What type of notification process does your organization have in place to both track and

react to harmful events? What steps does the board take to learn about and understand
a harmful event that is the factors involved in why the event occurred? How do you
reinforce accountability while continuing to monitor outcomes of care?
We monitor quality very carefully at the granular level, so when we set our quality goals
for the year, we do not start at the top and work down. We start at the bottom and work
up, so we go unit by unit and determine where they perform well.
Where they are not performing well and have opportunities to make gains, we take that
roll up and make that our goal for the coming year. That means that our quality
performance is not something the board pushes down. However, it comes up from the
organization with the commitment from everyone to perform better to design care for the
way our patients need it. Bring that to the board, and then get the board fully behind
them. We want everybody to it being fully engaged in this process. I think the quality is
all about the process. So I am a strong believer in the process, whether it is in quality
finance or any other part of our organization, unless we have a process to deal with our
issues on a day-to-day basis. We do not know what we are doing. That same thing
applies to an event occurs in our organization. We have a formalized process where we
step back and say what was the event? How did it occur? How do those holes in the
Swiss cheese lineup? Where are we doing things that we should be doing things
differently boards are an incredibly important to leverage point for quality and patient
safety in general what we find with boards is if you take a three-part approach you tend
to get really positive results in quality and patient safety and that approach can be
summarized as number one see the problem number two own the problem and number
three fix the problem in other words a board that is unaware that every hospital has
quality and patient safety problems that does not see that there's a problem will not be
able to do anything to address the problem or improve quality or patient safety by the
same token a board that knows that there's a problem that's that sees there's a problem
but doesn't believe they have any role in addressing the problem once again nothing of
any consequence or sustainability will occur it's only when a board through an
educational process and through a process of self-reflection both sees the problem in
owns the problem understands because they are the ultimate authority of the
organization or health system because they are in charge of over overseeing the
medical staff and the credentialing process the CEO performance evaluation process
that they control the levers of system asst and then and only then can they begin to fix
the problem many boards have now demanded an active notification of for significant
harm event and many management teams have built that into their routine evaluation of
central events where the senior management team is informed by frontline staff of a
potential central sentinel event of serious nature and that is correctly communicated to
either the board chair or the full board depending on the organization these active
notification systems allow boards to understand the issues that confront the
organization everyday and engage them in the active solution of recurrent problems we
have an automated patient safety tracking report that while I'm glad that it's less
frequently used because of our improvements does in fact send out broadcast
messages to all levels of the organization whenever an adverse event occurs in addition
we've on several occasions taking the unique step I think bringing patients and their
families into our board meetings and have them discussed firsthand with our board
members adverse events so that our board could understand both the challenges and
the opportunities for improvement respond immediately to first take corrective action
and secondly to develop a plan to ensure that it does not occur again and not only are
the individuals who are involved advised of it but there may be a need to share that with
the entire staff and in some instances training modules are developed around that
particular issue so that yes we respond immediately certainly to ensure that there's no
further harm to the patient or the patients we are serving we're also very transparent
about quality we publish that both on our intranet and owner owner internet and it is
hardwired into every single management agenda throughout the organization quality is
also a major part of our evaluation of our employee staff from the front lines to the
boardroom we have some checks and balances in place to not only identify but more
importantly I'm not to sweep it under the carpet quality is something that that we feel
has to be totally transparent and realizing that we we all strive for a hundred percent but
we're not going to get there so when we come up short that the key to it is how do we
do better so that we don't have a reoccurrence of some of the same issues what we
tried to do in our organization is set their expectations very very clear regarding quality
safety performance and behaviors and we know that if we set clear expectations that
the vast majority of people perform to those expectations and usually exceed them if
people are challenged in meeting those expectations we believe in addressing that we
believe in coaching that so when something happens in our organization we learn about
it right away we talk about our quality we talk about our safety we talked about events
we talk about things happening within our communities over the next week so all of us
can be aware of what's going on we get a chance to ask the questions as to why how
and how do we avoid this from happening again what are the the factors that
contributed to to the shard coming and how do we again prevent it from from being a
reoccurrence our board is very involved in our quality oversight now quality
improvement efforts we do have a quality and patient safety board committee that
meets monthly and they focus on specific results and initiatives and strategies we also
have at the Quality committee not only a deep dive of results but we include a patient
story it could be a near miss it could be an event that we regret it happen so we talk
about the issue the systems that led to it what we learned from it actively participate in
helping devise two solutions to the problems and spread the learnings to all parts of the
organization this is a critical role for the board notification should be a way that
management engages the blood in all their harm and safety improvement activities
organizations need to have effective quality and safety measures and tracking
processes in place that identify a patient harm has occurred the board and hospital or
health system leadership should have an established process for responding to and
learning from harm events boards and leadership need to be transparent about
performance in order for learning to occur and must be open to hearing the bad as well
as good patient stories ------------
hi everyone i'm jess blank shane from the national security affairs department at the
naval war college everything i'm about to say represents my own personal views not
those of my employer today we're going to introduce the organizational process
perspective this is intended to complement your assigned reading from chapter 5 of the
decision making in american foreign policy textbook to start we'll situate the
organizational process perspective in our overall foreign policy analysis framework as
