Safety, Quality, and Informatics
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BSN-FP4008_TallarineSamantha_Assessment4-1.pptxMOBILIZATION PLAN
SAMANTHA TALLARINE
CAPELLA UNIVERSITY
ORGANIZATIONAL AND SYSTEMS MANAGEMENT FOR QUALITY OUTCOMES
JULY, 2018
Mobilization plan in place for international medical mission
Topics addressed:
Identifying stakeholders and effect plan will take on them
Impact on staffing
Mission statement, and distribution of power
Assurance of quality of care and safety for participants
Breaking barriers in a potentially hostile environment
MEDICAL MISSION FOR NURSING PROFESSIONALS
“Medical mission teams provide healthcare goods, services, and education to help fill the gap where access to care is extremely limited.” (Hawkins, 2013)
Scenario:
A nursing facility has recently committed 20 nurses to participate in a 4-month long multinational effort to treat patients exposed to a highly contagious virus in a “hot zone” in Africa. There will be physicians, as well as administrative staff that will also take place in the mission. Nursing professionals will make up the majority of the staff because they handle will be handling administering treatment as well as monitoring the patients for the physicians.
This mobilization plan will tackle the following:
Identifying the major stakeholders within the health care system that will be affected.
Analyze the mobilization efforts impact on staffing and nursing care in the home nursing facility.
Describing the organizational structure that will be in place, and the distribution of power.
Assessing the effect of the organizational structure on the staff, and how to empower each level.
Evaluating potential power conflicts when dealing with health care personnel from Africa.
Evaluating the potential for issues that personnel may come across, and how to avoid future mishaps.
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Stakeholders affected by mobilization:
Hospital board members
Investors
Organizational leadership and management team
Nursing Leadership
Physicians
Patients
Impact on staffing patterns and nursing care?
Potential for further staff shortages
Stakeholders
Stakeholders affected by mobilization plan:
Hospital board members
Investors
Organizational leadership and management team
Nursing leadership
Physicians
Patients
How will staffing patterns and nursing care be impacted?
Staff shortages can occur due to nursing professionals making up the majority of the team
Nurses who stay behind will face the potential for:
Longer shifts
Working shifts or days they aren’t accustomed to
Increased need for float nurses
Overall increased workload
“The social structure of an organization influences the flow of information, resources, and power among its members.” (Meyer & Huber, 2014) Therefore, each stakeholder has the potential to be impacted by the mobilization plan. In order to effectively complete this medical mission, everybody needs to be on board and be willing to pick up the slack that will be left behind due to the different staff members taking temporary leave.
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Recruitment of Per Diem hospital staff
Float pools
Form unit teams
Leadership training
Shared governance
Softening the Impact on Staffing Patterns and Nursing Care
Mobilizing 20 healthcare professionals will leave behind a big gap in the medical center. In order to alleviate the pressure for the staff left behind there are different approaches that can be taken; one specific thing is not going to keep the hospital running, but if all interdisciplinary members band together and work to improve in all areas this can become possible.
Recruitment of Per Diem hospital staff
Since the majority of the members of the mobilization team are going to be nursing professionals, the nursing staff is going to take the greatest hit. Per diem nurses who are experienced can be a major asset to the team while also ensuring that the nurses who left come home to their respective positions. I would suggest that a minimum of 5 years nursing experience be required, only because the full time nurses on the unit will already be stretched too thin to have to accommodate a new nurse. Experienced nurses will also bring better insight into patient care, and ensure that the patients do not feel the strain of the limited nursing personnel. “The major goal of staffing management is to provide the right number of nursing staff with the right qualifications to deliver safe, high-quality and cost-effective nursing care to a group of patients and their families as evidenced by positive clinical outcomes, satisfaction with care, and progression across the care continuum. (Birmingham, Pickard, Carson & Huber, 2014)
Float Pools
Increasing the number of nurses within the float pool will ease the needs of units who may suffer from the medical mission. “Pool nurses are assigned each day to one of the units in the pool, where a pool typically contains between 3 and 7 units.” (Maass, Liu, Daskin, Duck, Wang, Mwenesi, Schapiro, 2015) This allows for nurses from multiple units to be part of the medical mission without one unit taking too much of a hit. It also allows for the mission team to have a well rounded team with different aspects of experience. By increasing our float pool, it allows the float nurses to help pick up the slack and keep each unit running smoothly.
