exam 2

Question 1

organizational design

Answer 1

The arrangement of authority, responsibility, and flow of information within an organization, resulting in an organizational structure

Question 2

relation to management activities

Answer 2

1. Statement of mission
2. Strategy development
3. organization design
4. Information needs
5. Rewards
6. Performance evaluation
7. Feedback loop (change)

form (3) follows function (mission and strategy)

Question 3

twin structural issues

Answer 3

differentiation and integration

Because we have so much differentiation (medical specialties) in the org, we need to integrate

Question 4

continuum of structures

Answer 4

functional

direct contact

integrators and liaisons
-long-term point of contacts for each department to communicate across departments

task forces

• limimited in time and focused
• often interdepartmental

committees

• the “parallel organizatin”
• continue overtime and interepartmental

teams

programs/service line

• Centers of excellence
• Mini org within org for high volume and complex specialties
• So large and so complex, you may have a specific program
• Cancer and heart care

Question 5

programming approaches to coordination of work

Answer 5

Standardization of work processes (Clinical pathways) (sometimes protocols): standardized way of going about your work

• Benefits of standardization
• Often protocols (same thing)
• Pathway from admissions to discharge

Standardization of skills

Standardization of outcomes

Question 6

feedback approaches to coordination of work

Answer 6

Supervision: exchange of information in hierarchical relationships

Mutual adjustment: not in hierarchical relationships; one-on-one relationships that occur to get jobs done; informal interactions between MDs and RNsd

Group coordination: more formal and typical done in morning rounds
-Get the whole team across disciplines together

Question 7

responsbility matrix

Answer 7

fixes accountability

Assign task and responsibilities to primary owner, supper, coordination, decision

Question 8

communication

Answer 8

the creation of exchange of understanding between sender(s) and receiver(s)

Repeat back in your own words so you understand what i meant

Question 9

channels of communication

Answer 9

Face-toface

• need to be face-to-face to solve a problem
• If not possible, can do virtual

Virtual

Correspondence

Phone

E-mail

Question 10

defensive communication to open communication

Answer 10

defensive communication is a barrier to open communication

Evaluating ——> descriptive

Controlling ——> supporting

Making statements ——> asking questions

Acting parent-child ——> acting adult-adult

Question 11

how do we communication

Answer 11

Non-verbal 55% (why in-person is best)

Tone of voice 38%

Verbally 7%

Question 12

communicating with stakeholders

Answer 12

stakeholder mapping
-Map out people with stake (interest in org) in org to determine stakeholders and then find out 4 things from them

Stakeholder analysis

• Needs
• Expectations
• Challenges
• recommendations

Question 13

tools for managing organizational communication

Answer 13

Interviews

Nominal group technique; silent brainstorm then group together

Focus groups

• Limited to 5-7 people; focus on a specific issue
• Surveys or questionnaires will show up as a problem so you run a focus group to drill down on that problem

Questionnaires
-Less effective; bad response rate

Delphi techniques

• Delphi technique used to reach out to people who cannot be there
• Do this if you have geographically dispersed people
• Survey, synthesize, send back out (see what others are saying and piggy back on those ideas), survey back again

Question 14

key communication hints

Answer 14

Eye contact
Voice, non-verbal
Consistency of message
Paraphrasing
Watch filters and barriers
Simple and focused
Enough time
Right channel

Question 15

power

Answer 15

ability/potential to exert actions that either directly or indirectly cause a change in the behavior and/or attitudes of another individual or group

Often characterized by coercion

You have the ability but not the influence to take action

Question 16

influence

Answer 16

actions, either directly or indirectly, cause a change on the behavior and/or attitudes of another individual or group

Influence is power turned into action

Question 17

politics

Answer 17

ongoing process of managing influence, characterized by its hidden nature

This is a process whereby participants attempt to influence organizational decisions and activities in ways that are not sanctioned by the organization

