Structural Empowerment In Healthcare Organizations

Abstract

Healthcare organizations recognize the value to providing quality care requires implementing new methods practice, focused on reforming the structural components of the culture. As healthcare organizations prepare for the future, they are redirecting focus on creating an environment conducive to providing safe, quality, patient-centered services. The culture of healthcare is transforming the concepts of leadership and management focused on empowering their team to deliver quality, safe, patient care.

Keywords: transformational, culture of work environment, quality of leadership, organizational structure, patient-centered care, empowerment, safety

The Forces of Magnetism

Organizational Analysis

Healthcare organizations are in a

race to create an improved work environment, recreating the culture, and the quality of leadership to ensure patient receive the safest, quality, patient centered care. Organizations are recognizing structural stabilization and growth is a method of the past. In order for these entities to sustain existence, they must be proactive and transform the culture to provide a positive work environment, with strong nurse leaders. The future of delivering quality healthcare relies on the nurse’s ability to expand their role in leadership.
Five Components of Magnetism
Many healthcare organizations are working to create a positive work environment to promote growth and development of their nurse leaders and team, and improve the method of delivering safe, quality patient-centered healthcare. An organizational analysis of Fort Duncan Medical Center in Eagle Pass, Texas with reference to the fourteen forces of magnetism reflected the structures in place promoting a healthy practice environment for nurses and patients. In 2006, a new technologically advanced Fort Duncan Regional Medical Center (FDRMC) opened a 101 private patient room hospital facility, to provide medical services to this rural population. They offer 24 hour seven days a week access to medical care services, accredited by the Joint Commission.
Transformational Leadership
Nursing leadership qualities are an important component of the fourteen forces of magnetism. In fact, transformational leadership encourages leaders and managers to treat people the same way when they assign tasks or make decisions (Drenkard, 2011). The organizational structure of the hospital leadership consists of the chief executive officer, the chief financial officer, the chief operating officer, and chief nursing officer. The nursing unit manager reports directly to the chief nursing officer. The unit manager’s open door policy allows the team members to maintain communication at their convenience. Team members, also have the option to communicate via e-mail or phone when the manager is not in her office. Furthermore, the leader needs to form a vision and provide a positive attitude to achieve that vision (Drenkard, 2011). The unit manager communicates the organizational vision statement to achieve 100% compliance of pneumonia and congestive heart failure core quality measures. The leader needs to motivate its followers to achieve a goal and serve as a role model (Drenkard, 2011). The unit manager has created a method of practice to recognize team members for providing service excellence and continuous quality patient care.
The unit manager of the medical surgical department in Fort Duncan Regional Medical Center (FDRMC) has created an environment empowering the charge nurse to create a “Fair Assignment” each shift team members are delegated patient care duty. Nurse to patient ratio is 7:1. Nurse assistants assigned no more than 14 patients per shift. Nurse’s assigned more than seven patients are accountable for reporting to the charge nurse or unit manager. The culture of patient care focuses on the nurse’s ability to deliver safe, quality patient-centered healthcare services. However, there are times when leaders can serve as mentors and give unique personal attention to their followers (Drenkard, 2011). The unit manager conducts “huddles” at the beginning of each shift to review potential challenges for the nurses. The nurses are encouraged to initiate unit huddles with team members to address pertinent patient safe, and quality care issues. The “huddles” are an effective method of communication between members of the team. In addition, the leader needs to have good communication skills with their followers in order to find solutions to unit problems (Drenkard, 2011).
Structural Empowerment. Organizational structures are generally flat, rather than tall, and decentralized decision-making prevails. The organizational structure is dynamic and responsive to change. Strong nursing representation is evident in the organizational committee structure. Executive-level nursing leaders serve at the executive level of the organization. The Chief Nursing Officer typically reports directly to the Chief Executive Officer. The organization has a functioning and productive system of shared decision-making, (Forces of Magnetism, 2014).
The component of the Magnet Recognition Program model includes organizational structure, personnel policies and programs, professional development, community outreach, and the health care organization’s promotion of a positive nursing image, (Tinkman, 2013).

