Systems Theory
Ludwig Von Bertalanffy introduced general system theory several decades
age in an attempt to present concepts that would be applicable across
disciplines and would be applicable to all systems. The theory was one of
wholeness, proposing that the whole is more than the sum of parts; the system
itself can be explained only as a totality. Holism is the opposite of
elementarism, which views the total as the sum of its individual parts.
A system may be defined as "sets of elements standing in
interrelation". All systems have elements in common. Societies,
automobiles, human bodies and hospitals are system The theory of open system is
part of a general system theory; An open system is defined as a "system in
exchange of matter with its environment, presenting import and export, building
up and breaking down of its material components. Open systems theory emphasizes
the relationship between a system and its environment and the
interrelationships of different levels of system (Katz & Kahn, 1996, p.3).
Systems are either closed or open. Closed systems are self-contained and
usually can only be found in the physical sciences. This perspective has little
relevance for the study of organizations. The open system perspective
recognizes the interaction of the system with its environment. Katz and Kahn
outline 10 characteristics that are common to all open systems. Understanding
these characteristics helps one to conceptually understand how organizations
function.
The first characteristic is input, or importation of energy. Open
systems import forms of energy from the external environment. As, the human
cell receives oxygen and nourishment from the blood stream, and organization
receives capital, human resources, material, or energy (e.g. electricity) from
its environment.
The second characteristic is through put, in which open systems
transform the energy and materials. Just as the human cell transforms
nourishment into structure, an origination can create a new product, process
materials, train people, or provide a service. The third characteristic is
output. Open systems export some product a manufactured substance, an inquiring
mind, or a well body into the environment. Fourth, an organizations throughput
works as a system of cyclic events. Organizational activities occur over and
over again in a self-closing cycle, as the material that is input is
transformed by throughput and results in output.
System-boundaries-it follows that systems have boundaries, which
separate them from their environments. The concept of boundaries helps us
understand the distinction between open and closed systems. The relatively
closed system has rigid, impenetrable boundaries; where as the open system has
permeable boundaries between itself and a broader supra system. Boundaries are
relatively easily defined in physical and biological systems, but are very
difficult to delineate in social systems such as organizations.
The fifth open system characteristic is negative entropy. To survive,
open systems must reverse the entropic process, they must acquire entropy. The entropic
process is the universal law of nature in which all forms of organization move
toward disorganization or death" (Katz & Kahn, 1966). In order to
arrest entropy and be transformed into negative entropy, a process of
transformation with continuous up dates or changes in the organization is
necessary. The outside forces and governmental agencies (importing resources
from its environment) supply major financial support to fuel the system's
ongoing functions and continue operational processes.
The six characteristic of an open system is information input: the
feedback and coding process. Every organization must take in information and
feedback from the environment, code that information, and then store it so it
can be used to predict the environment. Negative feedback is the type of input
that allows the system to identify deviations in its functioning processes.
Feedback enables the organization to maintain a steady state, the seventh
characteristic of an open system.
Sometimes called homeostasis, a steady state
refers to the ability and desire of an organization to maintain some constancy
in energy exchange. Just as the human body stays in a steady state, with no
significant variation in its size and mass over time, so an organization
attempts to stay in a steady state. This is acquired through avoidance of
entropy.
The eighth characteristic is differentiation,
which occurs with growth of the organization.
This requires multiplication and changes in established roles with new
knowledge and expansion of expertise. This activity must create a constant flow
of energy exchange as each member also continuously adapts to new functional
changes. As a result, integration and coordination are achieved. This process
leads to the establishment of a new organizational structure. The last
characteristic of an open system is equi-finality: The principle that any final
goal or end can be reached by a variety of means. As open systems move and
develop within their environment, they may set different goals at different times
and choose different methods to attain them, but the ultimate goal of any open
system is survival. The adaptability of humans for survival represents
equi-finality.
The total nursing management process and each management functions can
be preserved as a system consisting of several inputs, one or more throughput
processes, numerous outputs, and multiple feedback processes between outputs
and throughput, output and inputs, and throughput and inputs. When management
malfunctions, in the major system or a subsystem, analysis of the
interrelationships among system elements will usually reveal imbalances,
obstruction of some point in the system. Usually, when the cause for system
malfunction is accurately diagnosed, the problem can be eliminated or relieved
by appropriate managerial interventions.
