to the ViSN directors seen eu negative aspects of the reorganized structure and
ID: 392253 • Letter: T
Question
to the ViSN directors seen eu negative aspects of the reorganized structure and decentralization? 4. Describe alternatives for a service line structure internal to each VISN in the VA case. 5. Why is the hierarchical structure limited in its capability to facilitate coordination in health care organizations? CASE The vice president for patient care services (VP-PCS) and the vice president for medical affairs (VP-MA) at Northeast Medical Center (NMC) were very concerned about coordination between Medicine and Nursing in the inpatient medical/surgical units NMC was a large tertiary-care teaching hospital, affiliated with the Northeast Schools of Medicine (NSOM) and Nursing (NSON). NMC participated in a joint residency program with three other hospitals affliated with NSOM. Most residents spent six weeks at NMC. that coordination sharply decreased after restrictions on resident hours were implemented. The vp he residents rotate through our hospital so quickly that the nurses hardly get to know their names, much less establish a working relationship. The VPs also observed that handoffs of patients from one resident team to another were problematic and had become more so, they believed, as a result of the shorter shifts worked by the residents suggested expanding NMC's hospitalist program to address the coordination problems. He argued that The VP-MA hospitalists would provide by residents. However, the chief of medicine was opposed to this proposal. He argued that it would negatively affect educational experience of residents by reducing their responsibilities. He was backed in this argument a consistent medical coverage that would compensate for what he calle d "fragmented" coverage by the chairmanof cine at NSOM. As was common in academic centers, the chief of medicine reported to the VP-MA at NMC and also to the chairman of medicine at NSOM. Questions I. Is it consistent with organizational theory to expect that coordination between nurses and residents would suffer as a result of the change in resident working hours? 2. Would the addition of hospitalists improve coordination? 3. What other changes could improve coordination? t are counterarguments to the position held by the chief of medicine and chaiman of medicine that the hospitalists would negatively affect the educational experience of residents?Explanation / Answer
1. Yes , as per Kurt Lewin’s theory about organizational change, it is consistent to expect that coordination between nurses and residents would suffer as a result of change in resident working hours. This is so because it is usually the human tendency to show resistance to change. In the given case, the resistance to change is portrayed in the form of non-cooperation between nurses and residents.
2. In my views, the addition of hospitalists will help in execution of the change process. There will be less opposition and resistance from the existing teams of nurses and residents as the hospitalists will try to reach them at a common ground. The presence of hospitalists can also increase coordination among the existing teams and increase the overall team synergy,
3. Some other changes which will help facilitate coordination among teams:
4. The counterargument can be that the inclusion of educated hospitalists will help and charge the residents to boost their capabilities and pump up their performance. It is a general notion that competition drives out the best from a person. The same notion can be applicable in this case. Also the interaction between the hospitalists and the residents will inspire the residents to increase their awareness and knowledge about the various medical coverage, thus improving their overall performance.
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