Open Healthcare Systems

Chamberlain College of Nursing: NR-534- HEALTHCARE SYSTEMS MANAGEMENT
Open Healthcare Systems (graded)
Healthcare systems have been seen traditionally as closed systems. Select a current or recent-past issue or process in which there has been discussion of change for improvement. How can this issue or process be changed to an open-system perspective that would improve outcomes?

Laying the Foundation
Welcome to our first week of class, where you will begin to identify how decisions are made in organizations and what leaders and managers must do to ensure that quality, evidence-based knowledge, information, and data are the foundation of these choices. We will see that to be a great healthcare organization, there needs to be a clear vision with aligned values that is the umbrella for all work that is completed within the organization. The vision is the driving force for the rationale for the existence of the organization. For the healthcare organization, this vision defines the basis of its function, which is firm and unchanging, and what aspects of the organization must be open to change as change occurs in the internal and external environment.
Once the vision and values are determined, those selected to lead in the organization must be chosen. The chosen leaders are those placed in formal roles in which there are clear reporting lines and delineation of duties, responsibilities, and accountably for each position (Porter-OGrady & Malloch, 2015). The formal leaders deal directly with the challenges and barriers within their specified area or unit by wielding power and influence. Often overlooked but extraordinarily important is the informal leader (Clancy, 2012). The informal leaders are those among the ranks of staff that are clinical and communication experts, have a willingness and desire to teach and mentor others, are often the first staff members to volunteer for projects, inspire the entire staff to do better, and have credibility among leaders and staff members. Appreciating the role of the formal and informal leaders within the organization and how each works to improve patient care and patient and staff satisfaction is an important component for achieving goals.
Importance of Vision
The organizational vision is where we find the ideology and beliefs about the industry: healthcare. The vision answers the questions of why we exist, what our contribution will be to healthcare, and what our long-term goal for the future will be. The ideology and beliefs define the values of the organization. The values are directly aligned with the vision. The values statements are universal and unchangeable guidelines. Confusion comes with missing that the values underlie organizational beliefs but are not demonstrated in organizational operations (Porter-OGrady & Malloch, 2015). Operational practices and the environment in which the organization functionssuch as culture, climate and strategymay change but values do not change.
Consider the organization that you currently work in or one you are familiar with. What are the stated values? What organizational actions align with these values? What organizational actions do not align with these values?
Do You Believe?
Considering that ideology and beliefs are part of the organizational core, the ideology and beliefs need to be part of the belief system of the employees who work in the organization. Employees and potential employees must carry with them the ability to embrace the ideology and beliefs of the organization. One of the values will include the purpose of the organization, which must align with the purpose of those that would work in or seek work in the organization. Values can be enhanced but do not change (Stacey, Johnston, Stickley & Diamond, 2011). Those who seek work in the organization must have alignment of their ideology and beliefs with those identified in the organization.
A classic American company is Disney. The Disney ideology and beliefs determine the company values, which are (a) no cynicism, (b) nurturing and promulgation of wholesome American values, (c) creativity; dreams; and imagination, (d) fanatical attention to detail and consistency, and (e) preservation and control of the Disney magic (Rasmus, 2012). The purpose of Disney is to make people happy. How does your organization compare?
Competency and Goals
Although some confusion may surround appreciation of the separation of values and competency, it is clear they are not the same thing. For example, if the organization is a critical- access hospital, it may have the same values as the university hospital system, but the critical-access hospital does not have the same competencythe ability to deliver healthcare at the same level.
Each organization, based on its vision, values, and competency, establishes goals that are short term and long term. These goals embrace the organizations vision, values, and competency within the environment in which they are placed. There will be goals that are clearly attainable and those that, by most estimates, will be a stretch to reach. Organizational goals present a picture to those within the organization and in the external environment of what goal achievement will look like: the outcomes. The goals are strategic, dynamic, and aligned 100% with the vision.
