Additional Learning Exercises and Applications
DISPLAY 12.6 Factors to Consider When Organizing Committees
The committee should be composed of people who want to contribute in terms of commitment, energy, and time.
The members should have a variety of work experience and educational backgrounds. Composition should, however, ensure expertise sufficient to complete the task.
Committees should have enough members to accomplish assigned tasks but not so many that discussion cannot occur. Six to eight members in a committee are usually ideal.
The tasks and responsibilities, including reporting mechanisms, should be clearly outlined.
Assignments should be given ahead of time, with clear expectations that assigned work will be discussed at the next meeting.
All committees should have written agendas and effective committee chairpersons.
Responsibilities and Opportunities of Committee Work
Committees present the leader-manager with many opportunities and responsibilities. Managers need to be well grounded in group dynamics because meetings represent a major time commitment. Managers serve as members of committees and as leaders or chairpersons of committees. Because committees make major decisions, managers should use the opportunities available at meetings to become more visible in the larger organization. The manager has a responsibility to select appropriate power strategies, such as coming to meetings well prepared, and to use skill in the group process to generate influence and gain power at meetings.
Another responsibility is to create an environment at unit committee meetings that leads to shared decision making. Encouraging an interaction free of status and power is important. Likewise, an appropriate seating arrangement, such as a circle, will increase motivation for committee members to speak up. The responsible manager is also aware that staff from different cultures may have different needs in groups, which is why multicultural committees should be the norm. In addition, because gender differences are increasingly being recognized as playing a role in problem solving, communication, and power, efforts should be made to include both men and women on committees.
When assigning members to committees, cultural and gender diversity should always be a
goal.
The manager must not rely too heavily on committees or use them as a method to delay decision making.
Numerous committee assignments exhaust staff, and committees then become poor tools for accomplishing work. An alternative that will decrease the time commitment for committee work is to make individual assignments and gather the entire committee only to report progress.
In the leadership role, an opportunity exists for important influence on committee and group effectiveness.
A dynamic leader inspires people to put spirit into working for a shared goal. Leaders demonstrate their commitment to participatory management by how they work with committees. Leaders keep the committee on course. Committees may be chaired by an elected member of the group, appointed by the manager, or led by the department or unit manager. Informal leaders may also emerge from the group process.
It is important for the manager to be aware of the possibility for groupthink to occur in any group or committee structure. Groupthink occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully. If the manager is actively involved in the work group or on the committee, groupthink is less likely to occur. The leadership role includes teaching members to avoid groupthink by demonstrating critical thinking and being a role model who allows his or her own ideas to be challenged.
Organizational Effectiveness
There is no one “best” way to structure an organization. Variables such as the size of the organization, the capability of its human resources, and the commitment level of its workers should always be considered.
Regardless of what type of organizational structure is used, certain minimal requirements can be identified:
The structure should be clearly defined so that employees know where they belong and where to go for assistance.
The goal should be to build the fewest possible management levels and have the shortest possible chain of command. This eliminates friction, stress, and inertia.
The unit staff need to be able to see where their tasks fit into common tasks of the organization.
The organizational structure should enhance, not impede, communication.
The organizational structure should facilitate decision making that results in the greatest work performance.
Staff should be organized in a manner that encourages informal groups to develop a sense of community and belonging.
Nursing services should be organized to facilitate the development of future leaders.
Despite the known difficulties of bureaucracies, it has been difficult for some organizations to move away from the bureaucratic model. However, perhaps as a result of Magnet hospital research demonstrating both improved patient outcomes and improved recruitment and retention of staff, there has been an increasing effort to redesign and restructure organizations to make them more flexible and decentralized. Still, progress toward these goals continues to be slow.
Integrating Leadership Roles and Management Functions Associated With Organizational Structure
Integrated leader-managers need to look at organizational structure as the road map that tells them how organizations operate. Without organizational structure, people would work in a chaotic environment.
Structure becomes an important tool, then, to facilitate order and enhance productivity.
Astute leader-managers understand both the structure of the organization in which they work and external stakeholders. The integrated leader-manager, however, goes beyond personal understanding of the larger organizational design. The leader-manager takes responsibility for ensuring that subordinates also understand the overall organizational structure and the structure at the unit level. This can be done by being a resource and a role model to subordinates. The role modeling includes demonstrating accountability and the
appropriate use of authority.
The effective manager recognizes the difficulties inherent in advisory positions and uses leadership skills to support staff in these positions. This is accomplished by granting sufficient authority to enable advisory staff to carry out the functions of their role.
