Strategic Planning and Implementation in Healthcare Organizations, Exams of Nursing

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NUR 4320: Exam

power - correct answer capability of acting or producing some sort of an affect usually associated with the ability to influence the allocation of scarce resources compel obedience, control or dominate, delegate right or privilege

• Some sort of cohercion - you want someone to do something for you, you have power over someone
• Someone has an authoritarian role •Your nurse manager wants you to work this weekend, you say that you can't that you need some time off, the manager says well you wanted to apply for that day shift position, lets see how fast we can fill that position three formal dimensions of power: Relational aspect - correct answer one person is affected by the other three formal dimensions of power: dependency aspect - correct answer one is person is dependent on other three formal dimensions of power: sanctioning aspect - correct answer one person manipulates the other, there may be rewards or punishment

empowerment - correct answer nurse has control over practice, opportunities for mobility and growth, access to resources, support, and information in work environment Exists simultaneously on three levels: •Individual •Organizational •Psychological Where does power come from? - correct answer Dependence: having something someone else wants Providing resources: personal resources, financial resources, equipment Derived from being irreplaceable: what we bring to the table is irreplaceable (RN) Ability to affect the decision process: union nurses, power in numbers, the more numbers the stronger the group, the more of the decision process you can affect assertiveness - correct answer express your opinion without inhibiting the rights of others Ingratiation - correct answer try to make the other person feel important (brown-nosing)

Rationality - correct answer using logical arguments to persuade Sanctions - correct answer threats (rewards or punishment) Exchange - correct answer "scratching each other's back" Upward appeal - correct answer going to higher authority blocking - correct answer ignoring, blocking, bullying coalitions - correct answer groups getting together (big group of nurses coming together) five sources of power - correct answer 1.Reward: pay raise, promotion 2.Coercive: threat of firing, punishment 3.Expert: use of expertise, sought out by others (knowledge, competence) 4.Referent: use of charm, charisma to influence 5.Legitimate: has power because of the position person holds, supervision

connection power - correct answer knowing people and networking, calling a nurse on another unit information power - correct answer if you have the information you have the power, useful in negations group decison-making power - correct answer act as a united front persuasive power - correct answer skill in making rationale requests positional power - correct answer legitimate, cohersive, and informational personal power - correct answer expert, reference, and persuasive Basic Methods for Acquiring and Maintaining Power - correct answer Gaining control over tangible resources - you have something that everyone else wants Obtaining information and control of information channels - if you have the information, and you hang onto it and so not share it, you have the power Establishing favorable relationships Power is derived from the following: - correct answer ØDependence (someone is dependent on someone else) - one nursing unit is dependent on another: ER is dependent on beds in the hospital, L&D to MBU ØProviding resources (tangible resources)

ØCoping with uncertainty (who has the scoop?) ØBeing irreplaceable (NURSES for sure have this) ØThe ability to affect the decision process ØA shared consensus within the organizational subunit Cost of Mismanaged Conflict - correct answer Management time Presenteeism: person is present but not working very hard - not engaged Absenteeism: person is not there (calling in sick) Turnover: unit has high turnover, lots of open positions Litigation: someone is suing us job conflict - correct answer Opposition, the goals of the organization and the job goals are not aligning (You are Pro Choice, you go to work at a Catholic hospital) organizational conflict - correct answer The struggle over scarce organizational resources (hospital has $10,000 to spend on equipment MBU wants it, L&D wants it, cannot split it) conflict - correct answer The struggle that occurs when a real or perceived threat or difference exists in the desires thoughts, attitudes, or feelings of two or more behaviors intrapersonal conflict - correct answer Internal individual conflict

interpersonal conflict - correct answer Conflict between two or more people intergroup conflict - correct answer Conflict between members of two or more groups relationship conflict - correct answer Interpersonal incompatibilities task conflict - correct answer Differences in viewpoints about a group task process conflict - correct answer Controversy about how task is accomplished General Causes of Conflict - correct answer Personality differences Value differences Blurred job boundaries Battle for limited resources Constraints on decision-making process Communication Departmental competition Unmet expectations for co-workers Complexity of organizations Negative Outcomes of Conflict - correct answer Hostility

Gossip Burnout Lack of professional growth Increased turnover Lack of professional collaboration Less efficient use of resources Core Process of Conflict: manifestations of interpersonal conflict - correct answer Disagreement Interference Negative emotion Positive Effects of Conflict - correct answer Increased group performance Improved quality of decisions Increased creativity and innovation Increased interest and curiosity Improved problem solving Implementation of self-evaluation and change Negative Effects of Conflict - correct answer Discontent Reduced group effectiveness Disrupted communication Reduced group cohesiveness Infighting among group members

