NR 446 Edapt Week 5 Leading in an Organisation

NR 446 Edapt Week 5 Leading in an Organisation

NR 446 Edapt Week 5 Leading in an Organisation

Name

Chamberlain University

NR-446 Collaborative Healthcare

Prof. Name

Date

Leadership in Healthcare Organizations

Healthcare organizations rely on both formal and informal leadership to function effectively.

Formal and Informal Leadership

Formal leadership is structured within a defined hierarchy. Authority and accountability are outlined in organizational charts and job descriptions, which ensures consistency in decision-making, communication, and reporting. For instance, a Chief Nursing Officer (CNO) may issue directives to department heads, who then guide nurse managers and frontline staff.

On the other hand, informal leadership develops naturally. Individuals without official titles may influence others through expertise, interpersonal skills, or earned respect. Such leaders are crucial in shaping workplace culture, mentoring peers, and fostering collaboration.

NR 446 Edapt Week 5 Leading in an Organisation

Both types of leadership are vital. Formal leadership provides stability and direction, while informal leadership strengthens adaptability and team cohesion—both essential for quality patient care.

Top-Level Healthcare Management

High-level executives such as the Board of Directors, Chief Executive Officer (CEO), and Chief Nursing Officer (CNO) hold ultimate responsibility for organizational direction and success. Their duties include strategic planning, policy development, and ensuring compliance with regulations to prioritize patient safety and sustainability.

Middle-level managers, including department heads and nursing supervisors, implement executive strategies through operational activities such as budget oversight, staffing, and workflow management. They act as a link between leadership and frontline staff.

This tiered system allows for alignment between strategic objectives and everyday healthcare delivery.

Medicare and Healthcare Delivery Systems

Medicare Coverage Breakdown

Medicare PartType of Coverage
Part AHospital insurance, inpatient care, skilled nursing facilities (SNFs), home health
Part BOutpatient services, physician visits, durable medical equipment (DME)
Part CMedicare Advantage combining Parts A & B, often including dental, vision, hearing
Part DPrescription drug coverage

Medicare mainly supports individuals over 65 and those with qualifying disabilities or chronic illnesses. It ensures equitable access to essential services through federal funding.

Private and Public Insurance Funding

Healthcare in the U.S. is funded by both private and public sources. Private insurance, often employer-based, requires shared payment of premiums, deductibles, and copayments. Public programs such as Medicaid and Medicare are tax-funded, with Medicaid assisting low-income individuals and people with disabilities, while Medicare supports older adults and certain younger populations.

Types of Healthcare Delivery Systems

Delivery System TypeExamples
Preventive CareImmunizations, public health campaigns
Primary CareFamily physicians, community health centers
Acute CareEmergency rooms, inpatient hospital units
Sub-Acute CareRehabilitation centers, outpatient surgery centers
Long-Term CareAssisted living, home health agencies
Chronic CareDiabetes programs, cardiac rehab
Rehabilitative CarePhysical therapy, occupational therapy
End-of-Life CareHospice, palliative care units

These systems ensure patients receive care suited to their needs across different health conditions and stages.


Shared Governance and Organizational Models

Shared Governance in Nursing

Shared governance empowers nurses by involving them in policy-making, quality improvement, and professional development decisions. It encourages open communication, leadership development, and accountability for practice standards.

Magnet Recognition

Magnet status, awarded by the American Nurses Credentialing Center (ANCC), recognizes excellence in nursing, leadership, and patient outcomes. Hospitals with Magnet designation often experience improved staff retention, stronger collaboration, and superior patient results.

Organizational Structure and Management Roles

Hierarchical Structure and Chain of Command

Management LevelCommon Roles
Top-Level ManagersBoard of Directors, CEO, CNO
Middle-Level ManagersNurse Directors, Department Heads
First-Level ManagersCharge Nurses, Team Leaders, Case Managers

This structure maintains accountability and communication. For example, staff nurses report to nurse managers, who in turn report to the CNO.

Centralized vs. Decentralized Decision-Making

  • Centralized: Decisions occur at the executive level, ensuring uniformity but reducing response speed.

  • Decentralized: Decisions are made at unit level, allowing faster adaptation to patient needs.

