How is the BC HC system funded? Canadian HC is funded through: fed taxes, prov/terr taxes (most revenue comes from income taxes and consumption taxes) 1. Provincial Gov funding (tax revenues, income tax, sales tax) 2. Fed Gov transfers through the Canada Health Transfer (CHT) 3. User fees and other revenue sources (ambulance services, prescription drugs) What are the 5 tenants of the Canada Health Act? • Accessibility: Prov/Terr gov must provide reasonable access to services • Portability: residents who move to another province are covered by their home province • Universality: all insured persons have the same terms as everyone else • Publicly funded: HC plans are administered and offered on a not-for-profit basis • Comprehensive: plan must provide coverage for all medically necessary services provided in hospitals and medical practitioners Most Prov health ministries have delegated resp for the delivery/admin of health services to the regional health authorities Fed government is responsible for delivery of HC to some groups: First nation/ Inuits, Veterans, Refugees, Inmates First nations health authority is self governing Prov/Terr governments are responsible for the administration, organization and delivery of the HC services for their residents 5 Health Authorities in BC are responsible for - Identifying population health needs - Planning appropriate programs and services - Ensuring programs and services are properly funded/managed - Meeting performance objectives What are the P3s and why are they in the Canadian HC system? • Public-Private-Partnership • Formal collaborative arrangement between the public and private sector to deliver and manage public health care • For example: contracting a private company to design, build, finance, maintain a public healthcare facility. Also laundry, food, housekeeping, security • The private group assumes some of the risk associated with the project • Advantages: o Gov shares risks/costs for large investments and services with private, for-profit partners • o Shares risks Disadvantages o Lower standards of service o Creates inequity (parking costs) Organizational structure • System that describes orgo hierarchy in terms of functions, roles, resp, supervision • Describes how info and decision making flows, how info is reported, allocation of tasks • Influenced by orgos missions, vision, values • Can be represented graphically Mission, Visions and Values • Determine how nursing care is delivered in a HC orgo • Determine the characteristics of the orgos structure by doing the following o Describing patient needs and services as a prescription for the technologies and human resources needed to accomplish the defined purpose (mission) o Creating an ultimate state of existence (vision) o Citing values and beliefs that shape and are shaped by the nature of the work and rights/resp of the workers/patients • Mission: formal document expressing an orgos purpose • Vision: future-oriented statement identifying orgos future • Values: guides organizational obligation/rights/mission Philosophy statement: reflects the orgos values 5 factors that influence design of an organization structure are: 1. Type of service performed or product produced 2. Characteristics of the employees performing the service or producing the product 3. Beliefs/values held by the people responsible for delivering the service 4. Technologies used to perform the service and produce the product 5. Needs, desires, characteristics of the users of the product/service Structure of an Orgo • • • Hierarchy: chain of command (vertical on chart) that depicts lines of formal authority/resp Centralized: top down flow of info. Increased hierarchy. o Pros: useful for managing complexity o Cons: delays decision making/decreased sense of staff belonging Decentralized : middles/lower levels of management can make decisions o Pros: increased speed/nimbleness, employee accountability o Cons: higher costs, task duplication Followership: Followers: Effective followers can manage themselves and work well with others, work collaboratively with leaders, managers and teams. NOT passive. Followership guidelines: - Find out what you are expected to do - Take initiative to deal with problems à NOT Passive - Show appreciation and provide recognition when appropriate - Challenge flawed plans and proposals Magnet Hospitals AKA Quality practice environments • Nursing working index: nursing tool to help identify magnet hospitals through a common set of organizational attributes • Mt Sinai in Toronto: first and only Canada hospital with magnet status • Some components required to be a magnet hospital o Chief nursing officer with at least a master’s degree or a BSN o Nurse managers that are accountable for front line nurses o Nurse leaders at all levels that are degree trained or masters trained • Essential Components for quality practice environments (magnet hospitals) o Nursing leadership: competent and well prepared leaders at all levels § Indicators • nurse leads at every level • research • Nurse leader’s authority to support safe nursing practice o Workload management: safe staffing levels, resources for safe, quality, ethical care § Indicators: # of nurses, # of patients, # of admissions, % bed occupancy, Overtime (frequency? mandatory?) § Recommended ratio: 1 nurse to 4-5 patients. Critical care – 1 nurse to 1-2 patients o Control over practice: nurses make decisions – they have power/autonomy about their own practice § Indicators: • nursing input into policies/practices • participatory decision making • policies to support evidence based practices o Organization support: Nurses are valued § Indicators: • Orgo shows nurses are valued and their expertise is respected • creative and innovative ideas from nurses are received • health wellness and safety programs for nurses o Professional development: lifelong learning, research, conferences § Indicators: • sufficient orientation time for new staff\ • orientation tailored based on individual needs • precepting and mentoring programs What are the key features of magnet hospitals? • Transformational leadership – inspire and empower staff, encourage participation, innovation and shared decision making • Structural empowerment – involving nurses in decision making at all levels, encouraging autonomy, valuing their input • Exemplary professional practice – evidence-based practice, encourage engagement in research • New knowledge innovations and improvements – continuous learning, innovation, and improvement • Empirical quality results – systems in place to measure quality of care • Collaboration and interdisciplinary care – promote interdisciplinary care • Professional development and support – mentorship programs, supportive