Capella University Formal and Informal Power Structures in Healthcare ORGs Analysis

Using the case scenario provided, write a 4 page analysis of the organization’s political landscape, including formal and informal power structures at play and their impact on culture, policy, and communications.

case scenario: 

You are a new nurse executive at a community-based hospital system in the southeastern region of the United States. The system is not-for-profit and serves five rural counties. The system comprises one flagship hospital, three smaller critical access hospitals, and a number of clinics and urgent care centers. The health care system serves a diverse population of insured, Medicare, Medicaid, and uninsured patients. The hospital is Joint Commission accredited and for three years in a row has been rated as a Top 100 Hospital.

Historically, the hospital system has been physician-centric, meaning that the physician staff have had the power to influence change, policy, and protocol. The current chief executive officer (CEO) was recently hired from a large university-affiliated hospital system. The chief medical officer (CMO) started the organization’s orthopedic program (one of the most lucrative service lines) and has been with the organization for more than 25 years. He is well respected in the local community and serves on a number of community boards. In light of this strong influence from the department of medicine, nursing has struggled over the past five years. You are the second chief nursing officer (CNO) in four years. The hospital board is applying pressure to seek Magnet designation, which was recently lost due to poor leadership by your predecessor.

The hospital has recently adopted the hospitalist model to cover all in-patients. The hospitalist group was developed by physician leaders in the organization and operates as a separate department within the organization. The hospitalist group desires to become a limited liability corporation (LLC) to maximize benefit offerings but needs a larger staff to make this happen. They have presented a proposal to executive leadership to transfer all advance practice registered nurses (APRNs) working in the organization (there are more than 50) to the hospitalist group, which is housed under the department of medicine. The CMO is spearheading this initiative. Traditionally, ARPNs were hired and managed by the department of nursing.

As the new CNO, you have been approached by a group of 15 APRNs who are against the transition as it will severely impact their scope of practice, in addition to affecting their paid time off, salary, and work hours. The CMO has offered to make APRNs eligible for the annual physician hospitalist bonus structure, as an incentive. At the same time, the CMO has informally proposed that a new policy be created for APRN hospital privileges. If the APRNs choose not to join the hospitalist group, they will not be eligible for hospital privileges. In the state in which the organization is located, a supervising physician is required for APRN practice.I

Instructions

Articulate meaning relevant to the main topic, scope, and purpose of the prompt.  

Write with a specific purpose and audience in mind.

  • Adhere to scholarly and disciplinary writing standards.

Proofread your writing to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your analysis.

  • Analyze the formal and informal lines of power within the organization in the case study. 
  • Describe the informal and formal lines of power within this organization.
  • What source of power is being used by the different stakeholders? For example: authority, rewards, coercion, expertise, reputation, personal power.

Describe the effects of power structures on organizational culture, policies, and communications at all levels.

  • Incorporate organizational power dynamics as a factor in executive-level decision making. 

Based on your analysis of internal power structures and your perspective as CNO, what would be the best way to respond to the concerns of the ARPNs in this scenario, and why?

  • What support for your response can be found in the evidence-based literature?
  • What underlying assumptions might influence your decision making?
  • Assess the potential impact or influence of power on this change in organizational policy. 
  • What is the basis for your conclusions?

Identify the appropriate source of power for achieving the CNO’s primary strategic objective. 

  • For example: authority, rewards, coercion, expertise, reputation, personal power.
  • What evidence do you have to support your conclusion  

Expert Solution Preview

Introduction:

This analysis will focus on the political landscape of a community-based hospital system in the southeastern region of the United States, including formal and informal power structures at play and their impact on culture, policy, and communications. Based on the provided case scenario, this analysis will address four specific questions related to power dynamics within the organization, the impact of these power structures on organizational culture, policies, and communications, the appropriate response to the concerns of the ARPNs, and the identification of the appropriate source of power for the CNO’s primary strategic objective.

Question 1: Analyze the formal and informal lines of power within the organization in the case study.

