The Elements and Types of Health Care Organizations. A systems health approach uses scientific evidence to understand the factors that influence health outcomes. It models the relationships between these factors and adapts design, processes, and policies based on the resulting evidence to achieve better health at lower costs.
What are Elements and Types of Health Care Organizations
Healthcare organizations can be classified according to the types of services they offer, their ownership, and the length of hospital stay. The main types include hospitals (general, specialty, community, and tertiary), primary care centers, home care, and ambulatory care centers. Managed care organizations, such as HMOs, also play an important role in the provision of healthcare services.
Primary health care includes eight essential components: health education about prevalent health problems and methods for their prevention and control; nutrition promotion, including food provision; provision of adequate drinking water and sanitation; maternal and child care; and immunization.
Health-Care Organizations
Nurses work in many different types of health-care organizations and take on varying roles within each. Nurses at all levels must have a good understanding of how health-care systems work to be able to function effectively within an organization and deliver safe and quality nursing care. Understanding the nuances of health-care systems allows nurse leaders and managers to better navigate an organization, recognize the level of complexity, comprehend the need for change and innovation, and, in turn, see how nurse’s best play a role in the environment.
With knowledge of how different systems work, nurse leaders and managers can better facilitate compliance with health-care regulations, identify opportunities and threats for strategic planning, and manage personnel and units and/or departments effectively.
Basic Elements of A Health-Care Organization
Various types of health-care organizations providing different levels of care are needed in today’s society. The variety of care and services received by patients from a variety of health-care providers in a variety of settings constitutes a continuum of care. Continuum of care is defined as “a concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care” (Young, Clark, Kansky, & Pupo, 2014, para).1)
The continuum of care covers the delivery of health care over a period of time, as expansive as from birth to end of life, and is important to ensure safe and quality care and to decrease fragmentation of care. Nurses at all levels need to develop an understanding of the continuum of care and the basic elements of health-care to integrate health promotion, injury prevention, disease prevention, and disease management elements into their nursing practice (American Association of Colleges of Nursing [AACN], 2008).
Nurse leaders and managers must be knowledgeable and develop necessary skills to coordinate the care of patients with many other health-care providers and organizational units involved in providing care. Understanding the basic types of health-care organizations and the levels of services provided across them is the first step in achieving a continuum of care.
For-Profit Versus Not-for-Profit Organizations
Some health-care organizations are for-profit organizations, meaning they are owned by stockholders, shareholders, or corporate owners. Money brought in is reinvested into the organization to keep it running (e.g., in areas including maintenance, expansion, purchasing of equipment and supplies) and to develop new services. A for-profit organization must always have reserve funds to pay the corporate owners or the stockholders.
As a result, funds may not always be readily available for certain purposes that can affect nurses and patient care. In contrast, not-for-profit organizations do not have stockholders or shareholders yet must also have funds available to run the organization. Possible sources of funding for not-for-profit organizations are public and/or government funding, grants, private donations, or a combination of these sources.
A not-for-profit organization typically serves a large number of nonpaying patients. This can cause the organization to spend more money than it is bringing in. Additionally, a not-for-profit organization may have to cut services or make other changes to ensure a positive cash flow.
Types of Health-Care Organizations
Hospitals represent the largest type of health-care organization, and, in fact, more nurses work in hospitals than in any other type of health-care organization (Bureau of Labor Statistics, 2015). Other types of health-care organizations include extended care facilities, retirement and assisted living facilities, ambulatory care centers, home health care agencies, medical homes, psychiatric care facilities, and substance abuse treatment facilities.
Levels of Service
Health-care organizations are frequently categorized according to the complexity of the level of care provided throughout the continuum, which can be primary care, secondary care, or tertiary care. Primary care is the first line of defense and involves health promotion and illness prevention. In a primary care facility, the focus is on health education and health screening. Examples of primary care facilities include health-care provider’s offices, immunization centers, and wellness centers.
Secondary care involves emergency care and acute care. In this environment, the focus is on diagnosis, treatment, and limiting disability. Examples of secondary care facilities include hospitals, urgent care centers, ambulatory care facilities, and birthing centers. Tertiary care involves restoration and rehabilitation. In this environment, the focus is on maintaining and improving (if appropriate) the current state of health. Examples of tertiary care facilities are rehabilitation centers, assisted living centers, long-term care facilities, and hospices.