work env, work life balance • Nursing excellence – highest standards of nursing care – ongoing professional development What is a policy and the policy making process? - Policy: Specifically designated statement to guide decisions and action - Public policy: course of action that is anchored in a set of values regarding appropriate public goals and a set of beliefs about the best way of achieving those goals o Shaped by politic economic and social forces o Enacted through gov policy decisions o Determines the distribution of resources that influence people’s health Policy making process: How are nurses involved in the process of policy making? - Can raise public awareness of an issue - Nurse are ideally placed to collect and share stores of peoples lives that can riase awareness about health inequities Oppressed groups: - Disempowerment = oppression - Nursing is considered an oppressed group (female dominant) - Factors o Female occupation o Patriarchal, hierarchal structure in HC o Education (misconceptions) o Powerlessness is socially conditioned o The opposite of oppression is emancipation through social activism - Oppressed behaviors o Horizontal violence o Bullying culture o Nurses eat their young o Siding with physician and admin o Turning against nursing values (not advocating for patients) Definition of Power and Empowerment Types of Power - Legitimate power (position power): formal authority - Expert power: knowledge and skills - Connection power: who you know - Symbolic power: what you symbolize - Personal power: your reputation and credibility - Perceived power: having a reputation as a powerful person Empowerment: enabling one to act. The process of exercising one’s own power Types of empowerment What are the various theories of empowerment and how are they similar or difference from one another? Critical social theory: People are in positions of power/oppression based on their gender, race, sexual orientation, socioeconomic status - Sociopolitical and societal approaches to power - Critical feminist theory: focuses on the gender element of power. Nursing is largely female (gendered profession) Social psychology theory - Positive psychology – focuses on how individuals are motivated or not by our work - Psychological empowerment: if we help people start to see their work as a place where they have autonomy and a voice, they become psychologically empowered. Organization and management theories - Empowerment structures – which structures in the orgo that would lead to empowerment What is structural empowerment? What strategies help with structural empowerment? Structural empowerment: influencing the work env Strategies - Information: access to necessary info about aspects of an orgo – how the orgo functions - Resources: access to what you need as a nurse to efficiently carry out daily tasks - Supports: supports you need to function in your role - Opportunities - Formal and informal power What is psychological empowerment? What strategies help with psychological empowerment? Psychological empowerment: influencing individuals interpretations of the work env. Reflecting on individuals beliefs about their work. Intrinsic (interests, pride, curiosity, sense of achievement) and extrinsic (money, grades, career, praise, exams) motivation - 4 main dimensions o Meaning: you believe your work is valuable, meaningful o Impact: you believe your work will make a difference o Self determination: you believe that you have personal control or choice at work o Competence: you believe you have the ability to succeed - Access to empowerment structures (power tools) – improves how nurses feel about themselves in their workplace Nurses who are structurally and psychologically empowered are more satisfied and less likely to burnout/leave orgo Structural empowerment through the mediating variable of psychological empowerment leads to improved outcomes (orgo commitment, decreased burnout, more effort) What are leader empowering behaviors? What strategies help with leader empowering behaviors? 5 Categories of empowering behaviours 1. Enhance work meaningfulness 2. Foster participation in decision making (including staff in problem solving and decision making) 3. Express confidence (You can do it!) 4. Facilitate goals (education and prof dev opportunities) 5. Foster autonomy (remove obsolete policies and bureaucratic restraints, support nurses to regularly update evidence based protocols and policies 6. Networking (linking individuals with different skills and talents) - Empowering leaders express confidence in their staff Publicly value nurses Involve nurses in making imp decisions about health care delivery Support nurses in reaching their professional goals Empowering work env - Strong nurse leadership at all levels - Positive nurse-physician relationships - Safe staffing - Professional dev - Giving nurses more control over practice Emotional Intelligence - Self awareness, emotional self regulation, other awareness, interpersonal skills. - Knowing one’s own and other’s feeling and emotions - Critical to professional practice as are cognitive and technical skills - Need to be able to establish constructive criticism Appreciative inquiry: - A way to question and problem solve. Focuses on identifying what is working well and building on those strengths - Strength based strategy from positive psychology Individualized consideration - Often used by transformational leaders - Used with individuals or small groups of followers - Attentive and respectful listeners and engage with their followers to examine problems and find solutions together What is the process of empowerment and what outcomes does it drive? What other empowerment strategies can are used by nurses and nurse leaders? - Need nurse leaders to create a supportive env that fosters empowerment and encourages professional growth - Building powerful professional identities by accentuating why they are irreplaceable - Networking o Developing and maintaining relationships with a system of individuals who are sources of power, information advice and support o Eg: having coffee with someone from another department, using social media (wisely!) - Collective action o Activities that are undertaken by a group of people ro advocate for common interests or goals o Coalition building is an effective strategy for collective action o Coalitions: groups of individuals or orgos that join together temporarily around a common goal (eg. Community coalition concerned about COVID19) § Disseminate info, combat potentiel ethnic group discrimination, raise funds - Lobbies o More permanent partnerships that colations. Coalitions can develop into lobbies o Group of people who seek influence from the gov on specific issues
