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Essay: Management structure of a non-profit health care organization

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  • Published: 23 September 2022*
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Executive Summary

This paper will examine the management structure of a non-profit health care organization. The key initiatives and goals of this organization will be explained as well as the practices of the leadership, specifically the organizations CEO. The CEO demonstrates a leadership style that can be primarily categorized as transformational leadership. This leadership style is based on an process of influence shared between individuals in an effort to reach higher goals. The strengths and weakness of this leader will be explored in addition to a SWOT analysis of the organization as a whole. Recommendations for improvement will also be made in regards to the leadership style of the organizations CEO.

A1: Description of the Organization

The organization evaluated is a non-profit hospital system in Northern Nevada serving both a rural and urban demographic. The author has experience in both a clinical supervisory role within this organization and as a community partner continuing to work with the organizations top managers on initiatives to serve the health care needs of the community. This organization is locally governed with no out of state owners or shareholders and has greater than 150 community members serving on the boards or in advisory capacities.

The organization has three key initiatives. One of these key initiatives for this organization is to integrate care in an effort to better manage the health of the community. The goals of this initiative are to help the population served achieve better health through improved outcomes, manage or reduce their healthcare costs, and improve the patient experience.

The second initiative is to build key relationships through community partnerships. The goal of this initiative is to increase partnerships with physicians, employees, and community organizations. An example of this is the creation of a shared governance model to make recommendations to the leadership team. The shared governance committee is made up of designated staff from each department. This creates a partnership between the employees and the leadership and gives staff an outlet for their concerns to be heard. The hospital has also partnered with the community to offer health education classes at some of the larger churches in the area and has sponsored community gardens at some of the city parks encouraging members of the community to grow their own vegetables and encourage healthier lifestyle choices.

The third key initiative of this organization is to grow the scale and scope of the hospital system. The goal of growing in scale and scope is to develop new kinds of local, rural, and national partnerships in order to expand services for patients. These partnerships would allow for innovation in seeking new solutions and would provide opportunity to invest in and develop major service lines to meet community needs. An example of this is the formulation of several specialty practices under the hospital system umbrella and the addition of clinics inside of local shopping centers, often staffed with a medical assistant and a advanced practice nurse, that can be utilized as primary care offices and also treat minor ailments such as upper respiratory or urinary tract infections. This alleviates burden on the emergency department for the hospital and provides a lower cost option for treatment.

A2: Leadership Practices

The leader analyzed is the CEO of this healthcare organization who demonstrates a transformational leadership style with practices that include inspiring a shared vision through idealized influence, enabling others to act through intellectual stimulation, and enhancing team spirit through inspirational motivation. This style of leadership often inspires trust, admiration, loyalty, and respect toward the leader, and motivates employees to do more than what was originally expected of them (Yukl, 2). The CEO’s leadership practices stimulate the employees and influences their beliefs, assumptions, and behaviors by appealing to the importance of collective and organizational outcomes. A transformational leader provides individualized consideration, intellectual stimulation, idealized influence, and inspirational motivation (Yukl, 3).

The CEO leads by inspiring a shared vision through the sharing of ideas for the future with the organizations leadership. This is accomplished through idealized influence in which the leader is a strong role model for the leadership team (Manss). By doing this, he is enlisting others in a common vision by appealing to shared aspirations. This style of leadership makes the employees more aware of the importance of task outcomes and induces them to transcend their own self interest for the sake of the organization (Yukl, 2). This practice stimulates and inspires the employees to strive to achieve the desired outcomes and, in the process, develop their own leadership capacity. Unit leaders are encouraged to conduct a needs assessment and literature review to determine the evidence based best practices in the areas of employee retention and clinical documentation. The desired outcome of this practice is to bring the people within the organization together to foster a commitment to a shared future they seek to create. Focus on the mission with branding, both internally and externally, of the central message has been stressed with the creation of the position of Vice President of Advocacy and Community Partnership. A local news personality was hired for this position in an effort to capitalize on her existing relationships and the trust of the community. The goal of this position is to cultivate relationships with community organizations and build grassroots engagement by increasing the organizations visibility and program delivery. Additionally, this role was created in an effort to advance the organizations public stance for health and health policy issues.