Organizational Structure And Culture, And Strategic Planning
The structure and culture of a health-care organization need to be understood by nurse leaders and managers to ensure a safe and healthy work environment.
Organizational Structure
Organizational structure outlines who is accountable and responsible for the work in an organization and subsequently helps define working relationships. Health-care organizations continue to be fairly traditional, with most having a hierarchical organizational structure and reflecting the classical principles of chain of command, unity of command, and span of control (Rundio & Wilson, 2013). Chain of command refers to a formal line of authority from the top to the bottom of the organization. Each unit is connected to another, and reporting relationships are hierarchical (i.e., a unit’s immediate manager reporting to the one above).
Unity of command suggests that each individual employee is accountable to only one manager, with expectations clearly defined and well understood (Rundio & Wilson, 2013, p. 15). Span of control defines a man ager’s scope of responsibility and reflects the number of employees who report to a given manager. Theoretically, the goal is to accomplish the work of the organization by dispersing responsibilities and duties equally so that one individual or unit is not overburdened. Organizational charts visually represent these principles, with each unit connected in a hierarchal manner.
The goal of an organizational chart is to reflect formal relationships between and among units within an organization. Organizational structures can be centralized or decentralized. A centralized structure, often referred to as tall (or hierarchical), is one in which the authority for decision making is held by a few individuals at the top level of management. Typically, the chief executive officer and administrators hold the highest level in the organization. They have authority to hire and fire, make financial decisions, and implement change. Depending on the levels of management, some authority may be delegated to those employees reporting to an administrator.
In a centralized structure, there is minimal innovation or creativity, and problems are dealt with by a few leaders and managers; this system sometimes results in delays in decision making. Communication flows from top to bottom and is tightly controlled. Nurses may or may not participate in decision making in a centralized structure. Responsibilities of nurse leaders and managers vary de pending on their position and level in the organization.
In a decentralized structure, often referred to as flat, authority and power for decision making are shared by a number of individuals across the organization. In this environment, problems can often be solved at the level where they occur. Typically, staff members are responsible for making decisions related to their areas of expertise. Communication flows from the bottom upward and between units. Nurses participate in decisions that affect their nursing practice and patient care. Nurse leaders and managers foster shared governance and teamwork and collaboration.
Organizational Culture
Organizational culture is an informal, yet recognizable, group philosophy or world view that guides behaviors of the members of the organization. It is shaped by the mission, vision, and philosophy of the organization and reflects its values and beliefs as well. The mission statement of an organization describes the organization’s overall purpose. Being future oriented, the mission statement should reflect the direction toward which the organization intends to head. The vision statement reflects the image for the future the organization plans to create (Roussel, 2013, p. 343).
Mission and vision statements often are created by top-level administration. However, when all staff members are involved in developing mission and vision statements, they will believe in their abilities and become committed to the organization (Roussel, 2013; Rundio & Wilson, 2013). A philosophy is a statement of beliefs, values, concepts, and principles that reflect the ideas, convictions, and attitudes of the organization. The philosophy of an organization becomes the basis for operationalizing the mission and vision of the organization (Tuck, Harris, & Baliko, 2000).
Nurse leaders and managers have a major responsibility to model the core values of the organization and ensure that the activities of their unit or department reflect the vision, mission, and philosophy of the organization. The nursing mission, vision, and philosophy emerge from the organization’s and should articulate the nature of the nurse’s role, the values of nursing, what nursing should and will be, and what populations are served, as well as a purpose statement (Roussel, 2013).
Additionally, the mission, vision, and philosophy of nursing should be known and understood by everyone within the organization including health-care providers, patients and families, and the community (Roussel, 2013).
Strategic Planning
Strategic planning is how an organization defines its future. It aligns an organization with defined goals and can be considered a roadmap for the future of an organization (Roussel, 2013; Schaffner, 2009). Strategic planning is defined as “a continuous, systematic process of making risk-taking decisions today with the greatest possible knowledge of their effects on the future; organizing efforts necessary to carry out these decisions and evaluating results of these decisions against expected out come through reliable feedback mechanisms” (Drucker, 1974, p. 125).
