DNP 840 TOPIC 1 DQ 2

DNP 840 TOPIC 1 DQ 2

An organizational chart is a diagram that visually conveys the internal structure of the health care organization. The chart details roles, responsibilities, and relationships between individuals. Describe how you will work across and between levels of the organization at your project to achieve the measurable patient outcome for your project. Describe any impact of bureaucracy that you anticipate. Explain how organizational influence and bureaucracy both impact patient quality and safety outcomes. What are two challenges or rewards to be gained?

Initiating change in the healthcare system can be very challenging due to its constantly evolving complexity (Braithwaite, 2018). Organizational culture and influence can play a determinant influence on the direction a process takes as new policies and rules are contingent on the leaders’ final decision and approval. For an effective change implementation and the best patient outcomes, communication and engagement are vital for effective information dissemination establishment of understanding, and agreement (Siegel et al., 2018). Leadership in an organization holds a key role in decision making and observing the chain of command is essential. Consulting and recognizing the leadership is imperative to secure the administrator’s approval as approval is contingent upon their decision. Siegel et al. (2018) suggest the top-bottom approach to communication contact. Some instances may incorporate some informal contacts where ideas may be exchanged to build upon and strengthen the formal communication contact with the top leaders. The role of the mentor who is the content expert regarding the project process in the facility is functional in this aspect in directing the best approach and steps for a smooth transaction (Siegel et al., 2018). Though the top-bottom was ideal for my communication approach, the mentor guided and facilitated the steps to make the communication contact quicker and smoother. Using a facilitator to increase engagement and coordination is another means to aid in achieving measurable patient outcomes. The facilitator would coordinate and enable other employees and team members encouraging them to embed change and work hard to achieve the goal of quality improvement. Through the work of the facilitator in enhancing the workplace culture, empowering employees to facilitate change by managing the process, establishing rules, setting goals auditing the process, employees can embrace the change and quality improvement directed towards improved patient outcomes (Harvey & Lynch, 2017). Organizational influence can negatively or positively influence patient quality and safety. A positive organizational culture that promotes open communication is one that supports and adopts reporting of errors with a non-punitive response to errors, management support and commitment to investigate errors, effective communication, and organizational learning. On the contrary, a negative organizational influence with poor safety cultures such as poor nurse staffing, poor nursing work environment, lack of support and resources, ineffective communication, and fear of reporting due to punitive repercussions all contribute to patient outcomes (Alanazi et al., 2022). Most of the changes and decisions are affected by organizational bureaucracy. Andreasson et al. (2018) discuss the professional bureaucracy with a clear bottom–up decision-making structure in which both independent professionals and strategic managers must agree to proposed changes that work autonomously from their colleagues. Conversely, a hierarchical bureaucracy follows well-defined work positions and specified duties, and work processes with predesigned standards for tasks. The challenges would how to gain everyone’s interest in adopting the new change to become a routine and maintaining sustainability. The reward would be adherence to the new guideline that would reduce antimicrobial for asymptomatic bacteriuria reducing antibiotic resistance.

Reference

Alanazi, F. K., Sim, J., & Lapkin, S. (2022). Systematic review: Nurses’ safety attitudes and their impact on patient outcomes in acute‐care hospitals. Nursing Open, 9(1), 30-43. https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.1063

Andreasson, J., Ljungar, E., Ahlstrom, L., Hermansson, J., & Dellve, L. (2018). Professional bureaucracy and health care managers’ planned change strategies: Governance in Swedish Health Care. Nordic Journal of Working Life Studies, 8(1). https://tidsskrift.dk/njwls/article/view/104849

Braithwaite, J. (2018). Changing how we think about healthcare improvement. Bmj, 361. https://www.bmj.com/content/bmj/361/bmj.k2014.full.pdf

Harvey, G., & Lynch, E. (2017). Enabling continuous quality improvement in practice: the role and contribution of facilitation. Frontiers in public health, 5, 27. https://www.frontiersin.org/articles/10.3389/fpubh.2017.00027/full

Siegel, E. O., Bakerjian, D., & Zysberg, L. (2018). Quality improvement in nursing homes: Alignment among leaders across the organizational chart. The Gerontologist, 58(4), e281-e290. https://academic.oup.com/gerontologist/article/58/4/e281/3865798

