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How to build capacity?

This document discusses capacity building in healthcare organizations through the implementation of nursing systems like Primary Nursing. It begins by explaining how traditional organizational models in healthcare can lead to misaligned responsibilities and limited capacity. It then introduces Primary Nursing as a patient-oriented nursing system where each nurse takes responsibility for a patient's total care. The Primary Nurse acts as the process owner and works together in a flat hierarchy with an interprofessional care team centered around the patient's needs. Implementing a system like Primary Nursing is argued to minimize disruptions and fears for both patients and staff by deriving work processes from patient requirements rather than traditional disciplinary structures.

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How to build capacity? An example of nursing systems in health care organisations. Prof. Dr. Ulrike Schulze Prof. Dr. Michaela Zeiß B.Sc. Nursing (RN) Dominik Advani
Contents 1. Capacity building focus: Organization of work 1.1 Congruence principle of the organization 1.2 Existing organizational models of nursing and health work 1.3 Organization: Structure-follows-process 1.4 Capacity of organizations 2. Capacity building focus: Nursing systems 2.1 Primary Nursing as patient orientation 2.2 Structure and process organization of Primary Nursing 2.3 Primary Nurse as process owner 3. Capacity building: Thesis 3.1 Capacity building: Primary Nursing 4. Vision
• Description of tasks and workflows / processes • Continuity and consistency, reliability in the management of processes • Quality requirements • Assignment of tasks, jobs, functions to or within the organization (1) Problem: Work organization is determined by unsystematic everyday routines. Result: Job, responsibility and competence often diverge (no congruence) and capacity is limited. 1. Capacity building focus: Organization of work
1.1 Congruence principle of the organization Responsibility CompetenceWork place What I am legitimated for? Which task should be fulfilled? For which decisions do I take the responsibility?
1.2 Existing organizational models of nursing and health work Design of care according to areas and processes Design of care according to functions and qualifications.
1.3 Organization: Structure-follows-process Process Structure Structure-follows-process Is organization flexible enough to be aligned with working procedures? Which capacities, personal skills and work processes are associated with this? Nursing system Potential to failure is that organizational structures aren‘t flexible enough.
1.4 Capacity of organizations Personal approach Change of: • behaviour • attitude through learning processes Structural approach Change of: • technologies • structure • hierarchies Problem: How has the organizational structure to change in order to implement the new care system? Integrative Approach With participation of employees change of culture and structure! • uncertainty • relapse into old habits • discouragement • struggle for power Problem: Which skills do employees need to apply the new care system? • fears • resistance • struggle for power 1 bis7
Team nursing Hierarchical-centralist Patients do not have a clear contact person Qualification-specific tasks division Management as an authoritarian system administrator Task-specific knowledge Area nursing The ward is split in areas and teams The ward manager decides There is a task division in the team Nurses decide and plan their care Patient knows who is in charge for them Danger of overloading for the nurses Hierarchy 2. Capacity Building Focus: Nursing systems
2.1 Primary Nursing (PN) as patient orientation • Nurses take responsibility for nursing care • Responsible for the quality of care the whole time • Work assignment according to the case method • Direct communication and interaction with the patient • Each Primary Nurse is assigned an associated nurse  Professional approach: nursing is the focus and responsibility of the nurses
2.2 Structure and process organization of Primary Nursing Structure management and PN Process Management and PN Associate nurseMedical Nursing assistant Health care services Primary nurse + patient Therapeutic Team Nursing assistant Health care services MedicalPrimary nurse Associate nurse Therapeutic Team
2.3 Primary Nurse as process owner Medical Therapists PN Associated Nurse Relative Case Management Domestic Administration
3 Capacity Building: Thesis First insights: • We have to define our responsibility. (see focus group 1, participant 6) • There is not always a shortage of human or time resources, but also the question of how to use our resources in a meaningful way?! (see focus group 1, students 4)
3.1 Capacity Building: Primary Nursing • Does not follow the structural-functionalist concepts of traditional health care provision in Germany. • Disciplinary demarcation between professions does not appear to be suspended, but they are not primarily action-determining. • Flat hierarchies, coupled with a principle of professional reflection, characterize teamwork and make it possible to identify specific competencies that can be described as transdisciplinary.
• Interprofessional collegial cooperation • Process derivation according to the needs and requirements of the client • Competence-oriented teamwork Primary Nursing minimizes disturbances and fears of those involved and thus minimizes disruptions and fears in the system 4. Vision
Sources 1. Bartscher, T., Nissen, R. (2018): Arbeitsorganisation. online: https://wirtschaftslexikon.gabler.de/definition/arbeitsorganisation- 29839/version-253436, abgerufen am 21.09.2019. 2. Manthey, M. (Hrsg.) (2011): Primary Nursing. Ein personenbezogenes Pflegesystem. Huber, Bern, S. 195. 3. Elkeles, T. (1994): Arbeitsorganisation in der Krankenpflege. Zur Kritik der Funktionspflege. Mabuse-Verl., Frankfurt/Main, S. 384. 4. Schäfer, W., Jacobs, P. (2016): Praxisleitfaden Stationsleitung. Handbuch für die stationäre und ambulante Pflege. Verlag W. Kohlhammer, Stuttgart, S. 440.