Outline for Assignment 3

Outline for Assignment 3

Introduction:

Healthcare organizations across the globe have been experiencing challenges In the installation of continuum methodology in redress to evolving change in the working environment. This is forced by variation in the expectation in the quality of care and care demand intensification. These changes call for healthcare organizations across the globe to implement measures to maintain equilibrium between organization current and desired state. The desire to create and maintain state equilibrium has enabled much healthcare organization to create a positive practice environment and develop a human resource that alight with the healthcare organization goals. Research by Dans, Pabico, Tate, & Hume, (2017) alludes that empowerment of healthcare professional to be in the forefront in the drive toward the provision of high-quality healthcare services is the key to instilling sustainable excellence. In such cases, nurses can control practice environment within the internal structures of the organization, thus increasing the rate and prevalence of all employees’ satisfaction. This situation has also been shown to increase nurses retention and satisfaction with their working environment conditions (Nei, Snyder, & Litwiller, 2015).

The Pathway to Excellence® Self-Assessment of Organizational Culture provides the protocol for conducting self-assessment to identify any existing gap within the organization culture.  In daily bases, nurses within healthcare organizations are involved in the provision of care to patients who are a critical role in the determination of organization culture. Despite working in an environment integrated with professional with different cultures, the role of nurses can positively or negatively affect the culture of an organization (Bellou, 2018).  Therefore the Pathway to Excellence ® Self-Assessment of Organizational Culture allows nurses to control nursing practice and orientate them work environment through a collaborative relationship with other healthcare providers profession.

Evaluation of four questions and their examples

The question in the questionnaire assesses different categories of organizational culture which represent a different element of performance.  These categories include shared decision making, leadership, safety and quality. The shared decision-making pathways of the assessment determine the ethics involved in interprofessional collaboration available mechanism to support nursing staff while addressing ethical concerns. Example of the question in this category includes:

• Is there evidence that the shared governance structure is integrated throughout the organization and direct care nurses utilize this shared governance structure.
• Does the organization utilize evidence-based practice to implement change in nursing practice?
• Does the organization foster and support a culture of interprofessional decision-making?
• Is input from direct care nurses used in the hiring process for new staff?

The leadership category address the application of change principles, succession plan and implementation of emerging trends in nursing care alongside their competency and qualification. The question in this category include;

• Do nurse managers accommodate and actively support direct care nurses to participate in shared governance committees?
• Is the CNO accessible to nursing staff?
• Does the organization have role-specific orientation for nurse managers?
• Does the organization provide leadership development activities to enhance leadership competency?

The safety category assesses available security measures, a collaboration between different profession, workplace environmental health, and readily available mechanism to address patient care. The question in this category include;

• Does the organization support direct care nurses to communicate concerns about the long-term nurse staffing plan?
• Do direct care nurses have input in daily staffing decisions?
• Does the organization promote a workplace culture free of incivility, bullying, and other violence within the healthcare team?
• Is an interprofessional decision-making process in place when transitioning patients from one level of care to another across the health care continuum?

Quality category assesses collaboration between different profession within organization initiatives to promote the achievement of origination mission, vision and objectives.  Examples of the question in this category include

• Do nurses implement evidence-based practice in patient care areas?
• Is there a process in place to communicate updates regarding changes in quality initiatives and performance in quality measures?
• Does the organization’s quality improvement process reflect interprofessional collaboration?
• Does the organization promote a culture of person-and family-centred care?
• Our direct care nurses in the organization educated about the concept and application of evidence-based practice?

Three administration theories with four questions to each

Shared decisions making category

In the strive to create a friendly working environment within a healthcare system, shared decision making plays a critical part in the integration of cultural diversity within the healthcare profession. Shared decision making occurs in a relationship that encourages participation, respect, collaboration and openness in care and provision of patient needs. Shared decision making determines the knowledge of healthcare environment as well as communication and relationship building.  The question in the Pathway to Excellence® Self-Assessment of Organizational Culture under the subcategory of shared decision making tried to alight with this perception. In the question “Is there evidence that the shared governance structure is integrated throughout the organization and direct care nurses utilize this shared governance structure”  measures the ability of healthcare organization to create an environment for decision sharing in the different healthcare professionals.  Provision of care is a multi-faced process which entailed shared governance structure integration in a broad healthcare system (Truglio-Londrigan & Slyer, 2018).   This means that the question sought to assess that ability of healthcare facility to create an environment for clinical knowledge development, effective communication, healthcare policy understanding as well as the development of healthcare governance understanding.

