Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
Chapter 4: Organizational Structure for Effective Care Delivery
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Compare and contrast the key organizational theories.
Suggestions and Strategies for Classroom Experience
• Using large paper and colored felt tip pens, divide the class into teams (3–4), and
ask each to make a drawing that would describe one of the theories. (Make sure
Suggestions and Strategies for Clinical Experience
• Ask students in clinical conference how they would apply the four key players in
the healthcare system as they see it in their clinical experience.
LEARNING OUTCOME 2
Distinguish between structure and process.
Suggestions and Strategies for Classroom Experience
• Review examples of organizational charts with students, and discuss the key
Suggestions and Strategies for Clinical Experience
• Ask students to review the organizational chart from their clinical site. How do
they see it implemented on the unit they are assigned to for clinical? How do they
view the elements of process operationalized on the unit?
LEARNING OUTCOME 3
Explain the key differences between for-profit and not-for-profit healthcare
organizations.
Suggestions and Strategies for Classroom Experience
• Ask students to identify examples of marketing that have been used by local
healthcare organizations, and bring examples to class for discussion. Which of the
four P’s are used in the advertising (radio, print, television, signage, other)?
• If there are for-profit healthcare organizations in the local community, do students
recognize any differences in marketing when compared with not-for-profit
healthcare organizations in the community? If so, what are they?
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Suggestions and Strategies for Clinical Experience
• What level(s) of care are the healthcare organizations in which students are
LEARNING OUTCOME 4
Examine the use of marketing in healthcare delivery.
Suggestions and Strategies for Classroom Experience
• Ask students their reaction to marketing in general, and then as applied to
Suggestions and Strategies for Clinical Experience
• Ask students to find out more about how the healthcare organization in which
they are assigned for clinical experience uses marketing, and to critique the effort.
LEARNING OUTCOME 5
Compare the key healthcare providers and their services.
Suggestions and Strategies for Classroom Experience
• Lead a discussion with students on the pros and cons of having so many different
healthcare providers.
Suggestions and Strategies for Clinical Experience
• Students should identify all healthcare providers who interact with their assigned
LEARNING OUTCOME 6
Apply the process for analyzing an organization.
Suggestions and Strategies for Classroom Experience
• Discuss why it is important for organizations to analyze themselves and what they
Suggestions and Strategies for Clinical Experience
• Ask students to take one of the aspects of analyzing an organization and describe
briefly what it is and how they would apply it to a clinical setting in which they
have had experience.
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LEARNING OUTCOME 7
Compare and contrast the different nursing care models discussed in this chapter.
Suggestions and Strategies for Classroom Experience
• Assign students to teams, and ask them to take one of the nursing care models and
identify the pros and cons to the model, how the model might be used where they
Suggestions and Strategies for Clinical Experience
• During post-conference, ask students to discuss how one of the models of care
might be applied to their assigned patient(s).
• What model of care is used in clinical site? Ask students to discuss in clinical
conference and consider how the model is applied, the differences from the view
LEARNING OUTCOME 8
Explain the key advantages of shared governance for nursing staff.
Suggestions and Strategies for Classroom Experience
• Ask students how the key advantages of shared governance apply to their clinical
experiences.
Suggestions and Strategies for Clinical Experience
• If any of the clinical sites where students are assigned uses shared governance,
students can explore how the staff view shared governance, how it is applied, and
how students view shared governance within the organization. How does shared
governance affect patients and patient care?
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KEY CHAPTER CONCEPTS
1. Classical theory has affected the development of other theories. It emphasizes several
2. Bureaucratic organizations incorporate the classical theory principles, and have more
3. Systems theory views organizations as one entity with multiple elements, and can be
4. HCO systems can be viewed from the microsystem, mesosystem, and macrosystem
views.
6. Organizations typically are described by two methods, one of which is structure. An
organization’s structure usually is best described in its organizational chart, which
7. Process is the second method used to describe organizations, which describes how the
8. Healthcare organizations can provide one, two, or all of the three levels of care
(primary, secondary, and tertiary).
9. The three major purposes of healthcare organizations are; (1) health promotion and
10. Healthcare organizations are either for-profit or not-for-profit. For-profit
11. Marketing is an important function in any healthcare organization, regardless of
13. There are many healthcare providers within the complex healthcare delivery system.
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15. Organizations can be analyzed to describe the organizationand identify their strengths
and limitations. To accomplish this, the following would be analyzed: integration of
16. Models of care are developed to support or enhance professional practice, describing
17. AONE assumptions for the future of healthcare delivery need to be reviewed.
18. The five IOM health professions core competencies are currently important in
healthcare and could be used to develop new models of care.
19. Examples of older nursing models of care include total patient care/case method,
20. Newer nursing models include interprofessional practice, synergy, primary care team,
21. The total patient care/case method is the oldest method. A nurse cares for a patient the
22. Functional nursing is a task-oriented approach, focusing on specific jobs. The risks
23. Team nursing replaced functional nursing to respond to a nursing shortage. The team
24. Primary nursing focused on the role of the RN as the primary nurse who provided
direct care for a group of patients and plans their 24-hour care. Second generation
25. Care and service team focused on empowered staff, interprofessional collaboration,
26. Complementary models used a unit assistant to take care of environmental issues so
27. Case management arose as a nursing approach when the integrated delivery system
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28. Interprofessional practice occurs when team members function independently but
collaborate with team members. Advantages to this model include decreased
30. Patient navigation focused on decreasing barriers to patient care for cancer patients
that were at risk for poor outcomes.
32. Shared governance emphasizes that accountability and responsibility should occur
together in the same person. Key advantages are; (1) control over professional practice,
(2) influence over organizational resource allocation, (3) formal authority, (4) committee
33. Collaboration is a critical element of shared governance, and there is greater
decentralized decision making. The key components of shared governance are practice,
quality, education, and peer process/governance.
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand the how these nursing
education standards apply to the chapter content and the nursing profession.
My Hospital Unit: An Evolving Case Experience
See the overview of the My Hospital Unit feature found in the front of the textbook.
Refer students to the specific My Hospital Unit scenario found in the chapter.
This chapter feature can be used in a variety of ways within a course. Students can be
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to
identify which of the AONE competencies apply to the content in the chapter.
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online
options are noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may
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ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
The Chief Nursing Officer for a children’s hospital has been asked by hospital
Questions:
1. Why would it be important to market nursing services?
2. How should the plan be designed?
3. Identify four specific marketing strategies that might be used, and add rationales for
their use.
4. How might the plan be evaluated?
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