Structural Empowerment centers on the idea that executive leaders can influence the professional practice of staff members by providing an innovative environment that supports collaboration and professional development, (Tinkman, 2013). Leaders can promote this type of environment using multiple methods, such as developing a strong strategic plan and solid policies and procedures, promoting certification, encouraging staff members to pursue higher education and become involved in the community and working to recognize nurses for their expertise and contributions. In turn, when staff members feel valued, they engage as part of a team that helps leaders achieve the organization’s mission and vision. The Medical/Surgical Manager reports directly to the Chief Nurse Officer, which works extensively in the strategic planning and decision-making process for the unit. As a key member of the Hospital’ leadership team, the Nurse Manager oversees the unit’s development to fulfill the patient care, and educational missions of the organization by following a Patient Centered Approach Model. The nurse manager rounds daily to assess the activities of all sections of the institution to monitor the competent, compassionate,

uniformed patient care is given to each patient.
The entire staff follows the Team Steppes Tool. This structure clearly supports unit-based decision-making, giving nurses a strong voice in the decision-making process. For example, monthly meeting with all departments provides a continuum of care and interdisciplinary structure. Team member are encouraged to participate in “Town Hall Meetings” and employee surveys are completed, and reviewed, engaging them in the fact-finding and decision-making process. Collaborative Governance is in the FDRMC culture. It continues to be the structure that sets the standard for nursing staff involvement, both formally and informally in both program and unit activities. Its mission is to integrate multidisciplinary clinical staff into the formal decision-making structure of Patient Care Services to stimulate, facilitate, and generate knowledge that will improve patient care and enhance the environment in which clinicians shape their practice, (Moore, 2014).
The organizations salaries and benefits are competitive for the regional area. Rotating shifts are minimized and creative and flexible staffing models are used. Team members are encouraged to provide feedback regarding effectiveness of clinical policy and procedure. Fort Duncan Regional Medical Center (FDRMC) has a long history of supporting and recognizing employees as evidenced in its policies and practices that support employee education, training, and professional development; in rewards that recognize exceptional employee performance, special accomplishments, and length of service; and in competitive wage and salary programs. Organizational leaders, make a valiant effort to address the ongoing nursing shortage issue. Multi-strategic recruitment plans include, sign-on bonuses, participation in regional job fairs, and international nurse recruitment of nurses from the Philippine’s and Puerto Rico. The healthcare organization struggles to retain international nurses once their two-year obligation is complete. Flexible work hours support nurses to participate in advance degree programs, including tuition reimbursement. FDRMC has a number of policies that address employee rights and promote a safe and healthy work environment. These include Human Resource policies on violence in the workplace, harassment, sexual harassment, and substance abuse. Supporting career development for employees enables the organization to attract and retain a highly skilled and diverse workforce, as it strives to meet its goal of providing the highest quality of care to patients.
