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RAA Series May 2017 Part II of III May 10, 2017

Posted by mariemanthey in Creative Health Care Management, Professional Practice.
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By Marie Manthey

When the design of nursing service delivery and function allocation is organized with integrity and balance between Responsibility, Authority and Accountability (RAA), the hospital workplace culture is efficient, quality of care is high and organizational trust is in place. That dynamic is similarly true in all other workplace environments.

Working theories and ideas and practices from general industry have been put to use in our work over the years creating Primary Nursing, Relationship-Based Care and leadership practices, now we will also be expressing these ideas in terms of nursing as well as other workplaces.

In using these concepts to design the organization of work, four questions need to be answered. They are:

Who has decision-making authority, and for what time frame?

Is work allocation basically by task/skill levels or whole function assignment?

How is communication handled?

How is the whole function managed?

These four elements ultimately govern how most work is assigned and performed.   The way they are defined has a profound impact on the experience of the workers and the quality of the work.   I was astonished during the formative years of Primary Nursing to see major changes in both performance level and personal growth of individuals when the organization of work changed! That’s all that changed: not the patients, not the doctors, not the staffing, not the hospital systems.   With the same staffing levels, the same level of knowledge and skill of the workers, the same amount of tenure and experience, the quality of work dramatically improved, the culture of the unit did a 180 change and all involved, patients, nursing staff, physicians and others commented on the extraordinary difference they experienced.

For me personally over many years, I have observed whole nursing staffs move from a state of dependency-framed entitlement-voiced victim thinkers, to a group of professionals able to assume their legitimate role as full participants in the collaborative management of patient care.   In order for that collaboration to be real, registered nurses need to be in the role of Primary Nurse where they fully experience the professional autonomy that their license affords them.

Implications for Teamwork

Throughout my years of experience with these concepts, one issue has become crystal clear:   The morale of the work group has a profound impact on the quality of the work.   Furthermore, I fully realize that morale is the result of the interpersonal relationships of the work group, the way the staff treats each other in the face of these every day realities of hospital work. Strong team work and healthy staff relationships create positive morale. These and other attributes of Relationship-Based Care are essential to optimal patient care delivery.

Healthy interpersonal relations require three behaviors.   These are:

Open communication

Functional trust and

Mutual respect

Interestingly, it seems that liking/loving your team mates is not at all essential to healthy team work.   In fact, it matters little, if at all.   What is absolutely vital however is for each member of a healthy work group to accept responsibility for managing relationships using these behaviors.

Open Communication

Of the three, the most challenging is open communication.   It has been my experience, that difficult conversations are often avoided.   In highly stressful situations, this is even truer.   I have found that more often than not, the culprit is inadequate communication skills.   Most of us simply don’t know how to say hard things tactfully.   And the effort to learn that skill is often at the lowest point of a busy person’s priority list.

It is incumbent on everyone to find ways to deal directly with one another about difficult issues tactfully, and for others to learn how to not accept one workers complaint about another, unless it is to help the complainer figure out how to deal directly with the issue.

Functional Trust

In the sense used here, trust means trusting one another to do the work assigned in the right way.   This impacts interpersonal relations in many ways, as well as the effective utilization of the resource of support workers.

It is the person who mistrusts that has the biggest impact on team functioning and therefore it is incumbent on that person to identify and openly communicate to the mistrusted person what they need to do to regain trust.

Mutual Respect

This element is also absolutely key to healthy team work, and requires moving beyond role valuation when that valuation creates dysfunction.

It is vital that each member of the team be recognized as having equal potential for improving or destroying morale, and for contributing to their teams effectiveness.

Are these elements in place where you work now? What has your experience been, currently or at prior work places?

Questions or Comments? Join the conversation!

Part III of this particular mini-series on RAA is coming soon!

Comments»

1. RAA Part III – Achieving Full Experience of Will Power | Marie Manthey's Nursing Salon - June 15, 2017

[…] is part III of an initial series of articles about RAA. Here are links to the previous parts: RAA Part I RAA Part […]

2. URL - June 15, 2017

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[…] Informations on that Topic: mariesnursingsalon.wordpress.com/2017/05/10/raa-series-may-2017-part-ii-of-iii/ […]


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