Disruptive Behavior - correct answer Abuse Bad behavior/bullying Covert abuse Horizontal violence: one nurse says something to a unit manager to causes conflict Incivility Interactive workplace violence/drama Lateral violence: one nurse says something to another nurse that causes conflict Nonverbal abuse Overt abuse Psychological violence Toxic behavior Verbal abuse Vertical violence Conflict Management Versus Conflict Resolution - correct answer Conflict management

• Control of conflict Conflict resolution
• Elimination of conflict

Conflict Management Styles - correct answer Competing-one person seeks to satisfy his own interest regardless of the impact Collaborating-both sides desire to satisfy their group by clarifying differences Avoiding-realizes there is conflict but avoids it Accommodating-one party appeases the opponent, (self-sacrificing, giving in) Compromising-give and take carefronting - correct answer Uses "I" instead of "you" Ø"I felt" instead of "You did" negotiation - correct answer sometimes requires third party conciliation - correct answer third person attempt to diffuse negative emotions involved in conflict mediation - correct answer uses neutral third party, Mediator is to listen to the evidence and assist the parties to see each other's viewpoint Mediator does not make the decision (people resolve conflict) arbitration - correct answer uses third party, the arbitrator makes the decision (decision of arbitrator is final) Three Ways to Resolve Conflict - correct answer 1.Win-lose

2.Lose-lose 3.Win-win Five Styles of Handling Interpersonal Conflict - correct answer Avoiding Obliging Compromising Integrating Dominating Nursing Strategies to Resolve Conflict - correct answer Recognize conflict early Be proactive Actively listen Remain calm Define the problem Seek a solution A hospital's executive leadership team wants to increase nurse-to-patient ratios in an effort to decrease costs. The staff nurses are against the change because they feel they already have difficulty completing care for their patients. Adding more patients to their assignment will decrease quality, safety, and patient satisfaction. This is a type of which kind of conflict? A.Intrapersonal conflict B.Intergroup conflict C.Intragroup conflict

D.Relationship conflict - correct answer b. intergroup conflict The executive leadership team's recommendation of increasing the nurse- to-patient ratio spurs the nursing staff to strike against the hospital. This is an example of which type of conflict? A.Competitive conflict B.Disruptive conflict C.Process conflict D.Intrapersonal conflict - correct answer b: disruptive conflict Strategic management - correct answer involves strategic planning and implementation. it provides a blueprint for operating a business, establishing a competitive position, ensuring customer satisfaction, and reaching strategic objectives or goals mission - correct answer is what you do right now, organizations purpose vision - correct answer where you want to be down the road, future direction Core values - correct answer define characteristics or beliefs that underly the organizations beliefs, core purpose is the reason the organization is in business - NEVER change strategy - correct answer competitive move or business approach to help you get to your outcome

tactics - correct answer operational choices of action made to implement strategy - recruit and enroll students, provide faculty, provide courses strategic plan - correct answer a document that outlines a plan for actualizing the mission stakeholders - correct answer the people, the groups, the other institutions with a financial interest in what happens at organization (Stryker) strategic planning process - correct answer 1. create mission & vision

2. assess environment
3. set objectives
4. develop strategies to achieve the objectives
5. plan for implementation
6. plan for evaluation the strategic plan provides a framework for strategic management, considering both external and internal environmental factors Components of Strategic Planning Frameworks - correct answer Creating strategic mission and vision: mission delineates what the organization does, vision articulates the preferred state of the organization

Assessing the environment: analyzing both internal and external environmental factors (SWOT: strengths, weaknesses [internal], opportunities, and threats [external]) Setting objectives: define who, what, where of the strategies to be implemented. SMART objectives Developing strategies to achieve the objectives: realistic, planned, and intentional, yet flexible Planning for implementation: trying out the activities in a way that determines how best to close the gap between how things are done and what it takes to achieve the strategy Planning for evaluation: to ensure the systems and measurements are in place to determine whether the strategic plan has been achieved core values - correct answer DO NOT CHANGE assessing the environment - correct answer SWOT analysis ØStrengths ØWeaknesses ØOpportunities: new, flashy, clean, and bright (internal or external) ØThreats: competing hospital 10 miles down the road has a new outpatient center as well (internal or external) Strengths and weaknesses are related to:

