Organizational Management
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- Words: 600
- Pages: 5
Organizational Management •
Trends in Healthcare o
o
o
Advances in technology
Improved diagnostics and equipment
New medications
New treatments decrease hospital stay
Computers •
Internet
•
telemedicine
Social changes
Savvy consumers
Increasing number of people without healthcare
Alternative health methods
Litigation
Globalization
Different cultures
o
Increasing number of Elderly
o
Healthcare Delivery System Changes
Financing and Reimbursement •
DRGs
•
HMO
•
PPO
Prevention of disease
Location of services
Downsizing/ Merging of hospitals
•
Organizational Structure o
•
Nurse Manager
RN
LPN
NA
o
Shorter pyramids are called decentralized (more decisions are made at a lower level)
o
The higher the pyramid the more centralized it is, more of the decision making is done by people who are higher up
Patterns of Nursing Care Delivery o
Private duty Nursing
o
o
•
Hospital
•
At home
Functional Nursing (Nursing Homes)
Med Nurse
Treatment nurse
Nursing Assistants
Clerical
Team Nursing
o
Agency
Example: •
RN is team leader
•
Two LPNs
•
Two Nursing Assistants
Primary Nursing
One RN responsible for plan of care over a 24 hour period (not taking care of them for the whole 24 hour period)
o
Eliminates the fragmentation of care between shifts and nurses, because one nurse is accountable for planning the care of the patient around the clock
No CNA, like in ICU
Patient-focused
People are cross trained in different things (LPN who is IV certified)
Expanded roles (nursing assistance who are putting in catheters, accuchecks, etc.)
•
Case management p. 336
•
Disease Management
•
•
o
Not for acute care, management of a chronic disease (ex. ESRD, DM, heart failure)
o
Emphasizes prevention of exacerbations and complications by using evidence-based practice guidelines and patient empowerment strategies.
Clinical Pathways o
Care maps (ACS pathway)
o
Multidisciplinary plans of “best” clinical practice for groups of patients with a specific medical diagnosis
o
There are four essential elements of a clinical pathway:
Has timeline outlining when specific care will be given
Categories of care or activities and their interventions
Intermediate and long term outcomes to be achieved
A variance record
How are work assignments determined? o
Patient classification
o
JCAHO requirement
Examples: •
Budgeted nursing hours per patient per day
•
Patient acuity
•
Staffing levels are recalculated annually
•
Setting staffing levels unit by unit
•
Adjusting staffing levels from shift to shift
•
Use outcomes to evaluate the plan
Fixed staffing ratios
o
8 hour shifts = 5 days a week, 7 on/ 7 off
o
12 hour shift
3/2 split
7 on 7 off
Requires less nurses that 8 hour shifts
o
10 hour shift = 4 days a week
o
Baylor plan Weekends 32 hours = 40
Working short staffed o
•
•
Staffing Patterns
•
Hospital Specific written staffing plan
What do you do?
Can the remaining staff meet the needs?
Can someone from the previous shift stay over?
Call a nurse not scheduled to work to come in
Notify the supervisor that the unit needs a nurse
Consumer Relations o
Have it your way
o
You can get better results if you are sweet that if you are rude
Caring
•
Cost effective
Patient centered
Avoid complaints and potential for lawsuits
What do clients want? Based on surveys o
Pain relief
o
Clean room
o
Food
o
Confidence in their healthcare provider
Trends in Healthcare o
o
o
Advances in technology
Improved diagnostics and equipment
New medications
New treatments decrease hospital stay
Computers •
Internet
•
telemedicine
Social changes
Savvy consumers
Increasing number of people without healthcare
Alternative health methods
Litigation
Globalization
Different cultures
o
Increasing number of Elderly
o
Healthcare Delivery System Changes
Financing and Reimbursement •
DRGs
•
HMO
•
PPO
Prevention of disease
Location of services
Downsizing/ Merging of hospitals
•
Organizational Structure o
•
Nurse Manager
RN
LPN
NA
o
Shorter pyramids are called decentralized (more decisions are made at a lower level)
o
The higher the pyramid the more centralized it is, more of the decision making is done by people who are higher up
Patterns of Nursing Care Delivery o
Private duty Nursing
o
o
•
Hospital
•
At home
Functional Nursing (Nursing Homes)
Med Nurse
Treatment nurse
Nursing Assistants
Clerical
Team Nursing
o
Agency
Example: •
RN is team leader
•
Two LPNs
•
Two Nursing Assistants
Primary Nursing
One RN responsible for plan of care over a 24 hour period (not taking care of them for the whole 24 hour period)
o
Eliminates the fragmentation of care between shifts and nurses, because one nurse is accountable for planning the care of the patient around the clock
No CNA, like in ICU
Patient-focused
People are cross trained in different things (LPN who is IV certified)
Expanded roles (nursing assistance who are putting in catheters, accuchecks, etc.)
•
Case management p. 336
•
Disease Management
•
•
o
Not for acute care, management of a chronic disease (ex. ESRD, DM, heart failure)
o
Emphasizes prevention of exacerbations and complications by using evidence-based practice guidelines and patient empowerment strategies.
Clinical Pathways o
Care maps (ACS pathway)
o
Multidisciplinary plans of “best” clinical practice for groups of patients with a specific medical diagnosis
o
There are four essential elements of a clinical pathway:
Has timeline outlining when specific care will be given
Categories of care or activities and their interventions
Intermediate and long term outcomes to be achieved
A variance record
How are work assignments determined? o
Patient classification
o
JCAHO requirement
Examples: •
Budgeted nursing hours per patient per day
•
Patient acuity
•
Staffing levels are recalculated annually
•
Setting staffing levels unit by unit
•
Adjusting staffing levels from shift to shift
•
Use outcomes to evaluate the plan
Fixed staffing ratios
o
8 hour shifts = 5 days a week, 7 on/ 7 off
o
12 hour shift
3/2 split
7 on 7 off
Requires less nurses that 8 hour shifts
o
10 hour shift = 4 days a week
o
Baylor plan Weekends 32 hours = 40
Working short staffed o
•
•
Staffing Patterns
•
Hospital Specific written staffing plan
What do you do?
Can the remaining staff meet the needs?
Can someone from the previous shift stay over?
Call a nurse not scheduled to work to come in
Notify the supervisor that the unit needs a nurse
Consumer Relations o
Have it your way
o
You can get better results if you are sweet that if you are rude
Caring
•
Cost effective
Patient centered
Avoid complaints and potential for lawsuits
What do clients want? Based on surveys o
Pain relief
o
Clean room
o
Food
o
Confidence in their healthcare provider
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