Organizational structure refers to the system consisting of the policies and implicit as well as the explicit rules of an institution that are designed for the purpose of outlining the way different responsibilities and roles are coordinated, controlled and delegated. Nurses always work within complex environments; they not only respond to the different management structures that they have, but they also must integrate within the structures of leadership of diverse medical disciplines to give their patients the finest imaginable care. The nursing organizational structure operates on informal and formal organizational structures. The nursing organizational structure looks upon the nurse leadership in delivering the best through the staff.
Decision-making processes in an organization may face difficulties arising from the complex adaptive system (CAS). CAS is the kind of system where many agents that are independent interact and result to the emergence of outcomes that may prove hard to be dealt with thus difficult to predict by simply looking at a single interaction. CAS has several characteristics including self-organizing, nonlinearity, complexity, adaptability, and agents among others. Understanding why CAS affects the daily decision making of an organization may be difficult since the agents are simply the individual employees. For instance, considering an ant colony, each of them has a different decision role to play (maybe foraging among others). Despite their roles, the ants frequently interact as they perform their respective duties. Similarly, in an organization, an individual employee has his/her own decision role (printing, filing, issuing message, attending to patients and providing for their needs like feeding among others if it is a nursing home, among other roles present in an institution). As every one of them is focusing on their respective role, they interact with each other more frequently. In the end, this results in the complex adaptive system in the institution thus affecting the decision making processes.
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In every aspect of the organizational structure, change must be continuous. Implementing the change may need some considerations. Nurse leaders usually strive hard to use their skills and knowledge in driving the accountability of the staff for sustaining and implementing organizational change. Steps taken by the leaders today in nursing are as a result of Kotters’ outlines in the year 1995 (Roussel, 2016). Creating change will need empowering from the leader to make the other members work towards the vision of the institution. This can be achieved through obstacle clearance as well as changing unsupportive systems of the vision. This pushes for a corporation by the nurse leaders to work as one with all levels of staff thus improving the service offered. Another thing is that a powerful coalition can be formed to guide others through the creation of an inter-professional team with the capacity to spearhead the change (Roussel, 2016). Also, new approaches can be institutionalized among other things (Roussel, 2016).
For the effective implementation of Triple Aim data inputs and outputs are usually employed to monitor the work of nurse leaders. Nurse leaders understand that by realizing IOM’s (Institute of Medicine) key message of an effective staff policy making and planning depends on an upgraded information structure and the better collection of data that needs nursing practice to venture into new explorations (Roussel, 2016). This usually requires nurse leaders to question about different topics about the model of care delivery. They may include "use of registry data to improve patient outcomes, use of specific metrics to measure and share with the public and use of public scorecards for benchmarking among others” (Roussel, 2016).
As earlier noted, nurses always work within complex environments. They not only respond to the different management structures that they have, but they also must integrate within the structures of a leadership of diverse medical disciplines to give their patients the finest imaginable care. The nursing organizational structure has both the informal and formal organizational structures. Informal structure describes social and personal relationships which are not present on an organizational chart while formal structure describes relations, tasks, responsibilities, and positions among individuals within their different position and departments in an organization presented on an organizational chart. The senior nurses who are the leaders are at the helm of the leadership structure and bellow them lies the junior nurses.
Cultural competence greatly impacts the care provided by individual caregivers since it has a direct bearing on the receiving and delivering of health care. With reference to the report by Institute of Medicine, Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare showed that an absence of culturally competent care results in poor patient outcomes, undermines patient compliance, and rises health disparities, notwithstanding of the quality of systems and services delivered (Lehman et al. 2012). Knowledge pertaining cultural customs makes it easy for the health care providers when dealing with the patient since it cuts on misunderstandings thus delivering better care. Being culturally competent will not only impact the delivery of healthcare but will also improve the healthcare plans. Also, with a competent culture, the health institution plans will be easily understood.
An organizational structure relates and aligns with the organization parts to attain its best performance. To achieve it a number of strategies need to be considered. They include IPUs (Organize into Integrated Practice Units) which may change how health care providers are organized in delivering care; measuring costs and outcomes for every single patient; change to payments which are bundled for cycles of care; integrate systems for delivering care; expanding the geographical reach; and building an enabling IT platform (Porter & Lee, 2013).
