ORGANIZATIONAL STRUCTURE/MAKING

DECISIONS

February 21, 2012

INTERRELATIONSHIP OF MISSION, VISION AND

PHILOSOPHY

Mission Statement: • Tells what the organization does• Defines the purpose and primary objectives• Internal- defines key measures of success for leadership

Vision Statement:• Explains why; where it is aiming• Descriptive state of future• External- Shapes customers understanding

Philosophy:• Values: How they will do that work- the talk they want to

walk

GROUP PROJECT

Search the web and define assigned organizations• Mission Statement• Vision Statement• Philosophy or Values Statement

Post on Wallwisher at:http://www.wallwisher.com/wall/Missionvisionvalues

ORGANIZATIONAL CULTURE

The reflection of the norms or

traditions of the organization as

exemplified through behaviors

that illustrate the values and

beliefs of the organization.

CHARACTERISTICS OF ORGANIZATIONAL

STRUCTURES

Complexity

Formalization

Centralization

TYPES OF ORGANIZATIONAL

STRUCTURES

Functional

Service Line

Matrix

Flat

Shared governance

FUNCTIONAL

SERVICE LINE

MATRIX

FLAT

SHARED GOVERNANCE

Promotes autonomy and accountability

Also referred to a professional practice models

Magnet hospitals

Varies hospital to hospital• Forums• Committees• Councils with authority- organizational

MAKING DECISIONS AND SOLVING PROBLEMS

CRITICAL THINKING

Critical thinking is the mental process of analyzing

or evaluating information• Reflects upon the meaning of statements,

examines available date and uses reason to make informed decisions

• Necessary to reflect and evaluate from a broader scope of view

• more complex than decision making but is needed in order to make good decisions

• Nurses us when making decisions, prioritizing and managing the care of clients.

BLOOM’S TAXONOMY

ATTITUDES OF CRITICAL THINKERS

Intellectual Humility

Intellectual Courage

Intellectual Empathy

Intellectual Integrity

Intellectual Perseverance

Faith in Reason

Intellectual Sense of Justice

INTELLECTUAL HUMILITY

Knowing what you don’t know

Knowing your own personal bias

or prejudices

INTELLECTUAL COURAGE

Involves the ability to withhold

judgments and conclusions until all

the facts are in.

Willing to be open to other ideas,

beliefs, and concepts

INTELLECTUAL EMPATHY

Being able to imagine yourself in

the role of another in order to better

understand comprehend and assist

the other person in dealing with

whatever it is they are face with

INTELLECTUAL INTEGRITY

Hold yourself to the same

standard that you hold

others.

INTELLECTUAL PERSEVERANCE

Involves taking the appropriate

steps and persevering through to

the conclusion because the end

results is worth the time and

trouble.

FAITH IN REASON

The belief that people owe

it to themselves and to their

profession to develop,

maintain and enhance critical

thinking abilities and skills.

INTELLECTUAL SENSE OF JUSTICE

The ability to fairly evaluate and

reach conclusions based on what is

known, not what you or someone

else only perceive to be true.

CRITICAL THINKING

Professional Judgment

Creativity

Decision Making

Problem Solving

PROFESSIONAL JUDGMENT

Skill

Training

Education

CREATIVITY

Conceptualizing new and

innovative approaches to a

problem or issue.

DECISION MAKING

Is a purposeful and goal-directed effort that

uses a systematic process to choose among

options

The process by which a course of action is

determined. The course of action may be in

response to a problem or an issue.

DECISION MODELS

Satisficing- good enough

Optimizing – best possible

DECISION-MAKING STYLES

Autocratic- decide and

announce

Democratic/participative- group

input

DECISION MAKING TOOLS

Decision Grids

SWOT

DECISION GRID

SWOT

Framework for situation analysis

Encompasses both internal and external

environment• Internal factor: Strengths &

Weaknesses• External factors: Opportunities and

Threats

CREATE A PLAN OF ACTION

What steps can you take to:• Capitalize on your strengths• Overcome or minimize you weaknesses• Take advantage of some new

opportunities• Respond to the threats

• Set goals and objectives, like with any other plan

SWOT TEMPLATESWOT Analysis Template

Internal Strengths Weaknesses

1.