Forces of Magnetism. Community and the Health Care Organization “Relationships are established within and among all types of health care organizations and other community organizations, to develop strong partnerships that support improved client outcomes and the health of the communities they serve”, (ANCC, 2014). Ford Duncan Regional Medical Center (FDRMC) currently has a partnership with Maverick County Hospital District, (MCHD, n.d.). Both organizations work in collaboration to provide an array of specialists in order to meet the community’s healthcare needs. FDRMC is a level IV trauma center, unable to provide services for a higher trauma level. In order to provide emergency services for a large area, FDRMC established a partnership with Air Evac Life-Team, (Air Evac Life Team, 2015).
Images of Nursing can be characterize the services provided by nurses are essential. Nurses are viewed as an integral to the healthcare organization. Nursing effectively influences system-wide processes, (ANCC, 2014). FDRMC received recognition by JACHO, 2 years in a row for Quality Measures. They are among the Top 1000 Performers in the country for establishing Excellent Quality Management for Acute MI, CHF, and Pneumonia for 2013, 2014, (FDRMC, 2015). Currently FDRMC has structures in place that promote an environment in which the services provided by nursing staff are valued and respected. Patient Discharge Satisfaction Survey verbally acknowledge nurses for service excellence, is review by the Patient Advocate Director.
The healthcare organization values and supports the personal and professional growth and development of staff. Programs that promote formal education, professional certification, and career development are evident. Competency-based clinical and leadership/management development is promoted and adequate human and fiscal resources for all professional development programs, (ANCC, 2014). FDMC supports personal and professional development of staff members. All hospital employees are required to attend a TEAM Steps program to encourage interdisciplinary approach to patient care. As of last year, all new team members must complete the TEAM steps program. The Hospital collaborates with nursing colleges and universities such as UTSA, Laredo College, and SWTJC to promote the nursing profession. FDMC increase nurses skills through training and experience. The hospital will pay a nurse to attend a specialty certification course, as wound care certification. Professional growth educational programs such leadership classes are also available for nurses. On-line access to clinical and reference materials such as Lippincott, health stream, evidence based literature resources are easily available through CERNER mobile computer system. Hospital publications such as Health News magazine reach community and promote community education as well, (FDRMC, 2015).
Exemplary Professional Practice FDMC principles of care components are; service excellence, continuous improvement in measurable ways, employee development, ethical and fair treatment of all, teamwork, compassion, and innovation in service delivered. System is in place to educate and support cultural related differences affecting patients served by FDMC. A peer review process is in place to assist nurses and to ensure patients receive the highest quality care. Standards of practice professional model are a method of practice followed by FDMC. FDMC principles of care components, service excellence, continuous improvement in measurable ways, employee development, ethical and fair treatment of all, teamwork, compassion, and innovation in service delivered:
• Patient centered care, clear communication, individual and team accountability,
• Follow a “Just Culture”
• “Shape-up”
• Role models-individual performance review
• Empower nurses to learn new skills and develop management and leadership qualities
(Manager Unit, 2015)
Consultation Resources, and Autonomy, The healthcare organization provides adequate resources, support, and opportunities for the utilization of experts, particularly advanced practice nurses.

