Healthcare institutions are very dynamic and complex. Particular organizations require that managers should be enriched with leadership skills to oversee and excellently coordinate the employees. Nevertheless, leadership duties are not limited to managers at the top in most organizations. Management positions appear in three levels –high level, middle level, and low level. Power and authority in an organization usually declines and is delegated downward these levels of management. The high-level management position has the highest power, while the lower-level management position has the least power and authority. The chain of command refers to how instructions flow within an organization. Most healthcare organizations adopt the hierarchal instead of a flat chain of command (Jahn & Black., 2017). Hierarchal chain of command is where managers at the lower level report to managers at the middle level who finally report to managers at a high position.
In a Medicare organization, high-level management positions may include a Finance manager, patient care manager, support and services manager, and human resource managers. Under each manager, there are middle-level managers. For example, under patient care manager, there are unit managers, such as nurse managers, rehabilitation directors, and directors of diagnostic services, pharmacist manager, and medical officers' managers. All these managers are expected to their senior manager in charge of patient care. Each staff belongs to a particular unit and has a unit manager to whom the staff should report (Lee et al., 2017). In the case of nurses, they are expected to report to the nurse manager. The other management system is flat. In this case, when staff identifies the need for change, they communicate directly to the high-level management. There are no middle-level managers or low-level managers.
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As mentioned earlier, healthcare organizations are highly dynamic –there will always be changes to implement with time. These changes may improve quality patient care or reduce the institutions running cost, among other things that are beneficial to the organization. There can be a demand for change, maybe from downward upwards or vice versa. For example, when a nurse's workload is increased, and there is a need for more staffing, the nurse on duty will report and request more staffing from the nurse manager. The need for staff increment is then addressed to the patient care manager, finance and human resource manager, and the administrator. If they all agree, then more nurses are recruited. Nurses are expected to channel changes and suggestions to their unit managers (Saleh et al., 2018). On the other hand, change can be coming from the administrator or senior managers to the manager at lower administration levels.
In conclusion, it is important to understand the chain of command to succeed as a nurse manager. It helps you to comprehend the process of change. With such an understanding, one can predict the possible changes and the duration they may take to be implemented. With hierarchy management, it takes longer to implement change, and everyone is involved in the process of change. On the other hand, with the flat management system, changes take a shorter time, and not everyone is involved in change.
References
Jahn, J. L., & Black, A. E. (2017). A model of communicative and hierarchical foundations of high reliability organizing in wildland firefighting teams. Management Communication Quarterly, 31(3), 356-379.
Lee, T. W., Hom, P. W., Eberly, M. B., Junchao (Jason) Li, & Mitchell, T. R. (2017). On the next decade of research in voluntary employee turnover. Academy of management perspectives, 31(3), 201-221.
Saleh, U., O'Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., & Patton, D. (2018). The impact of nurse managers' leadership styles on ward staff. British journal of nursing, 27(4), 197-203.
