5.-ORGANIZING-1.pdf

ORGANIZATION MANAGEMENT FUNCTION  DISCLAIMER  This presentation is intended for educational purposes only and do not replace independent professional judgment. Information herein presented are taken from the following resources:...

ORGANIZATION MANAGEMENT FUNCTION  DISCLAIMER  This presentation is intended for educational purposes only and do not replace independent professional judgment. Information herein presented are taken from the following resources: Leadership and Management in Nursing, A Transformative and Reflective Patient Care 2nd Edition by Tan & Beltran Marquis, B. L., Huston, C. J. (2015). Leadership roles and management functions in nursing: theory and application, 9th ed. University of Bohol College of Nursing   the form of every human association for the attainment of a common purpose.  An act of putting into systematic relationship those elements and activities essential to the satisfaction of the purpose.  Serves as a facilitating agency in the achievement of a purpose  A form of identifying roles and relationships Definitions of each staff in order to delineate specific tasks or functions that will carry out organizational plans and objectives  Process of identifying and grouping the work to be performed, defining and delegating responsibility and authority, and establishing relationships for the purpose of enabling the people to work most effectively together in accomplishing objectives. University of Bohol College of Nursing  Organization is…  It is both a function and a framework or a process and structure.  It is both a human activity, and at the same time, it is a group of people.  It is deliberately designed and exists because of an objective which is geared towards efficient and effective goal attainment.  Organizing determines what tasks are to be done, who is to do these, how the tasks are to be grouped, who reports to whom and what decisions are to be made. University of Bohol College of Nursing  Characteristics of Bureaucracy by Weber: There must be a clear division of labor A well-defined hierarchy of authority must exist in which superiors are separated from subordinates ORGANIZATIONAL There must be impersonal rules and THEORY impersonality of interpersonal relationships. A system of procedures for dealing with work situations (i.e., regular activities to get a job done) must exist. A system of rules covering the rights and duties of each position must be in place. Selection for employment and promotion is based on technical competence. University of Bohol College of Nursing  Organization as a Process 1. Identification and definition of basic task of individuals at work such as staffing and creation of job descriptions. 2. Delegation of authority and assignment of responsibility to each member of the team for the accomplishment of activities 3. Establishing relationships of people by providing a system of vertical and horizontal communications through hierarchal relationships to bind and coordinate all the activities to be done. University of Bohol College of Nursing  Organization as a Structure 1. Objectives and plans of the unit or area of assignment 2. Lines of authority, responsibility and accountability 3. Environment within which it is to function 4. Quality of available manpower to run it. University of Bohol College of Nursing   1. Formal Organization – a system of well-defined jobs, each with a measure of authority and responsibility and accountability.  2. Informal Organization – refers Categories largely to what people do because they are human personalities and to their actions in terms of needs, emotions and attitudes and not in terms of procedures and regulations. University of Bohol College of Nursing   Division of work = each box represent an individual or sub-unit responsible for a given task Chain of command = lines indicating Characteristics  who reports to whom and by what of an authority Organization  Types of work segments = shown by clusters of work groups  Levels of management = hierarchal relationships University of Bohol College of Nursing  Top-level managers look at the organization as a whole, coordinating internal and external influences, and generally make decisions with few guidelines or structures. Middle-level managers coordinate the MANAGERIAL efforts of lower levels of the hierarchy and LEVELS are the conduit between lower and top- level managers. First-level managers are concerned with their specific unit’s workflow. University of Bohol College of Nursing   A process used to improve the probability that an organization will be successful. It is a formal, guided process for integrating the people, information and technology of an organization. Organizational  It is used to match the purposes with Design the operations undertaken and improve collective efforts of members to ensure success  It