Organizational Structure
An organization is a group of people working together, under formal and
informal rules of behavior, to achieve a common purpose. Organization also
refers to the procedures, policies, and methods involved in achieving this
common purpose. Thus, organization is both a structure and a process.
Organizational structure refers to the lines of authority, communication, and
delegation; can be formal or informal. Organizational process refers to the methods
used to achieve organizational goals. An organization's formal structure is
depicted in its organizational chart that provides a "blueprint,"
depicting formal relations, functions and activities.
The principal purpose for defining the organization diagram is to
clarify chain of command, span of control, official communication channels, and
linkage for all department personnel. It is customary to show formal
organization structure in a diagrammatic form with a three dimensional model
having depth, height and width. Boxes containing various position titles are
positioned vertically to highlight differences in status and responsibility.
Position boxes are connected with lines to demonstrate the flow of
communication and authority throughout the entire network. Different types of
interconnecting lines signify different types of relation ships.
For example, a solid line between two positions, indicate direct
authority or command giving relationship. A dashed line or broken or dotted
line indicates a consulting relationship with no prescribed frequency of the
structure to collaborate for planning or control purpose. Commands do not flow.
The primary significance of formal organization structure is the frequency
of communication between particular staff members. Particular worker is
expected to relate directly with certain individuals and not others. For
instance, the Nursing director must give direction to and receive reports from
vice-director or supervisors and not others. In this sense, the formal
organization structure restrains worker behavior.
The organization chart does not show the degree of authority that a
manager has over subordinates. A manager with authority of head nurse may lack
authority to hire or fire the worker.
Every organization also has an informal structure, characterized by
unspoken, often covert, lines of communication and authority relationships not
depicted in the organizational chart. The informal structure develops to meet
individuals' needs for friendship, a sense of belonging, and power. The lines
of communication in the informal structure (commonly termed "the
grapevine") are concerned mainly with social issues. Persons with access
to vital information can become powerful in the informal structure. Some
administrators try to hinder the effects of informal organization because they
facilitate the passing of information. The information may be rumor, but the
best way to combat rumor is by free flow of truthful information. The informal
organization can help to serve the goals of the formal organization if it is
not made the servant of administration. It should not be controlled. A major
shortcoming in its use is that not all employees are part of the informal
organization.
Organizational characteristics
Span of control - refers to the number of employees a manager can effectively oversee.
Mostly top executive cannot manage as many employees’ managers at lower levels.
Theoretically, A 1:3 supervisory ratio is common at the top of an organization;
a 1:6 ratio is common at the middle; and a 1:20 or larger ratio is common at
the base.
The effective span of control for each manager depends on work pace and
pattern of workers skill and knowledge, the amount of work in interdependence.
The top executive must supervise managers of different specialties; although
mid level and first level managers supervise workers in the same specialty that
performs similar tasks often in a common work area.
When span of control is too broad, the manager has
insufficient time to observe and cannot evaluate performance or give feed back.
On the other hand, too narrow span of control has time to supervise each one
closely, and too close supervision discourages subordinates problem solving
independent judgment and creative thinking. Research shows that worker
productivity is higher when close supervision is impossible.
Organizational Principles
·
The
principle of unity of Command: An employee may interact with many individuals
in the course of the work but should be responsible to only one supervisor.
·
The
principle of Requisite Authority: when responsibility for a particular task is
delegated to a subordinate, subordinate must also be given authority over
resources needed for task accomplishment.
·
The
Principle of Continuing Responsibility: When a manager delegates a function to
a subordinate, the manager's responsibility for that function is in no way
diminished.
·
The
Principle of Organizational Centrality: Workers who interact with the greatest
number of other workers receive greatest amount of work related information and
become most powerful in organizational structure.
Organizational Concepts
Responsibility-
is the obligation to do, to the best of one’s ability, the task that has been
assigned, or delegated. In any organization, responsibility begins with the
overall objective of the organization. For example, for nurses in a hospital,
service or patient care is the responsibility.
Authority- the right of decision and commands.
An individual with authority has the right to make decisions about his or her
own responsibilities. Responsibility and authority are delegated down the
scalar chain.