The case scenario indicates that historically, the hospital system has been physician-centric, which suggests that physicians hold significant formal power within the organization. The CMO, who has been with the organization for 25 years and is well respected in the local community, also appears to hold significant formal power, particularly with regard to the orthopedic program. The CEO, who was recently hired, likely holds formal power as well, although this may be in the process of shifting, given the mention of pressure from the hospital board to seek Magnet designation. Additionally, the hospitalist group, which operates as a separate department within the organization, appears to hold significant formal power, given the proposal to transfer all APRNs to this group.

Informal lines of power are also evident in the case scenario. The CMO’s status as a long-time employee and community leader likely gives him significant informal power, especially with regard to the physician staff. The hospitalist group’s desire to become an LLC also suggests that they may have significant informal power, particularly given their proposed plan to transfer APRNs from the nursing department to the hospitalist group.

Question 2: Describe the effects of power structures on organizational culture, policies, and communications at all levels.

The physician-centric power structure and the influence of the CMO on the orthopedic program may have contributed to the struggles of the nursing department over the past five years. The turnover of two CNOs in four years is indicative of potential clashes between nursing and physician leadership, as well as the challenges of establishing a strong nursing presence and culture in a physician-centric environment. The hospitalist group’s proposal to transfer APRNs from the nursing department to their own department is likely to have a significant impact on the culture, policies, and communications within the organization, particularly given the potential loss of hospital privileges if APRNs choose not to join the hospitalist group. The use of incentives for APRNs to join the hospitalist group may also significantly impact the culture and dynamics of the nursing department.

Question 3: Based on your analysis of internal power structures and your perspective as CNO, what would be the best way to respond to the concerns of the ARPNs in this scenario, and why?

As a CNO, the best way to respond to the concerns of the ARPNs would be to engage in open and transparent communication with them, as well as with the physician and hospitalist groups involved. This would involve understanding the concerns of the APRNs and advocating for their needs and interests, while also seeking to understand the motivations and objectives of the physician and hospitalist groups. The use of collaborative decision-making processes, such as shared governance, may also be useful in promoting a more egalitarian power structure and reducing potential conflicts between different departments and stakeholders.

Evidence-based literature supports the use of collaborative decision-making processes in healthcare organizations, as these processes can foster greater engagement and commitment from employees, as well as improved organizational performance (Salomonsen-Sautel et al., 2010). In addition, evidence suggests that leadership styles that prioritize open communication and collaboration can lead to greater employee satisfaction and improve organizational outcomes (Cummings et al., 2010).

Assumptions that may influence decision-making in this scenario include the importance of advocating for the needs and interests of nursing staff, the potential risks and benefits associated with transferring APRNs to the hospitalist group, and the potential impact on the nursing culture and power structure within the organization.

Question 4: Identify the appropriate source of power for achieving the CNO’s primary strategic objective.

The appropriate source of power for achieving the CNO’s primary strategic objective would depend on the nature of the objective. For example, if the objective is to improve collaboration and communication between different departments and stakeholders within the organization, a power source based on personal power or expertise may be most effective. If the objective is to influence policy decisions related to nursing staff or APRNs specifically, then authority or reputation may be more appropriate. Ultimately, the most effective approach may be to utilize a variety of power sources, depending on the specifics of the objective and the context in which it is being pursued.

Evidence to support the use of different power sources in healthcare organizations is somewhat limited, as much research in this area has focused on issues related to power and politics rather than specific power sources per se. However, some studies have suggested that effective healthcare leaders must be able to draw on a variety of power sources, including personal power, authority, and expertise, in order to effectively influence change and promote positive outcomes (Denis et al., 2012).

In conclusion, an analysis of the political landscape of the community-based hospital system in the case scenario highlights the importance of considering both formal and informal lines of power, as well as their impact on organizational culture, policies, and communications. The development of collaborative decision-making processes and a leadership style that emphasizes open communication and engagement may be useful in promoting a more egalitarian power structure and reducing potential conflicts between different stakeholders.  When identifying the most appropriate sources of power, it would be wise to make decisions based on specific objectives and the context in which it is being pursued.

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