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Management Test Ch 1, 3, 5, 6, 12

Terms in this set (60)

Management
has a greater emphasis on following protocols and procedures. Managing can also refer to control of one's own individual work and energies. Discuss patient care and administrative situations that require the use of management skills
Leadership
The use of individual traits and abilities to interpret an emerging situation and to address the situation in the absence of a script of defined plan
Followership
The optimal use of personal attributes in a team situation, while acquiescing to a peer who is leading or managing, to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes
Emotional intelligence
Having self-awareness, managing emotions, motivating self, being empathetic, handling relationships
Values
Beliefs of a person or social group in which they have an emotional investment (either for or against something).
Motivation
A need or desire that energizes and directs behavior
Bleich's tasks
Demonstrate individual accountability while working within the context of organizational systems and processes; do not alter the process for personal gain or shortcuts
-honor and implement care to the standards and specification required for safe and acceptable care
-offer knowledge, skills, and abilities to accomplish the task at hand
-collaborate with leaders and managers; avoid passive-aggressive or nonassertive responses to work assignment
-include evidence-based feedback as part of daily work activities as a self-guide to efficiency and effectiveness and to contribute to outcome measurement
-demonstrate accountability to the team effort
-take reasonable risks as an antidote for fearing change or unknown circumstances
-evaluate efficiency and effectiveness of systems and processes that affect outcomes of care; advocate for well designed work
-give and receive feedback to others to promote a nurturing and generative culture
Gardner's task
Envisioning goals-Effective change occurs when a nurse/leader can establish a shared vision.
Affirming values-Driving forces that give purpose, direction and precedence to priorities.
Motivating-Reinforcers that keep positive actions alive & sustained for change to occur
Managing-Create structures that support clinical & organizational outcomes. Management skills are necessary for all.
Achieving workable unity-May need to use principles of conflict resolution (Box 1-2) to restore unity
Developing trust-Important to behave with consistency, truth telling, and clarity.
Explaining-What are the steps?
Determine what needs to be shared
Know who will receive the information
Provide opportunity for dialogue & feedback
Plan the message in concise terms
Be willing to repeat information in different ways.
Serving as a symbol-Be an ambassador
Representing the group-Participate on committees to promote innovation, focus on the organizational objectives, mission, & purpose
Renewing-Provide celebrations of accomplishments
Complexity theory
Requires leaders to expand and respond to engaging dynamic change and focus on relationships rather than on prescribing and approaching change as a lock-step, prescribed method. Traditional organizational hierarchy plays a less significant role as the "keeper of high level knowledge" and replaces it to complex problems is better distributed among the human assets within an organization, without regard to hierarchy. Leaders try less to control the future and spend more time influencing, innovating, and responding to the many factors that influence health care.
Conflict resolution/management
1. Put the focus on interests:
-Examine the real issues of all parties
-Be expedient in responding to the issues
-Use negotiation procedures and processes such as ethics committees and other neutral sources
2. Build in "loop-backs" to negotiation:
-Allow for a cooling off period before reconvening if resolution fails
-Review with all parties the likely consequences of not proceeding so that they understand the full consequences of failure to resolve the issue
3. Build in consultation before and feedback after the negotiations:
-Build consensus and use political skills to facilitate communication before confrontation, if anticipated, occurs
-Work with staff or patients after the conflict to learn from the situation and to prevent a similar conflict in the future
-provide a forum for open discussion
4. Provide necessary motivation, skills, and resources:
-Make sure that the parties involved in conflict are motivated to use procedures and resources that have been developed; this requires ease of assess and a nonthreatening mechanism
-Ensure those working in the dispute have skills in problem solving and dispute resolution
-Provide the necessary resources to those involved to offer support, information, and other technical assistance.
Transformation leadership
Leader attends to the needs and motives of followers to raise levels of motivation and morality.
Leader is a role model-displays optimism, provides intellectual stimulation, & encourages creativity.
These organizations are responsive to customer needs, are morally & ethically intact, promote employee development, & encourage self-management.
Nurse leaders experiment with systems redesign, empower staff, create enthusiasm & promote scholarship.
Transactional leadership
leadership based on an exchange process in which followers are rewarded for good performance and punished for poor performance
Leader vs Manager
Leader is concerned with doing the right thing; vision, mission, goals and objectives. Manager is concerned with doing things right; productivity and efficiency.