is guided by external facilitators whose role is to assure a systematic process and to encourage creative thinking. University of Bohol College of Nursing  We recognize that acting alone limits our ability to achieve our goals, and that by acting as a group, we come up with collective efforts to overcome individual limitations. REASONS The best way for an FOR organized group to succeed. ORGANIZING The end result of effective organizational design. University of Bohol College of Nursing  Division of labor – promotes departmentalization and specialization Unity of Command – follows a line of command or vests it in one superior ensures unity of vision Principles of Authority and responsibility – determine the line Organizational and staff authority, which delineates the distribution of power Design Span of control – determines the extent of control in each level, area or unit within the system Contingency Factors – environment and technology or knowledge of team members University of Bohol College of Nursing  Organizational Chart University of Bohol College of Nursing  Organizational Structure  It is a formal system of task and reporting relationships that controls, coordinates, and motivates employees so that they cooperate to achieve an organization’s goal  It is a formal structure, the official arrangement of positions or working relationships that will coordinate efforts of workers of diverse interest and abilities. University of Bohol College of Nursing  Tall or Centralized Structure Patterns of Organizational Structure Flat or Decentralized Structure University of Bohol College of Nursing  Line organization/Bureaucratic/Pyramidal Flat organization Staff organization Types of Functional organization Organizational Structure Ad Hoc organization Matrix Organization Shared Governance organization Lateral organization University of Bohol College of Nursing  Organizational relationships depicts the nature and status of workers in an organization. Formal – represented by Organizational uninterrupted lines between units, Relationships showing who reports to whom Informal – represented by a broken line or dotted line where no direct power relationships and responsibilities are merely coordinated. University of Bohol College of Nursing  The personality of the organization comprised of the assumptions, values, norms and tangible signs of the corporation, as well as its attitudes, feelings, beliefs, norms and customs. Organizational Culture Is a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common. University of Bohol College of Nursing  What is the organization’s physical environment? What is the organization’s social environment? Assessing How supportive is the organization? Organizational What is the organization’s power culture? Culture How safe is the organization? What is the communication environment? What are the organizational taboos? University of Bohol College of Nursing   Tough-Guy Macho Culture = Feedback is quick and the rewards are high. This often applies to fast moving financial activities such as a brokerage.  Work Hard/Pay Hard Culture = characterized by few risks being taken, all with rapid feedback. DIFFERENT TYPES People work hard on the grounds of their assigned tasks and are appropriately OF compensated on their work output. ORGANIZATIONAL  Bet your Company Culture = involves high stakes CULTURE but delayed feedback. Big stakes decisions are taken, by the company with less rewards and it may be years before the results are known.  Process Culture = formed in organizations where there is little or no feedback. People become bogged down with how things are done not with what is to be achieved. University of Bohol College of Nursing   The structure should be clearly defined so that employees know where they belong and where to go for assistance.  The goal should be to build the fewest possible management levels and have the shortest possible chain of command. This eliminates friction, stress, and inertia.  The unit staff need to be able to see where their tasks fit into common tasks of the organization. Organizational  The organizational structure should enhance, Effectiveness not impede, communication.  The organizational structure should facilitate decision making that results in the greatest work performance.  Staff should be organized in a manner that encourages informal groups to develop a sense of community and belonging.  