Organizational Analysis

After reviewing the keynote and studying the readings, you should now be ready to proceed with your assignment. In this assignment, you will conduct an organizational analysis based on what you have learned from the readings in this unit. Using Collins’ work as a model and framework for advanced organizational analysis (and other references as needed), analyze a system, organization, and/or subsystems. Consider each of the concepts proposed by Collins’ breaking down the organizations’ strategic plan, financial management and systems, organizational structure, leadership, organizational culture, performance outcomes, etc. Collins’ research is good and provides a framework based on science rather than opinion or anecdotal observations. Consider the writings of Senge (1990) found in the Fifth Discipline and other related writers and models when performing an organizational analysis.

As part of this analysis, consider interviewing members of the staff, board members, organizational historians, key administrative personnel (CFO, CEO, CNE, etc.). Review what is written about the organization and its system in the local paper, regional documents, trade journals, etc. These qualitative methods, along with review of clinical, financial and other evaluation measures (quantitative measures), will provide a more holistic perspective of an organizational systems’ performance.

If you choose to perform the analysis of the practice setting in which you intend to do a capstone project, this assignment could provide you with much foundational work for your practice change. “Immerse” yourself into your organizational system, getting to know the inner workings, how decisions are made, informal and formal networks, how change and innovation are perceived, and other organizational system dynamics.

GUIDELINES FOR ORGANIZATIONAL ANALYSIS ASSIGNMENT
Using Collins’ work as a model and framework for advanced organizational analysis (and other references as needed), analyze a system, organization, organization systems and/or subsystems.
Consider each of the concepts proposed by Collins’ breaking down the organizations’ strategic plan, financial management, organizational structure, leadership, organizational culture, performance outcomes, etc. Collins’ work is a good foundational text, along with Fifth Discipline (Senge, 1990) and other related writers and models.
When analyzing an organizational system, along with Collins’ work, consider chaos theory and complexity science (Wheatley, Porter-O-Grady), learning organizations (Senge), change and innovation (Gladwell, Rogers, Quinn). If you have not found these references in the required or recommended course readings, google the names of these authors and learn more about their contributions to understanding organizational behavior and leading complex systems. Such references may be useful in arriving at a greater level of understanding of organizations necessary to truly transform our current health care systems. As part of this analysis, consider interviewing members of the staff, board members, organizational historians, key administrative personnel (CFO, CEO, CNE, etc.). If you are not familiar with the organization/system, it will be essential that you talk to members of the organization who can help you develop a rich understanding of the leadership, culture, and decision-making patterns. Consider what is written about the organization and its system in the local paper, regional documents, trade journals, etc. These qualitative methods, along with review of clinical, financial and other evaluation measures (quantitative measures), will provide a more holistic perspective of an organizational systems’ performance.
The paper should be carefully written in a formal style, based on primary sources, provide an integration of ideas, and be 4-6 pages in length, excluding title page & reference list. Organized flow, logical progression of ideas, and clarity in thought are essential. Please use headings to separate content.

Grading Rubric Criteria Points
Introduction paragraph (one paragraph). There must be a thesis statement at the end of the paragraph that tells the reader the purpose of paper and what will be discussed.
/1
Establishes healthcare organizations in the 21st century as complex adaptive systems (Wheatley, Plesk & Greenhalgh, Deming) and discusses the challenges of transformation of complex systems.
/2
Identify an organization, system or subsystem within a larger system. You may want to use the system in which you have been working or one where you anticipate working.
Give an overall description to include such aspects of the mission, philosophy, values, overall goals, structure, resources, etc.). Discuss whether your organization’s mission and values are alive and well?
/3
Describe the organization’s culture using Schein’s definition of culture (assumptions of group members learning to cope with internal and external pressures and consequently explaining behaviors and feelings within the organization. Reflect on the organization’s norms, traditions, sacred cows. Describe the organization’s climate (dynamic, supportive,
innovative, bold, stagnant, caring, etc.) and employees’ attitudes, fears, and behavior (engagement, commitment, resistance to change, etc.).

Describe the organization’s culture for learning (Senge, Deming). Support discussion with examples.
Discuss the predominant leadership style (central vs. hierarchal, autocratic vs. participative, transformative, etc.) for the organization (Porter-O’Grady). Support your leadership assessment with examples.
/2
Based on Collins’ research findings and conclusions, describe the organization, agency, system, etc. and note the “level of greatness” (Collins). Is there is a “low level” of greatness? What in particular can you identify as lacking? If there is a “high level”? What examples or evidence can you describe to validate this determination of the “greatness level”?
/4
What evidence exists regarding the system’s readiness for change? What are the next steps to ready the organization for change? How can you personally and in the role of a DNP enhance or sustain readiness? Using this system’s analysis, how will you apply this information to a future improvement plan?
/4
Conclusions: Summarize the essential points of paper (one paragraph). /1
Total /20
Deductions:
Papers over the page limit will be penalized by a disregard of content over the page limit.