The CEO of this organization attempts to create an ideal and unique image of what the organization can become and shares this vision with the leadership team. This mainly consists of discussion at quarterly leadership meetings. The CEO projects a positive and hopeful outlook in hopes of generating enthusiasm and excitement for the vision from the leadership team through the use of metaphors, symbols, positive language, and personal energy. The CEO has a tendency to focus on opportunities that health care changes present rather than the disciplinary actions for not following new guidelines.

The CEO also attempts to enable the leadership team to act by fostering collaboration through building trust among the team and developing competence. This practice consists of involving the leadership team in planning and gives them the feeling of having freedom of choice in the decision-making. This allows employees to do their job while, hopefully, realizing their full potential. This is accomplished by stimulating the group to be creative and innovative while challenging their beliefs (Manss). The goal of this practice is to foster an environment of trust and help each person feel capable and powerful within the organization. This practice considers the needs and interests of the employees and lets them feel as if they carry ownership and responsibility within the organization. A goal of transformational leadership is to stimulate and inspire followers to both achieve extraordinary outcomes and, in the process, develop their own leadership capacity (Jacobson, Anderson, 831). This has led to clinicians becoming increasingly engaged in operations including improvements to service lines.

Another leadership practice that is demonstrated by this CEO is inspirational motivation. This is accomplished by recognizing contributions by showing appreciation for individual excellence and celebrating the values and victories of the organization in an effort to create a spirit of community. The goal of this practice is to inspire a shared vision and enhance team spirit among the leadership. Employees often need encouragement and motivation to achieve the goals set by the organization. The CEO is working to achieve motivation through attaching rewards and recognition to job performance. By celebrating achievements together, employees feel they are part of the group and part of something significant which then fosters a sense of belonging. This trait of a transformational leader focuses on inspiration that will lead to increased employee satisfaction. Employees can recognize each other through a kudos program and unit managers recognize employees efforts through presenting truthful, specific, and positive praise at monthly staff meetings.

A3: Effects of Current Leadership

The current leadership has focused on strengthening the organization by developing employee skills and capabilities. Leadership has laid out a vision that employees can buy into and a strategy with the intent to create a culture of engagement. With this strategy the employees now know where the organization is headed, how it will get there, and their role in helping achieve the vision. Through creating new ideas and prospects and providing the organization with a new path of growth and prosperity, they also promise the improvement of organizational performance and competitive advantage with the hopes of providing motivation, which will lead to more innovation in the organization (Nouri, 673). This has resulted in the formation of interdisciplinary committees to evaluate policy change and improvement, a shared governance model, and the creation of opportunities for growth for the staff to seek promotion and to build leadership skills.

The current leadership has had the effect of empowering the staff to make decisions that affect their jobs, giving them the authority to act, and to make them take responsibility for consequences. This has created a culture of leadership on all levels of the organization. There is now a twelve-week leadership-training program that prepares staff to assume leadership roles in the organization. Leadership training programs resulted from the new focus on increased retention through mentoring to decrease the high turnover within the organization. This program has helped the newly promoted leader succeed and gives the mentor satisfaction in seeing the growth in these new supervisors. Employees now feel engaged, creating a more positive atmosphere and the belief that they are part of a strong team.

B1: Strengths

The hospital has the benefit of having a central location within the city and being easily accessed from all areas within the city limits. In addition, urgent care centers are located throughout the county making the hospital system accessible for those with emergent needs outside of the city limits. The hospital system has the benefit of having the greatest number of remote urgent care locations of the three hospital systems that are present in the area.

