Answer for DNP 840 Explain how organizational influence and bureaucracy both impact patient quality and safety outcomes Re: Topic 1 DQ 2
Answer for DNP 840 Explain how organizational influence and bureaucracy both impact patient quality and safety outcomes
Re: Topic 1 DQ 2
In discussion one, we looked at the healthcare delivery system. Healthcare teams have a critical role in the healthcare delivery system. Healthcare teams have been defined in previous literature as two or more healthcare professionals who work collaboratively with patients and their caregivers to accomplish shared goals (Naylor M. D. et al., 2010). However, a healthcare team may involve various team members in multiple settings, including non-clinical, executive, and senior-level teams. I will utilize a team-based model to work across and between levels of the organization in your project to achieve a measurable patient outcome for my project. Upon reviewing my organization chart, which visually conveys the organization’s internal structure, I would work across and between levels by following the chain of command to secure leadership approvals where necessary, engage, and buy in. Team-based care will be essential for meeting value-the goals of my DPI project while delivering a positive patient experience. In addition to patients and their support groups, potential members include physicians, nurses, pharmacists, social workers, trainees, and others identified as persons necessary to help achieve shared goals. The fundamental concept is that a team is a group of individuals who coordinate their actions for a common purpose, which in health care is preventing or treating disease and promoting health. A team-based model of care strives to meet patient needs and preferences by actively engaging patients as total participants in their care while encouraging all healthcare professionals to function to the full extent of their education, certification, and experience. Achieving measurable outcomes requires all workers and professionals to work as a team to achieve the desired objectives and goals (Smith, C. D., et al., 2018). Achieving measurable outcomes in the project requires involving all stakeholders. Team-based care acknowledges that multiple key players treat patients and must work together to drive optimal care outcomes. Members of a care team will include doctors, nurses, physician assistants, specialists, and other non-clinical professionals who are integral to caring for a patient, according to a report from the National Academy of Medicine (nam.edu). The measurable patient outcomes of the project are about improving the quality of care delivery which is the basis of the project.
The potential aspect of bureaucracy is the issue of rank and chain of command. In my organization, the managers at the top level have more power as compared to the junior and low-level nurses. The impact of this bureaucracy is that it will only be able to control and influence outcomes for some people. Barriers included a lack of intentional focus on team building and the loss of autonomy from standardized workflows (Bodenheimer T. et al., 2016). Another anticipated driver of bureaucracy is mindset. What constitutes “our team,” and who is on it? Some healthcare professionals may carry a somewhat narrow and inflexible mindset (e.g., “only the people who work for me and directly around me are on my team”). Others may have a more wide-ranging, flexible, and adaptable perspective (e.g., “anyone who supports efforts to care for this patient is part of ‘our team’; decisions will be made based on the information and concerns provided by everyone on the team, including the patient”). These perspectives can manifest in issues such as whether a radiologist or pharmacist is part of the team or how to coordinate care and accountability for medically and socially complex patients. It should be noted that leading teams is a difficult undertaking, especially when conflicts arise or unexpected challenges require changes to care plans. According to the Agency for Healthcare Research in Quality (AHRQ), “the primary goal of medical teamwork is to optimize the timely and effective use of information, skills, and resources by teams of healthcare professionals to enhance the quality and safety of patient care.” When implementing a new quality-based approach, the organization’s bureaucracy affects patient quality and safety (DeNisco, 2019). High-functioning healthcare teams come in various compositions, yet all possess vital features that make them successful (Smith, C. D., et al., 2018). These include shared team identity, values, and goals; leadership; defined and complementary roles; continuity and regular meetings; adequate staffing; shared physical space; psychological safety; open communication and mutual respect; effective help among team members; constructive conflict resolution; task sharing and shifting; team coordination; and observation and feedback (Smith, C. D., et al., 2018). My organization tends to slow the process of change. Hence, for a change to be brought to effect, it requires consideration of leadership as a totality of change to be brought to development.
The challenge is the slow uptake of change. In increasingly complex healthcare systems, high-functioning teams are more essential than ever and more challenging to develop and sustain. The rewards will be an increased number of patients, better care access, and robust outcomes for all people. Another reward is that change will be realized, enabling everyone to achieve better outcomes. In addition to the digital health barriers mentioned above, many issues related to the workforce can impede and facilitate team-based care. These issues range from the training and mindset of healthcare team members to team organization and leadership. They also include issues related to resources and staffing patterns.
Bodenheimer, T., and R. Willard-Grace. 2016. Teamlets in primary care: Enhancing the patient and clinician experience. Journal of the American Board of Family Medicine 29(1):135-138. https://doi.org/10.3122/jabfm.2016.01.150176
Hackman, R. 2014. What makes for a great team? Washington, DC: American Psychological Association. Available at: https://www.apa.org/science/about/psa/2004/06/hackman (accessed March 6, 2023).
Naylor, M. D., K. D. Coburn, E. T. Kurtzman, J. P. Bettger, H. G. Buck, J. V. Cleave, and C. A. Cott. 2010. Inter-professional team-based primary care for chronically ill adults: State of the science. Unpublished white paper presented at the ABIM Foundation Meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings, Philadelphia, PA.