Form Unit Teams:
A team is defined as “a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable.” (Huber, 2014) In this case, teams will be formed within each unit in order to ease the loss of staff. There will be a nurse manager in charge, and the rest of the staff will be paired off in order to help each other pick up the slack. Unit teams will help everybody stay on task, and allow for a smoother work day. It will help the staff to work collaboratively and interdependently, as well as ensuring safe patient care. This is especially helpful when float nurses are being implemented because it will allow them to be paired with a nurse who works on the unit regularly, allowing for a seamless transition.
Leadership Training:
In order to effectively lead, nurse managers should be required to go through leadership training. This will allow managers to experience different leadership types, and can help guide them to see what approach they want to take to lead their staff. “Determining the structure is a key responsibility of leaders and managers in planning an organization that is conductive to high-quality nursing care.” (Meyer & Huber, 2014) Mandatory leadership training will be effective in shaping how a unit will be run, and will help to develop strong leaders that will be able to lead during the potential staff shortage during the medical mission; it will also help to give them a sense of empowerment.
Shared Governance:
“A dynamic process for achieving organizational effectiveness by promoting decision-making and accountability for practice through empowerment.” (Hoying & Huber, 2014) That is the definition of shared governance. Many people would describe it as a framework to help nurses feel a sense of empowerment which would lead to an increase in autonomy and confidence. In implementing shared governance a support structure needs to be put into place, and continuous support from upper management is a must. This will give our staff nurses the opportunity to perform autonomously in certain aspects of their job, and allow nurse leaders some breathing room while handling the staffing aspect of their unit. This has the potential to help the unit run smoother during the absence of the staff on the medical mission.
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Shared governance
Hierarchical decentralization
Open system theory
Organizational Structure of the Medical Mission Team
In order to effectively complete this medical mission communication needs to be excellent, and everybody needs to have a clear vision of their role within the team. When team members know their roles it allows for a good work environment with little to no conflict. By pulling examples from different theories and organizational structures it can provide a well rounded structure for the medical mission team to follow
Shared Governance:
This will create the framework of the structure and allow for empowerment of all mission team members. All team members will be responsible for their own actions and allow for full accountability. This will bring together all team members regardless of title because shared governance promotes no transfer of power which lets nurses acquire legitimate power and authority. Respect and trust will be easy to come by among all team members when everybody feels a sense of autonomy and empowerment.
Hierarchical Decentralization:
Hierarchical decentralization goes hand in hand with shared governance; allowing for authority to be spread down through the hierarchy. Instead of leaving all decisions to be made within the upper management team, this structure allows for all members of the interdisciplinary team to work together as well as having a sense of autonomy. The medical mission team will be composed of a number of different healthcare professionals so in order to keep each member happy and working as a team, allowing each member to control their own outcomes will help the team atmosphere. It will reduce any added conflict in what is sure to be an already high stress environment. Each staff member will in turn feel empowered to take control, and
Open System Theory:
The health care organization is “characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality.” (Meyer & Huber, 2014) In order to be effective, the different units need to be willing to adapt to whatever environment they’re in. This is specifically effective for a medical mission because the atmosphere is so unpredictable and the staff needs to always be on top of their game. In implementing the structure around an open system our staff will have the autonomy necessary to man their own stations of the “hot zone” which will cause them to feel empowered. The boost in confidence will help the staff to keep pushing through their time away in Africa, and ensure peak patient care and quality outcomes.
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Organizational Structure of the Medical Mission Team
Mission Coordinator: Person in charge of organizing the entire medical mission team. This person is the top of the leadership structure, and will be the liaison between the other multinational teams that are present in the “hot zone”. They will be the person that is in touch will all members of the interdisciplinary team and be in charge of creating the plan both before hand and while on the ground.
Leading Physician: This will be the main point of contact for physicians, and will also work hand in hand with the rest of the leading staff to coordinate patient care, and how supplies will be used. They will disperse daily tasks, and handle the scheduling of the physicians in the team.
Physicians: Supportive staff to the lead physician. They will work together with the nursing professionals to provide optimal patient care.
