The quality of nursing services is one of the pivotal issues in any healthcare organization especially in the context of skilled personnel shortages. To solve the problem of service delivery well, it is however not enough to analyze the hospital-level staffing indicators alone. The view on the healthcare organization as an open, input-output system and the focus on the overall organizational environment is more beneficial in this regard as they are associated with a multifaceted decision-making approach. For this reason, the purpose of this paper is to investigate the selected practice problem by using the Systems Theory and evaluate it by applying such major theoretical constructs as inputs, throughputs, outputs, cycles of events, and negative feedback.
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Organizational Mission, Vision, Values, Culture, and Climate
Quality has intangible characteristics and is regarded as an essential customer value. According to Mosadeghrad (2014), healthcare service quality comprises such attributes as “timeliness, consistency, and accuracy,” which can be mainly measured subjectively by care recipients and, thus, it largely depends on the manner of practitioner-customer interactions (p. 78).
In this regard, a hospital that does not have a mission to achieve excellence and a vision to meet and exceed customer expectations may face the problem of low-quality nursing service delivery. To avoid this issue, quality as a value must be integrated into the organizational culture. Additionally, healthcare practitioners should be provided with a supportive workplace climate conducive to better professional relationships, compliance with standards and requirements, and availability of necessary resources.
The concept of the open system implies that any organization constantly interacts with its environment. In other words, organizations may be considered open in case there is “import and export of material” (Cordon, 2013, p. 16).
Based on this, the problem with the quality of nursing service delivery emerges when there is an imbalance between energic inputs, throughputs, and outputs. It means that to support the sustainability of service and the system as such, the hospital needs to ensure an inflow of energy (that is to say, people, materials, information, et cetera). The input is basic to quality services because, without them, such throughputs as nursing interventions and practitioner-customer interactions may not be produced. Consequently, the desired hospital’s outputs such as high-quality nursing service delivery and greater customer satisfaction cannot be attained.
The concept of cycles of events plays an essential role in the maintenance of sustainable quality outcomes as well. Overall, it implies that energy transformation activities are continually repeated at the individual and organizational levels. Thus, to transform nursing resources and generate desired outputs, not only must the hospital systematically coordinate practitioners’ efforts and processes but also ensure value maintenance. Dubois, D’Amour, Pomey, Girard, and Brault (2013) define the latter as the creation and promotion of “values and standards that guide choices in the design of nursing services” (p. 7).
Lastly, to improve the quality of nursing services, the hospital must implement negative feedback – internal information about operational functioning collected at the subsystem level and utilized to orient the organization towards goal achievement. The assessment of pre-and post-intervention performance indicators may enhance organizational learning, facilitate change management, and foster a balance among inputs, throughputs, and outputs.
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Desired Outcomes, Goals, and Objectives
Overall, increased customer satisfaction may be regarded as the primary desired outcome because, as was mentioned above, the perception of healthcare quality is subjective. The main goal is the improvement of the performance indicators related to quality: timeliness, consistency, accuracy, and patient communication. As for the short-term objectives that may help attain this goal, they are mainly related to the intervention of the nursing practice environment by the discussed Systems Theory constructs.
First of all, it is essential to optimize the quality and quantity of primary inputs: nurses. Secondly, to ensure the generation of desired throughputs (high-quality nursing interventions and patient communication), they must be provided with the necessary information, resources, and support, as well as appropriate work structure. These objectives are in line with such relevant solutions as efficient workload management, increased nurse autonomy and nursing leadership capabilities, and professional development. A key standard applicable to the problem of interest is as follows: “Maintain the Highest Standard and Quality of Health and Nursing Services with the Available Resources” (Dolamo, 2018, p. 4). It refers to the necessity to eliminate the resource shortages and ensure compliance with the principles of ethical and legal nursing practice.
The creation of a supportive environment through the elimination of input shortages, enforcement of policies, and integration of quality as a value into the culture aligns with the organizational mission and vision because it helps achieve excellence and meet patient needs and expectations better. The focus on the quality of rendered services attained through the improvement of inputs and throughputs is crucial for patient safety, which is the major value for the hospital. Additionally, the solution directly impacts the culture as it implies the promotion of and the emphasis on the specific value. It also affects the workplace climate through the normalization of workloads and reduction of nurse burnout, which often contribute to conflicts and low morale.
By analyzing the healthcare practice problem in the context of the organization as an open system, one may come up with a comprehensive and effective strategy aimed at its elimination. As it was shown in the paper, the improvement of the quality of nursing care delivery mainly requires the optimization of quality and quantity of inputs and the development of the environment needed for their transformation into throughputs. As a result of resource shortage elimination and enforcement of policies and standards, as well as other practices leading to the continuation of organizational learning, better patient satisfaction and safety can be achieved.
Cordon, C. P. (2013). System theories: An overview of various system theories and their application in healthcare. American Journal of Systems Science, 2(1), 13-22.
Dolamo, B. L. (2018). Maintaining nursing practice standards while changing with times: SANC perspective. Journal of Scientific & Technical Research, 4(5), 1-6.
Dubois, C.-A., D’Amour, D., Pomey, M.-P., Girard, F., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: A systematic and interpretive review. BMC Nursing, 12(7), 1-20.
Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International Journal of Health Policy and Management, 3(2), 77-89.