Delegation- is the process of assigning duties
or responsibilities along with corresponding authority to another person. Authority
must be delegated with the responsibility.
Accountability- is answering to someone for what
has been done. It is related with responsibility.
Centralization versus Decentralization
In a highly centralized organization, the chief executive makes most
decisions. Decentralization is the allocation of responsibility and authority
for management decisions downward through the chain of command. In centralized,
decisions made at the apex of the organization takes longer period of time than
decisions made at the lower levels. Therefore, highly centralized organizations
are slow in adapting to major changes. Lower level workers become passive,
unenthusiastic and mechanical.
The executive who will not permit supervisors to select staff, determine
staff schedule, institute working improvements, evaluate goal achievement, and
recommend policy change deprive middle managers of opportunities for
professional growth.
Decentralization of responsibility leads to improved employee morale.
When middle managers are given responsibility for decision-making, they in-turn
make still further, empowering staffs to formulate unit level work plans,
policies and procedures.
As job responsibility and autonomy increase, so does job satisfaction.
It improves staff nurse moral and retention. The head nurse's tasks in a
decentralized organization are similar to a nursing director task in a highly
centralized organization. Therefore, expert staff specialist should support the
head nurses.
Types of Formal Organization Structures
Line Pattern/Relationship: This is the oldest and simplest type of formal organization chart. It is a
straightforward, direct chain of command with superior subordinate
relationships. The line pattern is more efficient than other structures,
because it provides clear authority-responsibility relationships between
workers and requires less information transmission between managers and
workers.
The typical line pattern is divided laterally into segments representing
different nursing specialties. The perspective of workers differs from the
bottom to the top of the structure. Workers at the base of pyramids-Nursing
assistants, Orderlies, staff nurses perform the basic work of nursing mission,
i.e. direct patient care.
Employees in the middle of the structure- head nurses, patient care
coordinators, supervisors are responsible for professional decision-making and
direction of day to day operations. Personnel at the top of the structure-Vice
president or director and assistant directors are responsible for non-programmed
decision making, such as goal setting, program planning, and performance
evaluation.
Advantages of Line Pattern
·
It is easy
to orient new employees, because of clearly defined interpersonal relations as
well as responsibility and accountability;
·
Easy to
manage, because orders can be transmitted quickly;
·
Well
established division of labor;There is a clear-cut work specialization and role
separation.
Disadvantage
· As a result of specialization, it makes
employee's task narrow, repetitive performance and causes communication
difficulties among specialists;
· Since it is rigid, workers tend to resist
innovative changes and resist recommendations from outsiders;
· Line pattern causes passivity and dependence in
staff members and autocratic behavior in managers. The strong chain of command
and concentration of authority at the top of hierarchy cause lower level
employees to refer difficult problems to their immediate superior. Managers
talk more than to listen;
·
It is
characterized by weak integration of different divisions or departments.
Interaction is only on the same division and there is no lateral communication.
Head nurses will never seek advice from a more experienced head nurse in a
different clinical division to resolve a patient care.
Line and Staff Pattern/Relationship/in an
Organization
Line functions are
those that direct responsibility for accomplishing the objectives of a nursing
department. For the most, part they are filled with registered nurses licensed
assistant nurses or other types of nurses. Staff functions are those that
assist the line in accomplishing the primary objectives of nursing. They
include clerical, personnel, budgeting, and finance, staff development, and
research. The relationship between line and staff are a matter of authority.
Line has authority for direct supervision of employees, while staff provides
advice and counsel.
To make staff
effective, top management ensures that line and staff authority relationships
are clearly defined. Personnel of both should work to make their relationships
effective; they attempt to minimize friction by increasing mutual trust and
respect.
The advantage of a line and staff pattern is that key management
functions that the chief executive has neither skill nor time to execute well
are delegated to functional experts who can devote full time to the assigned
function without being distracted by responsibilities of day today management
of personnel and material.
The disadvantage of line and staff pattern is that staff officers have
less power than line officers, because the latter direct the basic operations.
Furthermore, staff officers must stand quietly in the background, while line
managers receive recognition for improvements. Staff positions are also located
at the periphery of formal structure, which casts incumbents in the role of
social isolates.