ØOperations: new unit is open 24 hrs per day, 7 days a week ØManagement ØProducts: patient care ØFinances: money to run unit 24 hrs per day, 7 days per week setting objectives - correct answer Defines the who, what, and where of the strategies to be implemented Identifies where the organization is, where it wants to go, and how long it will take to get there Developing Implementation Strategies - correct answer Strategies must be: ØAligned with organizational culture ØRealistic ØPlanned: well-planned ØIntentional ØFlexible Adapting to Change - correct answer Organization's strategy must remain flexible to respond to: ØEvolving needs and preferences of customers and stakeholders ØAdvances in technology ØChanges in political climate/regulatory requirements ØNew opportunities

ØAltered market conditions ØDisasters and crises Planning for Implementation - correct answer Strategies must be implemented: ØProficiently ØEfficiently ØIn a timely manner Implementing Strategy - correct answer Implementing strategy is closely linked to organization's operations and involves: ØManaging ØBudgeting ØMotivating ØChanging culture ØSupervising ØLeading Functions of Strategic Planning and Implementation - correct answer Demonstrate leadership in implementation of the strategy Reward those who carry out the strategy successfully Allocate resources Formulate policies and procedures Initiate continuous quality improvement activities

Develop and reward best practices Maintain a culture that supports the strategy Planning for Evaluation - correct answer Determines if strategic plan has been achieved If strategy is not successful, further evaluation (SWOT analysis) is needed Sections of a Strategic Plan Document - correct answer Executive summary: synopsis of plan (2-3 pg) Background: describe institution, its history, and current state. Mission, vision, and values: a description of the philosophy of the organization Goals and strategies: a list of the target objectives and the strategies identified to ensure achievement of the objectives Appendices: all additional documentation related to the strategic planning process to provide the background information used by the strategic planners to arrive at the final plan ØAnnual report ØSWOT analysis ØFinancial information ØEnvironmental scan results ØStaffing information ØCurrent/projected programs

Action Plan - correct answer Maintains focus on implementation of strategic plan Breaks strategic plan into manageable components Becomes a living document that is constantly consulted Requires a champion to guide others Leadership and Management Implications - correct answer Strategic management exposes opportunities and threats Nursing process helps nurses grasp strategic planning process Strategic plan unifies staff Strategic plan encourages collaboration and cooperation of staff All of the following are true about strategic management except: A.It involves establishing goals and setting targets. B.It allows an organization to obtain and maintain a competitive advantage. C.It includes only financial goals. D.It requires implementation and evaluation. - correct answer c: It includes only financial goals. The statement "As a member of a progressive health care system, we deliver high-quality comprehensive services to the local and extended community with excellence, compassion, and competence" is an example of which part of a strategic plan document?

A.Executive summary B.Background C.Mission D.Goals and strategies - correct answer c: mission Nurse staffing management plan - correct answer Is used to determine staffing through a forecasted workload and recommended care standard. skill mix - correct answer all RN staff or RN and unlicensed personnel, new grads and vets staffing pattern - correct answer the day to day, identifying and allocating nurses on a shift scheduling - correct answer determining a set number and type of staff needed and assign them to work, the number of staff for the future time period Nursing direct-care hours - correct answer what is the nurse doing, hands on Average daily census - correct answer 25 bed surgical unit, daily census = 20?

Admission, discharges, and transfers - correct answer 30 patients in 25 beds Average length of stay - correct answer 2-3 days Framework for Staffing Management - correct answer Budget based Nurse-patient ratio Patient acuity Four Hospital Types According to AONE - correct answer Large academic medical center (U of M) Integrated health care system (Bronson, Spectrum, or Ascension Borgess) Small community hospital (Spectrum Pennock, Bronson Battle Creek) Rural hospital setting (Allegan, Bronson Lakeview in Paw Paw) Elements of Nursing Care Delivery Models - correct answer Nurse/patient relationships and decision making Work allocation and patient assignments Communication among members of the health team Management of unit or environment of care ØCommon among these in the value of the nurse/patient relationship and role of the charge nurse (must use real time data to assign right nurse) (competency and expertise to right patient) Don't be upset if you don't get to take care of the sickest patient when you first start.