The question “Does the organization utilize evidence-based practice to implement change in nursing practice” seeks to increase and assess whether nurses knowledge of the healthcare environment workplace culture, resources and structure empower nurses to drive change. Workplace culture needs to provide effective communication of evidence-based practices to foster knowledge accumulation, high performance and optimal utilization of resources to meet all patients’ needs (Kueny, Shever, Lehan Mackin, & Titler, 2015). The question “Does the organization foster and support a culture of Inter-professional decision-making?” in the self-assessment is used in the subcategory of decision making to assess nurses communication and relationship between origination culture, job satisfaction and collective decision making between different inter-professional teams within healthcare facilities (Körner, Wirtz, Bengel, & Göritz, 2015). The question assesses team communication effectiveness, diversity embrace and interprofessional relationship in collective decision making in the provision of care to the patients.

Leadership category

Leadership in nursing play a critical role in the provision of direction and support, advocating for nursing rights, communication, coordination of activities as well as the creation of motivating environment for nurses (Al-Dossary, 2017). In the  Pathway, to Excellence® Self-Assessment of Organizational Culture, the following questions play a critical role in the assessment of this role of nurse leaders in the strive to create a conducive working culture. “Do nurse managers accommodate and actively support direct care nurses to participate in shared governance committees?” assesses whether nurses leaders create a working environment that is highly conducive for both the nurse and patient safety and personal discipline in the involvement of other is leadership roles (Page, 2011).  “Is the CNO accessible to nursing staff”  is used in the questionnaire to access the availability of nurses leaders to the nursing staff and their ability to be associated with.

“Does the organization have role-specific orientation for nurse managers?” assess whether healthcare facilities have structures in place for the development of nursing healthcare managers skills and critical thinking. According to Keays,( 2015), new nurses manager need to receive an orientation on their duties, responsibilities and limitation of their work to develop discipline in their scope of work.  This question assesses whether healthcare facilities have such programs which are critical in the development of nursing leadership.  Finally “Does the organization provide leadership development activities to enhance leadership competency assesses the existence of programs within a healthcare organization to promote leadership development and growth within the confine of the nursing process. Nursing is a complex process that goes beyond the provision of care and development of leadership skills in nursing sometimes can be hinder by duty requirement.

Safety category

Safety culture in nursing brings forth organization values and behaviours that can be achieved through a collective commitment by organizational leadership to take into consideration healthcare professional safety over organization vision and objectives.  Safety within healthcare organization entail developing profound knowledge of the healthcare environment interns of governance, patient safety,  risk management and work design  The question “ Does the organization support direct care nurses to communicate concerns about the long-term nurse staffing plan assesses the ability of healthcare organization to create a conducive environment for nurses to air their grievances on their safety in the workplace. Do direct care nurses have input in daily staffing decision question assesses the ability of nurses to participate in daily decision making on the issues which affect their duties and safety. It is used to determine whether nurses can contribute to a positive working environment through collaborative decision making on their safety.  The question “Does the organization promote a workplace culture free of incivility, bullying, and other violence within the healthcare team” assesses whether the organization create a free and fair environment for nurses to advocate for their safety needs without victimization.  “Is an interprofessional decision-making process in place when transitioning patients from one level of care to another across the health care continuum is used the pathway to determine the available measure to foster nurses safety in transfer of the patient from one department to another.

Quality category

Nursing care is validated in the six essential themes; empathy, respect, intentionality, advocacy and responsibility (Burhans & Alligood, 2010). The provision of high-quality care services calls for profound leadership, extensive knowledge of the healthcare environment and effective communication and relationship-building strategies. The following questions in the Pathway to Excellence® Self-Assessment of Organizational Culture assessed nursing quality in the provision of healthcare. “Do nurses implement evidence-based practices in patient care areas” assess nurse’s responsibility and intention in the provision of high-quality healthcare services to their patient.  This question assesses the nurse’s knowledge of the healthcare environment’s clinical knowledge as well as understanding the utilization of case management. “Is there a process in place to communicate updates regarding changes in quality initiatives and performance in quality measures” assess nurse’s advocacy ability for implementation of high-quality care policies through the development of a basic understanding of communication and relationship building capacity. “Does the organization’s quality improvement process reflect interprofessional collaboration responsibility of the healthcare organization in the provision of high-quality healthcare services” assesses knowledge on healthcare environment and leadership in place to foster change. “Does the organization promote a culture of person-and family-centred care assesses nurse’s ability to provide assess respect and empathy aspect of nursing quality care provision. “Are direct care nurses in the organization educated about the concept and application of evidence-based practice” assess the knowledge of healthcare environment transition to align to high-quality information and continuous research to support empathy toward their patients while advocating for high-quality healthcare services.