Matrix Organizational Structure
This Pattern is a complex construct in which and employee may be
responsible to two or more bosses for different aspects of work. In this
pattern, a staff nurse stationed on a given patient unit is responsible to the
head nurse of that unit but also to a case manager who oversees the clinical
progress of her patients. It could also be through vertical and horizontal
coordination.
Potential problems with a matrix type organization can easily be
discerned. If, for example, the head nurse and the case manager give
conflicting orders to the staff nurse, the job may be indefensible, or a
manipulative staff nurse may play his/her two bosses off against each other.
When a matrix organization is used, there must be clear decision rules and, it
is hoped, good interpersonal relationships. The employee must know which boss
has the final word when they receive conflicting orders or conflicting demands
concerning work priorities.
Functional Line and Staff Pattern
A third type of formal organization structure is the functionalized line
and staff organization. In this structure, staff officers are no longer purely
advisory but have some command authority over line employees. The director of
in-service may have the authority to decide how much indoctrination training
and what type of orientation each new nurse must receive and when orientation
classes will be held. The director of quality improvement may have the
authority to assign selected staff nurses to gather data on critical indicators
of care quality, regularly submit quality monitoring reports, and remedy
identified problems.
As a nursing organization increases in size, it may evolve from a pure
line, to a line and staff, and finally, to a functional line and staff
structure. The advantage of functionalized line and staff organization is that
the expert responsible for a specified management function, such as staffing,
policies, quality improvement, or staff development, has authority to command
line managers to implement needed actions that relate to the expert’s specified
function.
Standards for evaluating the effectiveness of
line and staff relationships in a hierarchical organization Standards
1. Line authority relationships are clearly
delineated and defined by the organizational and/or functional charts and
policies;
2. Staff authority relationships are clearly delineated
and defined by the organizational and /or functional charts and policies;
3. Functional authority relations are clearly
delineated and defined by the organizational and /or functional charts and
policies;
4. Staff personnel consult with, advise and provide
counsel to line personnel;
5. Service personnel functions are clearly
understood by line and staff personnel;
6. Line personnel seek and effectively use staff
services;
7. Appropriate staff services are being provided by
line nursing personnel and other organizational departments or services;
8. Services are not being duplicated because line
and staff authority relationships.
Systems of Nursing Service Delivery
Effective management makes the organization function, and the nursing
manager has a responsibility of nursing care delivery systems that demonstrate
ways of organizing nursing’s work. Within these systems there are advantages
and disadvantages for quality of care, use of resources, and staff growth.
Case Method
The new method, traced back to Florence Nightingale, began in the early
days of the nursing profession and was the convenient and appropriate way to
manage care. Individuals are assigned to give total care to each patient,
including the necessary medicine and treatments. The nurses report to their
immediate superior, who is the head nurse. The disadvantages of this system are
that all personnel might not have been qualified to deliver all aspects of
care, and depending on the structure, too many people were reporting to the
head nurse (overextended span of control).
Functional Method
The functional method is the next step to deal with different levels of
caregivers. Assignments of patient care are made by the level of task; in other
words, each person performs one task or functions in keeping with the
employees’ educational experience. For example Nurse Aides /Health Assistants/
give baths, feed patients, and take vital signs to all patients. Professional
nurses are responsible for medications, treatments, and procedures for all
patients. The head nurse is responsible for overall direction, supervision, and
education of the nursing staff.
Advantages
·
Reduce
personnel costs
·
Supports
cost control
Disadvantages
·
Fragments
nursing care
·
May
decrease staff job satisfaction
·
Decreases
personal contacts with client
·
Limits
continuity of care
Team Nursing
A dramatic change occurred after World War II in the years between 1943
and 1945. The level and number of auxiliary personnel began increasing, and the
professional nurse was assuming more and more of the management functions.
Because of the changing configuration of the work group and the dramatic social
upheaval, a study was commissioned to device a better way to provide nursing
care. Dr. Eleanor Lambertson of Columbia University in New York and Francis Perkins
of Massachusetts General Hospital were the authors of the system known as team
nursing. Team nursing was developed to deal with the influx of post war workers
and the head nurse’s overextended span of control. This was accomplished by
arranging the workers in teams.