The comprehensive services offered have grown in scope over the past 3 years. The hospital system now has many specialty offices with a focus on cardiac, pulmonary, and oncology. There are also medical groups and diagnostic centers that operate under the hospital system umbrella located throughout the county in addition to the many urgent care centers.

B2: Weaknesses

The hospital has a persistently high turnover rate for clinical staff. The hospital has become increasingly reliant on the use of agencies to staff the clinical team and the hiring of newly graduated nurses. This creates strain on the longer-term staff that are then required to train new employees frequently and care for higher patient loads during periods of low staffing.

There is also a high nurse to patient ratio in critical care areas. Due to high staff turnover, and a shortage of nurses that are available for hire, the critical care units have nurse to patient ratios that are often higher then one to three, creating an unsafe work environment. This has created poor word of mouth marketing both internally and externally in addition to decreased patient satisfaction scores. Lack of action on the part of the upper leadership team to focus on retention of current, experienced clinical staff has created crisis-staffing levels. The leadership of this organization needs to act urgently to increase staff retention and decrease turnover as the nursing shortage is expected to continue and worsen for some time. Marketline projects that by the year 2020 there will be 400,000 fewer nurses available across the U.S. (p.8)

B3: Opportunities

There is opportunity to affiliate with a research hospital to partner with oncology and pediatrics. The hospital would benefit from the marketing that would be provided by partnering with a renowned research hospital that could provide second opinions and expert consultation. This partnership would save the patients of the hospital system from having to drive several hours and paying out of pocket expenses for second opinions or pathology.

The surrounding rural communities, within two hours of the main hospital location, are currently unsaturated and can tolerate the opening of satellite clinics in strategic locations. Most of these rural areas do not have ready access to healthcare. Urgent care centers with physican offices would provide primary care to the rural community that either currently does not have access to healthcare or that has to drive two or more hours for even routine physican visits. The opening of clinics in these rural locations would create easily accessible healthcare to a large rural population.

B4: Threats

There is steep salary competition between the local hospitals. Many of the hospitals in the area offer a wage that is competitive with California nursing wages, which are significantly higher than those in Nevada. There are also employment opportunities for nurses in the northern Nevada region to work in California due to easy commute times. This is a recruitment challenge for a non profit healthcare system that has to manage costs closely, including staffing, while at the same time battling a shortage of nurses and high staff turnover.

Increasing healthcare and pharmaceutical costs has lead to backlash from the community that places the blame on the hospital system that provided the care. The need for increased patient satisfaction to maintain a returning customer base is difficult with rising costs that are passed on to the consumer. This is especially challenging when combined with the need to offer the latest treatments and most recent advances in healthcare technology to an informed consumer.

C1: Strengths of the primary leader

The current CEO demonstrates strength in the ability to quickly formulate a vision and communicate that vision enthusiastically to the organizations leadership. The CEO has the ability to think in the long term and sees the opportunities for growth that are present in the local healthcare market. He shows strength in motivating the leadership team to think outside of the box and break out of their comfort zones.

The CEO has also demonstrated the ability to promote enthusiasm within the leadership team. The leadership has become excited about the possibility of working for an organization that will lead the way in the local healthcare industry. This has a trickle down effect after the CEO discusses plans for organization expansion or innovation and the leadership team discuss the CEO’s ideas with the staff in their departments.

Another strength of this CEO is his ability to inspire action within the leadership team. The CEO has encouraged the leadership team to act autonomously when making decisions that are in the best interest of the organization and employees. The CEO’s management style has been to empower the leadership team to work among themselves to resolve any issues that effect there day to day productivity.

C2: Weaknesses of the primary leader

The CEO has demonstrated a lack of ability to communicate detail when unveiling a vision for the future of the organization. The CEO frequently discusses ideas for the future of the organization with the leadership team and has the ability to create excitement among the leaders about new ideas and projects. However, there is a lack of follow through and detail regarding how these objectives will be met. This includes failure to give deadlines for having elements of a project finished, so leadership does not have a timeline for achieving many of the objectives required in order to make the CEO’s vision a reality.