we discussed previously this course will use a number of analytical perspectives to
isolate key actors and behaviors that help us understand foreign policy decision making
today we're going to look at the organizational process perspective which focuses on
governmental organizations making foreign policy decisions or making foreign policy by
processing information and initiating action based on pre-existing procedures and
organizational culture this also means that we're moving to the state or societal level of
analysis in our levels of analysis framework looking at explanations of foreign policy
decision making that focus on the internal organizations and political cultures of a state
we'll start by talking about what it means to think of organizations as actors and then
we'll talk about what it means to view foreign policy as outputs of these organizations so
what does it mean to think of an organization as an actor we know that organizations
like the department of state or the central intelligence agency are made up of people but
just like when we talked about the unitary state perspective we abstracted away from all
the organizations and people that make up states when we use the organizational
process perspective we're going to abstract away from the people who make up the
organizations to look at organizations as actors in their own right and in this view
organizations are defined by their mission their structure and their culture a government
organization's high level mission or purpose is usually determined at its founding by
congress or the president or some combination whoever created the organization but is
often stated in broad terms leaving plenty of room for interpretation of the mission and
for changes over time morton halperin created the term organizational essence to
describe quote the view held by the dominant group within the organization of what its
mission and capabilities should be end quote essence is in a sense the organization's
identity and it's important to note that as halperin's definition suggests these definitions
of identity can be contested they can change over time and different groups within the
organization or different subcomponents of the organization may have different views of
what the organization should be doing and may compete over that but we're going to
assume that most of the time our government organizations do have some dominant
sense of essence of what their overall mission and purpose is organizations are also
defined by their structure a key function of organizations why we have them is that they
allow for specialization and for coordination through organizations people can
accomplish things that they couldn't do working independently tasks are split up both
across and within organizations allowing sub organizations and individuals to specialize
in different types of tasks but this also requires delegation which means that the leader
either of an organization or of the state as a whole loses some degree of control in
exchange for the benefits of specialization this this phenomenon of specialized
specialization and delegation is sometimes called factored problems and fractionated
power an organization structure determines how it divides up issues into different
specialties and then coordinates or puts them back together as with essence an
organization structure can evolve and change over time both through intentional
reorganizations which we see from time to time and less explicitly through changes in
the reality of how things are done which doesn't always exactly match the formal
organizational chart finally an organization is defined by its culture culture is a shared
understanding within the organization about what behaviors and actions are valued and
accepted by the organization and it really shapes the way that the organization sees the
world and thinks about its work and its role in the world and this is true even when
culture is implicit or not fully explicitly recognized by members of the organization
sometimes people describe the relationship between members of an organization and
its culture as similar to the relationship between fish and water it's so pervasive that they
don't even know they're in it so that's what it means to think of an organization as an
entity that has an identity in the sense of essence and even a personality in the sense of
its culture but what does it mean to think of foreign policy as outputs of what that
organizational of what that organization does an organization's mission structure and
culture lead it to create processes and capabilities and to accumulate information and
knowledge in the course of attempting to fulfill its mission in accordance with its culture
but organizations are compete are completing dozens or hundreds or thousands of
tasks all at the same time so they need to operate efficiently dealing with each incoming
issue or problem on an individual basis applying the rational decision-making model that
we discussed last time in the unitary state perspective would take way too much time
the organization would get very little done so instead of optimizing organizations do
what is called satisficing that means that rather than considering all of the possible
alternatives all of the things they could do and picking the very best one the
organization instead is just going to contin consider alternatives until it finds one that is
good enough and so in a satisficing process two things are really important in
determining what decision will be made the first is the way that the organization
searches for alternatives the order that it goes through things and also the way that it
defines its standards of good enough which will determine what it finally chooses and
both of these things are going to be shaped by the organization's mission structure and
culture organizations basically institutionalize satisficing through the use of routines and
standard operating procedures which we often abbreviate as sops much of the
everyday work of an organization is done by sop these often take an almost computer
program like form of if then statements if this happens then i do that in response some
of these are very simple for example if i work in a consulate maybe and someone
arrives asking for a visa i ask them for the appropriate form and documentation and
then if they give me that then i give them the visa or in a different type of situation if i as
an analyst receive a report of type x then i know i'm supposed to summarize that report
and pass it on to person a in my organization now of course sops can also be much
more complicated than these simple examples but the idea is that they provide a
structure and a regularized way of doing things that will be good enough on average
most of the time it will do a good enough job it will get the job done but it's important to
note that there are situations where this can go wrong where sops can produce very
bad or occasionally very good although we talk about those less frequently outlier
outcomes this can happen in particular if a situation is categorized incorrectly and then
as a result the wrong sop is applied or perhaps an sop just produces unintended
consequences in a particular situation still overall again we're concerned about
efficiency about getting a lot done relatively well sops are going to give us good
performance on average and they also allow for coordination within and across the
organization as different parts of the organization know what to expect from the other
parts so this view of policy as organizational outputs something happens and as a result
the organization more or less automatically does something helps us understand how
things work well below the level of our senior decision makers that we often think of as