Question 18

power abuse

Answer 18

use of power in ways that are not acceptable, often involves self-interest and not the organizations best interest

Often inflicts negative outcomes on workers, customers and other stakeholders

Question 19

sources of power

Answer 19

Structural
-hierarchical (you have power because you are the boss)

Structurally derived (ex. Support services)
-We have the power because we have the important services that you need

Cultural (ex. informal/peer leaders)

Knowledge-based
-someone with the knowledge to lead a project; specialties in medicine

Network centrality
-Being close to power

Question 20

preventing abuse of power

Answer 20

Transparency

Board and advisory boards
-important to make sure things are done correctly

External auditors
-Check the books

Code of ethics
-guidelines for how we behave in an organization

Appraisal systems

Personal integrity in hiring

Question 21

Conflict can be good but it can be detrimental if there’s too much and you don’t manage it well

Answer 21

Why we need conflict

• Can stimulate productivity and creativity
• Can unearth differences
• Serves as an antidote to groupthink

Why we don’t need conflict

• High levels can be detrimental and destructive
• Diverts attention away from mission
• Increases stress
• Reduced well-being
• Loss of trusting, supportive relationships

Question 22

3 types of conflict

Answer 22

Task conflict (what to do)
-Disagreement about the actual job/task

Administrative conflict (how to do it)
-Disagreement on how task is to be done

Relationship conflict (ways to work together)
-Interpersonal conflict

Question 23

conflict management; each have tradeoffs for self/others

Answer 23

Pressing: assertive and uncooperative (win/lose)
-Times to do this such as urgency and patient safety

avoiding: unassertive and uncooperative (lose/lose)
- Need time to cool off or you don’t have enough info to resolve the conflict

Collaborating: assertive and cooperative (win/win)
-Trying to meet the needs of 2 people

Accommodating: unassertive and cooperative (lose/win)
-Needs of other more important than own

Compromising: no winners or losers
-Resolve by splitting the difference

Question 24

learning

Answer 24

Involves the acquisition of knowledge and skills through study, instruction, or experience. We take action, we gather info about the effects of our actions and then we revise our understanding of our world and ourselves. It is a balanced feedback loop

Gain skills, apply them, learn from that application, adjust as necessary

Experience is the best way to learn

importance of non-stop learning

Question 25

types of organizational learning

Answer 25

Adaptive (single loop) : patient shows up late, you work them in - Whack a mole - Adapt to circumstances then move on Generative (double loop): what caused that patient to be late or what caused us to be behind schedule - Looking at underlying root causes - Fixes system

Question 26

disciplines of the learning organization

Answer 26

System thinking: how 1 thing affects another Personal mastery Mental models: challenge your own assumptions of people, things Shared vision Team learning

Question 27

5 building blocks of learning organizations

Answer 27

1. Systematic problem solving 2. Learning from own experience and past history 3. Learning from the experiences and practices of others 4. Transferring knowledge quickly and efficiently throughout the organization 5. Experimenting with new approaches (innovation)

Question 28

the innovative process (5th step of learning organizations

Answer 28

Genesis (generate ideas and narrow down) - Generation, exploration of multiple ideas (brainstorming) - Convergence of ideas (pros/cons) - Trigger for concentrated effort - Vague goals, optimistic projections 2. Development (develop a few ideas) - Multiple paths/approaches - adaptation/change based on experience/testing - evolving/changed goals - Sponsor involvement/influence on change 3. Termination (decide which one to adopt) - Final adaptation.change to local or unique situation - Implementation or termination - Lessons learned

Question 29

characteristics of complex systems

Answer 29

Interconnected (change in one area affects another area) Non-linear (small changes can produce big effects) Dynamic (constant change, prior conditions influence current events)

Question 30

lewin's change model

Answer 30

Unfreezing —> moving —> refreezing

Question 31

managing change

Answer 31

1. Establishing urgency (unfreezing) 2. Creating a guiding coalition (unfreezing) 3. Developing a vision (unfreezing) 4. Communicating the change vision (moving) 5. Empowering broad-based action (moving) 6. Creating short-term wins (moving) 7. Consolidating gains (refreezing) 8. Anchoring new approaches into the culture (refreezing)

