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Andrea Raines and Karen Hardin
2018 Global health care outlook: The evolution of smart healthcareRetrieved from: https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-hc-outlook-2018.pdf |
Introduction
Learning Objective
Hospital Organizational Structure
Hospitals require precision in the execution of job responsibilities and multiple layers of accountability to function. To accomplish this, hospitals use vertical and horizontal (depending on the hospital) organizational structures with many layers of management. Understanding hospital organizational structure ensures that hospital employees know their responsibilities, the responsibilities of those around them, to whom they report, and who to talk to about particular responsibilities or fields of knowledge.
Board
All hospitals include some form of governing body responsible for making high-level decisions about the organization. A hospital’s board of directors is often drawn from the healthcare community and is made up of experts in their respective fields. Religiously affiliated hospitals often include clergy on their boards of directors. Teaching hospitals often include university faculty from the medical school with which they’re affiliated.
Executives
Hospital executives are responsible for managing the organization, making financial decisions, and overseeing business strategy. Medical and health services managers may oversee entire practices or clinical areas. A hospital typically has a chief financial officer who tends to the financial health of the business and a chief operating officer or chief executive officer responsible for high-level business strategy and decision-making.
Department Administrators
Department administrators report to the hospital executives and manage the day-to-day operations of specific departments within a hospital. The chief of surgery, for example, is responsible for overseeing daily activities within the surgical department as well as performing surgery. A chief of surgery might engage in public relations activities, fundraising, and recruitment. Non-medical departments within a hospital, such as food services or switchboard personnel, also have department administrators.
Patient Care Managers
Nurse Managers and supervising physicians are both patient care managers. These individuals manage small groups of professionals who provide direct patient care. They ensure that orders are carried out, that hospital employees are fulfilling their duties appropriately, and that employees are complying with legal requirements.
Service Providers
The vast majority of hospital workers are service providers: doctors, nurses, orderlies, physical therapists, laundry workers, and the many other people required for a hospital to function. They provide patient care, maintain records, and ensure that the hospital can deliver care to patients in an effective manner.
Systems Thinking
Understanding how each of the above systems works together to promote high-quality patient care is critical to nursing. Please review this brief article on the importance of understanding beyond the organization toward a systems thinking process.
View your organization as a system:
http://www.ihi.org/resources/Pages/ImprovementStories/ViewYourOrganizationasaSystem.aspx
Having a Reliable Organization– 2017 Executive director Frank Federico explains the importance of reliability in this IHI Open School five-part video series.
Part 1: What is Reliability?
Please use the outline provided below to take notes during this 7-minute video. Click the following link from the IHI:
- Reliable design and reliable procedures
- Standard operating procedures
- Deliberate design
- All focus on reliability
- Testing
- Measurement
- Why are some processes not reliable?
- Individual autonomy
- Focus on benchmark performance
- Over reliance on training, vigilance, and hard work
- Expecting policies to result in improved reliability
- Reliable design method
Part 2: How Can You Make Processes Reliable?
Please use the outline provided below to take notes during this 5 minute video. Click the following link from the IHI:
- Start small
- Simplify
- Subset or segment
- Easy to identify
- Willing participants
- Can learn how to design for other subsets
- High volume to test daily or every other day
- Create a flow diagram
Part 3: What Is The Goal of Reliable Design?
Please watch this 4 minute video and use the outline below to take notes. Click the following link from the IHI:
- What is your goal?
- Why not 100%
- Processes should be linked to outcomes
- Change concepts
- Simplification
- Standardization
- Why should you standardize?
- How do you standardize?
- Determine what to standardize
- Ask people who do the work to contribute ideas
- “Steal” ideas from others
- Test!
- Measure!
- Don’t be afraid to give up on an idea if it doesn’t work
Part 4: Why Do You Need a Back-Up Plan?
Please watch this 6 minute video and use the outline below to take notes. Click the following link from the IHI:
- First plan 80% reliable
- Examples of back up plans
- When do you move to the backup plan?
- When will the backup plan fail?
Part 5: How can Data Drive Reliability?
Please watch this 4 minute video and use the outline below to take notes. Click the following link from the IHI:
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Cost Conscious Nursing Care
Think about your future self as a practicing nurse. These are questions to consider in order to be a cost conscious nurse.
- As a nurse, how familiar are you with the cost of common supplies and equipment which is utilized in bedside care for the patient?
- Throughout your workweek, how often do you apply what you know about the cost of supplies and equipment to your practice?
- What are the cost conscious practices in place at your place of work?
- Are you actively involved with any of the following financial aspects?
- Participation in determining your unit annual budget
- Acquiring the appropriate resources, supplies or equipment needed to provide patient care?
- Evaluation of equipment costs and supplies?
- Assisting in the financial decisions for the unit where you practice nursing?
- Do you participate in discussions related to cost-effective practices or promote any cost- effective practices to adopt?
- Are you part of the team that provides input related to staffing decisions that have a direct impact on unit costs?
- Do you promote unit discussions related to ways to minimize the waste of unit resources?
As a practicing nurse it can be overwhelming to think about providing safe competent care, while also trying to be financially responsible. As time progresses and new graduate nurses find a practice rhythm and routine, it also becomes routine to think like a cost conscious nurse. A nurse has the most direct and frequent contact with patients and plays a major role in the control of health care cost (Black, 2014). It is the responsibility of nurses to be financially responsible and this can be achieved while establishing, maintaining and improves the ethical environment of the work setting to make it a safe place to provide high quality patient care (American Nurses Association, 2015). Learning to streamline processes, engaging in decisions about equipment, medication, staffing, and supplies can all lead to improved quality and cost control (Shuldham, 2017).
Staffing and Acuity
History has proven that the number of nurses staffed on a unit, has a direct impact on patient outcomes (Hill & Dewitt, 2018). Hospital reimbursement is directly tied to patient outcomes. Thus nurses need to improve patient outcomes through high-quality, safe, patient care. Historically staffing was determined through ratios which were calculated by the manager through hours per patient day, adjusting for discharge dates, and using a specific formula to calculate the number of nurses needed for a specific unit; i.e. 4 – 5 patients for one nurse (a one-size-fits-all model of staffing). Now, the acuity level of the patient is taken into account by leadership (Nguyen, 2015). The higher level of acuity a patient has, the sicker the patient is and will require a greater level of nursing care for the patient. As a leader, nurse manager, or charge nurse, specific patient requirements should be examined when planning to staff: workload, physical demands, psychological needs, family dynamics, and the nurses own judgment regarding the patient, are specific examples of what to consider when assessing acuity (Nguyen, 2015). Basing the staffing assignment on acuity allows for the most appropriate care by ensuring the right staff (Boivin et al., 2017). When managers and leaders look at productivity, flexing of staff, patient volume, and acuity together evidence of financial improvements may be noted (Nguyen, 2015).
