Decentralization and

Shared Governance

Objectives:
1. Define and differentiate
Centralization and Decentralization.
Centralization
The extent to which power and
authority for decision making
rests in top levels of the
organization.

Decentralizatio
n
The extent to which power and
authority for decision making
are systematically dispersed to
middle and lower levels of the
organizations.

Organizational philosophies about power

distribution based on the hierarchal level
of decision making authority

In a narrow span of management the number of people

reporting to a manager is comparatively low. The opposite of
narrow span of management is a wide span of management, in
which number of people reporting to a manager is
comparatively high.

Objectives:

-Operating philosophy and decision

making authority.
Centralizatio
Decentraliza
n
tion
Rigid control over decision
making and power in the
institution.
*Top down style
It results in a narrower
span of control and more
levels of management.
Executive leaders retain
decision making authority.
* Central nursing office

The decision making

authority rest in levels
closer in the point of
service/care rather than
executive levels
Governi Span of control is larger
ng
for each manager.
Philosop
hy
Subordinates are
empowered to make
decision.
-Unit based plan

Centralizati Decentralizati
on
on
Advantages

Chief Nursing Officer

( CNO) involve into day
to day activity,
Focused Vision
Fast Execution
Reduced Conflict
Control and
Accountability

Encourage and facilitate

innovation

Disadvantages

Individual consideration
are minimized

Limited functional
supervision, to complete
quality monitoring and to
carry out specific unit
responsibilities, ( asst.
manager)

Rigid approval
mechanism

Nurse manager has more

responsibilities that was
previously handled by both
upper level admin and

2.Shared

Governance

Management strategy to transform

the role of nurses from one that was
devalued and subservient to
meaningful and autonomous
It is described as an accountabilitybased model.
Nurses actively engaged in decision
making about:
Nursing practice
Quality of patient care
Education nursing peer issues

2.Shared

Governance

In terms of nurse decision making it

promotes:
Involvement
Investment
Participation
Sharing of power EMPOWERMENT
Interdependence
Cooperation
Horizontal relationships
Autonomy and
Accountability

2.Shared

Governance
Shared governance
journey begins
levance
to Nursing
Pract
with EDUCATION.

It must be continually available

Clinical staff are empowered as

knowledge workers and decision
makers.
Nurse managers fosters the
development of leaderships
behaviors in staff nurses

2.Shared

Governance
Research suggest
that hospitalsPract
with
levance
to Nursing
shared governance have improved
nurse retention and improved patient
outcomes.
Obstacles:
varied levels of skills and knowledge of
nurses
Lack of nurse experience and education
about collaboration, handling meetings,
decision making, and conflict resolution
Traditional autocratic nurse leaders and

Models of Nursing Care

Delivery

Objectives:
1. Define professional practice nursing
care delivery models.

The conceptual framework and

philosophy under which the
method of delivery of nursing care
is a component.

Objectives:
5 subsystem of professional
nursing practice models:

Professional values
Professional relationship
A care delivery model
Management or governance
Professional recognition or
awards

Definitions:
Box. 20.2
Elements of nursing care delivery
pg. 443

MODELS OF CARE OF DELIVERY

The operational mechanisms by
which care is actually provided to
patients and families.
The basic elements are:
- nurse patient relationship
- clinical decision making
- work allocation

Definitions:
..Cont.
MODELS OF CARE OF DELIVERY
The basic elements are:
- patient assignments
- inter disciplinary communication
- leadership/ management of
working environment
*Coordination is a critical component

Definitions:
Direct and Indirect patient care
functions
Box. 20.3
Pg. 443

2.Traditional Nursing Care Models

Nursing
Care
Models
Private duty
Nursing
Group
Nursing

Total patient
care
Functional
nursing

Description Advantage

One nurse to
one client
Private duty
nurses in
group
practice
One-shift
responsibilit
y for a client
Assignment
by function

Disadvanta
ge

2.Traditional Nursing Care Models

Nursing
Care
Models
Team
nursing

Primary
nursing

Description Advantage

Care to a
group of
client by a
mixed-staff
team
24 hour
accountabilit
y by a nurse
for a specific
clients from
hospital
admission

Disadvanta
ge

2.Traditional Nursing Care Models

Nursi
ng
Care
Model
s
Case
manag
ement

Description

A collaborative
process of
assessment,
planning,
facilitation and
advocacy for
options and
services to meet
an individuals
health needs

