2.1 Organizational Structure

Systems Theory and Health Care

As nurses we know that the success of our patient-centered care interventions is dependent upon many factors. All too often, despite extensive planning and hard work, a patient care intervention fails to lead to the intended results. Factors beyond our control, and often beyond our knowledge, change the intended outcomes. This is typical of events in a complex adaptive system.

So how can we be successful leaders if we cannot predict what will happen when we attempt to guide others? Perhaps a review of the first two principles of the complex adaptive system will provide an answer to this question. The first principle, which is focused on using the lens of complexity, and the second principle, which describes good enough vision, provide us with clues on how to lead others within the complex adaptive health care system. Organizations and nurse leaders acknowledge that they cannot control change, and thus they do not try to control every aspect of organizational change. Successful health care leaders attempt to give a general sense of direction to employees, rather than focus on specific details. Next, leaders also encourage employees to develop innovative responses that best meet their individual strengths and needs and meet the healthcare system’s ultimate goal of quality patient care. Leaders cannot predict all the factors that will influence the final results of change activities, but by following these principles, they know that the final response will be what is best suited to the environment, or healthcare system, and the needs of the individual.

Learning Exercise 2.1.1

What are we talking about when we speak about systems theory in a health care organization? For a deeper understanding, watch this video titled “System Theory of Management” (7:37) by Nguyen Thanh Thi, then answer the following questions:

  1. What are the three basic system types? Describe each type.
  2. What type of system is a hospital?
  3. What is synergy? What is entropy?

There are three fundamental concepts that, when applied to our individual organizations, can transform the way we provide health care. For additional information, watch this video titled “Systems Thinking and Complexity in Health: A Short Introduction” (5:02), then complete the following exercises:

  1. Define the three fundamental concepts that can transform the way we provide health care.
  2. Give an example of how each concept can make a difference to health care provision.

Organizational Culture 

Organizational culture is often referred to in healthcare organizations, but there is a lack of consensus on what it actually is, how it influences behaviors and if leaders can change the culture (Watkins, 2013).  In a social media platform, Watkins facilitated a discussion on perceptions of organizational culture and later published a synthesis of responses in Harvard Business Review (Watkins, 2013), As you can see from the variety of responses compiled in Table 2.2.1, there is not one clear consensus for a definition of organizational culture.  Implications for nursing leadership include the need to be aware of cultural nuances in their own organization and that it can change based upon a number of variables (Watkins, 2013)

Table 2.1.1 What is Organizational Culture? (Watkins, 2013)

“Culture is how organizations ‘do things’.” — Robbie Katanga

“In large part, culture is a product of compensation.” — Alec Haverstick

“Organizational culture defines a jointly shared description of an organization from within.” — Bruce Perron

“Organizational culture is the sum of values and rituals which serve as ‘glue’ to integrate the members of the organization.” — Richard Perrin

“Organizational culture is civilization in the workplace.” — Alan Adler

“Culture is the organization’s immune system.” — Michael Watkins

“Organizational culture [is shaped by] the main culture of the society we live in, albeit with greater emphasis on particular parts of it.” — Elizabeth Skringar

“It over simplifies the situation in large organizations to assume there is only one culture… and it’s risky for new leaders to ignore the sub-cultures.” — Rolf Winkler

“An organization [is] a living culture… that can adapt to the reality as fast as possible.” — Abdi Osman Jama

Further Research

Hung, D., Chung, S., Martinez, M., & Tai-Seale, M. (2016). Effect of organizational culture on patient access, care continuity and experience of primary care. Journal of Ambulatory Care Management, 39(3), 242–252.

Purpose:  To examine the relationships between organizational culture and patient-centered outcomes in a large medical practice.

Discussion:  This American study was conducted in a large physician group practice setting of 357 physicians, 41 primary care departments, and nearly a million patients. Organizational culture was found to be significantly associated with “patient access to care, continuity of care, and reported experiences with care delivery” (Hung et al., 2016, pp. 245–246).

Application to Practice:  When introducing change to an organization, it is essential to recognize the underlying organizational culture. Acknowledging and leveraging this aspect of collective behavior, while targeting specific patient-centered care goals, will lead to improved care.

Leaders know that employees frequently resist change and innovation in their workplace using the argument that “it has always been this way.” Leaders play a pivotal role in inspiring change. When introducing innovation or transformation, it is important to recognize that cultural change cannot be commanded, but can only be inspired. Effective leaders understand both implicit and explicitly stated cultural norms and traditions when they introduce change into the organization. One highly valued nursing leadership and innovation is Magnet® (Learning Exercise 2.1.2).

Research with Magnet® hospitals in the United States reinforced the need for a health care environment that is focused on the provision of quality patient care. This necessity has also been identified in the UK. When caregivers are provided with adequate resources, support, and respect, there is evidence of increased job satisfaction and reduced patient morbidity and mortality (Aiken, Clarke, Sloane, Lake, & Cheney, 2008).

Holistic leadership approaches, which include a focus on relational leadership and staff empowerment, foster a strong and robust care provider culture within the organization. When supportive care provider cultures are present, improved health is likely to be evident for both care providers and patients.  Research indicates that successful and effective nurse leaders have a positive impact upon the well-being of nurses, which converts into improved patient–client outcomes (Specchia et al., 2021)

Learning Exercise 2.1.2

Explore the Magnet® Recognition Program:  https://www.nursingworld.org/organizational-programs/magnet/about-magnet/why-become-magnet/

Reflect on the following:

  • What is a Magnet® Recognition Program?
  • What are 3 characteristics of Magnet® Organizations?
  • How does Magnet® recognition benefit stakeholders?
  • Is your organization a Magnet®-recognized organization?
    • If yes, what do you perceive as the primary benefit?
    • If not, what would it take for your organization to pursue this recognition?

Next: Organizational Vision, Mission, and Values



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Leading Change in Health Systems: Strategies for RN-BSN Students Copyright © 2023 by Kathy Andresen DNP, MPH, RN, CNE is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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