The present paper will consider the Brigham and Women’s Hospital Department of Nursing [BWHDN] (2016) and its individual nursing units from the perspective of the open systems theory as explained by Meyer and O’Brien-Pallas (2010). This approach can be employed for organizational analysis to describe a hospital unit as a dynamic system, which has its own processes, inputs, and outputs and remains a component of greater systems, for example, the department or the hospital (Hayajneh, 2007; Meyer & O’Brien-Pallas, 2010).
The analysis indicates that BWHDN (2016) is a relatively typical healthcare system, but some of its units need to improve the negative feedback element, and this goal can be achieved through the employment of a concerns review practice, which already exists in one of the units, by the remaining ones.
Department Description: Systems Theory
BWHDN (2016) does not offer a direct systems theory analysis of the work of its units, but the key aspects of its organization can be deduced from its statements. The inputs that BWHDN (2016) specifically singles out include information (knowledge, research) and individual effort (nurses and their contribution). Other inputs include funding, various raw materials, and equipment. Throughputs that the department specifically focuses on include clinical and leadership activities, but there are also administrative and managerial actions like planning, budgeting, scheduling, and so on. Also, BWHDN (2016) discusses the application of research to the department’s practice and the ongoing education and training of the staff.
The outputs that BWHDN (2016) highlights include the services provided by the units, improved health outcomes of the patients and community, and the enhanced proficiency of the employees. The remaining throughputs produce their own outcomes; for instance, the process of planning leads to strategic plans development, and improved staff motivation can be the result of leadership activities. Some of the outcomes are internal, but others illustrate the units’ connection to larger systems.
BWHDN (2016) does not reflect on feedback in detail, but it mentions that the units focus on outcome-related measures that provide the information on the system’s performance. For instance, BWHDN (2016) is preoccupied with increasing patient falls, and it uses this feedback to adjust its patient safety practices with the help of research on the topic. Finally, the cycles of events that are highlighted by the department include continued quality and safety improvement, which attracts new sponsors that can provide more funding to improve the quality further.
Such cycles demonstrate the fact that the department and its units are dynamic systems. It appears that the specifics of BWHDN (2016) units as systems generally correspond to those of a typical healthcare system as described by Hayajneh (2007), although they have certain prominent features, including the focus on human resources and research.
The monitoring system of BWHDN (2016) is focused on outcomes, but it is not instantly clear if there exist any measures and mechanisms of reviewing the concerns of nurses. However, BWHDN (2016) reports the activities of the Medical Intensive Care Unit Practice Committee, which has introduced a practice of monthly evaluation of staff-driven concerns. This practice should be expanded to other units of BWHDN (2016). The issue of insufficient communication between nurses and administration regarding the nurses’ concerns can be viewed as a negative feedback issue: the individual units of the department lacks a mechanism that can provide crucial information about the system’s functioning (Meyer & O’Brien-Pallas, 2010).
Addressing the Problem
The solution to the problem consists of adjusting the practice that exists in the Intensive Care Unit to be used by the remaining ones. Desired outcomes include the development of a mechanism for the negative feedback from nurses on non-outcome related issues, which can be employed by every unit of the department. Other outcomes that would be expected to follow include the involvement of nurses in decision-making and leadership, improved communication between nurses and administration, timely investigation and resolution of nursing issues, and the improvement of nurses’ working environment and performance quality.
The goal that would contribute to the achievement of these outcomes can be phrased as follows: the practice of the Medical Intensive Care Unit Practice Committee will be expanded to the remaining units in order to provide nurses with the mechanism that can be used to voice their concerns and make suggestions. Objectives are more specific than goals (Marquis & Huston, 2015), and this goal can involve several objectives.
First, it will be necessary to review the practice of the Medical Intensive Care Unit Practice Committee within a reasonable amount of time. Then, the information about the practice should be disseminated, and the remaining units should provide their ideas on it, including their perspective on the possible general improvements and customizations. After that, the objective of developing general or individual practices for units will be set. To improve the outcomes, the goals and objectives should be made SMART by the change leaders who are aware of the department’s realistic opportunities and limitations (Narayanasamy & Penney, 2014).
The practices that will eventually be developed should be formalized with the help of policies and procedures. BWHDN (2016) does not report much on the practice, but it can be deduced that the procedures should include the mechanisms of communicating the concerns of nurses and the format and frequency of the meetings that will discuss them. For instance, an Internet platform can be provided as a mechanism for concern communication, and an official statement should describe the policy of their review (for example, the requirements for their description and the procedure for examination).
The professional standards that are relevant to the problem and the proposed change include, for instance, the Nursing Scope of Practice and the Code of Ethics by the American Nurses Association (2015a, 2015b). The standards state that nurses should promote the quality of care, as well as healthcare, health, human rights, and research, in collaboration with other professionals while also taking the lead in the process of change management. The introduction of the mechanisms to voice nursing concerns will help nurses to promote all these elements locally.
The proposed solution is aligned with the units’ mission, vision, values, and beliefs. For example, the value of collaboration supports the proposed change, which fosters the cooperation between nurses and administration. It also promotes shared decision-making, which is why it is likely to improve the culture and climate of the department’s units, making them more empowering (Manley, O’Keefe, Jackson, Pearce, & Smith, 2014).
The vision of a healthier world that BWHDN (2016) hopes to achieve by fulfilling its mission through nursing leadership and high-quality, evidence-based care should also be facilitated by improved consideration of nurses’ concerns, which will promote the quality of service provided by them. Thus, the change is well-aligned with the philosophy of BWHDN (2016) units while also offering them multiple benefits and addressing the stated issue.
The systems analysis of the units of BWHDN (2016) demonstrates that not all of them share strong negative feedback mechanisms. The problem can be resolved through the customization and improvement of the existing practice of the consideration of nursing concerns. The proposed change is in line with the department’s philosophy and should improve the climate and culture of the units, making them more empowering for nurses.
American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements. Web.
American Nurses Association. (2015b). Nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association.
Brigham and Women’s Hospital Department of Nursing. (2016). 2016 annual report. Web.
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