Download OrganizationPPT - Austin Community College

Understanding and Working in Organizations
5/25/2017
Carolyn Morse Jacobs, Rn, MSN, ONC
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Understanding Organizations
Defined
Organizations
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Formally constituted groups of people who work
together
Have identified tasks to achieve a specific
purpose defined by the organization
Defined by unique purpose and structure
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Organizational structure includes
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How the group is formed
Chain of command
Lines of communication
How decision-making occurs
Max Weber, the Father of
Organizational Theory!
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To understand organizations
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Organizational function: is it parallel to organization
structure?
Structure of organization
 Must accomplish its purpose in effective way…make
money!
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Understanding Organizational Structure (know definitions/
advantages/ disadvantages)
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Tall or centralized structure
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Has “core” individuals; few in power
“Narrow” area of responsibility
Problems in communication
Flat or de-centralized structure
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Decision-making “spread-out”
Simplification of communication
“Charge person” with broad span of control
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Understanding Organizational Charts cont
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Matrix Structure*
Secondary lines of authority
 Typical of large organizational structures
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• Characterized by having individuals with expertise as resources
• Team approach to problem solving!
• Involves a two directions for lines of authority, accountability and
communication
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Understanding Organizations
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Adhocracy
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Bureaucracy and “adhoc” type structure using teams as
specialists; has director
Special projects
Shared governance
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Professional practice model
Increasing importance
Various models, widely used in nursing, facilitates nursing input
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Understanding Organizational Charts
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Provides graphic description of roles and patterns of
interactions among parts of the system
Shows formal structure of organization
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Solid lines: communication relationships
Vertical lines: lines of authority; chain of command
Dotted lines: advisory
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Hospital Organizational Charts
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Organizational Chart
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Answer these questions
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What do the vertical lines represent on an organizational chart?
Lines of authority and accountability= chain of command
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What do the horizontal lines represent?
Communication among individuals with similar levels of authority; no authority, same “work”
level
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A dotted (or broken) line in an organizational chart indicates what type of
relationship among individuals?
A communication relationship…not an authority relationship!
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More on understanding organizations…defining characteristics
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Authority
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Responsibility
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Official power from top down; earned
Ethical and legal obligation
Accountability
Involves liability
 (Delegation)
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Answer this question!
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When the RN “delegates a task to a UAP…who is
accountable for performance of that task?? (see
p 48)
When the nurse delegates (assigns) a task to a UAP (unlicensed assistive personnel) the nurse is still
accountable/responsible for performance of that task!
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Relationships within Organizations
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Chain of Command
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Also known as “organizational hierarchy”
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Identifies path of authority and accountability!
Span of control
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Number of individuals a person is responsible for
The greater the # the more authority and responsibility &
greater span of control
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Channels of Communication
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Formal and informal pathways
Think about advantages/disadvantages of each and effect on clinical work!
Formal
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Informal
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Understanding Organizations
 Mission Statement
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“Why” of existence
Describes what the organization plans to accomplish, aims or function
Generally very brief
 Philosophy
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Results from “mission” statement
Generally a listing of beliefs and values
Promotes quality care
Sets “Benchmark” to evaluate the organization’s performance
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Understanding Organizations
 Policy
 Plan or course of action for specific situation (such handling
rape victims)
 Found in policy manual
 Procedure
 “How” a specific activity is to be carried out, the actual steps
 Found in a procedure manual
 Standard of Care
 Authoritative statement to describe acceptable level of care
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Relationships within Organizations
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Job Descriptions
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Written statements
Provides general guidelines for function
Outlines scope of authority, responsibility, and
accountability
Basis for evaluation
Found in policy manual
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Consider these questions
1. Why would a nurse find it useful to understand organizational
structure?
2. Give one example of a situation in which a nurse might find it
helpful to understand organizational structure.
3. Give one example of how a nurse participates in shared
governance..
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Review your answers:
1. Why would a nurse find it useful to understand organizational
structure?
1.
Work more effectively within organization
2. Give an example of a situation in which a nurse might find it
helpful to understand organizational structure.
1.
A nurse identifies a need to change a procedure; would need to know the
organizational structure to determine “who” has authority to make changes and
how change occurs.
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Review your answers:
3. Give one example of how a nurse participates in shared
governance.
Mary, RN, was elected as Medical-surg floor representative to the Shared
Governance committee; nurses have complained that the new rotation schedule is not
satisfactory; staff is dissatisfied and are leaving. What are the options besides everyone
having to work every other weekend?
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Consider this question
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Which statement BEST describes a “Matrix” organization?
1.
Decision-making by a few people “at the top”
2.
Lines of communication and accountability highly structured
3.
Authority and accountability widely dispersed within organization; not one person in
charge
4.
Involves a secondary structure with two directions for lines of authority,
accountability and communication
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Consider this question