1.

External Opportunities Threats

1.

1.

SWOT Analysis Summary

PROBLEM SOLVING

Includes a decision-making step, is

focused on trying to solve and

immediate problem, which can be

viewed as a gap between “what is” and

“what should be.”

PROBLEM SOLVING PROCESS

Define problem, issue, situation

Gather and analyze data

All possible solutions are identified

and evaluated

Select and Implement a solution

Evaluate results

CAUSE & EFFECT DIAGRAMS

Also called CEDAC, Fishbone diagram,

Ishikawa diagram

Identifies many possible causes

Can be used to structure a brainstorming

session

Sorts ideas into useful categories

FISHBONE TEMPLATE

PRIORITIZATION

Requires decisions be made regarding the

order in which• Clients are seen• Assessments are completed• Interventions are provided• Steps in client procedure are completed• Components of client care are completed

PRIORITIES BASED ON

Shift reports and other communications

with members of the healthcare team

Through careful review of documents

By continuously and accurately

collecting data

ATI PRIORITIZATION PRINCIPLES

Prioritize systemic before local (life before limb)

Prioritize acute before chronic

Prioritize actual problems before potential future problems

Listen carefully to clients and don’t assume

Recognize and respond to trends versus transient findings

Recognize signs of medical emergencies and complications versus

“expected client findings.”

Apply clinical knowledge to procedural standards to determine the

priority action

PRIORITY SETTING FRAMEWORKS

Maslow’s Hierarchy of Needs

Airway Breathing Circulation (ABC) Framework

Safety/Risk Reduction

Assessment First

Survival Potential

Least Restrictive

MASLOW’S HIERARCHY

ABC FRAMEWORK

An open airways is necessary for breathing, so it is highest

priority• Identify airway concern• Establish airway if indicated

Breathing is necessary for oxygenation of the blood to occur• Assess effectiveness of breathing• Intervene as appropriate (reposition, Narcan etc.)

Circulation is necessary for oxygenate blood to reach tissues

Disability_ Assess for current or evolving disability

SAFETY/RISK REDUCTION

Look first for a safety risk.

Next ask, “What’s the risk to the client?” and “How

significant is the risk compared to other posed

risks?”

Give priority to responding to whatever finding

poses the greatest (or most imminent) risk to the

client’s physical well-being

ASSESSMENT FIRST

Use the nursing process to

gather pertinent information prior

to making a decision regarding a

plan of action.

SURVIVAL POTENTIAL

Use this framework for situations in which health

resources are extremely limited (mass casualty,

disaster triage)

Give priority to clients who have a reasonable

chance of survival with prompt intervention. Clients

who have a limited likelihood of survival even with

intense intervention are assigned the lowest priority.

LEAST RESTRICTIVE

Select interventions that

maintain client safety while

posing the least amount of

restriction to the client.

TIME MANAGEMENT

Good time management• Facilitates grater productivity• Decreases work-related stress• Helps ensure the provision of quality and appropriately

prioritized client care• Enhances satisfaction with care provided

Poor time management• Impairs productivity• Leads to feelings of being overwhelmed and stressed• Increases omission of important tasks• Creates dissatisfaction with care provided

HOW TO ORGANIZE CARE

What must be done immediately?

What must be done by as specific time to ensure

client safety, quality care , and compliance with

facility policies and procedures?

What must be done by the end of the shift?

What can be delegated?

CYCLIC PROCESS

Time initially spent developing a plan will save time later and help to

avoid management by crisis

Set goals and plan care based on established priorities and thoughtful

utilization of resources

Complete one client care task before beginning the next, starting with the

highest priority task

Reprioritize remaining tasks based on continual reassessment of client

care needs

At the end of the day, perform a time analysis and determine if time was

use wisely.

TIME MANAGEMENT AND TEAMWORK

Be cognizant of assistance needed by other health

care team members

Offer to help when unexpected crises occur

Assist other team members with provision of care

when experiencing a period of “down time.”

TIME MANAGEMENT & SELF-CARE

Take time for oneself

Schedule time for breaks and meals

Take physical and mental breaks

from work/unit

CASE STUDIES

Critical Thinking