Organization for health professions: Implementation

Organization for health professions: Implementation

Implementation of the organizational redesign

Implementation of the organizational redesign

Organizational redesign

Consistency with the cultural climate of the organization

Department

Blending between staff management and organization

Enhancement of professional independence

Implementation of the organizational redesign

From administration

Hierarchical and bureaucratic approach to planning and control

To management

Ability to involve professionals in planning and management processes

Independence and responsibility

The strength of the top management lies in its authority when supervising and managing the compatibilities between different Operating Units

The departmental organization

The departmental organization significantly strengthens the middle management, contributing to the integration and coordination process within the organization

The departmental organization: the Mintzberg model

Strategic apex

Technostructure

Middle line

Staff

Operating core

The Department: an organizational tool for clinical governance

Clinical governance, considered as the ability to ensure the continuous improvement of the quality of services through the creation of a context where excellence can thrive, is made of the following key elements:

Continuing education

Performance monitoring and measurement

Interdisciplinarity

Efficiency and appropriateness

Research

Risk Management

The Department: an organizational tool for clinical governance

Risk Management

Technical quality

Technical and allocative efficiency

Quality perceived

The Department: an organizational tool for clinical governance

Organizational and care complexity

The features of the organization:

1. ENVIRONMENT

2. PEOPLE

Organizational and care complexity

The features of the organization (2):

The healthcare organization and the new institutional and organizational context

The healthcare organization and the new institutional and organizational context

The healthcare organization and the new institutional and organizational context

What are the most common administrative problems in the running of a hospital?

 Little attention is paid to quality processes and results in the services provided

 Conflicts between Operating Units

 Staff burn-out

 Deresposibilization

 Litigation with users

The healthcare organization and the new institutional and organizational context

What are the main causes?

ENVIRONMENT:

 Uncertainty of the position

 High variability

PEOPLE:

 Understaffing

 Demotivation

 Errors in the selection and allocation of resources

 Lack of appropriate systems of rewards and sanctions

The healthcare organization and the new institutional and organizational context

What are the main causes? (2)

ACTIVITY:

 Lack of professional differentiation

 Fragmentation

 Lack of expertise and scientific validation

 Rigidity

COORDINATION:

 Ambiguous and poor definition of roles and responsibilities

 Centralized decision-making

 Lack of integration mechanisms

 Complex procedures

Organizational and care complexity

Organizational and care complexity

Organizational and care complexity

Organizational and care complexity

It is necessary to develop integration tools to overcome difficulties through the redefinition of professional behaviours. Such tools aim at:

Organizational and care complexity

In order to choose the tool that best suits the different situations, the following must be taken into account:

Integration tools

DEFINITION DESCRIPTION GOALS

PROCEDURE

Detailed and logical sequence of operations intended for the different operators according to their specific skills

Give precise instructions on the behavioural sequences that do not require discretionary decision-making

PROTOCOL

Predefined pattern of behaviour intended for professionals

Give validated and quite rigid behavioural instructions for specific situations and contexts, leaving little room for professional discretionary decision-making

GUIDELINES

Recommendations of behaviour aimed at supporting professionals in specific situations

Provide instructions and guidance, derived from the scientific evidences available and validated by experts, on the appropriate behaviours for situations in which the professional has significant discretionary decision-making powers

Integration tools (2)

DEFINITION DESCRIPTION GOALS

WORKING PLAN Organizational integration of an Operating Unit

Ensure the achievement of an Operational Unit, define task allocation, their coordination, and the resources needed

CARE PLAN

Planning of the care of a specific patient and documentation by the nurse

Ensure to each patient personalized, safe, effective, continuous and complete care

The systematic processes for the drafting of guidelines differ according to the specific issues and to the contexts (clinical, organizational, teaching, etc.) in which they are implemented. Nevertheless, it is possible to outline some key points for the drafting of guidelines:

Guidelines: requirements

Requirement

Validity

Reproducibility

Applicability

Flexibility

Motivation

Guidelines are valid only if they bring the benefits expected (in terms of quality of the care provided, of the beneficts expected by one or more patients after one or more specific interventions, and/or in economic terms)

Guidelines are reproducible when, starting from the same scientific evidences and using the same method, different experts come to the same conclusion.

Guidelines should be applicable to populations of patients defined according to scientific evidences and/or clinical experience, and to the resources available

Guidelines should state what clinical situations are an exception to the recommendations, and under what circumstances the patient’s preferences can or have to be taken into account

Guidelines: requirements (2)

Requirement

Clarity

Documentation

Substantiation

Recommendations

strength

Motivation

Guidelines should be written with a clear language and in a format making them easy to use in clinical practice

Guidelines should clearly state those who took part in their drafting

Guidelines should clearly state the scientific evidences they are based on, specifying:

• the method used to establish the evidences

• the quality of the evidences (the absolute number of studies available)

• the consistency of the evidences available (degree of homogeneity of the different studies available)

Guidelines should state the quality of the scientific evidences on which their recommendations are based (expert opinions or evidences/facts that are objectively proven)

Guidelines: classification of the strength of recommendations

Class Strength of the recommendation

A The recommendation formulated by the guidelines is supported by good scientific evidences

B The recommendation formulated by the guidelines is supported by fair scientific evidences

C The recommendation formulated by the guidelines is supported by poor scientific evidences, but other considerations make it equally acceptable

D Fair scientific evidences support the recommendation not to perform that intervention

E Good scientific evidences support the recommendation not to perform that intervention

Procedures: requirements

Requirement

Validity

Reproducibility

Applicability

Motivation

Aprocedure is valid when it allows to achieve a goal

Aprocedure is reproducible when, starting from the same scientific evidences and using the same method, different experts come to the same conclusion

Aprocedure is applicable when, for the situation envisaged, it indicates a series of operations that are feasible and for which materials are available

Clarity

The procedure should be written with a clear language and in a format making it easy to use in clinical practice

Procedures: requirements (2)

Requirement Motivation

Conciseness

Completeness

Aprocedure is very concise because it gives direct behavioural instructions

Aprocedure should clearly state the dates of drafting and validation by the authors

Updating Aprocedure should state the date of validity

Systematicity and continuity

Its implementation must be systematic and continuous

Specificity

Aprocedure always refers to a specific context in which it is applicable

Protocols

Protocols

Protocols: areas of implementation

Protocols: goals

Protocols: advantages

Protocols: requirements

Requirement

Validity

Reproducibility

Motivation

Aprotocol is valid only if it brings the benefits expected (in terms of quality of the care provided, and in economic terms)

Aprotocol is reproducible when, starting from the same scientific evidences and using the same method, different experts come to the same conclusion

Applicability

Inapplicable or theoretical protocols should be avoided, as well as those based on unavailable materials and resources

Clarity

Aprotocol must be written in a language leaving no room for arbitrary interpretations and making it easy to use in clinical practice

Protocols: requirements (2)

Requirement Motivation

Conciseness

Completeness

Aprotocol should not be encyclopaedic, but it must be complete

The names of the authors, the date, the methods, the scientific evidences and the study period must be stated

Sharing It must be accepted, rather than imposed

Sistematicity and continuity

Its implementation must be systematic and continuous

How to face organizational changes

How to face organizational changes

How to face organizational changes