Should drive the organizations culture and priorities and provide the framework in which decisions are made.
- Zanesville – GenesisNewark- Licking MemorialWooster Community HospitalMedcentral HospitalAshland SamaritanRiverside- Ohio HealthOSU Medical CenterKnox Community
- IncludeRituals/ customary forms of practice-celebrations for promotions, publications, degree attainment, professional performance, weddings and retirementsCharacteristics of people who are recognized as heroes by the organization and the behaviors-either positive or negative- that are accepted or tolerated within the organization.Expressed formally- Mission/vision/values etc. Informally- day to day experience of staff and patients (More true?)
- Must reflect the organization's mission, vision, philosophy , goals and objectivesOrganizational structure defines how work is organized, where decisions are made, and the authority and responsibility of the workerComplexity: Shows- organizational chart, hierarchy, chain of command, span of control Provides the road map .Formalization: the degree in which an organization has rules, stated in terms of policies that define a member’s function- depends on specialization and number of professionals.Centralization: the location where a decision is made. Highly centralized often delegate responsibility (the obligation to perform the task) without authority (the right to act, which is necessary to carry out the responsibility)
- A high degree of formalizationCentralization of decision making at the top of the organizationHierarchy of authority
- Departments and services organized according to specialtyDiscontinuity of patient services because of silo mentality
- Functions necessary to provide a specific service brought together under a single line of authority
- Dual authority for product and function- 2 people responsible for work- need to know who is responsible for what.Mechanisms such a committees to coordinate actions of product and function managersSuccess depends on recognition and appreciation of each others’ missions and philosophies and commitment to the organization’s mission and philosophy
- Decision making concerning work performed, decentralized to the level where the work is doneAuthority, accountability, and autonomy, as well as responsibility, provided to staff performing careLow level of formalization in relation to rules, with processes tailored to meet individual consumer’s needs
- The creation of organizational structures that allow nursing staff more autonomy to govern their practiceRecruitment and retention of nursing staff while meeting patient needs in an effective and efficient mannerGoes beyond participatory management through creation of organizational structure Goes beyond decentralizing and diminishing hierarchiesThe foundation is the professional workplace rather than the organizational hierarchVest necessary levels of authority ad accountability for all aspects of nursing practice in the nurses responsible for the delivery of careRequires new behaviors of all staff- interpersonal relationship development, conflict resolutions, personal acceptance of responsibility for action. Education, experience in group work, and conflict management are essential for successful transitions.Could include quality management, competency definition and evaluation and continuing ed.
- Essential skills for effective nursing practiceEffective critical thinkers are self-aware individuals who strive to improve their reasoning abilities by asking why or how.A nurse who questions why a patient is restless is thinking critically. Compare the analytical abilities of a nurse who assumes a patient is restless because of an upcoming procedure with those of a nurse who asks if there could be another explanation and proceeds to investigate possible causes.
- Knowing what you don’t know- never have taken care of someone with ______. Find someone who has- know you need more infoBias/prejudice- set aside- example drunk driver. Prejudice cannot be allowed to interfere with professionalism and judgment
- A person never knows how well something may work until it is triedCritical thinkers are always open to a new way to accomplish a task
- Imagine if you were the pt who has just been told you have invasive cancer. The MD walks about and states will come back to discuss options. How do you feel? What questions would you have? What are your options? What would you want a nurse to say to you right now?Important to note that some detachment is necessary. If emotion and empathy overwhelm= ineffectualThe nurses role: Advocate for the patient Assist when needed, Facilitate information sharing and communication Help the family deal with the factsIt is not total involvement but does involve awareness of situation and ability to be objective
- Holding your own evidence to the same standard of proof to which you hold others.It is difficult to judge all situations fairly, especially when a person is “married” to a specific idea or conceptCould you argue fairly for a concept that you do not completely believe in or support. While it is more difficult to argue for something , could you?
- Like the tortoise and the hare- not always the fastest win the raceEasy to become frustrated and discouraged while working through tough problemsOften have a high degree of complexity and require a longer period of timeExample constructing, facilitating and then evaluating a telephone triage program for COPD patients
- The critical thinker holds the belief that people have the ability and the desire to think criticallyA nursing instructor demonstrates this faith when facilitating students to develop and answer their own questions about a topicNot a spectator sport; it is a lifelong process that takes practice and thought.