Organizational Culture and Climate
The basis for the organizational-culture development should be found in the vision and the values of an organization. What is the organizational culture? It is a study of the environment within an organization context. Kurt Lewin, in a published work in 1939, is credited with identifying and making an effort to quantify organizational culture and climate (Roussel, 2013). Similar to cultures of people, the cultures of organizations have many paradoxes, outright contradictions, points of ambiguity, and utter confusion. These aspects of organizational culture speak to the fact that organizations are made of groups of people who also come from, and bring along, their cultural perspectives and shared experiences. It is clear, as many factors converge within organizations, that organizational culture is about groups of people working together to make meaning of the organizations values as these values are translated into the real world. It is through these groups within the organization creating new ways of functioning to meet the goals and expected outcomes that an organizations feel (its culture and climate) are developed. Thus culture and climate are a part of the movement within the organization that creates the environment within which people work (Schneider, Ehrhart, & Macey, 2013).
Supporting Moral Courage
Just as the culture and climate are generated by those within the organization as they translate and apply the organizations vision and values, professional nurses bring the added dimension of professional values and ethics that must be integrated and aligned with the organization. Decision making for leaders in healthcare requires a balance between organizational and professional values, which at times may not be well aligned (Gallagher, 2010). Situations of misalignment require a leaders moral courage to make decisions and advocate for the right thing. The right thing is based on identifying and acting on unethical practices that negatively impact patient care. Leaders suffer moral distress when faced with making decisions that are contrary to their values and beliefs.
The organizational structure can support professional nurses through the use of models of care, empowerment, shared governance, effective communication, establishing a just culture, and leaders that support moral courage (Gallagher, 2010). Organizations that meet these criteria often hold the designation of Magnet recognition. Nurse leaders meeting the challenges of healthcare today use their moral courage to transform their organizational environments and the profession of nursing, ensuring accountability and responsibility for decision making and patient outcomes.
Systems in Healthcare
Planning in healthcare requires a systems approach. Systems can be open or closed. Healthcare systems are generally thought of as closed systems. However, changes in healthcare legislation have impacted the traditionally closed systems. One example is the establishment of accountable care organizations (ACOs), which has become a requirement for many types of healthcare organizations and consumers.
A closed system can be thought of as unto itself. This means that although there may be other and competing entities, the closed system has no interaction and appreciates no impact from the external environment. An example of a closed system is a rural hospital with no other acute care hospitals within 50 miles. All the people in the rural community come to this hospital for their healthcare needs. A new hospital is being built in the city. The current hospital does not see this new hospital as competition or as impacting them; it is blind to the changing external environment. The current hospital believes the community belongs to it and believes that people have always come there and will continue to do so as they have for generations. This is a closed-system view.
It is only as the new hospital that is shiny and clean and sporting the best technology begins to market to the rural community that the current hospital finally begins to understand that the people are going somewhere else. Yet, interestingly, many administrators with closed-systems views continue to hold out for the return of the past. For some hospitals since 2008, the realization that an open view is important did not come in time to save the hospitals from bankruptcy and closure (Mosco, 2013).
A type of open system that continues to remain closed except to its own members is the large healthcare organization that has multiple hospitals. This system is closed to others, but within its own group. Patients may move from one hospital to another, where their healthcare record may be accessed, and there is seamless transition. However, even this more open approach is closed to other organizations. This means that if a patient in the same community is admitted to a competing large healthcare organization, a new chart will be generated without any opportunity for connectivity to the other large healthcare organization where all the patients previous health records are stored.
Leadership for Success
A great deal has been written and researched related to formal leadership (Edmunds, 2010). Researchers have discovered styles and behaviors that contribute to leader success. However, it is the informal leader role that will be expanded on here.
The informal leader, who is found among the staff, is an integral component of the organization. It is through the informal leader that the formal leader can discover information and gain support for achievement of specific goals among the staff. The informal leader is energetic and dedicated to the unit and the patients. This leader is committed to solving challenges and doing so in a collaborative manner. The informal leader is the person toward whom staff members gravitate to gain support, ask questions, and rely on in times of crisis. How do you identify the informal leader?