Rational for relevance to questions to nursing administration

The question in the Pathway to Excellence ® Self-Assessment of Organizational Culture is tailored to measure healthcare organization culture.  Since organizational culture is a broad facet with different specific components, the question in each category is tailored to specific nursing need within a healthcare organization. According to Jarrín, Kang, & Aiken, (2017), the question in each category positively impacts different factors that affect nursing administration either positively or negatively. The question influence bottom-line results in nursing administration by indicating how nursing engages and communicate with other professionals. Therefore, the question in the pathway help in the assessment of nurses practices control, working environment safety and systems in place to address care nursing practice concerns.

Nursing administration contains different components which cannot be assessed through a single question in self-assessment. Thus, the question help in the determination of factors like the qualification of the nursing manager and organizational skill set required for different leadership roles.  Through self-assessment, the question help nursing administrators champion for high-quality nursing practices and cultivate interprofessional collaboration.  Research by Dans, Pabico, Tate, & Hume, (2017) alludes that the question in the pathway helps nursing administrator improve nursing satisfaction by having clear information on the state of nursing staff working environment and relationship with organizational culture. This, in return, results to, organizational growth and increase in nursing administrator’s competency in the provision of a solution to challenges facing nursing.

How can each question and related theory contribute to a positive working environment

The question in the Pathway to Excellence ® Self-Assessment of Organizational Culture identifies specific challenges and possible solution to challenges facing nurses in their working environment. Through the integration of administrative theories into these questions, one can formulate a concrete answer to the issues raised by the question in each category.  The items on shared decision making can contribute to a positive working environment by controlling nursing practice through the provision of ethics for interprofessional relationship.  Through the provision of such ethical consideration, nurses are supported in redress to ethical concerns which have been shown to affect the nursing working environment negatively.

The questions under the leadership category provide provision for the application of change management principles and leadership succession plan. Through this, nurses are assured of dynamic leadership personality who can address the issues negatively affecting nursing working environment. The safety questions provide a solution to security issues that hinder effectiveness in nursing activities and provide baselines for collaboration. The quality category addresses organization mission, vision and goals and interrelates them to a positive working environment. Nurse’s wellbeing, which is extremely important for a positive working environment, is addressed through the culture of wellbeing category questions. In contrast, professional development question provides an avenue for a leadership transition in nursing.

Expert opinion on the applicability of the pathway to excellence organizational self-assessment

The Pathway to Excellence ® Self-Assessment of Organizational Culture provides an avenue for healthcare organization and nurses administrator to continuously improve the working environment within healthcare facilities. It allows employs to develop leadership skills and capability to take roles within the healthcare system through continuous improvement of survey question results. Research has shown that the pathway is highly essential in the development of employee’s interprofessional collaboration skills, communication and ability to make ultimate decisions within a short period.

Conclusion

References

Al-Dossary, R. N. (2017). Leadership in Nursing. Contemporary Leadership Challenges. https://doi.org/10.5772/65308

Bellou, V. (2018). Identifying organizational culture and subcultures within Greek public hospitals. Journal of Health Organization and Management, 22(5), 496–509. https://doi.org/10.1108/14777260810898714

Burhans, L. M., & Alligood, M. R. (2010). Quality nursing care in the words of nurses. Journal of Advanced Nursing, 66(8), 1689–1697. https://doi.org/10.1111/j.1365-2648.2010.05344.x

Dans, M., Pabico, C., Tate, M., & Hume, L. (2017). Understanding the New Pathway to Excellence® Standards. Nurse Leader, 15(1), 49–52. https://doi.org/10.1016/j.mnl.2016.09.010

Jarrín, O. F., Kang, Y., & Aiken, L. H. (2017). Pathway to better patient care and nurse workforce outcomes in-home care. Nursing Outlook, 65(6), 671–678. https://doi.org/10.1016/j.outlook.2017.05.009

Keays, V. (2015, November 17). The Understated Value of Nurse Manager Orientation Training. Retrieved May 11, 2020, from HealthcareSource Blog website: http://education.healthcaresource.com/nurse-manager-orientation/

Körner, M., Wirtz, M. A., Bengel, J., & Göritz, A. S. (2015). Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-0888-y

Kueny, A., Shever, L., Lehan Mackin, M., & Titler, M. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of Healthcare Leadership, 29. https://doi.org/10.2147/jhl.s45077

Nei, D., Snyder, L. A., & Litwiller, B. J. (2015). Promoting the retention of nurses. Health Care Management Review, 40(3), 237–253. https://doi.org/10.1097/hmr.0000000000000025

Page, A. (2011). Transformational Leadership and Evidence-Based Management. Retrieved from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK216194/

Truglio-Londrigan, M., & Slyer, J. T. (2018). Shared Decision-Making for Nursing Practice: An Integrative Review. The Open Nursing Journal, 12(1), 1–14. https://doi.org/10.2174/1874434601812010001

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