In addition, the organization promotes involvement of nurses in professional organizations and among peers in the community, (ANCC, 2014). “Nurses must have the ability to work with other members of the organization to design organizational models for care delivery that meet patient/customer needs and priorities”, (Yoder-Wise, 2015). At Fort Duncan Regional Medical center the Management Team encourage all members of the team to participate in organizational activities such as, actively participate in organizations activities such as:

Town Hall Meetings, Inter-disciplinary Team Collaboration, the organization provides access to electronic educational material and encourage nurses to obtain skills certification, The EHR system has evidence-based practice methods and measurements built into the documentation components. Members of the organization and community are encouraged to access Health News from Fort Duncan Regional Medical quarterly newsletter, (FDRMC,

2015).
There is a development and mentoring program for staff preceptors for all levels of students (including students, new graduates, experienced nurses, etc.). Staff in all positions serves as faculty and preceptors for students from a variety of academic programs. A patient education program meets the diverse needs of patients in all of the care settings of the organization.
Autonomy in nursing is the ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge. The nurse is expected to practice autonomously, exercising independent judgment within the context of interdisciplinary and multidisciplinary approaches to patient care (ANCC, 2014). Nurses are accountable for utilizing critical care skills to provide quality, safe care.
Professional nurses are involved in educational activities within the organization and community. Students from a variety of academic programs are welcomed and supported in the organization; contractual arrangements are mutually beneficial. There is a development and mentoring program for staff preceptors for all levels of students (including students, new graduates, experienced nurses, etc.). Staff in all positions serves as faculty and preceptors for students from a variety of academic programs. A patient education program meets the diverse needs of patients in all of the care settings of the organization, (ANCC, 2014).
Inter-disciplinary Relationships Collaborative working relationships within and among the disciplines are valued. Mutual respect is based on the premise that all members of the healthcare team make essential and meaningful contributions in the achievement of clinical outcomes. Conflict management strategies are in place and effectively maintained. Nurse Managers use a “Token System” to recognize inter-disciplinary team collaboration and quality performance, (Manager Unit, 2015).
New Knowledge, Innovation, and Improvements Strong leadership, empowered professionals, and exemplary practice are essential building blocks for Magnet-recognized organizations, but they are not the final goals. Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements. This Component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing, (ANCC, 2014).
Organizational Improvement has structures and processes for the measurement of quality and programs for improving the quality of care and services within the organization, (ANCC, 2014). At Fort Duncan Regional Medical Center (FDRMC) in Eagle Pass, TX, utilizes numerous quality improvement projects that are aimed to “enhance the services it provides to patients”, (FDRMC, 2015). This organization has noted measurable efforts of continuous improvement by stating, “We will identify the key needs of our customers, assess how well we meet those needs, continuously improve our services, and measure our progress”, (FDRMC, 2015). One example of these measures is by the implementation of the electronic health record. This includes built in programs that reinforce hospital policies. More specifically, this system entails the Braden scale which is used in predicting the amount of risk a patient may have in developing a pressure ulcer while in the hospital. In addition, Fort Duncan Regional Medical Center utilizes a Modified Morse Fall Risk Scale in an effort to prevent the number of inpatient falls. This scale assesses the risk a patient has for falling during a hospital stay. Another measure in the improvement of quality care is the use of an Electronic Medication Administration Record. This program automatically keeps track of all patient medications, from the physician’s order to the administration of the medication by the nurse. The electronic medication administration system identifies and implements measurements of safety to ensure correct administration of medication.
Fort Duncan Regional Medical Center has implemented serval efforts cultivating care for the community it serves. This organization demonstrates their commitment in providing innovative service delivery in stating, “We will invest in the development of new and better ways of delivering our services, (FDRMC, 2015).
Empirical Quality Results
Today's Magnet recognition process primarily focuses on structure and processes, with an assumption that good outcomes will follow. Currently, outcomes are not specific, and are minimally weighted. There are no quantitative outcome requirements for ANCC Magnet Recognition ®. Recently lacking were benchmark data that would allow comparisons with best practices. This area is where the greatest changes need to occur. Data of this caliber will spur needed changes, (Forces of Magnetism, 2014). Outcomes need to identify as clinical outcomes related to nursing, workforce outcomes, patient and consumer outcomes, and organizational outcomes. Patient care established on principals, to provide our patients, community, and self with safe, quality care. Every patient deserves the opportunity to receive competent, well-managed services. Healthcare organizations should be capable of establishing and maintaining facilities with innovative quality initiatives.
Evidence based practice will be essential as governmental regulatory agencies evaluate healthcare facilities to determine financial reimbursement, as it encourages continuous quality improvement. This will also allow patients, family and community the opportunity to select a service provider based on performance data.
Conclusion
The throughout nursing history, the nurse has been ambitious to discover and implement new, innovative, safe, quality patient-centered care. The due diligence attitude evolves to require a higher level, of critical decision-making and nurse management skills. Healthcare organizations recognize the importance of utilizing the nurse’s skills, and leadership abilities as the way of the future. They provide a large population high-tech medical care, in a clean, safe, patient-centered environment. The facility holds quality measurement top performance awards recognized by The Joint Commission. The culture among nurses is conducive to encourage professional growth and development, extending the organizational mission to ensure patients receives high quality, safe, collaborative healthcare. They organization is proactively seeking methods to address the nursing shortage issues. In this organizational analysis of Fort Duncan Regional Medical Center, it identifies the organizations valiant effort to improve the quality and safety of patient-centered care.