It is important that nurse leaders be equipped with the business related knowledge especially in marketing, human resource, and information management. For instance, having human resource knowledge will enable the nurse leader to manage and support the personnel as well as the conditions within the environment thus facilitating an effective and safe work within the institution (Utley, 2011). When it comes to marketing, extensive knowledge on of their responsibilities influences the entire strategy of the institution regarding service delivery (Roussel, 2016). Also, information management may be helpful since it will equid the nurse leader with skills on how to manage the information of the patients. More so, information management helps in the collection of data for the Triple Aim (Roussel, 2016).
Having knowledge of evidence-based practice may greatly impact the overall healthcare climate within an organization. This is because the nurse leaders using it as a part needed to bring change within the management can greatly facilitate innovation. Decision making which is evidence-based is not just for the clinicians’ direct use. Quality improvement, communication and “shared decision making” are all transformational pieces of leadership that endorse change within the diverse system of healthcare (Roussel, 2016).
The need for safety and quality improvement creativities permeates healthcare. Having quality healthcare will mean that the desired results may be achieved and are thus consistent with the professional skills. IOM has it that many medical errors are as a result of faulty processes and system ( Hughes, 2008). Therefore, having quality improvement tools may greatly impact the healthcare system thus making it safer and secure simply because there would be a reduction in medical errors.
Within the United States, it is very important for nurse leaders to collaborate with inter-professional care teams which to redesign the healthcare system of the nation. This is so significant simply because it aims at improving healthcare and health of the nation. Studies have shown that the interprofessional collaboration bears fruits since patients' quality and outcomes of care improve gradually. With the interprofessional collaborations, nurse leaders stand a chance of championing effective, efficient and safer care delivery (Roussel, 2016).
In the new patient care delivery model, there is governance in the design of work which is significant to healthcare. This because where there is an environment which has the model of shared governance, then there is a complete way for the nurse leaders to share their experience thus exploring specific matters which need action. As a result, it greatly benefits the organization, patients, surrounding community and employees through empowerment.
There is need to have nurse leaders involved in the collection of data and improving the infrastructure as a means of workforce planning and policy making. This will be a great thing for them since in this process they will be able to gain more understanding about healthcare. Another thing is that Nurses are in a better position to narrow the disparities in coverage and accessibility and coordinate the increasingly complex health care delivery to diverse patients. They can accomplish their potential as primary care givers to the full extent of their education and training, as well as actualize and maximize the economic value of their contributions across practice settings (Institute of Medicine, 2011).
An organizational structure is usually developed to ensure that the organizations assist and operates well while focusing on attaining its target thus allowing for further growth in the future. Organizational structure does not only have an impact in the business world but also in health and nursing industry. Nurse leaders need to be well equipped and informed to ensure that they do not fail to deliver the best. The nursing organizational structure enables the nurse leader to venture into new spheres to lead well the staff and attain the best of nursing as a profession.
Reference
Hughes, R. G. (2008). Tools and Strategies for Quality Improvement and Patient Safety: In Patient Safety and Quality: An Evidence-Based Handbook for Nurses . Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from ncbi.nlm.nih.gov/books/NBK2682/
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The Future of Nursing: Leading Change, Advancing . Washington (DC): National Academies Press (US).
Lehman, D., Fenza, P. & Hollinger-Smith, L. (n.d.). Diversity & Cultural Competency in Health Care Settings . Retrieved from matherlifewaysinstituteonaging.com/wp-content/uploads/2012/03/Diversity-and-Cultural-Competency-in-Health-Care-Settings.pdf
Porter, E. M & Lee, T. H. (2013). The Strategy That Will Fix Health Care. Harvard Business Review . Retrieved from https://hbr.org/2013/10/the-strategy-that-will-fix-health-care
Roussel, L. (2016). Management and leadership for nurse administrators . Burlington, MA: Jones & Bartlett Learning.
Utley, R. A. (2011). Theory and research for academic nurse educators: Application to practice . Sudbury, Mass: Jones and Bartlett Publishers.