Nurse leaders and managers participate in strategic planning at the organizational and department or unit level. Strategic planning forecasts the future success of an organization and begins by ensuring that its mission, vision, and philosophy are up to date (Conway Morana, 2009). Steps of the strategic planning process. A primary goal of strategic planning is to maximize organizational performance. One strategy used in the planning process is evaluation of the organization’s strengths, weaknesses, opportunities, and threats, known as SWOT analysis.
SWOT analysis can assist nurse leaders and managers in improving care delivery by identifying the strengths of the unit and/or staff, areas for improvement, and opportunities for facilitating positive change (Roussel, 2013). The first step in a SWOT analysis is to collect data, which may include staff characteristics, unit census, patient characteristics, and more. Next, the data are analyzed and sorted into one of the four categories: strengths, weaknesses, opportunities, and threats. Organization or unit strengths and opportunities are viewed as positive or helpful, whereas weaknesses and threats are considered negative or harmful.
Additionally, strengths and weaknesses originate internally, whereas opportunities and threats originate externally. Nurse leaders and managers lead strategic planning, conduct SWOT analyses, and provide strategic direction for their department and units (American Organization of Nurse Executives [AONE], 2011). Typically, nurse leaders and managers also contribute to organizational strategic planning. An expectation of nurse leaders and managers in upper-level positions within an organization is that they will provide leadership in the development of the organizational mission, vision, and philosophy and the strategic planning process (American Nurses Association [ANA], 2016).
Further, nurse leaders and managers are ac countable for communicating, implementing, and evaluating strategic plans. Employees must have the necessary skills to participate in developing and de signing care delivery models that support the organization’s strategic visions (ANA, 2016). Nurse leaders and managers are critical to ensuring that the nursing strategic goals are in line with the organization’s goals.
Given the current state of health care and the focus on cost containment, operational efficiencies, and safety and quality mandates, some believe that strategic planning will need to shift from a traditional business approach to a more futuristic approach. Impeding this change is the reality that many health-care stakeholders continue to be entrenched in an outdated mindset that focuses on financial rewards for providing health-care services to the sick, rather than promoting health and preventing disease (Luzinski, 2014).
The enactment of the Patient Protection and Affordable Care Act of 2010 placed pressure on health-care organizations to improve their patients’ experiences, the safety and quality of care, employee culture, and financial status. This change requires a more futuristic approach to planning, such as using strategic foresight (Luzinski, 2014). Although new to health care, strategic foresight has been used for years in other industries. Strategic foresight is seeing the relevant opportunities that could emerge from the future and strategizing how to make the most of them.
Leaders must shift their focus from the current existing state of the organization to envisioning the organization 10 years into the future (Luzinski, 2014). Futures thinking and foresight are seen as prerequisite competencies for success in the dynamic health-care system (Freed & McLaughlin, 2011; Luzinski, 2014). Futures thinking entails bringing vision to the planning process, seeing the relevant opportunities that are emerging, and creating a desired future.
Nurse leaders and managers need to become self-aware of their current mental model and embrace changing to futures thinking. Four practices that “create a culture where the future can be assessed and leveraged” are collaborating, reflecting, envisioning, and strategizing (Emelo, 2011, p. 8). Collaboration is needed because foresight emerges from the interactive vision of people throughout the organization. Collaborating with people with differing perspectives helps leaders better reflect on the past, evaluate current data and trends, and thoughtfully consider possible future options.
Fore sight embraces the past and requires leaders to reflect on previous performance to identify patterns that may indicate actions for the future. Reflecting on the past allows all involved parties to envision the future. Once future opportunities are identified, leaders must strategize approaches to bring the opportunities into reality (Emelo, 2011).
Nurses have always been prepared for the future, but now nurse educators are called to help nursing students develop futures thinking. Thinking for the future will assist all nurses as well as nurse leaders and managers to “make decisions in future-oriented ways, develop increased awareness and sensitivity to multiple influences and their interactions that have bearing on the future, take responsibility to build and shape desired futures (their own futures, the profession’s future, and the future of the health care system)” (Freed & McLaughlin, 2011, p. 177).
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