Three Nursing Care Delivery Models - correct answer 1.Synergy model: comes from critical care, match the needs of the patient with the expertise of the nurse 2.Case management: care coordination, discharge planning, post-clinical needs 3.Clinical nurse leader: improve patient outcomes, clinical expertise, EBP implementation Influences on Staffing - correct answer Professional organizations: ANA The Joint Commission: quality and safety Collective bargaining agreements: labor unions Legislation: California mandates minimum nursing staff ratios Demand Management - correct answer Focuses on: ØMeasuring, predicting, and understanding demand for an institution's products and services ØDeploying resources and management to ensure that demand is met so that customers' wants and needs are satisfied Three Types of Stressors Intrinsic Daily Health Care Operations - correct answer 1.Flow stress representing the appearance rate of patients for hospital care 2.Clinical stress expressed in the variability in type and severity of disease 3.Stress caused by competing responsibilities of health care providers

Essential Components for Effective Demand Management - correct answer Based on patient outcomes Focused on the individual patient Incorporation of progress goals Continuously measure progress in real time Projected into the near future Embedded in a decision support system Acceptable to all stakeholders Produces a need for care in terms of quantity, skill, and caregiver attributes Outcomes-driven acuity system improves patient care outcomes Incorporates electronic data to reduce data gathering and to use real-time valid data Results of Focusing on Individual Patient in Demand Management - correct answer Best-practice staffing protocols Early identification of patients who are not moving through their hospital stay as planned Improved near-term projection and prediction of staffing needs Staffing Allocation and Resource Pool - correct answer Protocols and processes for daily staffing decision support aligned with budget-sensitive variable staffing plans Centralized staffing benefits and challenges Computerized staffing systems

Supplemental staffing (staffing pool) ØResource guidelines ØOperational metrics Organizational Outcomes and Staffing - correct answer Staffing effectiveness Nursing-sensitive outcomes screening indicators Evidence of staffing on outcomes Fixed staffing: built around work-load Variable staffing: staff on call, if census goes up will be called and have to come in The staffing management plan: A.Is mandated by law. B.Does not include the use of hours per patient day. C.Is used to determine staffing through a forecasted workload and recommended care standard. D.Measures and predicts the demand for an institution's products and services. - correct answer c: A.Is used to determine staffing through a forecasted workload and recommended care standard. budget - correct answer financial plan

expenses - correct answer cost of doing business revenue - correct answer income Total operating revenues - correct answer multiply volume of services performed by charge for the service income - correct answer excess of revenue over expenses variance - correct answer difference between budgeted and actual amount (positive or negative) $100 light bill but $150 budgeted Three Major Types of Organizational Budgets - correct answer 1. Capital budget- major equipment (>$10,000)

2. Operating budget- annual revenue and expenses (supplies not personnel) day to day supplies (computers, syringes, bandages, IV tubing, toilet paper, hand sanitizer)
3. Personnel budget- (staffing budget of the unit) part of operating budget Capital Budgets - correct answer Capital budget preparation is the first step in the annual budget cycle Capital expense is defined according to dollar amount and anticipated life span of the purchase Extensive background material is needed to support capital budget requests

Finance department creates a compiled expenditure list from each unit Senior management prioritizes the list ØWhat equipment needs replacing/updating ØWhere will they get the biggest return on investment Aspects of the Operating Budget - correct answer Covers a fiscal year (July1-June 30, or Oct 1-Sept 30) It is the budget plan for day-to-day service delivery operations Has two parts: Ø labor budget Ø expense budget (costs other than budget) Developing the Operating Budget - correct answer Determine volume projections ØIs unit downsizing or growing? Ø Are services being done as outpatient now? Develop associated expense projections: ØSupplies, equipment, salary/labor expenses •Consider increase in supply costs, perhaps increase in nurses compensation Determine revenue projection projected volume - correct answer Census and average length of stay are factored into volume

ØThese numbers are provided by historical data, e.g. from last year or last 6 months ØDoes your unit tend to have lower census around holidays? ØIs your primary provider taking the month of January off? Must consider budget assumptions ØDid the union just negotiate a 20% raise for RNs? Supply and Revenue Budgets - correct answer Supply items are variable and fixed ØWhat supply items are fixed? You are going to have these expenses regardless of the number of patients •Phone bill, light bill Ø ØWhat supply items are variable? •The cost of IV supplies, IV pump , pts who need a sitter Leadership and Management Implications - correct answer Nursing services make up the single largest expense in most health care organizations Nursing services use a large share of supplies and equipment Leadership influences others to achieve the group's goals within the constraints of scarce resources Leaders must include ethical decision making that includes fairness, transparency, and reasonable targets Leadership in resource allocation can influence employee morale