Leading Nursing Professionals: Main point of contact for the nursing professionals. They will also be working with the other leading staff to coordinate patient care, and how supplies will be used. They will disperse daily tasks, and handle the scheduling of the nursing professionals in the team.
Nursing Professionals: Supportive staff to the lead nursing professional, as well as the physicians. They will work hand in hand with the physicians and supportive staff to provide optimal patient care.
Leading Administrator: Main point of contact for administrative staff/supportive staff. They will be handling taking inventory before the trip as well as throughout, assisting with making schedules, and managing all resources. They will also be held accountable for maintaining communication throughout the mission between interdisciplinary team members, as well as communication with our home base in the hospital.
Administrative/Support Staff: Assist all team members in tasks that require help, and help the day to day operations run smoothly.
All staff will work together to maintain an effective work environment and to ensure quality patient care. Day to day operations will be inclusive of all team members, and there will be constant communication throughout each assignment. Although there are leadership positions incorporated, all team members will have some degree of autonomy, and will be able to work within the scope of their practice to make decisions and empower each other. Daily meetings will take place among leadership as well as team members to ensure that the patients are receiving everything they need, and to give each team member a voice.
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Mission Coordinator
Leading Physician
Leading Admin.
Nursing Professionals
Leading Nursing Professional
Physicians
Admin./Support Staff
Leadership is all inclusive when dealing with team members
Shared governance and hierarchical decentralization model is carried out effectively
Empowerment = key leadership component
Empowerment within Team Members
“Empowerment is defined as giving people the authority, responsibility, and freedom to act on what they know and instilling in them belief and confidence in their own ability to achieve and succeed.” (Cox & Huber, 2014) It entails two steps; transfer of actual power, and inspiration of self-confidence. A work environment which empowers its workers allows the staff to come to work with a positive attitude, and it has been shown to give employees the opinion that their work holds a greater meaning for them.
This medical mission team will be all inclusive, and allow for all team members to have a voice. There will be experienced leaders in place, but that is just the framework to help other members who may not have been in a leadership role previously. All team members will have a degree of autonomy, and this will help build confidence as well as improve upon communication skills. Leaders will be involved with team members to ensure all members stay within their scope of practice, and to lend a helping hand when needed. Supplies, resources, and staff will experience shortages so in creating a decentralized hierarchy we can ensure that staffing levels are optimized to deliver effective patient care.
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Key actions that can be taken in order to keep patients and personnel safe and receiving the best care:
Patient-Centered Care
Collaborative Leadership
Safety Climate
Conflict Resolution
Appropriate Training
Assuring Quality Care and Patient Safety
Patient-Centered Care
“The re-design of patient care in the acute care setting so that hospital resources and personnel are organized around the patient’s health care needs.” (Huber, 2014) Participating in patient-centered care allows for the patients to always be number one, while allowing for the health care team to take care of both the patient and family members collaboratively. It ensures that decisions are based solely on patient needs, and will optimize the way treatment is delivered..
Collaborative Leadership
Shared governance can help to incorporate a collaborative leadership approach within the medical mission team. All team members must collaborate, not only just the leadership with each other, but all staff must work to have constant communication within the other departments. “Collaborative leadership in health care has been associated with improved patient outcomes, a reduction in medical errors, and lower staff turnover; it may also reduce the amount of workplace bullying and disruptive behavior.” (Hoying & Huber, 2014)
Safety Climate
By pushing a safety climate, it will allow all members of the medical mission to focus on safety within the team, as well as the organization within the “hot zone”. This will be implemented to keep both health care professionals, and the patients safe. The focus is on making sure that nurses specifically are able to identify what is normal for the patients within the medical mission, so that they can recognize any deviations from baseline. “Regardless of whether the focus of safety is on the patient or the nurse, the likelihood of injury can be lessened where there is a cohesive team.” (Bellot & Huber, 2014)
Conflict Resolution
If conflict is to arise during the mission, resolution needs to be swift and effective in order to keep our patients receiving constant quality care. This is where leadership will come into play most to provide techniques to give all parties involved an opportunity to speak their peace. Leadership will ensure that communication is open, and that all methods are exhausted if needed to resolve the problem.