Organizational structure in healthcare work, much like the democratic process, assists with oversight so that no man or person has absolute power; hence, making decisions is a checks and balance system (AplosAcademy, 2019). Although the Direct Process Improvement site is a small entity, its governing body represents standard visual representations of a nonprofit where the charitable foundation acts as the board of directors, in this case, Mission Arlington, a faith-based community center whose mission is to meet the needs of the community by taking the church to the people (Mission Arlington® | Mission Metroplex, 2021). At its core, the mission’s directive team believes that the church is more than a building but an outreach center moving past walls to service the people’s needs mimicking Jesus’ desire to heal and provide. However, as the Mission services comprise a food pantry and clothing and supply center, with a medical and dental clinic, each area has an executive director. The DPI site’s executive director is a Nurse Practitioner overseeing other staff members such as the office manager, clinic coordinator, and volunteer staff director. Therefore as the DPI initiator, the ability to work within the group to foster change is imperative.

For example, the office manager’s responsibility is to ensure that the paper and electronic charting system is updated regularly; yet, as there are only four paid workers, this work requires coordination with the volunteer and clinic coordinators (Mission Arlington® | Mission Metroplex, 2021). Therefore as the DPI initiator, the ability to work within the group to foster change is imperative. For example, the office manager’s responsibility is to ensure that the paper and electronic charting system is updated regularly; yet, as there are only four paid workers, this work requires coordination with the volunteer and clinic coordinators. 

Limitations in the number of people included in the organizational structure may be beneficial or a hindrance. The paid and unpaid laborers often work countless hours, and adding the learning needed to begin new processes requires extra effort. However, as the DPI proposer organizational structure buys in during the initial planning phases, committee members may be a valuable asset.

References

AplosAcademy. (2019). Yahoo Image Search. Yahoo.com. https://images.search.yahoo.com/search/images

Mission Arlington® | Mission Metroplex®. (2021). Mission Arlington | Mission Metroplex. Missionarlington.org. https://missionarlington.org/

The visual representation of internal structures by an organization chart provides learners the opportunity to identify how to communicate with the team. The learner will work across the organization effectively by ensuring that the process occurs in a respectful manner. This will be done by preventing overstepping boundaries and allow to get advice prior to presenting the project implementation to the chief medical officer for final approval.  The chief medical officer role is primary to accept or reject the project thus presenting unfinalized material can be a waste of his time as his responsibility does not entail support assisting in making the project feasible. The advanced practice nurse will be the main point of contact to communicate project, help with details and support of the project, and assist if re- enforcing communications with office managers. As Van Triest and William (2022) explains it is important to understand that the cascading effect prevents decentralization. Other trade of benefits is that authority is delegated. All individuals are given the opportunity to feel in control and able to move higher in the chain of command if responsibilities are not being meet or clear, therefore everyone’s role is important and to be respected.  The impact of bureaucracy identified is that the organization has a high rate of turn over. Due to this barrier the organization has identified it will be best to have advance practice director as the main point of contact.  The learner understands the importance of chain of command and will ensure to keep an open communication with the office.

Organization and bureaucracy impact quality and safety outcomes in several ways. Organizations are responsible implementation of safe care practices, communication, financial means, and effective workflows. Bureaucracy in health care is a multilayered system which provides an opportunity to identify errors before they reach a patient. Rewards to be gained is the and maintains uniformity, hierarchy, and a formalization. Interestingly, Al Banki et al. (2021) identified that standardization does not have a significant impact of the performance of staff. On the contrary a challenge is that this elaborate process can cause delay in care due to its need for approval in multiple sectors.

References:

Al Banki, K. R., & Aziz, W. A. (2021). The Influence of the Organizational Bureaucracy on the Employees’ Performance: Evidence from King Hamad University Hospital. 2021 International Conference on Decision Aid Sciences and Application (DASA), Decision Aid Sciences and Application (DASA), 2021 International Conference On, 6–11. https://doi.org/10.1109/DASA53625.2021.9682346

van Triest, S., & Williams, C. (2022). Following the chain of command? How managers balance benefits and risks in granting autonomy to employees. European Management Journal. https://doi-org.lopes.idm.oclc.org/10.1016/j.emj.2022.08.007