Nursing services should be organized to facilitate the development of future leaders. University of Bohol College of Nursing  The Manager’s Task  The task of a manager is to create an organizational structure and culture that: 1. Encourages employees to work hard and to develop supportive work attitudes 2. Allows people and groups to cooperate and work together effectively University of Bohol College of Nursing  ORGANIZING STAFFING University of Bohol College of Nursing  Process of assigning competent people to fill the roles designated for the organizational structure through recruitment, selection and development. Staffing Apart from recruitment, selection and hiring, this also includes induction and orientation of the new staff. University of Bohol College of Nursing  Accurately predicting staffing needs is a crucial management skill because it enables the manager to avoid staffing crises. Predicting Staffing Managers should know the source of their Needs nursing pool, the number of students enrolled in local nursing schools, the usual length of employment of newly hired staff, peak staff resignation periods, and times when the patient census is highest. University of Bohol College of Nursing  1. Determine the number and types of personnel needed 2. Recruit personnel Steps in 3. Interview Staffing 4. Induct or Orient the Personnel (indoctrination) 5. Job Offer University of Bohol College of Nursing  Recruitment is the process of actively seeking out or attracting applicants for existing positions and should be an ongoing process. An interview may be defined as a Terminologies verbal interaction between individuals for a particular purpose. Selection is the process of choosing from among applicants the best qualified individual or individuals for a particular job or position. University of Bohol College of Nursing  Indoctrination refers to the planned, guided adjustment of an employee to the organization and the work environment. The induction process includes all activities Terminologies that educate the new employee about the organization and employment and personnel policies and procedures. Induction provides the employee with general information about the organization, whereas orientation activities are more specific for the position University of Bohol College of Nursing   Managers should do what they can to see that employees feel University of Bohol College of Nursing they have some control over scheduling, shift options, and Staffing and staffing policies Scheduling as  Creates safe staff practices for Unit equitable nurse-patient Manager’s assignments on a regular basis Responsibility  The overall responsibility for scheduling is an important function of first & middle level managers.   Centralized Staffing = staffing decisions are made by personnel in University of Bohol College of Nursing a central office or staffing center  Decentralized Staffing = the unit Centralized manager is often responsible for and covering all scheduled staff absences, reducing staff during Decentralized periods of decreased patient census Staffing or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules  STRENGTHS LIMITATIONS Decentralized Managers retain greater control can result in more special Staffing over unit staffing pleading and arbitrary Staff are able to take requests treatment of employees directly to their manager May not be cost effective for Provides greater autonomy and organization because staffing flexibility for individual staff needs are not viewed members holistically Centralized Provides organization-wide Provides less flexibility for the Staffing view of staffing needs, which worker and may not account encourages optimal utilization for a specific worker’s desires of staffing resources or special needs Staffing policies tend to be Managers may be less employed more consistently responsive to personnel and impartially budget control in scheduling More cost-effective and staffing matters Frees the middle level manager to complete other management functions University of Bohol College of Nursing  University of Bohol College of Nursing  Nurse-managers must be cognizant of new recommendations and Complying legislation affecting staffing with Staffing  Mandatory licensed staffing Mandates requirements  Mandatory staffing ratios in states   10- or 12-hour shifts University of Bohol College of Nursing  Premium pay for weekend work (Agency or Travel Nurses)  Part-time staffing pool for weekend shifts Common and holidays. Staffing and  Cyclical staffing, which allows long-term Scheduling knowledge of future work schedules because a set staffing pattern is Options repeated every few weeks.  Job sharing  Allowing nurses to exchange hours of work among themselves   Flextime is a system that allows employees to select the time schedules University of Bohol College of Nursing that best meet their personal needs while still meeting work responsibilities. Common  Use of supplemental staffing from outside registries and float pools Staffing and  Staff self-scheduling allows nurses in a Scheduling unit to work together to construct their Options own schedules rather than have schedules created by management.  Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime  Minimum Criteria for Safe Staffing 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. Long-term as well as short-term solutions must be sought. Patient care must not be jeopardized. University of Bohol College of Nursing   Is a plan that articulates how many and what kind of staff are needed by shift and day to staff a unit or department. STAFFING  It can be generated by determining the nursing care hours PATTERN needed for a specific patient or patients and then generating the Full Time Equivalents (FTEs) and staff-to-patient ratio needed to provide that care. University of Bohol College of Nursing   Benchmarking = a management tool for seeking out the best practices in one’s industry so as to improve performance and be competitive with other productive companies in terms of quality of services rendered.  Regulatory Requirements = as mandated by RA 5901 Considerations  Skill Mix = the percentage or ratio of in Staffing professionals to non-professionals. Staff Support = necessary for the operations of Pattern  the unit (e.g. system in delivering medications,). The less support available to the staff, the more nursing hours have to be built in the staffing pattern to provide quality care to patients.  Historical information = must be kept intact to ensure effective ways of doing tasks. (absence of equipments, etc.) University of Bohol College of Nursing  1. Acuity of the patient’s illness Factors affecting 2. Degree of dependence of the time patients on caregivers requirement 3. Communicability of the ailment for nursing care 4. Rehabilitation needs and special treatments and procedures University of Bohol College of Nursing  Formula to determine staffing patterns 1. Full time Equivalents (FTE) – it measures the work commitment of a full time employee. (5 days a week, 40 hours a week for 52 weeks in a year) X = Total Nursing Care Hours x days in a year Total annual hours per one FTE University of Bohol College of Nursing  Formula to determine staffing patterns 2. Forty Hour Week Law (RA 5901) Average Bed Occupancy x Nursing Care hours = Total No. of personnel in 24 No. of Working Hours hours University of Bohol College of Nursing  40 hour week law A. Standard value for NCH AREA NCH AREA NCH Surgery 3.4 Nursery 2.8 General Ward 3.5 Medical 3.4 Pediatrics 4.6 OB 3.0 Mixed M/S 3.4 University of Bohol College of Nursing  b. Percentage of Professional and Non-professional (in ratio) Area Ration Surgery 60:40 Gen. Ward 60:40 OB 60:40 Pedia 70:30 Nursery 55:45 ICU 80:20 University of Bohol College of Nursing  Rights/Privileges Working hours Per week of Personnel 40 hours 48 hours Vacation leave 15 15 Sick leave 15 15 c. Distribution per Shift holidays 12 12 Shifts: continuing 3 3 AM =45% Off duties 104 52 PM =37% Total non 149 97 NOC = 18% working days/year Total working 216 268 days/year University of Bohol College of Nursing TOTAL 1,728 2,144  d. 40 hour / week – for personnel working in hospitals with 100 bed capacity or over or which is located in a 1 million population e. 48 hour / week – personnel who work in agencies with lesser bed capacity or which are located in communities with less than 1 million population University of Bohol College of Nursing  GUIDELINES for determining the Nursing personnel need  Determine type of hospital (primary, secondary or tertiary) e.g : Hospital A is a 100 bed capacity secondary level hospital  Categorize patients according to levels of care category primary secondary tertiary Minimal care 70% 65% 35% 100 pts x 65% = 65 pts needing minimal care Intermediate care 25% 30% 45% 100 pts x 30% = 30 pts needing intermediate care 100 pts x 5% = 5 pts needing intensive care Intensive care 5% 5% 20% University of Bohol College of Nursing   Find the NCH needed by patients per day and get the SUM Minimal Care = 1.5 hours Minimal care = 65 x 1.5 hrs = 97.5 NCH Intermediate care = 30 x 3 hrs = 90 NCH Intermediate Care= 3 hours Intensive care = 5 x 4.5 hrs = 22.5 NCH TOTAL: 210 NCH/day Intensive Care = 4.5 hours  Find the Total NCH x 365 days (210 NCH per day x 365 days = 76, 650 NCH in a year)  Find the number of working hours per year (refer to table 40 wk Law) 40 hrs/wk = 215 x 8 hours = 1,728 working hours/yr 48 hrs/wk = 268 x 8 hours = 2,144 working hours/yr University of Bohol College of Nursing  Find the Nursing personnel needed. Number of needed personnel = NCH per year 76, 650 NCH/yr = 44 nursing personnel 1,728 wrk hrs/yr (40 h /wk) Working hours per year Number of relievers needed = No. of personnel x 0.095 44 nursing personnel x 0.095 = 4 nursing relievers  Add nursing personnel and relievers 44 nursing personnel + 4 relievers = 48 nursing employees University of Bohol College of Nursing   Categorize into professional and non-professional Primary = 55.45 48 x.60 = 26 (professionals) 48 x. 40 = 18 (non-professionals) Secondary = 60:40 Tertiary = 65:35  Distribute by shifts. AM = 45% Professionals: Non-Professionals: 26 x.45 = 12 (AM) 18 x.45 = 8 (AM) PM = 37% 26 x.37 = 10 (PM) 18 x.37 = 7 (PM) 26 x.18 = 5 (NOC) 18 x.18 = 3 (NOC) NOC = 18% University of Bohol College of Nursing   Specifications of duties, conditions and requirements of a particular job prepared through careful job analysis.  