The informal leader may or may not be the first one to speak up, but if observations of staff actions are completed, the informal leader will begin to stand out as the go-to person. Qualities that can be attributed to informal leaders include being knowledgeable, confident, trustworthy, helpful, and friendly. Informal leaders build relationships within and among staff across the organization, yet when asked or rewarded for their excellent work, they may shrug off the compliment as just doing my job. The informal leader demonstrates humility and at times is shy when his or her accomplishments are pointed out. These individuals may not strive for formal leadership positions, understanding that the direct impact on staff, patients, and quality would diminish should they rise from the ranks. However, these informal leaders of today are the formal leaders of tomorrow.
Formal leaders need to identify the informal leaders from the staff. Formal leaders appreciate the importance of the informal leaders and work with them to achieve unit, division, and organizational goals. The informal leaders who desire formal positions should be selected for succession planning (Canadian Nurses Association, 2013).
Organizations function based on the vision that they define. From the vision, the values are generated. Those people who work in the organization bring with them their own experiences and expectations of the organization based on the vision and values where each individual within a group shapes the climate and culture. Professionals who function within an organization but who also have professional standards to maintain may find opposition between the organizational vision and values and those of their profession. Leaders require moral courage to work in organizations and remain true to their professional obligations. Healthcare organizations are systems that historically function most often from a closed-systems perspective. There are challenges to patients and professionals entering closed systems. Organizations that hold a closed-systems approach miss opportunities to evaluate the external environment that they are a part of, which may lead to deleterious effects. Fortunately, over the past 2 decades, there has been a realization that healthcare can no longer function from a closed perspective but must become an open system to survive in the new reality of healthcare.
Leaders are key elements to moving the vision and values of the organization to the patient. The formal leader has a clear, designated job description that defines the role, responsibilities, and accountabilities. The informal leader is a driving force among the staff that is a positive, professional-nursing role model. The informal leader, working with the formal leader, can create a positive impact for all who are a part of the unit and cared for by the staff.

Marquis, B. L. & Huston, C. J. (2014). Leadership roles and management functions in nursing: Theory and application (8th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins.
Chapter 1: Decision Making, Problem Solving and Critical Thinking: Requisites for Successful Leadership and Management
Chapter 7: Strategic and Operational Planning
Chapter 8: Planned Change
Chapter 12: Organizational Culture (p. 268269)
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Curtin, L. (2013). Quantum leadership: Upside down. American Nurse Today [online], 8(3). link to article
Johnson, J. K., Miller, S. H., & Horowitz, S. D. (n.d.). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. link to article
Neubauer, B. (2012, Jan. 29). Systems theory in context of modern healthcare organizations. link to video
Canadian Nurses Association. (2013). Succession planning for nursing leaders. Retrieved from
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Edmonds, C. (2010). Creating high performance, values-aligned culture. The Ken Blanchard Companies (TKBC). Retrieved from
Gallagher, A. (2010). Moral distress and moral courage in everyday nursing practice. OJIN: The Online Journal of Issues in Nursing, 16(2). doi: 10.3912/OJIN.Vol16No02PPT03
Mosco, S. (2013, June 5). Queens tomorrow: Innovative solutions sought to offset hospital closings. Times Ledger [online]. Retrieved from
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Rasmus, D. W. (2012, Feb. 28). Defining your companies vision. Fast Company & Inc. [online]. Retrieved from
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Schneider, B., Ehrhart, M. G., & Macey, W. H. (2013). Organizational climate and culture. Annual Review of Psychology, 64, 361388. doi: 10.1146/annurev-psych-113011-143809
Stacy, G., Johnston, K., Strickley, T. & Diamond, B. (2011). How do nurses cope when values and practice conflict? Nursing Times,107(5), 2023.