The CEO has a tendency to overlook the reality of a situation and ignore certain truths when they contradict an idea he has for how he would like the culture of the organization to be perceived. When there was an increase in patient falls on the units with the largest nurse and nursing assistant staffing shortage the CEO decided to put a process in place where the nurses for the patients had to go and explain the circumstances surrounding the fall and sign a corrective action plan and coaching form related to fall prevention. The issue of falls occurring because of not enough staff came up frequently during these meetings but the CEO instructed the leadership that the idea of staffing shortages creating unsafe working conditions for both patients and staff could not be supported or encouraged. This led to a culture where the staff felt that there input was not valued by the leadership team and was viewed as a contributing factor to continued staff turnover.

The CEO has overburdened the middle management and taken advantage of their loyalty and belief in his vision for the organization leading to burnout for unit managers. The middle management strives to achieve the outcomes required to achieve the visions for the organization that have been presented by the CEO. There are several barriers however to achieving these outcomes, including a clinical staff shortage and lack of feedback on processes and outcomes that are achieved, which has lead to misunderstanding among the leadership team and a lack of direction. All of these barriers been a cause of lack of motivation among the middle managers and have contributed to a culture where the leadership is has become less responsive to staff needs.

C3: Recommendation for the primary leader

The CEO should focus on fostering ongoing dialogue. Conversations must be 2-way and scheduled to occur on a regular basis with members of the leadership team to allow them to follow up on feedback from their staff and give them the support they need to perform their roles effectively. Individualized consideration is where the leader provides a supportive environment to help coach followers through the personal challenges (Manns). Consideration should be given for individual differences among the leadership team in order to provide better coaching experiences and delegate responsibilities more effectively. These discussions allow for concerns to be addressed immediately and a timeline for resolution and accountability to be established. Employees feel more supported by their leaders when leaders are concerned with their personal feelings and needs (Nouri, 678).

The CEO needs to set up and follow a plan of action about what specifically needs to be changed or improved in order to create a higher degree of performance. He should also communicate clearly the timeline in which the team is expected to accomplish these changes. The CEO needs to be more specific when assigning tasks in an effort to guide the leadership team toward more specific goals. These changes would lead to a focus on inspiration, which in turn will lead to higher performance. A transformational leader should have a clear vision of the future that is simple, understandable, and energizing (Manns)

The CEO needs to begin acknowledging problems and concerns from the employees within the organization and address them as quickly as possible in order to not let these issues grow before they can solved and increase the trust that the employees have for the leadership team. Having members of the leadership team on each unit make rounds at least weekly to discuss with staff any concerns that they may have about the organization or their current role and then having the leadership team debrief each other monthly on staff and environmental needs. Transformational leadership is based on having a clear vision of the future that is simple, understandable, and energizing (Manns) This process would follow the transformational leadership theory in that it would allow leaders to have a transparent view of the issues that are important to the employees and allow for the opportunity to quickly form a resolution or a plan for follow-up.

The CEO evaluated has primarily used a transformational leadership style to lead this non-profit healthcare organization. The leaders strengths include the ability to quickly formulate a vision and enthusiastically communicate that vision to the leadership team, the ability to promote enthusiasm regarding the future of the organization among the leadership team, and the ability to inspire action within the leadership team. The weaknesses of this leader include a lack of ability in communicating detail, the tendency to ignore certain truths that are incongruent with his vision, and overburdening middle management through lack of direction and clear timelines in regard to meeting objectives that are necessary to meet the leaders vision for the organization. Recommendations for this leader include fostering ongoing dialogue with the leadership team through individual meetings and coaching sessions, clearly communicating timelines when assigning tasks, and acknowledging problems and concerns from employees within the organization.


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