Name
Chamberlain University
NR-446 Collaborative Healthcare
Prof. Name
Date
Healthcare organizations rely on both formal and informal leadership to function effectively.
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.
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.
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 Part | Type of Coverage |
---|---|
Part A | Hospital insurance, inpatient care, skilled nursing facilities (SNFs), home health |
Part B | Outpatient services, physician visits, durable medical equipment (DME) |
Part C | Medicare Advantage combining Parts A & B, often including dental, vision, hearing |
Part D | Prescription 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.
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.
Delivery System Type | Examples |
---|---|
Preventive Care | Immunizations, public health campaigns |
Primary Care | Family physicians, community health centers |
Acute Care | Emergency rooms, inpatient hospital units |
Sub-Acute Care | Rehabilitation centers, outpatient surgery centers |
Long-Term Care | Assisted living, home health agencies |
Chronic Care | Diabetes programs, cardiac rehab |
Rehabilitative Care | Physical therapy, occupational therapy |
End-of-Life Care | Hospice, palliative care units |
These systems ensure patients receive care suited to their needs across different health conditions and stages.
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 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.
Management Level | Common Roles |
---|---|
Top-Level Managers | Board of Directors, CEO, CNO |
Middle-Level Managers | Nurse Directors, Department Heads |
First-Level Managers | Charge 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: 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.
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.
Advantages | Disadvantages |
---|---|
Clarifies authority and reporting | May ignore informal influence |
Defines decision-making hierarchy | May not reflect day-to-day operations |
Shows role relationships | Can overemphasize hierarchy over collaboration |
Model | Key Characteristics |
---|---|
Fee for Service | Payment per service; preventive care varies |
PPO | Flexible provider choice; no PCP requirement; variable copays |
POS | Combines PPO and HMO; out-of-network available at higher cost |
HMO | Requires PCP and referrals; restricted network except emergencies |
Barriers include language differences, cultural barriers, limited staffing, poor communication, ineffective care transitions, and miscommunication leading to medical errors.
Structure Type | Characteristics |
---|---|
Bureaucratic | Formal hierarchy, limited adaptability |
Service Line | Centralized, care-focused |
Ad Hoc | Temporary project-based teams |
Matrix | Dual authority, expertise-driven |
Flat | Bottom-up communication, decentralized authority |
Functional | Organized by service type, supports specialization |
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 Metric | Expected | Actual | Met/Not Met |
---|---|---|---|
Bimonthly meeting participation | 90% | 95% | Met |
Questions answered within 48 hrs | 100% | 100% | Met |
Emerging leader recruitment | 50% | 55% | Met |
Participation in recruitment | 90% | 80% | Not Met |
Orientation within 6 months | 25% | 10% | Not Met |
Assessment: Gather input from stakeholders.
Diagnosis: Identify practice gaps.
Planning: Develop evidence-based strategies.
Implementation: Apply interventions.
Evaluation: Review outcomes for effectiveness.
Model | Description |
---|---|
Total Patient Care | RN provides all care during shift |
Functional Nursing | Tasks divided by staff role |
Team Nursing | RN leads a team to provide patient care |
Modular Nursing | Teams assigned by geographic location |
Primary Nursing | RN oversees care from admission to discharge |
Case Management | Care 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.
Model | Characteristics | Example |
---|---|---|
Primary Nursing | Continuity from admission to discharge | RN plans and delegates when absent |
Team Nursing | RN leads a group of providers | ICU with RNs, UAPs, secretary |
Total Care | Nurse provides all care | RN handles two patients fully |
Type of Power | Definition | Effect |
---|---|---|
Coercive | Threat-based influence | Low morale |
Legitimate | Authority from position | Decision-making |
Expert | Knowledge-based influence | Credibility |
Referent | Based on relationships | Trust building |
Charismatic | Personal influence | Inspiration |
Informational | Control over information | Better decisions |
Reward | Incentives for motivation | Encourages effort |
Quality Characteristic | Example |
---|---|
Safe | Checking for drug interactions |
Effective | Evidence-based diabetes care |
Timely | Rapid ED heart attack response |
Efficient | Avoid unnecessary supply use |
Equitable | Equal care for all populations |
Client-Centered | Telehealth access for rural patients |
Feature | Quality Improvement (QI) | Quality Assurance (QA) |
---|---|---|
Approach | Proactive | Reactive |
Focus | Prevention | Problem detection |
Scope | System-wide | Specific issues |
Involvement | Team-based | Limited staff |
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
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.