Leader:
-guides others through complex, uncharted, or perilous circumstances
-no standard outcome
-decisions high in complexity
-Leads people

Manager:
-Guides others through derived routines, procedures or practices
-Pre-established outcomes
-Decisions routine in frequency and low in complexity
Mangages processes and resources
Covey's characteristics of effective leaders
-engage in lifelong learning
-are service-oriented
-are concerned with the common good
-radiate positive energy
-believe in other people
-lead balanced lives and see life as an adventure
-see things as greater than the sum of the parts
-engage themselves in self-renewal
Nurse practice act
law defines the scope of nursing and provides for the regulation of the profession by the state board of nursing
Negligence
Failure in following standard of care by failing to provide care, providing too much care (outside of your scope of training), providing innapropriate care, or failing to prevent problems.
Elements of Malpractice - duty
Easier to show is that a duty is owed the patient and is generally shown because the nurse has contracted to work for a given healthcare agency or facility
Elements of Malpractice - breach of duty
To determine the appropriate standard of care to apply, expert witnesses give testimony in court on a case-by-case basis, helping the judge and jury understand nursing standards of care. In nursing malpractice suits, nurses serve as the expert witnesses whose testimony helps the judge and jury understand the applicable standards of nursing care.
Elements of Malpractice - foreseeability
is based on prior knowledge; failing to meet the standard of care may result in harm.
Elements of Malpractice - causation
There must be a direct relationship between the failure to meet the standard of care and the patient's injury. It is not sufficient that the standard of care has been breached but, rather, that the breach of the standard of care must be the direct cause-and-effect factor for the injury.
Elements of Malpractice - injury
Some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider.
Elements of Malpractice - Damages
The patient must be able to prove injury so that damages may be assessed
Liability
Personal liability - Serves to make each personal responsible by law for his or her own actions

Vicarious liability - Imputation of accountability upon one person or entity for the actions of another person; substituted liability or imputed liability

Corporate liability - The condition of being responsible for corporate loss related to acts performed and not performed in meeting obligations to operate legally and judiciously
Standard of care
Represents the minimum requirements for acceptable practice or the minimum requirements for how one conducts oneself.
Assignment, delegation, supervision
Assignment - transfer of both the accountability and the reponsibility from one person to another.

Delegation - involves at least two people, a delegator and a delegatee, with the transfer of responsibility for the perform some type of task or work

Supervision - as the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity.
Failure to warn
Newer area of potential liability for nurse managers that involves the responsibility to warn subsequent or potential employers of nurses' incompetence or impairment.
Informed consent
Giving the patient adequate information concerning the method, risk and consequences to a specific procedure, it's risks, expected outcome and alternatives
Confidentiality
Describes a situation of trust insofar as any information regarding a person receiving or having received services may not be discussed with or otherwise made available to another person or group, unless that person has provided explicit authorization for release of such information.
Ethics/Ethical principles
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Code of Ethics
consists of a formal written set of ethical standards guiding an organization's actions
Moral distress
A type of distress that occurs when faced with situations in which two ethical principles compete, such as when the nurse is balancing the patient's autonomy issues with attempting to do what the nurse knows is in the patient's best interest. Moral distress may occur also when the nurse manager is balancing a staff nurse's autonomy with what the nurse manager perceives to be a better solution to an ethical dilemma.
Ethics committees
Multidisciplinary team assists with difficult ethical decisions. Usually the discussions relate to new or unusual ethical questions. Patients arrive with their cultural and/or their religion based ethics. What the person can and cannot do in regard to their health care has already been established by the culture of which they are a part.
Ethical/Legal issues
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Decision making styles
Paternalistic
Managers decide what is best for their team

Informative
Offers the staff the ability to make a decision after the information has been shared