Purposes: 1. Recruitment 2. Placement and transfer 3. Guidance and direction Job Description 4. Evaluation of performance 5. Reduction of conflict and frustration 6. Avoidance of overlapping duties 7. Facilitating working relationships with outside bodies such as professional associations 8. Serving as basis for employee’s salary range University of Bohol College of Nursing  Job Title = the position and the necessary qualifications Job relationships = degree of Job supervision, line and staff responsibilities Description and reporting mechanisms imposed on the worker Performance or Job description = a catalogue of the assigned tasks and responsibilities of the worker. University of Bohol College of Nursing   Process of generating employee compliance to institutional rules and regulations.  This must be properly communicated to employees by management.  Purposes: Employee 1. Created order and smooth transition Discipline during shifts and breaks 2. Helps nurses to perform their tasks better and they are able to care for their clients without guesswork 3. Provides direction for the delinquent employee University of Bohol College of Nursing  STEPS TO ADDRESS THESE PROBLEMS  Coaching - is a day to day process of helping employees improve their performance. This is done through interaction which encompasses need analysis, staff development, interviewing, decision making, problem solving, analytical thinking, active listening, Disciplinary motivation, mentoring and communication skills. Problems  Confrontation - communication technique used to address specific issues such as violations of a policy or procedure  Disciplinary conference – uses combination of directive and non- directive technique in order to minimize stress during interview University of Bohol College of Nursing  Progressive Discipline means the management’s adherence to the principle of due process, and fair treatment of subordinates. The measures taken should be graduated according to the frequency and severity of the offense. The measures are:  Counseling STEPS TO  Verbal Reprimand PROGRESSIVE  Written Reprimand DISCIPLINE  Short Suspension  Longer Suspension  Dismissal 1986 Bill of Rights –”No person shall be deprived of life, liberty or property without due process of law.” University of Bohol College of Nursing  Inform the human resources department and administration beforehand State the offending behavior and the reason for termination Explain the proposed termination process TOOLS FOR Termination must have the approval of TERMINATING higher authorities A STAFF Remain calm Arrange employee to be escorted out Report back to the human resources department and administration University of Bohol College of Nursing  Take note! Accurate definition and quantification of the work of nursing is critical to the identification of appropriate nursing resource requirements. University of Bohol College of Nursing  PATIENT CLASSIFICATION SYSTEM & NURSING CARE MODALITIES ORGANIZING University of Bohol College of Nursing  Is the measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. Patient PCSs are institution specific and must Classification be modified to reflect the unique System staff and patient population of each health-care organization. The measure of nursing workload that is generated for each patient is called patient acuity. University of Bohol College of Nursing  Self care or minimal care patients = capable of carrying activities of daily living Patient Intermediate or moderate care = requires some Care is help from the nursing staff with special treatments or certain aspects of personal care. classified Total care patients = bedridden patients and according who lack strength and mobility to do average daily living. to: Intensive care patients = critically ill and in constant danger of death or serious injury University of Bohol College of Nursing   Is the framework of nursing care delivery in any setting Nursing Care that meets the particular Models needs of a group of health care givers and clients. University of Bohol College of Nursing  Case Method or Total Patient Care Nurses assume total The goal of this responsibility during system is to have one their time on duty for nurse give all care to meeting all the needs the same patients for of assigned patients. the entire shift. University of Bohol College of Nursing University of Bohol College of Nursing   Advantages: 1. Continuity of holistic, unfragmented care 2. Needs are closely monitored, rapport is established, security of family 3. Provide nurses with high