Discuss about rituals and routines, olrganisational structure.
The collaborative working in the healthcare system is a multidimensional phenomenon that involves professional attitude, communication, team spirit and systematic service delivery, to positively enhance health service and patient care (Hall, 2005). According to Henderson et al. (2012) studies the ‘Cultural Web Model’ is a functional model to understand the organisation culture to tranquil its complexity. Speroff et al. (2010) further stated that this model explains organisation culture by revealing details on six elements of the organisation working that are stories, symbols, power structures, organisational structure, control systems, routine, and rituals.
As a Registered Nurse (RN) working in Surgical Ward of Hospital, the study is my personal evaluation of my organisation culture. This study focuses on two elements of Cultural web model that are Rituals and Routines & Organisational structure in done to perform an analysis as per cultural web model.
Levy (2009) indicated that routines are the ways in which members of organisation function in a collaborative manner, as well as rituals, help to determine the functionality process. Further, Hall (2005) supported by mentioning that the rituals structure the routines where to emphasise of working depend on rituals. One of the most important elements that link all the rituals and routines together in clinical practice is ward rounds.
Stanley (2010) studied that routine of daily ward rounds is a regular practice in the organisation performed by specific authorities to check the overall functioning in different wards of the hospital. The ward round occurs twice a day before the morning and evening shifts at the hospital. Further, Alahmadi (2010) mentioned about another routine process linked with ward rounds is to maintain the ‘shift functioning report’ that involves every detail of one particular shift. This change of shift transfers the responsibility from one nurse to another serving as a dome of socialization in collaborative nursing practice. The routine of ward round shift report is also considered as an occupational ritual in nursing practice (Koubel and Bungay, 2008).
In my organisation, ward round is a critical aspect of patient care starting from patient admission to transfer and discharge. Tyler and Parker (2010) stated that registered nurses play an important role in ward round routine. The main purpose of ward round process is to ensure proper admission of patients, attendance and care services, transfers, and discharge of the patient. This ward round is an essential element of organisation process as well as a connecting link between the patient and the hospital. The absence of ward round can give birth to unplanned practices, and improper care delivery (Goodman and Clemow, 2010).
In my organisation, the frequency of ward round varies according to admission volume and patient acuity within one area. If the emergency and service requirement is high this gives rise to the increase in ward round process. The ward round is considered as an individual patient review in my organisation. Koren (2010) stated that to overcome patient turnover in healthcare, ward round practice on the daily basis along with an individual review of the patient would fulfill the patient care delivery as well as business requirements.
According to the research of Cummings et al. (2010) ward round is a multidisciplinary process that requires a collaborative activity by all the members of the healthcare system. The three stages of ward rounds in my organisation involve antecedents, critical attributes, and consequences. In antecedent stage, patient review occurs followed by a critical stage that involves analysing the unstable outcomes of the investigation. Further, the last stage of consequences involves communication, motivation and organisation of team to overcome the errors. This is the overall ward round process followed in my organisation to deliver effective patient care (Macintosh et al. 2006).
This section demonstrates another important element of Cultural Web Model that is Hierarchy of Hospital structure. Hierarchy represents the complete internal structure of the organisation involving Directors, Executives, Department administrators, Care managers and service providers, that work in collective as well as connective manner to provide effective care services (Goodman and Clemow, 2010). Maon et al. (2010) indicated that hierarchy of organisation structure represents the level and position of different employs in the organisation where each level is ranked below the other. Shirey et al. (2010) studied that the organisations structure of Hospital starts with the CEO and director who is the one-person authority that deals with all the decision-making processes of the hospital. The hospital works by leadership applied by the CEO. This is the top-level position in my organisation as well.
According to Maon et al. (2010), Executive Officers or Supervisors perform decision-making for their individual allotted field of work as per Director’s instructions. Even these officers confirm that director decisions are carried out in regular functioning processes. First line managers or ward managers that are including in overall staff structure follow the instructions of their department supervisor. Different departments perform different functions, and these managers manage the working of the hospital. However, the decision-making power remains to the executives of particular departments (Littlechild and Smith, 2012). The supervisors followed by first line managers are working administration in my organisation that holds the power to instruct the service providing authorities in the hospital.
Lastly, Stanley (2010) mentioned in the study that after managers of each department, there are overall staff members who belong to the similar level of functionality in hospital structure. These service providers or staffs involve quality staff, finance staff, nursing staff and other labor workers. Each department staff is allocated with specific functions to perform that contribute to an overall working process of the organisation. The quality staffs assure patient safety, feedback, evaluation, medical review and accreditation. The finance staffs deal with maintaining records, medical records, revenue, reimbursements, assessment services etc. lastly, the nursing staff performs the overall nursing and care of the patients as well as maintains the care processes (Levy, 2009).