REQUIRED READINGS:

Thomas, P. (2014). Evaluating organizational frameworks for systems change. In Hall, & Roussel (Eds), Evidenced-based practice: An integrative approach to research, administration, and practice (pp149-170). Burlington, MA: Jones and Bartlett.

Roussel. L. (2014). The nature of the evidence: Microsystems, macrosystems, and mesosystems. In Hall, & Roussel (Eds), Evidenced-based practice: An integrative approach to research, administration, and practice (pp172-184). Burlington, MA: Jones and Bartlett.

Engebretson, J. C., & Hickey, J. V. (2015). Complexity science and complex adaptive systems. In Butts & Rich (Eds), Philosophies and Theories for advanced practice nursing (pp 111-135). Burlington, MA: Jones and Bartlett.

Collins, J. C. (2001). Good to great. New York, NY: HarperCollins Publishers.
The recommended readings are strongly encouraged to broaden your understanding of key concepts relative to organizational science and change theory. The readings have been subdivided into the following categories to help you locate content appropriate to the topics:

Complexity Science
Organizational Culture
Learning Organizations
Change Theory
These readings provide knowledge essential for performing an organizational analysis (the assignment for this unit). You will be expected to integrate important ideas and evidence from this material into your unit assignment.
Keynote

Healthcare in the 21st century is complex; thus, the theory of complexity science is applicable to this new age. The mechanistic mind-set of the industrial years, still in place in many organizations today, is no longer an appropriate thinking for addressing contemporary problems. Complexity science recognizes the many self-adapting mini-systems within each larger system. Nelson, Batalden, and Nelson (2007) describe healthcare systems as consisting of microsystems, mesosystems, and macrosystems. I suggest you do a little reading for yourself to see how the smaller systems fit into the larger and how each system influences the behavior of the others. Because system pieces are dynamic and constantly adapting, outcomes are unpredictable. Most of us, growing up in an industrialized society, are probably more comfortable with linear thinking (where cause and effect provides explanation and predictability); however, the reality is life is “messy”. Plesk and Greenhalgh (2001) state that unpredictability and paradox is inherent in complex systems; consequently, some things are simply unknowable. However, the unknown should not serve as a deterrent to understanding and improvement efforts. We are not victims of systems, we are co-creators.

References:

Nelson, E.C., Batalden, P.B., & Godfrey, M.M. (2007). Quality by design: A clinical microsystems
approach. San Francisco, CA: Josey-Bass.

Plsek, P.E., & Greehalgh, T. (2001). Complexity Science: The challenge of complexity in healthcare. British
Medical Journal 323, 625-628.
Edward Deming suggests four key elements give rise to profound knowledge necessary for improving a system: (a) appreciation of the system, (b) theory of knowledge (in other words, how do we know what we know), (c) knowledge of variation and (d) human behavior. A new lens search for profound knowledge is required for improving our nation’s health care. So what does this profound knowledge stuff really mean?
Take a moment to watch this short video clip applying Deming’s System of Profound Knowledge

As noted in the video, transforming healthcare requires profound understanding of the variables that influence change. Understanding the complexity in practice and processes and leading based on this knowledge is a hallmark of nurses with advanced nursing practice degrees. Now click on next and let’s take a closer look at organizational cultures.
High Reliability Organizations

High reliability organizations (HRO) are safety oriented focusing on system improvement rather than individual improvement. Processes are dependable, meaning one sees the same outcomes with limited variability. An example of minimal variability would be when patients’ wait times are 10 minutes on the average with a range between 5-15 minutes. So let’s take a quick look at what a HRO looks like.
High Reliability Organizations
High reliability organizations (HRO) are safety oriented focusing on system improvement rather than individual improvement. Processes are dependable, meaning one sees the same outcomes with limited variability. An example of minimal variability would be when patients’ wait times are 10 minutes on the average with a range between 5-15 minutes. So let’s take a quick look at what a HRO looks like.

High Reliability Organizations (HRO) are learning organizations as the leadership is these organizations is willing to take risks and is open to learning from mistakes. Senge (1990) describe learning organizations as “organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together “( p.3). Employee reporting of near misses and medical errors is typically higher in a learning organization, as learning organizations place focus for errors on systems and human error more than on individual blame. A learning organization investigates processes to find opportunities for improvement and looks for ways to put safeguards (i.e. barcoding, time outs, checklists) in place to prevent future errors. The author likens the learning disciplines to leadership disciplines. Those who excel in these areas are the natural leaders of learning organizations.