autonomy and responsibility Advantages &  Disadvantages: Disadvantages 1. The patient could receive different approaches to care in every shift, leading to confusion 2. This requires highly skilled personnel thus may cost more 3. Some tasks can be done more cost effectively by less skilled person. University of Bohol College of Nursing  Functional Method The needs of the group of patients are broken down into tasks, which are Also called Task assigned to RNs, LPNs RNs become Nursing, developed in or nursing aides so that managers of care response to a national the skill and licensure rather than direct care nursing shortage. of each caregiver is providers used to the best advantage. University of Bohol College of Nursing University of Bohol College of Nursing   Advantages: 1. Nurses become skilled in performing assigned tasks 2. Less equipment needed, more economical to administrators 3. Time is saved, efficiency – task is completed quickly Advantages 4. Task oriented approach improves both productivity and organization. and  Disadvantages: Disadvantages 1. Cannot establish rapport, patients cannot identify their nurse 2. Low job satisfaction – (under-stimulated in their roles) 3. Fragmented care and overlooked priority needs 4. Employees are focused only on their own efforts, with less interest in over all results University of Bohol College of Nursing  Team or Modular Nursing A team of nursing personnel provides total patient care to a group of patients. Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. Through extensive team communication, comprehensive care can be provided for patients despite a high proportion of ancillary staff. University of Bohol College of Nursing University of Bohol College of Nursing   Advantages: 1. Democratic Leadership 2. Members contribute their own expertise or skills leading to high job satisfaction 3. Feeling of participation and belonging 4. Workload is balanced. Each member learn Advantages from other members. Each team share responsibilities and and 5. accountabilities collectively. Disadvantages  Disadvantages: 1. Improper implementation 2. Requires great discipline on the part of each member 3. Insufficient time for team care planning and communication leading to blurred line of responsibilities, errors and fragmented care. University of Bohol College of Nursing   Bedside nursing care, relationship based nursing  This requires a nursing staff made up of only RNs  The nurse assumes 24 hour responsibility for planning the care of one or more patients Primary from admission to discharge. During Nursing working hours, he/she provides total direct care for that patient  When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care. University of Bohol College of Nursing University of Bohol College of Nursing   Advantages: 1. ARA is increased. 2. Nurse uses a wide range of skills knowledge and expertise and develops creativity. 3. Combination of clear interdisciplinary group communication and consistent direct patient care by relatively few nursing staff Advantages allows for holistic high-quality patient care and 4. High job satisfaction disadvantages  Disadvantages: 1. Disruption of continuity of care if transferred to different units. 2. Improper implementation 3. Incompetent or inadequately prepared primary nurse University of Bohol College of Nursing   Collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs through communication and available resources to Case promote quality, cost-effective outcomes. Management  Its focus is on individual patients, not populations of patients. Method  Care is directed by the case manager, focused on an entire episode of illness and not unit based.  Used to organize patient care according to diagnoses or other related groups. University of Bohol College of Nursing University of Bohol College of Nursing   Advantages: 1. Additional work efficiency 2. Established solid working relationships with staff Advantages  Disadvantages: and 1. Needs extensive training for Disadvantages advance practice nurse 2. Qualification of Case Manager 3. Confusion related to specific job of the case manager University of Bohol College of Nursing   Progressive Client Care = different areas or units provide various levels of care  Managed Care methods = unit based care that is organized to achieve specific patient outcomes within her stay in the unit  Practice Partnership methods = an RN & an Other assistant or less experienced RN agree to be practice partners. They work together with methods the same schedule and same group of patients. The senior and junior staff members share patient care responsibilities.  Modular methods = RN provides direct nursing care with assistance of aides. This is a modified team and primary nursing method where RN provides leadership, support and instructions. University of Bohol College of Nursing