Functional Roles of Managers

Managers plan, organize, and oversee operations through formal authority. Leaders inspire and influence others, often without formal power. Many nursing roles require both—for example, a charge nurse manages scheduling while motivating staff.

Organizational Chart Advantages and Disadvantages

AdvantagesDisadvantages
Clarifies authority and reportingMay ignore informal influence
Defines decision-making hierarchyMay not reflect day-to-day operations
Shows role relationshipsCan overemphasize hierarchy over collaboration

Managed Care Models

ModelKey Characteristics
Fee for ServicePayment per service; preventive care varies
PPOFlexible provider choice; no PCP requirement; variable copays
POSCombines PPO and HMO; out-of-network available at higher cost
HMORequires PCP and referrals; restricted network except emergencies

Collaborative Care and Leadership

Barriers to Care Coordination

Barriers include language differences, cultural barriers, limited staffing, poor communication, ineffective care transitions, and miscommunication leading to medical errors.

Organizational Models

Structure TypeCharacteristics
BureaucraticFormal hierarchy, limited adaptability
Service LineCentralized, care-focused
Ad HocTemporary project-based teams
MatrixDual authority, expertise-driven
FlatBottom-up communication, decentralized authority
FunctionalOrganized by service type, supports specialization

Case Study: Chamberlain Health Care (CHC)

CHC, a large nonprofit system with Magnet status, faced leadership challenges due to retirements and pandemic demands. To address this, the Emerging Leaders Task Force was created.

Outcome MetricExpectedActualMet/Not Met
Bimonthly meeting participation90%95%Met
Questions answered within 48 hrs100%100%Met
Emerging leader recruitment50%55%Met
Participation in recruitment90%80%Not Met
Orientation within 6 months25%10%Not Met

Application of the Nursing Process in Organizational Planning

  • Assessment: Gather input from stakeholders.

  • Diagnosis: Identify practice gaps.

  • Planning: Develop evidence-based strategies.

  • Implementation: Apply interventions.

  • Evaluation: Review outcomes for effectiveness.

Collaborative Care Models

ModelDescription
Total Patient CareRN provides all care during shift
Functional NursingTasks divided by staff role
Team NursingRN leads a team to provide patient care
Modular NursingTeams assigned by geographic location
Primary NursingRN oversees care from admission to discharge
Case ManagementCare coordinated using multidisciplinary action plans

Example: Modular nursing occurs when a charge nurse assigns a team of RNs, LPNs, and UAPs to cover a specific unit.

Nursing Care Delivery Models

ModelCharacteristicsExample
Primary NursingContinuity from admission to dischargeRN plans and delegates when absent
Team NursingRN leads a group of providersICU with RNs, UAPs, secretary
Total CareNurse provides all careRN handles two patients fully

Power and Authority in Nursing

Type of PowerDefinitionEffect
CoerciveThreat-based influenceLow morale
LegitimateAuthority from positionDecision-making
ExpertKnowledge-based influenceCredibility
ReferentBased on relationshipsTrust building
CharismaticPersonal influenceInspiration
InformationalControl over informationBetter decisions
RewardIncentives for motivationEncourages effort

Quality Management in Healthcare

Characteristics of Quality Care (Institute of Medicine, 2001)

Quality CharacteristicExample
SafeChecking for drug interactions
EffectiveEvidence-based diabetes care
TimelyRapid ED heart attack response
EfficientAvoid unnecessary supply use
EquitableEqual care for all populations
Client-CenteredTelehealth access for rural patients

Quality Improvement vs. Assurance

FeatureQuality Improvement (QI)Quality Assurance (QA)
ApproachProactiveReactive
FocusPreventionProblem detection
ScopeSystem-wideSpecific issues
InvolvementTeam-basedLimited staff

Global Health Workforce Transformation (WHO, 2016)

WHO recommends global health systems to:

  • Invest in healthcare education and lifelong learning

  • Promote gender equality

  • Support universal health coverage

  • Integrate technology into care

  • Protect and fairly treat healthcare workers

  • Use workforce data for accountability

  • View health workers as long-term investments

References

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

World Health Organization. (2016). Working for health and growth: Investing in the health workforce. High-Level Commission on Health Employment and Economic Growth.

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). Elsevier Health Sciences.

NR 446 Edapt Week 5 Leading in an Organisation

NR 446 Edapt Week 5 Leading in an Organisation.