Koren (2010) supported by indicating that half of the hospital is composed of these service providers that perform in a collaborative manner with higher authorities to offer patient-centric care services in the hospital. This care service involves medications, therapeutic processes, nursing interventions, patient care, patient safety, food, laundry, cleaning and other hands-off functions in the hospital ensuring a safe and healthy functionality. Alahmadi (2010) studied about the service providers that are the Doctors, Nurses, clinicians, consultants and workers that form the functioning body of the hospital by delivering care to patients. All the service providers have to follow instructions of their working area managers in the Hospital. Further, Stafford (2010) stated that the hierarchy of service providers are divided into different sections where the doctors instruct nurses, nurses instruct junior nurses and workers follow the guidelines of nurses for their working in healthcare scenario. This is the overall organisation hierarchy of my Hospital (Littlechild and Smith, 2012).
The above analysis on the two most important cultural web components provides a clear outlook on the routine and rituals as well as the organisation structures of my workplace. The ward rounds followed in organisation implements a effective care process, which is performed in a collaborative manner by all the stakeholders described in the organisation structure. As per Hierarchy structure of the Hospital, the organisation follows traditional hierarchy where a particular authority performs a specific function that indicates an organised form of functionality. This study helps to understand the base of overall collaborative functioning in my workplace.
References
Books
Goodman, B & Clemow, R. 2010. Nursing & Collaborative Practice. (2nd ed). Learning Matters, UK.
Koubel G, & Bungay H. 2008. The Challenge of Person-centred Care: An Interprofessional Perspective, Palgrave Macmillan, London.
Littlechild, B & Smith, R. 2012. A Handbook for Interprofessional Practice in the Human Services. Routledge, London.
Macintosh, R., Maclean, D., Stacey, R., & Griffin, D. 2006. Complexity & Organisation. Readings & Conversations. Routledge, London.
Journals
Alahmadi, H.A., 2010. ‘Assessment of patient safety culture in Saudi Arabian hospitals’. Quality & Safety in Health Care, vol. 19, no. 5, pp.1-5.
Cummings, G.G., MacGregor, T., Davey, M., Wong, C.A., Lo, E., Muise, M. & Stafford, E., 2010. ‘Leadership styles and outcome patterns for the nursing workforce & work environment: a systematic review’. International journal of nursing studies, vol. 47, no.3, pp.363-385.
Hall, P. 2005. ‘Interprofessional teamwork: professional cultures as barriers’. Journal of Interprofessional Care, vol. 19, no. 5, pp.188-196.
Henderson, A., Creedy, D., Boorman, R., Cooke, M. & Walker, R., 2010. ‘Development and psychometric testing of the clinical learning organisational culture survey (CLOCS)’. Nurse Education Today, vol. 30, no. 7, pp.598-602.
Koren, M.J., 2010. ‘Person-centred care for nursing home residents: The culture-change movement’. Health Affairs, vol. 29, no.2, pp.312-317.
Levy, D. 2009. ‘Gay and Lesbian Identity Development: An Overview for Social Workers’. Journal of Human Behavior in the Social Environment, vol.19, no.8, 978 – 993.
Maon, F., Lindgreen, A. & Swaen, V., 2010. ‘Organizational stages and cultural phases: A critical review & a consolidative model of corporate social responsibility development’. International Journal of Management Reviews, vol.12, no.1, pp.20-38.
Shirey, M.R., McDaniel, A.M., Ebright, P.R., Fisher, M.L. & Doebbeling, B.N., 2010. ‘Understanding nurse manager stress & work complexity: factors that make a difference’. Journal of Nursing Administration, vol.40, no.2, pp.82-91.
Speroff, T., Nwosu, S., Greevy, R., Weinger, M.B., Talbot, T.R., Wall, R.J., Deshpande, J.K., France, D.J., Ely, E.W., Burgess, H. & Englebright, J., 2010. ‘Organisational culture: variation across hospitals & connection to patient safety climate’. Quality & Safety in Health Care, vol.19, no.6, pp.592-596.
Stanley, D., 2010. ‘Multigenerational workforce issues & their implications for leadership in nursing’. Journal of Nursing Management, vol. 18, no.7, pp.846-852.
Tyler, D.A. & Parker, V.A., 2010. ‘Nursing home culture, teamwork, & culture change’. Journal of research in Nursing, vol. 10, no.1, pp.23-25.
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