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PubMed1989

Joint ventures in health care.

To remain competitive, many not-for-profit hospitals have turned to joint ventures with for-profit and other not-for-profit entities. The authors examine the organizational structures that are used most often to form joint ventures (contractual agreements, subsidiary corporations, partnerships, and not-for-profit title-holding corporations), as well as the advantages and disadvantages associated with each form. Nurse executives must be aware of the opportunities that joint ventures provide their institutions. These arrangements can help improve and expand services and profitability.

Financial Management↗
PubMedDate not supplied

Organizational change from the "mom and pop" perspective.

Can hospitals successfully embark on large-scale organizational change without using outside consultants? Nursing administrators have an intense interest in the answer to this question. If change can be designed from inside the organization, the chances are greater that the change will fit better with the organization as a whole, and that buy-in by staff will be significant. The authors review the elements that need to be in place to conduct a successful change process internally, and support their concepts with a case study.

Arizona↗
PubMed1994

Administrative support team. A structural innovation.

In response to societal, organization, and leadership changes, an innovative nursing structure was implemented and evaluated. An administrative support team was developed to provide specialized internal consultation and support to a flattened and decentralized nursing division. The four administrative support team roles provided an organization perspective that ensured constancy of purpose throughout the division. This structural innovation proved to be congruent with nursing shared governance and total quality management initiatives occurring in the organization. Evaluation studies indicated that the model has effectively supported 5 years of continuing organizational change.

Hospital Bed Capacity, 300 to 499↗
PubMed1995

Layoff survivor sickness. Minimizing the sequelae of organizational transformation.

In 1991, our University Hospital initiated a series of strategic changes designed to increase organizational effectiveness and efficiency, foster a culture of commitment to customer-driven service, and flatten the organizational structure, pushing decision making closer to the point of service. These events, although proactive and positive in their intent, triggered a significant, debilitating response among many members of the nursing staff. The authors discuss the experience of this organization, examines the process of transition and the responses of staff members to change, and provides recommendations for minimizing the sequelae of organizational transformation.

Employment↗
PubMed1995

Whole systems shared governance: a model for the integrated health system.

The healthcare system is under renovation and renewal. In the process, roles and structures are shifting to support a subscriber-based continuum of care. Alliances and partnerships are emerging as the models of integration for the future. But how do we structure to support these emerging integrated partnerships? As the nurse executive expands the role and assumes increasing responsibility for creating new frameworks for care, a structure that sustains the point-of-care innovations and interdisciplinary relationships must be built. Whole systems models of organization, such as shared governance, are expanding as demand grows for a sustainable structure for horizontal and partnered systems of healthcare delivery. The executive will have to apply these newer frameworks to the delivery of care to provide adequate support for the clinically integrated environment.

California↗
PubMed1995

Improving patient outcomes through system change: a focus on the changing roles of healthcare organization executives.

In this article, the authors report on a project that studied the impact of work redesign on the roles of hospital executives. Thirty-six in-depth interviews were conducted with executives from 13 VHA healthcare organizations that were considered excellent practice models in the area of work redesign. This report represents a broad, multidisciplinary perspective reflecting the ideas of various members of the healthcare management team. VHA hired Marie Manthey and Creative Nursing Management, Inc., to conduct the interviews in an objective manner and to assist with results interpretation.

Clinical Protocols↗
PubMed1996

Are nurse managers ready for the current challenges of healthcare?

In a study at four teaching hospitals, nurse managers rated themselves most competent in activities related to the management of their unit, and believed these activities were most important. Nurse managers lacked some of the skills and knowledge needed to relate to the larger organization and external environment, activities that they rated as less important. Selection, education, and development efforts should be targeted to newly important roles and skills for which nurse managers have little preparation.

Adult↗
PubMed1997

Pro-ACT II: integrating utilization management, discharge planning, and nursing case management into the outcomes manager role.

Building on redesign efforts that created case management, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating case management, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements.

Case Management↗
PubMed1997

Shared governance. Sharing power and opportunity.

Responding to an enlarged span of control and an ever changing health care environment, the author describes the implementation of a unit-based shared governance model. Through study,literature review, and team consensus, a new management style emerged. Using Rosabeth Kanter's framework for work effectiveness, the unit governance structure was transformed. The process, progress, and outcomes are described, analyzed, and celebrated.

Alabama↗
PubMed1997

The impact of organizational redesign on nurse executive leadership.

How have nursing leadership roles been affected by organizational redesign? The authors discuss the results of a survey of more than 5000 nurse executives and managers. They highlight reasons and core features of redesign processes, changing roles, expanded responsibilities, learning needs, and impact on quality.

Hospital Restructuring↗
PubMed1997

Professional practice. A framework for transition to a new culture.

The reorganization of healthcare systems has largely focused on the redesign of clinical management structures with little emphasis on the systems that are essential to support professional practice and quality of care. This article describes the unique process of designing a framework that clearly articulates the essential elements of professional practice. The framework was crucial in clarifying account-abilities and role relationships between the clinical management and professional practice structures in the design and implementation of a major reorganization at Toronto East General Hospital, a 400-bed community teaching hospital in Toronto, Canada.

Health Planning↗
PubMed1998

Performance improvement with patient service partners.

Once the decision is made to use a patient-focused care delivery system, a variety of methods can be used to successfully design the model. The author describes the process used by a multilevel, multidisciplinary team at a community hospital to design and implement a Service Partner role that would meet and exceed customer expectations. Demonstrated performance improvements included increased patient satisfaction, productive labor dollar savings, and improvements in the work environment for staff members.

Ancillary Services, Hospital↗
PubMed1998

System integration: a necessity.

Healthcare organizations are undergoing tremendous change in an attempt to become more flexible and adaptive. To be successful in any such transformation, organizations must build processes and systems that allow them to move with change and create a culture that allows individuals to thrive amid change. The authors describe how a community teaching hospital has attempted this through its partnership in a vertically integrated delivery system, its reorganization to product line management, its adoption of a shared governance structure, and its commitment to building a culture with strong relationships. Many of these processes and systems are in their infancy, but an examination of the journey will inform other organizations as they respond to change.

Delivery of Health Care, Integrated↗
PubMed1998

Work transitions.

The healthcare environment is changing rapidly. Work reorganization and redesign can lead to department and unit closures, resulting in work transitions for many staff members. The authors describe the findings of focus groups held with staff and management on units that have closed. These interviews highlight the difficulties encountered with change and provide suggestions to reduce uncertainty during department or unit closures.

Academic Medical Centers↗
PubMed1999

Decision-making activity and influence of nurse executives in top management teams.

This study assesses the impact on decision-making when introducing the nurse executive into the top management team (TMT) in Veterans Affairs Medical Centers. Results indicate that nurse executives formally elevated to the TMT were no more likely to perceive greater involvement in decision-making than non-TMT nurse executives or nurses informally appointed to the TMT. However, nurse executives in all categories perceived themselves as more involved in strategic decisions than other TMT members.

Decision Making, Organizational↗