Leadership requires that problems are pursued through appropriate channels, that upward communication is encouraged, and that unit structure is periodically evaluated to determine if it can be redesigned to enable increased lower level decision making. The integrated leader-manager also facilitates constructive informal group structure. It is important for the manager to be knowledgeable about the organization’s culture and subcultures. It is just as important for the leader to promote the development of a shared constructive culture with subordinates.
It is a management role to evaluate the types of organizational structure and governance and to implement those that will have the most positive impact in the department. It is a leadership skill to role model the shared authority necessary to make newer models of organizational structure and governance possible.
When serving on committees, the opportunity should be used to gain influence to present the needs of patients and staff appropriately. The integrated leader-manager comes to meetings well prepared and contributes thoughtful comments and ideas. The leader’s critical thinking and role-modeling behavior discourages groupthink among work groups or in committees.
Integrated leader-managers also refrain from judging and encourage all members of a committee to
participate and contribute. An important management function is to see that appropriate work is accomplished in committees, that they remain productive, and that they are not used to delay decision making. A leadership role is the involvement of staff in organizational decision making, either informally or through more formal models of organizational design, such as shared governance. The integrated leader-manager understands the organization and recognizes what can be molded or shaped and what is constant. Thus, the interaction between the manager and the organization is dynamic.
KEY CONCEPT
Many modern health-care organizations continue to be organized around a line or line-and-staff design and have many attributes of a bureaucracy; however, there is a movement toward less bureaucratic designs, such as ad hoc, matrix, and care-centered systems.
A bureaucracy, as proposed by Max Weber, is characterized by a clear chain of command, rules and regulations, specialization of work, division of labor, and impersonality of relationships.
An organization chart depicts formal relationships, channels of communication, and authority through line-and-staff positions, scalar chains, and span of control.
Unity of command means that each person should have only one boss so that there is less confusion and greater productivity.
Centrality refers to the degree of communication of a particular management position.
In centralized decision making, decisions are made by a few managers at the top of the hierarchy.
In decentralized decision making, decision making is diffused throughout the organization, and problems are solved at the lowest practical managerial level.
Organizational structure affects how people perceive their roles and the status given to them by other people in the organization.
Organizational structure is effective when the design is clearly communicated, there are as few managers as possible to accomplish goals, communication is facilitated, decisions are made at the lowest possible level, informal groups are encouraged, and future leaders are developed.
The entities in an organization’s environment that play a role in the organization’s health and performance, or which are affected by the organization, are called stakeholders.
Authority, responsibility, and accountability differ in terms of official sanctions, self- directedness, and moral integration.
Organizational culture is the total of an organization’s beliefs, history, taboos, formal and informal relationships, and communication patterns.
Subunits of large organizations also have a culture. These subcultures may support or be in conflict with other cultures in the organization.
Informal groups are present in every organization. They are often powerful, although they have no formal authority. Informal groups determine norms and assist members in the socialization process.
Shared governance refers to an organizational design that empowers staff nurses by making them an integral part of patient care decision making and providing accountability and responsibility in nursing practice.
Magnet designation is conferred by the ANCC to health-care organizations that exemplify five model components: transformational leadership; structural empowerment; exemplary
professional practice; new knowledge, innovation, and improvements; and empirical quality results.
Magnet-designated organizations demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status.
The Pathway to Excellence designation, also conferred by the ANCC, recognizes health-care organizations and long-term care institutions with foundational quality initiatives in creating a positive work environment, as defined by nurses and supported by research.
Too many committees in an organization is a sign of a poorly designed organizational structure.
Committees should have an appropriate number of members, prepared agendas, clearly outlined tasks, and effective leadership if they are to be productive.
Groupthink occurs when there is too much conformity to group norms.
Additional Learning Exercises and Applications
LEARNING EXERCISE
12.5
Restructuring—In Depth
Y
ou are the supervisor at a home health agency. There are 22 RNs in your span of control. In a meeting today, John Dao, the CNO, tells you that your span of control needs adjustment to be effective. Therefore, the CNO has decided to flatten the organization and decentralize the department. To accomplish this, he plans to designate three of your staff as shift coordinators. These shift coordinators will “schedule patient visits for all the staff on their shift and be accountable for the staff that they supervise.” The CNO believes that this restructuring will give you more time for implementing a continuous quality improvement program and promoting staff development.Although you are glad to have the opportunity to begin these new projects, you are somewhat unclear about the role expectations of the new shift coordinators and how this will change your job description. In fact, you worry that this is just a precursor to the elimination of your position. Will these shift coordinators report to you? If so, will you have direct line authority or staff authority? Who should be responsible for evaluating the performance of the staff nurses now? Who will handle employee disciplinary problems?