Which statement BEST describes a “Matrix” organization?
1.
Decision-making by a few people “at the top”
2.
Lines of communication and accountability highly structured
3.
Authority and accountability widely dispersed within organization; not one person in
charge
4.
Involves a secondary structure with two directions for lines of authority,
accountability and communication
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Try another question!
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1. As a recent graduate, you are seeking information on
“criteria for promotion and advancement through the clinical
ladder”. Where will you go to find this information?
 a. ask your charge nurse
 b. contact the hospital administrator
 c. ask another nurse
 d. consult the policy manual
 e. consult the procedure manual
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Try another question!

1. As a recent graduate, you are seeking information on
“criteria for promotion and advancement through the clinical
ladder”. Where will you go to find this information?
 a. ask your charge nurse
 b. contact the hospital administrator
 c. ask another nurse
 d. consult the policy manual
 e. consult the procedure manual
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Structuring Delivery of Nursing Care
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Case Method
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Functional Method
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1st type; hired for individual patient; provide all care; “home health”
1930’s model; task assignment such as one nurse do all medications or treatments;
used in nursing homes
Team Nursing
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1950’s model; use of RN, LPN, UAP.
Team leader gives assignments; have team conference
Variation emerging today
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Structuring Delivery of Nursing Care cont
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Modular Care variation of team nursing
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Primary Nursing
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1970’s-1980’s
“Primary” nurse develops, update care plans, plan discharge. RN has 24 hour
responsibility for patient’s care for duration of stay in hospital.
Considered “too” expensive; required decision-making skills; need for BSN’s
Total Patient Care
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1980’s replacement for Primary Care Model. RN, LPN assigned to give all care to
group of 4-6 patients. Assigned nurse has responsibility for care only during
his/her shift.
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Structuring Delivery of Nursing Care cont
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Case Management Method
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Monitors individual patient needs to achieve best outcome
Beyond primary care; works with multiple disciplines
No “direct” care; education and experience required
Partnership Model
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Also called “care pairs”
Care provided by RN working with LVN or UAP (usually) to groups of patients
RN has accountability and responsibility
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Culture and Climate of the Organization
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Informal organization and YOU!
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Social Needs
Organizational goals met, even informally
Communication
• Share information
• Job information
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Preserving group values
Leadership development (skills and abilities; changing)
Informal organization: why a risk?
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Undermine authority
Have “outsiders”
“Grapevine messages”
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Organizational Culture and Climate
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Organizational climate
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Perceptions held by employees
Influenced by organizational culture
Multiple factors influence
• Should be positive, compatible values
• Sum total of values, formal and informal communications
• Not static
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Your role as a new nurse within the organization
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Test Your Knowledge
Which of these is a function of the informal organization?
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Establishing lines of authority
Perpetuating cultural values and norms
Making organizational decisions
Evaluating performance
1.
2.
3.
4.
Which form of health care delivery has a nurse monitor the patient’s interaction
with the entire health care system?
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1.
2.
3.
4.
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Primary nursing
Case method
Total patient care
Case management
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Test Your Knowledge
Which of these is a function of the informal organization?

Establishing lines of authority
Perpetuating cultural values and norms*
Making organizational decisions
Evaluating performance
1.
2.
3.
4.
Which form of health care delivery has a nurse monitor the patient’s interaction
with the entire health care system?

1.
2.
3.
4.
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Primary nursing
Case method
Total patient care
Case management*
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