HCA 301 Leadership and Management in Healthcare PDF

HCA 301 Leadership and management in healthcare setting CHAPTER 3 HOW ORGANIZATIONS SHAPE LEADERSHIP AND MANAGEMENT Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD,...

HCA 301 Leadership and management in healthcare setting CHAPTER 3 HOW ORGANIZATIONS SHAPE LEADERSHIP AND MANAGEMENT Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 1 Learning Outcomes 1. Differentiate between reductive and adaptive organizational theories. 2. Describe traditional and emerging structures in healthcare organizations. 3. Discuss how the organizational environment and culture affect workplace conditions. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 2 Introduction When individuals come together to fulfill a common aspiration, organizations are formed. In healthcare, individuals form organizations to care for the ill and infirm or to advance health and well-being. Organizations almost always begin small, with structures that are easy to navigate. Organizational partnerships have a defined mission, purpose, and goals. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 3 Organization An organization is a collection of people working together under a defined structure to achieve predetermined outcomes using financial, human and material resources Coordinate the efforts of individuals allowing them to gather more information Develop knowledge Purchase supplies, equipment and technology Produce more goods, services opportunities and security than individual efforts alone HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 4 Reductive and Adaptive Organizational Theories Purpose of a theory-derived organization is to design work and optimize human talent in a manner that best accomplishes the aspirational goals of the organization Reductive Theory – Classical approaches to organizations, focuses heavily on: a) Nature of the work to be accomplished. b) Creating structures to achieve the work. c) Dissecting the work into component parts. – Leaders who use this model aim to: – Subdivide work. – Specify tasks to be done. – Fit people into the plan. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 5 Reductive and Adaptive Organizational Theories Reductive Theory ◦ Reductionist theory uses the mission of the organization to structure and design work. ◦ Traditional design of medicine is based on this model. ◦ Primary care physician oversees holistic concerns of patient. ◦ Specialists are called in to detail each subcomponent part. ◦ Most hospital organizations still orchestrate their clinical services and departments using this model. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 6 Reductive and adaptive Organizational Theories Classical theory Human relations theory Systems theory Contingency theory HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 Chaos theory Complexity theory 7 Reductive Theory-Classical theory ▪Focuses almost exclusively on the formal structure of the organization and is closely aligned with scientific management ▪Standard methods should be used for each job and variation should be eliminated ▪The main premise is efficiency through design ▪People are seen as operating most productively within a rational and well-defined organizational culture that spells out each person’s tasks and defines the relationship between employees. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 8 Reductive Theory-Classical theory One designs organization by specifying tasks to be done, dividing up those tasks and only then fitting people into the plan Built around 4 main elements Division and specialization of labour Chain of command Organizational structure Span of control HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 9 Classical theory ◦ Division and specialization of labor ◦ Dividing work reduces the number and range of tasks that each person carries out. ◦ Results in specialization and proficiency. ◦ Provides greater control over work, leading to greater consistency of outcomes and lower costs. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 10 Reductive Theory-Classical theory Chain of command ◦ Hierarchy of authority and responsibility within the organization.(Authority is the right power to direct activity and responsibility is the obligation to attain objectives) ◦ Depicted on an organizational chart through job titles listed in magnitude of authority and responsibility. ◦ Gives the appearance of orderliness and clarity around who is in charge 2 types of Authority ; Line authority & staff authority ◦ Line authority (who is accountable to whom) ◦ Person holding supervisory authority over other employees ◦ Staff authority (advisory relationship) ◦ Individuals yield considerable expertise to advise and influence others HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 11 Classical theory- Chain of command The relationships among the directorate manager, ward managers and staff nurses are shown as line authority: the ward manager reports to the directorate manager, and the ward manager has formal authority over the staff members The relationship between the modern matron and the ward manager is staff authority The modern matron gives advice to the ward manager, who is responsible to the directorate manager for implementing changes on the ward. The modern matron reports to the assistant director of nursing. Neither the modern matron nor the ward manager is responsible for the work of the other; instead, they work together to improve ensure the safe and effective delivery of care on the ward. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 12 Reductive Theory-Classical theory Organizational structure ◦ Describes the division of labour and the relationship between and among work groups ◦ work group arrangements based on the concept of departmentalization. ◦ Means to: Allocate responsibility Reinforce authority Provide a formal communication network Max weber’s term “Bureaucracy “ to define ideal organization but now it has a negative connotation (long waits, inefficiency, red tape.) HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 13 Reductive Theory-Classical theory Span of control ◦ Concept related to how many employees a manager can supervise effectively. ◦ Complex organizations have numerous highly specialized departments. ◦ Authority is centralized; Highly specialized departments and several layers of management ; tall organizational structure ◦ Less complex organizations have flat structures. ◦ Authority is decentralized, with several managers supervising large work groups HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 14 Contrasting spans of control Contrasting spans of control. From Longest, B. B., Rakich, J. S., & Darr, K. (2000). Managing health services organizations and systems (4th ed.). Baltimore: Health Professions Press, p. 124. Reprinted by permission. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 15 Contrasting spans of control Contrasting spans of control. From Longest, B. B., Rakich, J. S., & Darr, K. (2000). Managing health services organizations and systems (4th ed.). Baltimore: Health Professions Press, p. 124. Reprinted by permission. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 16 Human relations theory Human relations thinkers (in 1930s)proposed that organizations would be more productive if staff were encouraged to contribute ideas and participate in decision making, building cooperation and motivating the individual ◦ Major belief is that people desire : Personal fulfilment Good social relationships To be an accepted member of a group These ideas emerged as a result series of studies conducted by Elton Mayo at the Western Electric Company's Hawthorne plant in Chicago. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 17 Reductive and Adaptive Organizational Theories Humanistic Theory ◦ Hawthorne effect ◦ Tendency for people to perform better when special attention being paid to them [Mayo,1949]. ◦ Individuals cannot be coerced or bribed to do things they consider unreasonable. ◦ Formal authority does not work without willing participants [Bernard,1938]. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 18 Adaptive Organizational Theories ◦ Interplay among structure, people, technology, and environment led to perceiving organizations as adaptive systems. ◦ Consequently, rules developed about how organizations thrived or were challenged. Systems Theory Contingency Theory Chaos Theory continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 19 Adaptive Organizational Theories Systems Theory ◦ A system is interrelated parts arranged in a unified whole. ◦ Systems can be Open (interacts both internally and with environment) Closed (self-contained, rare and do not interact with environment) ◦ Organization is a recurrent cycle of input-throughput-output. ◦ The manager is the catalyst for the process; responsible for integrating information and resources from the environment and for coordinating and facilitating the work of the organization. Each healthcare organization: ◦ Requires human, financial, and material resources ◦ Designs services to treat illness, restore function, provide rehabilitation, and protect or promote wellness continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 20 The healthcare organization as an open system Every healthcare organisation, a hospital, outpatient clinic, primary care requires human, financial and material resources (inputs). Provides a variety of services (throughput) to treat illness, restore function, provide rehabilitation and protect or promote wellness. The result (output) is better physical, mental and emotional health and wellbeing HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 21 Adaptive Organizational Theories Contingency Theory ◦ Developed to explain performance is enhanced by matching the organization's structure to its environment. ◦ This system implies that as the environment or its constituents change, the organisation needs to react in order to retain its role in the grand scheme of things. ◦ Environment includes people, objects, and ideas outside the organization that influence it. ◦ Optimal form of the organization depends on the environment in which it operates. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 22 Adaptive Organizational Theories Chaos Theory Linked to the field of complexity science; inspired by quantum mechanics ◦ Natural systems such as meadows or ponds are good examples of chaos theory. A stream destined for the ocean, for example, never takes a straight path ◦ Concept of cause and effect is rarely predictable in work settings where the stakes are high, multiple variables interact, and predictive outcomes are not feasible. ◦ Organizations are living, self-organizing systems that are complex and self-adaptive. ◦ The set of rules that guided the industrial notions of organizations are no longer effective: newer principles that ensure flexibility, fluidity, speed of adaptability and cultural sensitivity must emerge. ◦ Chaos theory therefore suggests that the drive to create permanent organisational structures is doomed to fail. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 23 Complexity theory ▪Originated when scientists noted that random events interfered with the expected outcomes of computer experiments. ▪Linear cause and effect could no longer explain some outcomes. ▪Useful in healthcare because there are no end of random events and complexity ▪Patients’ conditions can change in an instant; equipment fails, staff are unavailable or urgent admission disrupt the planned care. ▪Managing in those situations requires considering every aspect of the system as it interacts and adapts to change. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 24 Complexity theory Hierarchy is not particularly important in complexity theory. Every encounter between a patient and health professional offers information for a possible solution to problems [Bleich and kosiak,2007] All theories that consider an organization as a total system, including contingency, chaos and complexity theory value individual contribution to the organization. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 25 Organisational culture Mintzberg (1989) described five classic organisational structures: ▪Simple ▪Machine bureaucracy ▪Professional bureaucracy ▪Divisional form ▪Adhocracy. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 26 Organisational culture The differences between these structures are in the relationship between ❖executive management (called the strategic apex by Mintzberg) ❖the individuals responsible for doing the work (Mintzberg's operating core) ❖the managers ❖the individuals who help standardize and improve the work (such as the clinical governance team, audit department, finance, and training and development, called the techno-structure) ❖the support staff— individuals supporting others who provide the basic work, such as maintenance, housekeepers, cleaners and ward secretaries. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 27 Organisational culture Mintzberg (1989) described five classic organizational structures: ▪Simple; An organization with a simple structure consists of only a strategic apex and an operating core. An example of this is a single-handed GP practice. The GP is the strategic apex and the practice nurse, office manager and secretary are the operating core. ▪Machine bureaucracy; is an example of the ideal bureaucracy that Weber found so attractive. These are tall, multilayered organizations with centralized decision making and separate specialized departments. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 28 Organisational culture ▪Professional bureaucracy ;the distinguishing feature is that the operating core consists of groups of professionals. e.g. Public services, such as schools, hospitals, social services, police and fire services Unlike machine bureaucracies, in professional bureaucracies most decisions are made by professionals, and the executive team's authority to make decisions is limited. In hospital trusts, for example, individual clinicians make treatment decisions, not the medical director. The medical director makes decisions that affect the organisation as a whole. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 29 Organisational culture ▪Divisional form; is one where a number of independent work units are under a single executive team. In these organizations, most decision making is decentralized to the divisions. For example, where there are a number of GP practices and a range of community services all under the same executive team. ▪Adhocracy; represents a fluid structure in which management, staff and professionals work together on teams. Power, coordination and control are constantly shifting. An example is that a community support group for people with cancer, where family members meet to discuss their concerns and give support to each other. Group members share the work of the group by providing a venue for meeting, shopping or cooking for each other, or simply providing emotional support. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 30 Working arrangement within structures ▪Authority in organizations can be centralized or decentralized, or more typically a mixture of both. ▪ Centralized authority means that decisions are taken 'up the line' to be made and then passed back down the line. ▪Decentralized authority is when decisions are made by the individuals involved, at the bedside rather than in the boardroom. ▪Clinical decisions are usually made in a decentralized way, meaning that nurses, doctors and other registered professionals, along with the patient and carers, decide the best treatment for the patient without consulting 'up the line’. ▪Other decisions, such as purchasing supplies and equipment, building maintenance and contracting with outside agencies, are usually made centrally because they affect every-one and have significant cost implications. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 31 Working arrangement within structures HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 32 Functional working arrangements ▪Employees are grouped in departments by discipline, with similar tasks being performed by the same group, similar groups operating out of the same department and similar departments reporting to the same manager. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 33 Service-line working arrangements ▪All functions needed to produce a service are grouped together ▪The service-line structure is decentralized; units are based on service, geographical location or type of patient. For example, the musculoskeletal service includes consultants, nurses, physiotherapists, occupational therapists etc. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 34 Organizational culture ◦ Comprises basic assumptions and values held by members of the organization ◦ Unstated "rules of the game" ◦ Varies among institutions, subcultures. ◦ Subculture is a group that has shared experiences or like interests and values. ◦ Pharmacists, therapists and nurses form subcultures within healthcare environments. Cooke and Lafferty (1989) have identified three types of culture: ◦ Constructive or positive, where the focus is on self-actualisation, humanism, affiliation and achievement; ◦ Passive or submissive, where the focus is on approval, dependence, convention and avoidance; ◦ Aggressive or defensive, where the focus is on competition, perfectionism, power and opposition. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 35 Organizational functions Organizations achieve their goals through management and leadership activities. The following activities are common to all successful organizations. ❖Strategic planning ❖Service planning ❖Values ❖Vision ❖Mission ❖Goals HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 36 Organizational functions Strategic planning ▪Successful organizations must focus their energies, resources and actions. ▪Strategic planning involves projecting the organization's goals and activities into the future, usually two to five years ahead, and is chiefly an activity undertaken at board level. ▪Strategic planning is an ongoing process, not an end in itself. It requires a continual focus on the goal and meticulous attention to progress; the organization's mission and vision must always guide activities. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 37 Organizational functions Service planning This is the operational plan for the delivery of a service and this feeds into the strategic plan of the organisation as a whole. Each service is expected to project the demand on the service into the future and to identify the resources that it will take to meet that plan. The strategic plan of the organization seeks to reconcile service planning between areas and make adjustments where necessary. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 38 Organizational functions Values Values are the beliefs or attitudes one has about people, ideas, objects or actions that form a basis for behavior. Many organizations translate the core values of the health service into their own words, making the values more easily understood for those who work there. UOB Values HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 39 Organizational functions Vision A vision statement describes the overarching goal to which the organization aspires. The vision statement is designed to inspire and motivate employees to achieve a desired state of affairs. At its best, a vision statement is succinct, engaging and simple, conveying a message with interest. Mission The mission of an organization is a broad, general statement of the organization's reason for existence. The mission statement defines the areas of healthcare service. Clarifying the mission of the organization is the necessary first step to designing a strategic plan HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 40 Organizational functions UOB Vision To become a world-class university that is recognized as a teaching, research and entrepreneurial institute UOB Mission To contribute directly to the economic growth and development of Bahrain, supported by leading edge teaching, technology and research with regional impact. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 41 Organizational functions CHSS Vision To be highly ranked regionally and internationally as a leader in healthcare and physical education, by promoting excellence in education, professional practice, research and community services. CHSS Mission To graduate qualified healthcare professionals and physical educators through promoting lifelong learning, and effective partnership with stakeholders and community. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 42 Organizational functions Goals Goals are specific statements of what is to be achieved. They follow the mission and vision of the organization. Goals are measurable and precise. 'Hospital-acquired infections will be managed effectively' is an example of a goal. Goals apply to the entire organization and are statements of outcome to which the organization aspires. Objectives are statements of outcome. An objective may be 'MRSA will be eradicated from Ward 5.’ Strategies follow objectives and specify what actions will be taken. 'Alcohol solution will be available for use in all wards by visitors' is an example of a strategy to meet the hospital acquired infection objective. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 43 Ponder points ▪The schools of organizational theory are classical, human relations, systems, contingency and chaos. ▪Organizations can be viewed as social systems consisting of people working in a predetermined pattern of relationships who strive towards a goal. The goal of healthcare organizations is to provide a particular mix of health services. ▪The organizational structure determines the formal communication system and guides organizational activities. ▪Organizations develop strategic and service plans based on the values and mission of the organization and the vision of its leaders. ▪Organizational culture defines the environment of the organization. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 44