How involved should the shift coordinators be in strategic planning or determining next year’s budget?
What types of management training will be needed by the shift coordinators to prepare for their new role?
Are you the most appropriate person to train them?
A S S I G N M E N T:
There is great potential for conflict here. In small groups, make a list of 10 questions (not including the ones listed in the Learning Experience) that you would want to ask the CNO at your next meeting to clarify role expectations. Discuss tools and skills that you have learned in the preceding units that could make this role change less traumatic for all involved.
LEARNING EXERCISE
12.6
Problem Solving: Working Toward Shared Governance
Y
ou are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for providing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve this issue and others like it but are not quite sure where to start.A S S I G N M E N T:
Assume that you are the supervisor in this case. Answer the following questions:
1. Who do I need to involve in this discussion and at what point?
2. How might I determine if the overarching organizational structure supports shared
governance? How would I determine if external stakeholders would be impacted? How would I determine if organizational culture and subculture would support a shared governance model?
3. What types of nursing councils might be created to provide a framework for operation?
4. Who would be the members on these nursing councils?
5. What support mechanisms would need to be in place to ensure success of this project?
6. What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model?
LEARNING EXERCISE
12.7
Finding Direction
Y
ou are a new graduate working on the 3 PM to 11 PM shift in a large, metropolitan hospital on the pediatrics unit. You feel frustrated because you had many preceptors while you were being oriented, and each told you slightly different variations of the unit routine. In addition, the regular charge nurse has just been promoted and moved to another unit, and the charge nurse position on your unit is being filled by two part-time nurses.You feel inadequately prepared for the job and do not know where to turn or to whom you should direct your questions. Assuming that your organization chart resembles the one in Figure 12.1, outline a plan of action that would be appropriate to take. Share your plan with a larger group.
LEARNING EXERCISE
12.8
Thinking About Committee Work
A
s a writing exercise, choose one of the following to examine in depth:1. What has contributed to the productivity of the committees on which you have served?
2. Have you ever served on a committee that made recommendations on which higher authority never acted? What was the effect on the group?
LEARNING EXERCISE
12.9
Participation and Productivity
Y
ou are a 3 PM to 11 PM charge nurse on a surgical unit. You have been selected to chair the unit’s safety committee. Each month, you have a short committee meeting with the other committee members. Your committee’s main responsibility is to report upward any safety issues that have been identified. Lately, you have found an increase in needle-stick incidents, and the committee has been addressing this problem.The committee is made up of two nursing assistants, one unit clerk, two staff RNs, and two licensed practical nurses/licensed vocational nurses. All shifts and staff cultures are represented. Lately, you have found that the meetings are not going well because one member of the group, Mary, has begun to monopolize the meeting time. She is especially outspoken about the danger of HIV and seems more interested in pointing blame regarding the needle sticks than in finding a solution to the problem.
You have privately spoken to Mary about her frequent disruption of the committee business; although she apologized, the behavior has continued. You feel that some members of the committee are becoming bored and restless, and you believe that the committee is making little progress.
A S S I G N M E N T:
Using your knowledge of committee structure and effectiveness, outline steps that you would take to facilitate more group participation and make the committee more productive. Be specific and explain exactly what you would do at the next meeting to prevent Mary from taking over the meeting.
LEARNING EXERCISE
12.10
Finding an Organizational Culture That Fits
J
oanie Smith is a 32-year-old single mother of two who will graduate in 3 months from a local associate degree nursing program. Joanie has accrued some debts in completing her nursing education. She has been offered two jobs upon graduation: one is at a local medium-sized hospital (Community Center Hospital) and one is in a larger city some distance away (Metropolitan City Hospital). Both job offers are in the obstetrical unit, which is Joanie’s desired place of work, because some day, she hopes to return to school tobecome a nurse midwife.
Research on the two hospitals shows that both are accredited and have good medical staffs, and Joanie has received positive feedback on both from people whose judgment she trusts.
A S S I G N M E N T:
Pretend you are this nurse. What additional type of information should you gather to be able to decide which of these organizations is a better fit? What particular assessment of organizational culture can you do that would help you make a better decision?
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