- Situation will be evaluated based on data and facts, not on personal likes or dislikes or the feelings of friends, community, or policy.Many of these areas overlap and seem similar.Just remember that the more you become aware of these attitudes and behaviors, the more you will become a creative, critical thinker.
- Not all decision making begins with a problem situation.Objectives are defined-What is the goal? Is it necessary?Data gathered-Establish needs. Who is affected?Alternatives determined (brainstorm)-.Alternatives evaluated in a logical and object mannerDecision made and choice acted upon./ EvaluatedHallmark of decision making is the identification and selection of options and alternatives.
- Strengths- positive tangible and intangible attributes. Within the organizations control.Weaknesses- detract from the organizations ability to attain the core goal. How to improve?Opportunities- External attractive factors that represent the reason to exist and develop/ time framesThreats- External factors, beyond organizations control that could put organization at risk- need contingency plans
- Stay focused. Be specific. Keep short and simpleAvoid complexity and over analysisLook at issues from customers/stakeholders perspectiveSeparate internal issues from external.Can be subjective/ don’t rely too much on it.Guide not prescription.
- At your table form a swot analysis
- Key questions:Is it important?Is it mine?Am I qualified?Do I have the authority?Do I have the resources?Can I delegate it?What are the benefits of solving the problem?Is part of decision making Potential or actual threat or situation that needs of could benefit from intervention may or may not resolve problem on first attemptNursing process may provide frameworkSteps Problem or issue is identified and defined data collected and analyzed in regard to problem identified all possible solutions identified and evaluated solution selected and evaluated results evaluated.Both require critical thinking which is a high cognitive process ad both can be improved with practice.
- Data should be accurate, relevant, valid and timelyTipsSeek additional informationLearn how others approach problemsObserve positive role models in actionResearch journal articles to expand your knowledge base.Risk using new approaches to problem resolution through experimentation, and calculate the risks to self and others
- Get into your groups for your gap analysis projectAgree on a problem statement (effect)Brainstorm the major categories of the problem (may alter generic headings as needed)-Major categoriesBrainstorm all possible causes of the problem. Ask “Why does this happen?” write as branch of category. Causes can be written in several places if relate to several categoriesAgain as “why does this happen?” about each cause. Write sub-causes branching off the causes. Continue to ask “Why?” and generate deeper levels of causes. Layer of branches indicate causal relationships
- Nurses must continuously set and reset priorities in order to meet the needs of multiple clients and to maintain client safety.
- Prioritizing interventions for a client in shock over a client with a localized limb injuryPrioritizing the care of a client with a new injury/illness (AMS/CP) or acute exacerbation over care of a client with long term chronic illnessPrioritizing admin of medication of client with acute pain over ambulating a client at risk for thrombophlebitisRecognizing a post report of pain could be due to pain other than surgical painRecognizing a gradual deterioration in loc and/o Glasgow coma scaleRecognizing sign of Increased ICP in a client with new CVA versus clinical findings expected following a strokeRecognizing timing of admin of antidiabetic and antimicrobial more important than some other meds
- The nurse should consider Maslows Hierarchy of needs when prioritizing Need for airway, oxygenation (or breathing), circulation and potential for disability over need for shelter Need for a safe secure environment over a need for family support
- Severity of symptom should be considered when determining priorities. A severe circulation problem may take priority over a minor breathing problem.Some frameworks include a D for disability, addressing the high priority given for prevention of disablilities.
- For example is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection injury?
- For example, determine if additional assessment information is needed prior to calling the primary care provider to ask for pain medication for a client (SBAR)
- For example, if a client with a high fall risk index is getting out of bed without assistance, move the client closer to the nurses’ work area rather than choosing to apply restraints.
- Administration of analgesic or antiemetic, assessment of unstable clientMedication administration, vs, glucose monitoring, etcAmbulation of client, discharge and/or discharge teaching, dressing change.What can be done only by RN, what can be delegated, how can scheduled client care activities be shared by team members?See time savers versus time wasters in ati book page 10.