Nurs 6231: healthcare systems and quality outcomes – discussion 3

Discussion: Comparing Frameworks for Analyzing Organizations

Avedis Donabedian’s work generated a pivotal means of assessing organizational performance relative to structure, process, and outcomes. However, it is clearly not sufficient to view health care quality merely in terms of outcomes—the structures and processes that facilitate these outcomes are equally as important.

In this Discussion, you consider multiple frameworks that can be used to analyze an organization. As you proceed, consider how these frameworks allow you to examine the interplay of interdependent and related parts and processes that comprise the systems within an organization, as well as the arrangements or structures that connect these parts.

To prepare:

Investigate and reflect on the systems and structures of an organization with which you are familiar. Consider the following:

What is the reporting structure?

Who holds formal and informal authority?

How many layers of management are there between the frontline and the highest office-holders of the organization?

How are interdisciplinary teams organized?

How is communication facilitated?

How well integrated is decision making among clinical personnel and administrative professionals?

How are particular service lines organized?

Which departments, groups, and/or individuals within the organization are responsible for monitoring matters related to performance, such as quality and finances?

Select two of the following frameworks:

Learning organizations, presented in the Elkin, Haina, and Cone article

Complex adaptive systems (CAS), presented in the Nesse, Kutcher, Wood, and Rummans article

Clinical microsystems, presented in the Sabino, Friel, Deitrick, and Sales-Lopez article

Good to great, presented in the Geller article

The 5 Ps, presented in the ASHP Foundation article

Review the Learning Resources for each of the frameworks that you selected. Also conduct additional research to strengthen your understanding of how to use each framework to assess an organization.

Compare the two frameworks. How could each framework be used to identify opportunities to improve performance? In particular, how would you use each of these frameworks to analyze the organization that you have selected?

Post an analysis of the systems and structures of the organization you selected, sharing specific examples. Explain insights that you gained by comparing the two frameworks, and how each can be used to assess an organization, identify a need for improvement, and, ultimately, enhance the performance of an organization.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Compare the organizational structure of your colleague’s selected organization to your own.

Ask a clarifying question.

Select an attribute of the identified organizational structure and ask your colleague to elaborate on how this attribute is evidenced in their organization.

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.

Chapter 1, “Evaluation and DNPs: The Mandate for Evaluation” (pp. 3-36)

Chapter 3, “Conceptual Models for Evaluation in Advanced Nursing Practice” (pp. 61-86)

Chapter 6, “Evaluating Organizations and Systems” (pp. 127-142)

Chapter 1 defines microsystem, mesosystem, and macrosystem and notes that evaluation can focus on one of these levels or all three. Chapter 5 examines the evaluation of organizations and systems.

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.

Chapter 2, “Understanding the Healthcare Organization” (pp. 31–43)

Although this chapter focuses on hospitals, the authors provide information about strategic planning and organizational structure that is applicable in many health care settings. The authors examine financial and quality issues as key aspects of performance measurement.

Elkin, G., Zhang, H., & Cone, M. (2011). The acceptance of Senge’s learning organisation model among managers in China: An interview study. International Journal of Management, 28(4), 354–364.

Retrieved from the Walden Library databases.

This article outlines the five disciplines that Senge argued could be found in a learning organization. The authors also discuss the worldview that is inherent in business organizations in China and explain how this relates to Senge’s theory.

Geller, E. S. (2006). From good to great in safety: What does it take to be world class? Professional Safety, 51(6), 35–40.

Retrieved from the Walden Library databases.

Geller reviews and applies Collin’s foundational Good to Great theory from its focus on financial success to safety.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23–28.

Retrieved from the Walden Library databases.

This article explores how to implement change in complex adaptive systems (CAS) such as health care. The authors purport that an understanding of the principles of change management in CAS is critical for success.

Sabino, J. N., Friel, T., Deitrick, L. M., & Salas-Lopez, D. (2009). Striving for cultural competence in an HIV program: The transformative impact of a microsystem in a larger health network. Health & Social Work, 34(4), 309–313.

Retrieved from the Walden Library databases.

The authors discuss cultural competence as part of a patient-centered perspective on health care delivery. They examine an approach to creating innovation that originates at the unit (microsystem) level and can be diffused to the larger health care environment (macrosystem).

 ASHP Foundation. (n.d.). Assessing your microsystem with the 5 Ps. Retrieved February 5, 2012, from http://www.ashpfoundation.org/lean/CMS9.html

This article discusses 5 Ps—purpose, patients, professionals, processes, and patterns—that you can analyze to deepen your understanding of a microsystem.

 Document: Course Project Overview (PDF)

Required Media

Laureate Education (Producer). (2013f). Organizational structures. Retrieved from https://class.waldenu.edu 

Note:  The approximate length of this media piece is 3 minutes.

Dr. Carol Huston discusses the influence of organizational structure on the delivery of quality care.