Closed-System Perspective on Management Views

¶ … closed-system perspective on management views organizations as relatively independent of outside forces. An open-system approach views the organization as in constant dialogue with the environment. A closed-system decision might encompass setting up a rotation schedule for a floor of nurses; an open systems approach would encompass an effort to improve recruiting to address the nursing shortage the organization faced as a result of macro social and economic factors (Helms 2006).

A philosophy is the organization's general attitude to the services it provides, such as the concept of the importance of holistic health for all patients. The stated goal of the organization is far more specific, such as to promote wellness within the community. Objectives are more specific, such as promoting preventative care, and functional objectives might include having seasonal health fairs, where members of the community could come and receive preliminary screening for heart disease, osteoporosis, and so forth.

Q3. Most organizations have a general manager, who makes broad-sweeping policy and financial decisions for the organization, followed by managers responsible for individual department decisions within the organization's network. On a 'micro' level, office and nurse managers make specific-day-to-day decisions to realize organizational objectives.

Q4. Imperfect information is perhaps the most frustrating barrier in decision-making. Healthcare providers may be confronted with a nonverbal patient in the ER, for example, and have no history of the patient's previous medical history, which would be extremely helpful in making healthcare decision. However, finances can also limit optimal care. A patient's health insurance company may refuse to pay for a treatment the healthcare provider believes is necessary for the patient's well-being. And larger systemic factors can inhibit rational decisions, such as patients without insurance who come to the ER primary care. Additionally, many patients without insurance develop acute conditions that could be better addressed with preventative care. This results in greater costs to the system as well as greater suffering for the patients.

Q5. An organizational chart lists the hierarchy for the organization, but also the relationships between the different 'cells' or positions on the chart. As well as authority (as in who supervises and directs whom on the vertical hierarchy), the chart also illustrates horizontal lines or connections between individuals within the organization. This is essential given the importance of relationships within healthcare organizations.

Q6. Temporary agencies allow healthcare facilities to adjust for seasonal or short-term increases in demand without hiring new staff; outsourcing allows organizations to focus on what they do best and reduce costs; using independent contractors allows certain functions of the hospitals (such as radiology) to be handled by specialized facilities and technicians.

Q7. Free agents, or the frequent moving of professionals such as doctors and nurses from one institution to another means that care providers seldom have an intimate knowledge of their patient's life history over a long period of time. The age of the family physician or the nurse that saw a family through their life cycle is no more, creating a more impersonal and less psychologically well-informed healthcare system.

Q8. Perhaps the most important factor contributing to employee stability is that of a pleasant work environment. Collegial relationships between employees, managers that actually listen to staff members, and humane working conditions (i.e., not constantly scheduling nurses to work nights and back-to-back shifts) are essential. Workers should also be fairly compensated, given the work that they do and the education demanded by their position. In the case of high-demand and highly-skilled professionals like nurses, salaries and benefits must acknowledge the competitive nature of the field and the fact that many institutions are offering attractive packages to enhance retention. Factors that work against retention and contribute to high turnover include insensitive management, a highly competitive and backbiting working environment, long and eccentric work shifts, unfair allocation of work shifts and other 'perks' and low rates of remuneration.

Q10. Six Sigma management is a philosophy of 'total quality' management. It emphasizes the concept of zero defect management at all costs ("What is Six Sigma," Six Sigma, 2011). This is particularly relevant for a healthcare organization, given that 'zero defects' is an important aspect of ensuring quality care for all patients. Zero defect management might include reducing high return rates to the hospital due to improper aftercare, and improving the long-term results of procedures.