References:

Kurpuis, D. (Fall, 1993). The Fifth Discipline: The Art and Practice of the Learning Organization (Book
Review). Consulting Psychology Journal, 31-32.
Senge, P. M. (1990). The fifth discipline . New York, NY: Currency Doubleday.

Systems’ thinking has the distinction of being the “fifth discipline” since it serves to make the results of the other disciplines work together for business benefit. Read more about Senge’s theory of learning organizations
Good to Great – By Jim Collins

Collins (2001) in his book Good to Great, and subsequent book (2011) Good by Choice, describe his extensive research of variables and factors occurring in companies that distinguish great companies that have made substantial leaps in performance and sustained excellence in their businesses, management strategies, and practices. Using a methodical approach to selecting the companies, interviewing CEOs, reviewing financial data, studying systems, Collins and his research team analyzed extensive amounts of data. From chaos (extensive data analysis) to concept, Collins (2001) suggests that executives consider the transformation (Good to Great) as a matter of conscious choice and discipline rather than happenstance. The three broad stages of discipline are: disciplined people, disciplined thought, and disciplined action” (p. 12). He uses a “flywheel as a model to captures entire process of going from good to great” (p. 12). Findings

· Level 5 Leadership: More like Lincoln and Socrates than Patton or Caesar.

· First Who . . . Then What: People are NOT your most important asset, the RIGHT PEOPLE make the
difference.

· Confront the Brutal Facts (Yet never lose faith): Have the faith to persevere, yet the discipline to confront
your current reality (Stockdale Paradox).

· The Hedgehog Concept (Simplicity within the three circles): Transcend the “curse of competence,” using
the three circles of the Hedgehog concept:
a. What are you deeply passionate about?
b. What you can be the best in the world at?
c. What drives your economic engine?

· A Culture of Discipline: When you have disciplined people, there is no need for hierarchy; when you have
disciplined thought, hierarchy serves no purpose. When actions are disciplined, excessive controls are not
necessary. “When you combine a culture of discipline with an ethic of entrepreneurship, you get the
magical alchemy of great performance” (p. 13).

· Technology Accelerators: Technology is not used as the primary means of igniting a transformation,
however, good to great companies “are pioneers in the application of carefully selected technologies” (p.
13). Technology is not the root cause of greatness or decline.

· The Flywheel and the Doom Loop: The core of this finding was that good to great was a step-by-step
process. “There was no single defining action, no grand program, no one killer innovation, no solitary
lucky break, no miracle moment” (p. 14). This was a relentless process, turn upon turn, building
momentum until the point of breakthrough and beyond (p. 14).

References:

Collins, J. C. (2001). Good to great. New York, NY: HarperCollins Publishers.

Collins, J. (2005). Good to Great and the social sectors. Boulder, CO: Jim Collins Publisher.

Collins, J. (2011). Good by choice. New York, NY: HarperCollins Publishers.

The following is a summary of the book for audio and visual learners:

Organizational culture (OC), the backdrop for change, is the sum total of an organization’s beliefs, norms, values, mission, philosophy, traditions, and sacred cows. It is a social system that is literally a subsystem of the total organization. The OC consists of artifacts, perspectives, values, assumptions, symbols, language, and behaviors that have been effective over time and support the “way we do things around here.” OC includes communication networks, both formal and informal. The communication networks include a status/role structure that relates to characteristics of employees and customers or clients. Such structures also relate to management styles, whether authoritative or participatory. Organizational culture evolves over time and runs deep. The importance of understanding situational or environmental context cannot be underestimated when attempting change. There are multiple readings in your required readings that will broaden your understand of organizational culture. Many of the articles in this section relate to organizational culture. Read extensively… enrich your knowledge… knowledge is power!

When considering a transformational change, the organization’s culture can provide context for the change (Roussel, 2013). Understanding one’s practice environment is essential to determining readiness for change. As you study an organization, ask yourself if the organization is ready for change? If yes, why? If no, why not? If an organization is not ready, do you abort the change collaborative or do you persist? If you choose to persist, what obstacles do you anticipate? How will you surmount the barriers? These important questions must be considered during the planning stage of change. Newhouse (2010) offers insight into several tools that have been used to assess an organization’s readiness for change. Study the key elements of these tools to gain knowledge of the elements of an organizational assessment.

References:

Newhouse, R.P. (2010). Instruments to assess organizational readiness for evidence-
b ased practice. Journal of Nursing Administration 40, 404-407.

Roussel, L. (2013) Management and leadership for nurse administrators. (6th ed.). Sudbury, MA: Jones

Please review the video with the instructions, thanks.


 

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