Question 32

productivity

Answer 32

rate of outputs to inputs Ex. number of admissions to ER nurses

Question 33

efficency

Answer 33

cost per unit of output Ex. average labor costs per admissions

Question 34

effectiveness

Answer 34

degree to which goals and objectives are met Ex. reduction in mortality or infections

Question 35

quality improvement

Answer 35

organized approach to planning and implementing continuous improvement in performance

Question 36

3 categories of quality measures

Answer 36

Structural: based on organizational features or participant characteristics (ex. % of doctors board certified) Process: activities in carrying out work (ex. Number of patients seen, number of nurses trained) -If you need a knee replacement, you might pick a doctor who does a lot of knee replacement every year (that doesn’t necessarily mean they’re good at it, but they have done a lot so maybe you want them more) Outcome: evidence of degree that ultimate objective is met (ex. Health status) - Effectiveness - Hard to measure so structure and process often used as surrogate

Question 37

QI approaches

Answer 37

Clinical practice guidelines: recommendations for treatment for specific clinical conditions based on a synthesis of the evidence in literature -Specify protocol; outline what needs to get done based on best practices Crew resource management training: a technique from aviation industry to address errors from communication and decision making in teams -Simulate stressful situations and give feedback Benchmarking: process of comparing (and then enhancing) an organization’s performance to those of “best practices” 1. Know your operation; assess strengths and weaknesses 2. Know the industry leaders and competitors 3. Incorporate the best 4. Gain superiority Lean: an improvement approach that focuses on improving efficiency and eliminating waste (excess inventory, duplicate steps, etc) -eliminating waste (make things more efficient) Six sigma: a data-drive methodology for eliminating defects in any process by applying a consistent framework of DMAIC (define, measure, analyze, improve, control) to minimize variation, improve processes, and enhance quality -eliminate problems in the system (ex. Infection rates) Total quality management: a participative, systematic approach to planning and implementing QI

Question 38

models of organization

Answer 38

traditional -top --> bottom (think triangle) is leadership, management, labor (workforce) total quality organization: servant leadership -top --> bottom (think upsidedown triangle) is customers, labor (workforce), management, leadership

Question 39

common QI approaches

Answer 39

patient/customer focus Employee involvement Teamwork, QI teams measurement/tracking process/systems improvement Use of problem solving tools Management action/leadership Improvement though 1. Eliminating defects 2. Meeting customer needs and preferences Proactive risk assessment High standards Use of IT

Question 40

improving quality of care

Answer 40

1. Develop a participative, team-oriented organizational culture that encourages input from professionals and other workers from all levels of the organization 2. Establish high standards and expectations 3. Develop information systems that provide relevant, timely, and accurate data for purposes of taking corrective action and reaching ever-higher standards - Use statistical thinking and tools to identify desired performance levels, measure current performance, interpret it, and take action when necessary 4. Look for opportunities to improve quality by detecting and preventing potential problems in the process 5. Design work to reduce complexity and increase standardization 6. Develop reward systems that reinforce participation and high performance 7. Recruit the best available talent

Question 41

Improving productivity and efficiency of care

Answer 41

1. Develop accurate, timely, and useful management information systems 2. Concentrate productivity improvement program in large departments where payoff will result 3. Consider streamlining and consolidating departments and functions 4. Develop scheduling systems consistent with professional values - Focus on areas where quality can be maintained or even enhanced through better scheduling of staff and support resources 5. Cross train staff to gain greater flexibility 6. Develop productivity based incentives based on work activities under the control of organizational members 7. Set high standards by establishing “best practices” in one’s own organization as well as using comparison from competitors and industry leaders 8. Involve organizational members, particularly professions, in the development, implementation