Theoretical models of organizational change in healthcare nursing shortage

THEORETICAL MATRIX Use Appendix A (attached) create a matrix theoretical change models. Include theoretical change models matrix. The matrix include model: • Name theoretical model • Description theoretical model 200 words • Description type change situation theoretical model applies 200 words.

Matrix of Theoretical Models

Theoretical Change Model

Description of Theoretical Model

(200 words each box)

Type of health care change situation where model best applies

(200 words each box)

Systems theory

Systems theory suggests that organizations are complex, adaptive systems greater than the sum of their parts. Organizations cannot always be logically analyzed in terms of their ability to accept or reject change. Organizational behavior is hard to predict. Systems are in dialogue with the environment, and changes in the environment can produce changes in the system but "some type of [exterior] energy is required" otherwise organizations grow static (Iles & Sutherland 2001). Also, "players within a system have a view of that system's function and purpose and players' views may be very different from each other" (Iles & Sutherland 2001). This can also complicate change, since managers' perspectives may be different than employees' perspectives.

The theory is flexible to some degree because it promotes two types of change. "Hard Systems promote a sequential, staged approach to change. The stages are numbered and the sequence provides the orderliness, characteristic to this methodology" (Iles & Sutherland 2001). When the need for change is agreed upon, this approach is acceptable. In contrast, Soft Systems approaches are used when there is a great deal of disagreement about how to deal with the change. Soft systems approaches are less sequential in nature and are highly dependent upon building consensus (Iles & Sutherland 2001). They are more appropriate when human-focused decisions are necessitated.

One of the most serious problems in healthcare today is that of recruitment and retention of new nurses, to address the nursing shortage. Many healthcare environments are severely understaffed, and understaffing is linked to nursing burnout and a spike in employee attrition. There are a number of complex environmental reasons that there is a nursing shortage. First and foremost, many nursing educational programs are understaffed, so even when there are many prospective students desiring to enter the program (such as now, given that there are many career-changers as well as new undergraduates seeking a stable profession) there are not enough instructors to teach new students. Also, many older nurses will be retiring in the next decades, and as they age out of the profession even more nurses will be needed. Understaffing creates a vicious cycle, in which new nurses are reluctant to stay in the profession, because they find themselves overburdened. Highly stressed older nurses take out their frustrations on younger nurses, compounding the problem of retention. Using a systems approach suggests dealing with the systematic problems that are at the heart of the nursing shortage. Creating a closer relationship between healthcare institutions and educational programs can enable young nurses to be mentored while they are still new students. This can also contribute to an environment where workplace bullying is reduced by improving emotional relationships between old and new nurses. This addresses some of the human-based problems and environmental problems causing the shortage.

3.Contingency theory

Contingency theory suggests that "there is no one best way of leading and that a leadership style that is effective in some situations may not be successful in others. An effect of this is that leaders who are very effective at one place and time may become unsuccessful either when transplanted to another situation or when the factors around them change" (Straker 2005). Leaders who are effective in military-like organizations with clear chains of command and organizational hierarchies that are highly defined may falter in situations in which buy-in by followers is required, or which require more creative and flexible approaches. Aspects of the situation which may affect leadership capacity include the experience level of followers, the complexity of the task, the time frame upon the need for change and the relationship between leader and followers.

Contingency theory is similar to situation-based theories of leadership. However, "the main difference is that situational theory tends to focus more on the behaviors that the leader should adopt, given situational factors (often about follower behavior), whereas contingency theory takes a broader view that includes contingent factors about leader capability and other variables within the situation" (Straker 2005).

Medication errors are one of the most serious problems facing healthcare institutions today and these errors arise from a variety of sources, some of which are unrelated and require contingency approaches to leadership. Nurses and doctors who have been working long shifts without adequate rest time may be more apt to commit more errors regarding medication administration. Scheduling in more breaks and time for sleep can result in improved patient care. Technical problems such as incomplete medical records can also generate errors in some instances, and these must be rectified to fully address the problem. A lack of communication between pharmacy staff and patients because of the staff's inability to direct patients with specific needs (such as elderly patients with vision problems or patients who speak English as a second language) may result in errors and incorrect doses. Bureaucratic, technical, and 'human' elements of leading change may need to be altered for a full solution to a multifactoral problem. Some leadership approaches may need to be directive (such as setting hard and fast limits upon hours workers can work in a row, based upon empirical evidence about when performance may decline) while others may need to be more democratic, such as finding out when staff members find it difficult to communicate accurately to certain patients about an aftercare regime.