DOCMAN

1. How to build capacity?
An example of nursing systems in
health care organisations.
Prof. Dr. Ulrike Schulze
Prof. Dr. Michaela Zeiß
B.Sc. Nursing (RN) Dominik Advani

2. Contents
1. Capacity building focus: Organization of work
1.1 Congruence principle of the organization
1.2 Existing organizational models of nursing and health work
1.3 Organization: Structure-follows-process
1.4 Capacity of organizations
2. Capacity building focus: Nursing systems
2.1 Primary Nursing as patient orientation
2.2 Structure and process organization of Primary Nursing
2.3 Primary Nurse as process owner
3. Capacity building: Thesis
3.1 Capacity building: Primary Nursing
4. Vision

3. • Description of tasks and workflows / processes
• Continuity and consistency, reliability in the management of processes
• Quality requirements
• Assignment of tasks, jobs, functions to or within the organization (1)
Problem: Work organization is determined by unsystematic everyday routines.
Result: Job, responsibility and competence often diverge (no congruence) and capacity is
limited.
1. Capacity building focus:
Organization of work

4. 1.1 Congruence principle of the
organization
Responsibility
CompetenceWork place
What I am
legitimated for?
Which task
should be
fulfilled?
For which decisions
do I take the
responsibility?

5. 1.2 Existing organizational models of nursing
and health work
Design of care according to areas and
processes
Design of care according to functions
and qualifications.

6. 1.3 Organization: Structure-follows-process
Process
Structure
Structure-follows-process
Is organization flexible
enough
to be aligned with
working procedures?
Which capacities,
personal skills and work
processes are associated
with this?
Nursing system
Potential to failure is
that organizational
structures aren‘t
flexible enough.

7. 1.4 Capacity of organizations
Personal approach
Change of:
• behaviour
• attitude through
learning
processes
Structural approach
Change of:
• technologies
• structure
• hierarchies
Problem: How has the
organizational structure to
change in order to implement
the new care system?
Integrative Approach
With participation of
employees change of culture
and structure!
• uncertainty
• relapse into old
habits
• discouragement
• struggle for power
Problem: Which skills
do employees need
to apply the new care
system?
• fears
• resistance
• struggle for power
1 bis7

8. Team nursing
Hierarchical-centralist
Patients do not have a clear contact
person
Qualification-specific tasks division
Management as an authoritarian system
administrator
Task-specific knowledge
Area nursing
The ward is split in areas and teams
The ward manager decides
There is a task division in the team
Nurses decide and plan their care
Patient knows who is in charge for them
Danger of overloading for the nurses
Hierarchy
2. Capacity Building Focus: Nursing systems

9. 2.1 Primary Nursing (PN) as
patient orientation
• Nurses take responsibility for nursing care
• Responsible for the quality of care the whole time
• Work assignment according to the case method
• Direct communication and interaction with the patient
• Each Primary Nurse is assigned an associated nurse
 Professional approach: nursing is the focus and responsibility of the
nurses

10. 2.2 Structure and process organization of
Primary Nursing
Structure management and PN Process Management and PN
Associate nurseMedical
Nursing
assistant
Health care
services
Primary nurse +
patient
Therapeutic Team
Nursing
assistant
Health care
services
MedicalPrimary nurse
Associate nurse
Therapeutic Team

11. 2.3 Primary Nurse as process owner
Medical
Therapists
PN Associated Nurse
Relative
Case Management
Domestic
Administration

12. 3 Capacity Building: Thesis
First insights:
• We have to define our responsibility. (see focus group 1, participant 6)
• There is not always a shortage of human or time resources, but also
the question of how to use our resources in a meaningful way?! (see
focus group 1, students 4)

13. 3.1 Capacity Building: Primary Nursing
• Does not follow the structural-functionalist concepts of traditional
health care provision in Germany.
• Disciplinary demarcation between professions does not appear to be
suspended, but they are not primarily action-determining.
• Flat hierarchies, coupled with a principle of professional reflection,
characterize teamwork and make it possible to identify specific
competencies that can be described as transdisciplinary.

14. • Interprofessional collegial cooperation
• Process derivation according to the needs and requirements of the client
• Competence-oriented teamwork
Primary Nursing
minimizes disturbances and fears of those involved
and thus minimizes disruptions and fears in the system
4. Vision

15. Sources
1. Bartscher, T., Nissen, R. (2018): Arbeitsorganisation. online:
https://wirtschaftslexikon.gabler.de/definition/arbeitsorganisation-
29839/version-253436, abgerufen am 21.09.2019.
2. Manthey, M. (Hrsg.) (2011): Primary Nursing. Ein personenbezogenes
Pflegesystem. Huber, Bern, S. 195.
3. Elkeles, T. (1994): Arbeitsorganisation in der Krankenpflege. Zur Kritik
der Funktionspflege. Mabuse-Verl., Frankfurt/Main, S. 384.
4. Schäfer, W., Jacobs, P. (2016): Praxisleitfaden Stationsleitung.
Handbuch für die stationäre und ambulante Pflege. Verlag W.
Kohlhammer, Stuttgart, S. 440.