The team consists of the senior professional nurse becoming the team
leader; the members of the team are other registered nurses (RNs), licensed
practical nurses (LPNs) or vocational nurses, and nurses’ aides. Each is being
given a patient assignment in keeping with the employee’s education and
experience. The team leader make the assignments, delegated the work through
the morning report, make rounds throughout the shift to make sure patients are
being cared for properly, and conducts a team conference at the end of the
shift to evaluate the patient care and plan an update nursing care plans.
Since 1950, team nursing is becoming a popular way to structure nursing
care.
Team nursing is a pattern of patient care that involves changing the structural
and organizational framework of the nursing unit. This method introduces the
team concept for the stated aim of using all levels of personnel to their
fullest capacity in giving the best possible nursing care to patients. The
structural and organizational changes necessary for this method includes the
introduction of the nursing team with the team leader assuming responsible for
the management of the patient care. The head nurse decentralizes authority to
the team leader to direct the activities of the team members. The head nurse is
no longer the center of all communication on the division because the members
communicate directly with the team leader. The team leader had the
responsibility for synchronizing the abilities of her/his team members so that
they are able to function effectively in a team relationship. Emphasis is
placed on the ability of all participants of patient care to plan, administer,
and evaluate patient care.
The team approach to patient care represents more than reorganization or
restructuring of nursing service. Instead, it is a philosophy of nursing and a
method of organizing patient care. The difficulty with this method concerns the
nurse’s absence at the bedside; the nurse is directing the care of others and
thus not using nursing’s specialized knowledge as the best provider of patient
care. Problems with this system have become the stimulus for a new system.
Advantages
- Supports comprehensive care
- May increases job satisfaction
- Increases cost effectiveness
Disadvantages
- Decreases personal contact with client
- Limits continuity of care
Primary Nursing
Primary nursing as a system of care provided for a way to provide
quality comprehensive patient care and a framework for the development of
professional practice among the nursing staff. Primary nursing was a logical
next step in nursing’s historic evolution. By definition, primary nursing is a
philosophy and structure that places responsibility and accountability for the
planning, giving, communicating and evaluating of care for a group of patients
in the hands of the primary nurse. Primary nursing was intended to return the
nurse to the bedside, thus improving the quality of care and increasing the job
satisfaction of the nursing staff.
The primary nurse is expected to give total care, to establish
therapeutic relationship, to plan for 24 hours continuity in nursing are
through a written nursing care plan, to communicate directly with other members
of the health team, land to plan for discharge. The patient’s participation is expected
in the planning, implementing, land evaluating of his or her own care. Perhaps
the best aspect of primary nursing is the improved communication provided by
the one-to-one relationship between nurse and patient.
Associate nurses are involved with this method by caring for the
patients in the absence of primary nurse. Their responsibilities include
continuing the care initiated by the primary nurse and making necessary
modifications in the absence of primary nurse.
Primary nursing was adapted in organizations to fit the staffing
patterns and general nursing philosophy. Because of the need for high
percentage of professional nurses, other modifications of the system developed,
such as modular nursing.
Advantages
- May increase job satisfaction
- I Improves continuity of care
- Allows independent decision making
- Supports direct nurse-client communication
- Encourages discharge planning
- Improves quality of care
Disadvantages
·
Increases
personnel costs initially
·
Requires
properly trained nurses to carry out systems principles
·
Restricts
opportunity for evening and night shift nurses to participate
Case Management
More recently, a new method of nursing care delivery has evolved known
as case management. The American Nurses Association (ANA) has defined case management
to be a system of health assessment, planning, service procurement and
delivery, coordination, and monitoring to meet the multiple service needs of
clients. This is an all-inclusive and comprehensive model and is not restricted
to the hospital setting.
When a patient deviated from the usual expected course of recovery or
health, consultation ensures to quickly correct the problem. This requires a
great deal of systematic knowledge about a patient's problems and putting that
knowledge into a type of nursing care plan (case management plans) with time
lines to demonstrate progress or deviations from the critical paths. In
addition to the nursing and medical services that are required for patients,
other services are included, such as physical therapy and respiratory therapy.
Advantage
·
Improves
nurse responsiveness to clients changing needs
·
Improves
continuity of care
·
May
increase nurse’s job satisfaction
Disadvantage
·
Increases
personnel costs