Shared decision making
Decisions are made through an interactive, deliberate process where the staff may express and discuss options and preferences
Decision Models
2 types
Satificing - good enough - the solution may minimally meet the objective or standard, allows for quick decision
Optimizing - best possible decision - consider the options carefully such as when seeking employment or comparing job applicants
Strategies
Approaches designed to achieve a specific purpose
Decision making tools/Models
Decision grids (Figure 6-2, page 109)
Helps to visualize the options that are being considered, can evaluate based on common criteria

SWOT (Box 6-2, page 109)
Strengths, weaknesses, opportunities, and threats
Problem solving
Using a systematic process to solve a problem

Establish the need for a solution.
What is the basic need? What is the desired outcome? Who stands to benefit and why?
Justify the need.
Is the effort aligned with the strategy? What are the desired benefits? How will we ensure the solution is implemented?
Contextualize the problem.
What approaches have we tried? What have others tried? What are the external and internal constraints?
Write the problem statement
Operating budget
a budget for day-to-day spending needs
Budget categories
Budget categories may include revenue budget, security of cash, profit and loss, labor cost budget, materials budget, food cost budget, overhead budget, and allocated cost budget.
Variance
a difference between what is expected and what actually occurs
Types of technology
Biomedical - The technological devices and systems that relate to biological and medical sciences

Informational - The use of computer hardware and software to process data into information to solve problems

Knowledge - The use of expert and decision support systems to assist in making decisions about patient care delivery
Patient safety
This is a given
Productive hours
Hours worked and available for patient care
Units of service
A measure of the work being produced by the organization, such as patient days, patient or home visits, or procedures
FTE
2080 (40hr x 52wks)
Productive hours
Nonproductive hours
Leadership tag
References the philosophic, patient-centered, and values-driven characteristics that give an organization its personality
Risk management analysis
is the identification, assessment, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events or to maximize the realization of opportunities.

Risk management's objective is to assure uncertainty does not deflect the endeavor from the business goals.
Capitation
managed care cost-control policy in which doctors and hospitals are paid a fixed amount per year for each insured patient, no matter what services they provide
Generational characteristics
look at pg 42-43
Traditional generation Those born before ~1946

Baby Boomer generation Those born between ~ 1946 and ~1964

Generation X Those born between ~1964 and ~1981

Generation Y/Millennials Those born between ~1981 and early 2000's

Characteristics of the Traditional generation Wise
Loyal
Value hard work
Process-oriented
Rigid respect for authority

Characteristics of Baby Boomers Bend rules when necessary
Willing to sacrifice for success
Independent thinkers
like meetings

Characteristics of Gen X Creative and innovative
Not loyal
Outcome focused
Entrepreneurial

Characteristics of Millennials Comfortable with technology
Seek work-life balance
High expectations
doesn't like meetings

Characteristics of Veterans
Live by rules and do not question authority
Cost of benefits
25-30%
Whistleblower
a person who informs on a person or organization engaged in an illicit activity
Medicare benefits
Part A (hospital, hospice, home health, skilled nursing)
Part B (provider, medical equipment, diagnostics)
Part D (drug benefit plans)
Brainstorming
list ideas as stated without critique or discussion, build upon suggested ideas, focus is on volume of ideas & not necessarily quality, allow group to decide on rules of discussion
SWOT
Strengths, weaknesses, opportunities, and threats
Types of budget
Operating budget- financial plan for the day-to-day activities of the organization.
Cost centers
Units of service
Full-time equivalents (FTEs)
Productive hours
Nonproductive hours
Capital expenditure budget- include those related to the purchase of major capital items e.g. equipment, physical plant.
Cash budget- operating plan for monthly cash receipts and disbursements
DRG's
Flat-rate reimbursement (prospective payment system)- used DRGs as the basis for payment. There is a concern of variability within a DRG e.g. acuity, needed resources including nursing
Cost based system
Cost-based reimbursement (retrospective)-consists of the cost of providing a service plus a markup for profit, allowable costs are calculated and used a basis for payment (60s and 70s)
Cost containing nursing
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Magnet status
awarded to hospitals that demonstrate strength & quality in nursing service
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