Nursing Management - Exam 2 (part 2)

olanjones's version from 2017-06-24 14:34

Organizational Structures & Strategic Planning

Question Answer
Importance of a mission statement & vision to an organization’s activitiesMission: reason for organization’s existence - influences the design of the structure; Vision: articulated goal to which organization aspires - suggests how far to strive in all endeavors
Bureaucracies & decisions made by written policiesbureaucracies tend to have labor specialization (pt care divided into highly specialized tasks); centralization; formalization (percentage of actions required to deliver pt care that is governed by written policy & procedure)
Centralized vs. decentralized organizations*Centralization refers to where the decision is made*
- Centralized organization: decisions are made at the top (bureaucracies)
- Decentralized organization: decisions made at or close to patient-care level (shared governance)
How are line & staff positions indicated on organizational chartsUsu indicate line positions through the use of solid lines & staff positions through broken lines
Line positions - involve direct responsibility for accomplishing obj of nursing dept
Staff positions - assist individ in line positions in accomplishing the primary obj
Strategic planningguiding members of an organization envision their futures & develop the necessary procedures/operations to actualize that future
Strategic planning process1. Assessment of environment: External (competition, trends, economic factors, technology, social/educational factors); Internal (pt care, financial & human resources, information & education systems, R&D); Organizational (admin, service depts. medical staff)
2. Review of mission statement, philosophy, goals, & objectives: making sure statement is reflective of purpose/direction of organization; setting goals/objectives that are Specific, Measurable, Agreed on, Realistic, Time bound; and adhere to deadlines, provide instruction & support to employees, appropriate feedback, and performance monitoring
3. ID of strategies: identifying major issues, establishing goals, & developing strategies to meet the goals (see Table 16-1 pg. 296)
4. Implementation: execution of plan; entails open communication w/ staff, development of revised policies/procedures re: changes, creation of area & individual objectives r/t the plan
5. Evaluation: on a consistent basis, at regular intervals, the strategic plans is reviewed at all levels to determine whether the execution of the goals, objectives, and activates are on target
Value of an environmental assessment phaseAllows ID of opportunities & threats (external), strengths & weaknesses (internal) to develop objectives
Most difficult phase of strategic planning Assessment of the external, internal, & organizational environment (the initial phase)
Relationship of the strategic plan to the mission of the organizationProvides direction for one’s efforts & toward which others must then react ? pg 292
How long in years that a strategic plan is made forplan of action that covers 3-5 years (used to be 10 but too much changes in that time)

Healthcare Organizations

Question Answer
Describe private non-profits (Not-for-profits) and for-profit organizations- Non-profit: tax exempt (for providing a community service), excess revenue is redirected into the organization
- For-profit: required to pay taxes, provide fewer unprofitable services, geared toward earning profit for shareholders
% of short-term hospitals that are for-profit today15% (pg. 122)
Discuss tax exemptUsu charitable organizations (think agencies on Pick. Click. Give.) may provide charitable, religious, educational, literary, scientific, public services
Do not pay federal or state income taxes, property tax, donors may be able to take a tax deduction for their donation to these organizations
Poor/indigent careOrganizations w/ taxing authority/direct support from local/state gov't have a clear mandate to care for indigent pts & receive at least some level of dedicated funds to do so
Mandated community service- Public & non-profit have a concomitant responsibility to provide to poor & indigent
- For-profit do not have mandated community service (they actively seek to avoid providing uncompensated care)
Agencies that JC provides accreditation foracute care hospitals (approx 80% of them), ambulatory surgicenters, clinical labs, critical access hospitals, HMOs, PPOs, home health agencies, & hospices
Fastest growing organization segment in health careHome Health Organizations
Regulatory Organizations:
How they set standards, ensure compliance, investigate consumer complaints
Lead regulatory agency in U.S. is CMS (d/t size): regulate by a complex set of rules (outlined in Conditions of Participation - CoP), to be in compliance with CoP, healthcare organizations must meet certain quality assessments & performance improvement requirements - CMS contracts state organizations (usu DHHS) to work w/ healthcare org. CMS provides financial incentive to report quality data.
Regulatory agencies for healthcare includeCenters for Medicare & Medicaid (CMS), FDA, OSHA, Equal Employment Opportunity Commission (EEOC), & state licensing boards for various health professions
Medicare (in terms of recipients, who/how many covered)not limited to individuals age 65+, also for persons with certain permanent illnesses (e.g. end-stage renal disease); MDCR covers more than 40 million individuals
CMS incentive for hospitals to report quality datafinancial incentive is provided for data to establish minimum quality standard for healthcare facilities & by pts to help them make decisions about where to seek healthcare (program is designed to ensure that healthcare organizations systematically examine the quality of care provided)
What is accreditationthe approval, recognition, or certifications by an official review board that an organization has met certain standards
Largest 3rd-party payer involved in healthcare provisionFederal government
3 forces that influence healthcare organizations (ID & describe)1. Social: Patients becoming better informed, more involved in their own healthcare decisions will demand more personalized care
2. Economic: Affordable care act (more people w/ ins) led to more people seeking care; more uninsured leads to more uncompensated care
3. Demographics: Geographical dispersion, regional access to care, aging or income of populations, immigration will change demand for care
Chaos theory includes successful managers as using flexibility, taking risks, tolerating ambiguity
Provide examples of each
- Flexibility: reorganizes schedule when a nurse is sick or floated off of the unit
- Taking risks: documents inadequate care given by self & staff d/t under-staffing in effort to verify need for more staff
- Tolerating ambiguity: not knowing where our preceptorship will be at ;-)
Demographics of health systembiggest growing group are >85 years old; ↑ gap btwn rich & poor people
Number of nurses, compared with doctors1% of people are nurses (approx. 3 million!), fewer doctors (<1 million) than nurses
Number of people in US; % those w/ private/employer ins; # w/ MDCR MDCD330 million in the US; >50% w/ private ins; approx. 100 million w/ MDCR/MDCD ??
List other ways or places that people in US get health care, other than being uninsuredDoD, Veterans, American Indian/Alaska Native tribal consortium, Dept of Corrections

DON'T FORGET to read: DO ALASKA NATIVE PEOPLE GET FREE MEDICAL CARE? (pg 78-80) & Beginning of COSTS & BUDGETS chapter (pg 211-??)