Advantage

Disadvanta
ge

Quality Improvement
and
Health Care Safety

RUSTAQ NURSING INSTITUTE

Summer 2014
Class Session no. 21

Objectives:
1. Define common terminologies
related to quality improvement
and health care safety
TB, pg. 524-526

Definition
1. Quality

Matching

Description

A. Health services to
improved health
outcomes
2. Patient safety practice B. A process to reduce
adverse event from
condition or procedure in
health care setting
3. Health care quality
C. Measuring and remeasuring of problem,
intervention and
implementation
4. Continues quality
D. Pursuit of excellence
improvement ( CQI)

Objectives:
2. Describe the 3 standards of quality.
Structure

Process

Outcomes

Focus on internal
characteristics of
the organization
and its personnel

Focus on whether
activities within
an organization
are being
conducted
appropriately,
effectively and
efficiently

Whether the
service provided
by the
organization
make any
difference?

Human,
organizational,
physical
resources and

work flow

were they
effective

Objectives:
3. Discuss the health care risk
management.
Risk management An
interdisciplinary process designed to
protect the financial assets of an
organization and to maintain high
quality medical care.
Risk management program An
organization-wide program to identify
risk, control occurrence, prevent

Objectives:
Functions of risk managers.
Risk manager needs to responds on
adverse or sentinel situation to :
- Assess/ Investigate situation
- Gather evidence
TB, pg. 557
- Communicate
- Evaluation/ Recommendation

Incident Reporting

Incident Reporting
Definition: Core of organizational
reporting from a risk
management
perspective.
Purpose: - To provide factual account of
an incident.
- Provide the risk manager the
opportunity to
investigate the
situation.
- It allow to study emerging risk
potential, adverse outcome or near
miss incidents

Incident Reporting
Definition: Core of organizational
reporting from a risk
management
perspective.
Purpose: - To provide factual account of
an incident.
- Provide the risk manager the
opportunity to
investigate the
situation.
- It allow to study emerging risk
potential, adverse outcome or near
miss incidents

Incident Reporting
Goal:
100% reporting of incidents/
adverse outcomes
to the risk
manager Overcoming barriers to
reporting
Challenge: Fear of blame
Incoherent indifference
Lack of supervisor support

Strategy:

NON-PUNITIVE
CULTURE
for reporting errors

Performance Appraisal

OBJECTIVES:
1. Define performance appraisal
and related terminologies.
Peer review
Self- evaluation

ERFORMANCE APPRAISA
Conventional performance
appraisal
a systematic, standardized
evaluation of an employee by the
supervisor, aimed at judging the
perceived value of the employees
work contribution, quality of work, and
potential for advancement.

ERFORMANCE APPRAISA
Peer review
the examination and evaluation of
practice by a nurses' associates.
Self-evaluation
self assessment of an employees
performance as compared with stated
objectives and expectations.

OBJECTIVES:
2. Describe the performance
appraisal process

.PROCESS
It includes:
Assessing needs and setting goals
Establishing objectives and time
frames
Assessing progress and evaluating
performance
And repeat process
It starts from hiring point to end of
employment.

.PROCESS
Performance appraisal process
A.Informal
- Day by day supervision
- Coaching\refine small parts of
performance

B. Formal

Box 33.1
Pg. 717

- Written documentation
- Formal interview with follow-up

Evaluatio
n

OBJECTIVES:
3. Specify the goals of
performance appraisal

OF PERFORMANCE APPR
IMPROVEMENT OF PERFORMANCE.
- It can offer opportunity for
numerous organization goals to be
achieved.
Box. 33.3
pg. 719

OBJECTIVES:
4. Identify the 4 common sources
of errors in performance
appraisal:
1.
2.
3.
4.

Recent behavior bias

Horn effect
Halo effect
Similar-to-me effect

ORMANCE APPRAISAL CRI

Set of expectations regarding job
criteria and performance as soon
as the nurse begins

employment

OBJECTIVES:
5. Discuss the alternative types of
performance appraisal

RNATIVE TYPES OF APPRA

360- degree evaluation
Peer
* Management
Position
A physician
Subordinate
Self evaluation
then evaluating manager add final
input and merge the feedback to
develop final score.

RNATIVE TYPES OF APPRA

Peer review- for staff position
Management by objectivesdefining goals and objectives for
the following year