Appropriate Training
In working with a different culture, the health care team needs to make sure they are undergoing the correct training to get a better idea of what they will encounter once on the ground in Africa. Whether that be sensitivity training in order to deal effectively with what they will see, or if they need specific medical training to deal with the virus. Doing a simulation lab to better prepare for the mission also can be helpful, and will allow for team members to work together before real patients are involved.
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Working with team members who have never worked together, as well as dealing with multinational contingents can cause the following issues:
Internal conflict of power
Cultural differences
Jurisdiction issues
Unwillingness to participate in shared governance model
Potential Power Issues
Nurses specifically will need to fight to maintain their power throughout the mission because other cultures may not be used to nurses working autonomously as has been outlined in this presentation. Also, physicians within the team may not be used to nurses having a say and manning their own unit teams. Culturally, all team members may not be able to be cognizant of actions that are potentially offensive to the other multinational teams present, or the people of Africa. There also may be an issue when it comes to making decisions that include other health care teams. Leaders from different areas may feel they are entitled to make decisions, while other team leaders feel they are; working together and communicating efficiently will be the most productive way to get through the 4-month mission.
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Language barriers
Unawareness of cultural practices
Different standards of practice
Potential Multicultural and Diversity Issues
Language barriers will be the number one issue faced while on this mission. Although translators will be part of the interdisciplinary team that is being sent to Africa, there are so many different dialects that there is always the potential for miscommunication. 20 health care team members with all different backgrounds are being brought together to enter this “hot zone”, and although there will be training before leaving it’s impossible to completely grasp the culture they’ll be experiencing. A lot of the knowledge they gain will be through experiences, so there is potential to offend the people they will be working with. Protocol will also be completely different, and will take time to get used to.
The mission team’s top priority is to respect the people and the culture of Africa, and provide patients with the best quality care possible. There may be issues that come about, but as long as they are dealt with in a timely and respectful manner the mission will be productive.
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Planning a medical mission is no easy feat. There are bound to be hiccups along the way, but ensuring that team members get to know each other prior to embarking on the journey, and allowing each member to work autonomously will allow for a less hostile work environment. When it comes to working as a unit with other health care teams, our members need to be culturally aware of who they are dealing with, and learn how to be respectful. Our team needs to feel empowered in order to provide quality patient care, and help to get this virus under control.
Conclusion
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Bellot, J. (2014). Organizational climate and culture. In D. L. Huber (Author), Leadership & nursing care management (pp. 55-64). St. Louis: Elsevier.
Cox, K. B. (2014). Power and conflict. In D. L. Huber (Author), Leadership & nursing care management(pp. 159-185). St. Louis: Elsevier.
Hawkins, J. (2013). Potential Pitfalls of Short-Term Medical Missions : Journal of Christian Nursing. Retrieved from https://journals.lww.com/ journalofchristiannursing/Fulltext/2013/12000/ Potential_Pitfalls_of_Short_Term_Medical_Missions.23.aspx
References
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Hoying, C. (2014). Decentralization and shared governance. In D. L. Huber (Author), Leadership & nursing care management (pp. 246-255). St. Louis: Elsevier.
Huber, D. L. (2014). Professional practice models. In Leadership & nursing care management (pp. 256-273). St. Louis: Elsevier.
Maass, K. L., Liu, B., Daskin, M. S., Duck, M., Wang, Z., Mwenesi, R., & Schapiro, H. (2017). Incorporating nurse absenteeism into staffing with demand uncertainty. Health Care Management Science, 20(1), 141-155. doi:http://dx.doi.org.library.capella.edu/10.1007/s10729-015- 9345-z
References
Manion, J., & Huber, D. L. (2014). Team building and working with effective groups. In Leadership & nursing care management (pp. 128- 146). St. Louis: Elsevier.
Meyer, R. M. (2014). Organizational structure. In D. L. Huber (Author), Leadership & nursing care management (pp. 226-245). St. Louis: Elsevier.
Noguchi, N., Inoue, S., Shimanoe, C., Shibayama, K., & Shinchi, K. (2016). Factors associated with nursing activities in humanitarian aid and disaster relief. PLoS One, 11(3) doi:http:// dx.doi.org.library.capella.edu/10.1371/journal.pone.0151170
References