making policy the everyday workings of foreign policy organizations often don't rise to
very senior levels they only have so much time and attention that they can give to
issues so most things are resolved at much lower levels but organizational process also
describes one other role that organizations affect foreign policy and that is that they
shape the foreign policy decision making environment in addition to taking actions
through sops organizations also use sops to collect and to process information now this
leads to an important phenomenon called uncertainty absorption which occurs when
various specialized parts of the organization collect information and then they
summarize the key findings of that information and pass it over or up within the
organization so as one analyst put it what they're effectively doing is quote substituting
inferences or judgments for facts end quote and so what we mean by uncertainty
absorption is that at each level uncertainty or sort of detail is being removed from the
process there are judgments made about what certain data means and that judgment is
passed up rather than the raw data itself which again is the benefit of organizations the
the more senior individuals don't have the time and attention to look at every detailed
piece of information so they rely on these summaries but that does mean that as we
said we're substituting analysis and judgments at various levels of the organization for
the raw data so the work that organizations do every day both in processing information
and in creating capabilities to do things um which can both be processes and actually
uh creating uh sort of capital stuff that allows them to do things do shape higher level
decisions so you can see here on the left we have information and capabilities of the
organizations the things that it has processes and the capabilities to do those create the
options that are available to senior decision makers for some of these decisions that do
rise to the highest levels but the organizational process perspective also helps us
understand how these high level decisions are then implemented on the right side of
your screen you see that once senior decision makers actually set policy they usually
don't do it in a way that specifies every single action that's supposed to happen there's a
lot of room for the organizations to fill in the blanks and to decide what a policy actually
means they should do so all of this put together through the organizational process
perspective helps us understand how foreign policy actions might not accord with the
predictions of the unitary state perspective that we talked about last time government
action might not be fully coordinated individual organizations may be creating outputs
independently not fully coordinated or sort of um intended by any one decision-making
entity and also at the same time organizational context in terms of capabilities and
information as it is summarized and passed up through the organizations can shape
decisions in ways that senior decision makers don't always fully realize so that was your
brief introduction to the organizational process perspective thank you for watching i will
be back next time to talk about another perspective that focuses on the state societal
level on organizations as actors the bureaucratic politics perspective
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we can view an organization in one of two ways either as a structure or some form of
framework of relationships or as a process or a set of processes and in this video I want
to look at how we can understand organizations as sets of processes to understand
organizations as a process or as a set of processes I think we first need to understand
the nature of a process and there are four components to think about the first of those
almost obviously is inputs this is ideas information knowledge strategy or materials or
equipment that goes into making things happen second there are controls controls are
the sets of rules that make certain things happen and stop other things happen they
drive the process third we have mechanisms this is the people or the technology the
systems or the suppliers that make things happen they execute the rules they exert
control over what's going on and finally a process has outputs the stuff that comes out
of the process either new information new services new products whatever it is that the
process is set up to create if the process is working it emerges as an output there are
two ways we can look at an organization as a set of processes we can first of all take
the organizing perspective from this point of view what we are fundamentally saying is
an organization is a body that organizes stuff the processes that it creates are there to
make stuff happen the second perspective is taking a look at an organization from the
point of view of a value chain a set of processes that start with something of low value
and turn out something of higher value that enables the organization to earn the
revenue that feeds it in a way this is like looking at organizations as an organism which
we saw in our video about morgan's eight metaphors an organism needs to take in
some food in order to provide the excess power to do work and it's the same with
organizations they take in raw materials or unfinished products and they finish those
products and put them out and that generates a value which feeds the organization and
perpetuates its existence from an organizing perspective here are some of the
processes that we would expect to see in any or most organizations determining
activities that are needed to accomplish the organization's objectives the grouping of
related activities securing the resources to carry out those activities then the division
and allocation of the work delegating authority to make stuff happen and coordinating
the efforts of different persons different groups in order to deliver value we can see that
those kinds of processes are going to happen throughout the value chain so what is the
value chain well the value chain is a set of processes that drive value let's take a look at
some of those typical processes the first process is understanding what your customer
needs or what it is that the organization will need to create to generate value then there
are a whole set of processes around research and development of the services or
products the organization is going to create then there is the sourcing of raw materials
and equipment and assets and people and then there's the purchasing of those raw
materials or assets their delivery and the whole supply chain then there's the processing
or manufacture or creation processes we've got marketing processes which bring the
organization services or products to the awareness of people who might need them and
then the selling processes which trigger the purchase then we've got processes around
delivery another aspect of the supply chain and finally there's the delivery of service that
goes with the products or services that the value chain has created organizations are
filled with processes and back in the late 1990s it became very fashionable to map out
those processes and to re-engineer them to become more efficient without a doubt that
has led to various movements like lean and six sigma which have aimed to optimize
those processes in different ways however if you start with the understanding that
organizations are filled with processes and that understanding those processes will help
you to understand your organization then you will be in a good place to better
understand your role as a manager please do give us a thumbs up if you like this video
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