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LEARNING OUTCOME 1 Describe how organizational theories differ.

Concepts for Lecture 1. Organizational theories remained largely unexplored until the Industrial Revolution in the late 1800s and early 1900s. Early philosophies are called classical theory and humanistic theory. Later approaches include systems theory, contingency theory, chaos theory, and complexity theory. 2. Classical theory focuses on efficiency through design. It is built around four elements: division and specialization of labor, organizational structure, chain of command, and span of control. Division of work and specialization are seen as economically beneficial. The chain of command is top down, with higher levels of management delegating work to those below them. 3. Humanistic theory focuses on the social aspects of work and organizational design. A major assumption of this theory is that people desire social relationships, respond to group pressure, and search for personal fulfillment. Formal authority does not work without willing participants. 4. Systems theory defines a system as a set of interrelated parts arranged in a unified whole. Systems can be closed or open. An organization is a recurrent cycle of input, throughput, and output, with the manager being the catalyst for the process. 5. Contingency theorists believe organizational performance can be enhanced by matching an organization’s structure to its environment. The health-care environment includes patients, third-party payers, regulators, competitors, and suppliers of facilities, personnel, equipment, and pharmaceuticals. Because organizations exist in different environments, the optimal form of organization is contingent on the circumstances faced by that organization. 6. Chaos theory looks at organizations as living, self-organizing systems that are complex and self-adaptive. The drive to create permanent organizational structures is doomed to fail, so organizations must be creative and flexible to adapt to change. The role of leaders is to build resilience in the midst of change and to maintain balance between tension and order, which promotes creativity and prevents instability. 7. Complexity theory notes that random events interfere with expectations. In health care, random events such as a change in a patient’s condition or necessary staff being unavailable often happen without warning. Hierarchy is less important and managers must encourage the flow of information in all directions among team members.

LEARNING OUTCOME 2 Describe the different types of health care organizations. ©2013 by Pearson Education, Inc. Sullivan, Effective Leadership and Management in Nursing, 8th Edition

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Concepts for Lecture 1. a. b. c. d. 2. a.

b. c. d. e.

Health care settings include: Primary care: physician’s offices, emergency rooms, public health clinics, and retail medicine sites (walk-in clinics) Acute care hospitals: general or special care facilities, teaching hospitals Home health care Long-term care organizations Complex health care arrangements include: Health care networks: deliver a continuum of care, provide geographic coverage for buyers of health care services, and accept inherent risk in taking a fixed payment for providing health care for all persons in the selected group Interorganizational relationships: horizontal or vertical integration; joint venture Diversification: concentric and conglomerate Managed health care organizations: health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service plans (POS) Accountable care organizations

LEARNING OUTCOME 3 Explain how health care organizations are structured.

Concepts for Lecture 1. Organizational structure integrates organizational goals, size, technology, and environment. Managers can use organizational structure as a tool to increase organizational efficiency. 2. Traditional organization structures include: a. Functional: employees are grouped in departments by specialty (e.g., all nursing tasks fall under nursing service); decision-making tends to be centralized b. Hybrid: organization consists of both self-contained and functional units c. Matrix: integrates both product and functional structures into one overlapping structure d. Parallel: result of complex relationships between the formal authority of the health care organization and the authority of medical staff; medical staff is separate and autonomous from organization 3. Service-line structures organize clinical services around specific patient conditions. 4. Shared governance is based on the philosophy that nursing practice is best determined by nurses. Principles of shared governance reflect partnership, equity, accountability, consensus, and ownership. 5. Ownership can be private or government, voluntary or investor-owned, sectarian or nonsectarian.

LEARNING OUTCOME 4 Discuss various ways that health care is provided.

©2013 by Pearson Education, Inc. Sullivan, Effective Leadership and Management in Nursing, 8th Edition

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Concepts for Lecture 1. Redesign includes strategies to provide safe, efficient, quality health care. Strategies include: a. Patient-centered care model, e.g., medical home that provides continuous, accessible, and comprehensive care b. Focusing on specific service lines c. Applying lean thinking to the system d. Flat, decentralized organizational structure

LEARNING OUTCOME 5 Demonstrate how strategic planning guides the organization’s future.

Concepts for Lecture 1.

A strategic plan projects the organization’s goals and activities into the future and guides the direction the organization is to take. Decision making is guided by: a. Philosophy: written statement of values, vision, and mission b. Vision statement: goal to which organization aspires c. Mission: broad, general statement of the organization’s reasons for existence d. Goals: specific statements of outcomes to be achieved

LEARNING OUTCOME 6 Discuss how the organizational environment and culture affect workplace conditions.

Concepts for Lecture 1. The organizational environment comprises system-wide conditions that contribute to a positive or negative work setting. 2. Six characteristics of a healthy work environment (AACN) are: a. Skilled communication b. True collaboration c. Effective decision making d. Appropriate staffing e. Meaningful recognition f. Authentic leadership 3. Organizational culture is the basic assumptions and values held by members of the organization. Organizational culture varies among institutions, subcultures, and even countercultures. Consonance occurs when the subculture’s norms and traditions agree with the organization’s; dissonance occurs when they are not in agreement. GENERAL CHAPTER CONSIDERATIONS 1. 2.


Have students study and learn key terms listed at beginning of  Have students complete end of chapter exercises either in their book 

©2013 by Pearson Education, Inc. Sullivan, Effective Leadership and Management in Nursing, 8th Edition

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Have students select one of the organizational theories described (or assign to groups of students) and discuss how a nurse would fit into each type of organization. How might the nurse feel in such an organization?

Find the organizational chart for your school and ask students to identify the theory and structure of the institution’s governance.

Have students who have part-time jobs identify the organizational theory behind their organizations and how the theory plays out in their daily work lives.


Have students identify examples of each type of health care organization in the community and the populations they serve.

Have students visit the various types of health care organizations and report in class what they observed. Did the nurses play an active role in the leadership of the organization?


Have students discuss strategic planning for the school of nursing they attend. What goals would they agree upon for the future and why?

Ask students to review a hospital’s philosophy, mission statements, and organizational structure and discuss whether nurses are part of governance.

Have students observe strategic planning in the community—at city council meetings, for example—and report to the class what they observed.


Have students describe and discuss two different classroom environments and identify what makes them different.

Have students discuss the work environment for nurses they have observed in the past.



NCLEX®­style review questions

©2013 by Pearson Education, Inc. Sullivan, Effective Leadership and Management in Nursing, 8th Edition

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Case studies


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Students can search, highlight, take notes, and more all in electronic format

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©2013 by Pearson Education, Inc. Sullivan, Effective Leadership and Management in Nursing, 8th Edition

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