Coordination & Communication Within Health Care Organization Essay Example
Coordination & Communication Within Health Care Organization Essay Example

Coordination & Communication Within Health Care Organization Essay Example

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  • Pages: 12 (3062 words)
  • Published: October 27, 2017
  • Type: Research Paper
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Health Care Organization is unique and complex entity consisting of groups of specialized people with specific purpose in the set of rules, policies, procedures, relationships and culture.

It is highly diverse organization consisting of people from different functionality, in management side includes human resources, finance and accounting, information systems, maintenance housekeeping; in clinical side includes physicians specialized in different departments of medicines, nurses, laboratory technicians and the list continues.Expertise in each department ranges from new to highly proficient. There is no room for a mistake in health care organization as they deal with life and death. It is very sophisticated, having very little tolerance with error, requires a very close net and efficiency between departments which has to be characterized by high level co-ordination and communication. In fact, communication can be considered a co-

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ordination device (Dietz, 2002).

Coordination is the act of making different people or things work together for a goal or effect.It deals with the interdependencies by effectively linking together the various parts of organization or by linking two or more organizations to pursue a common objective (Malone & Crowston, 1994). Many researches were conducted regarding effect of coordination in health organization. The results indicate that it plays an important role in performance and efficiency of health care organization. More recent studies of health care delivery settings also indicate that effective coordination of staff leads to better clinical outcomes (Gittell et all. , 2000; Yougn et al., 1997; Young et al. 1998). The logic behind coordination is the presence of dependencies between departments and their activities. And the goal of coordination is to manage these dependencies in such a way that the activities become par

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of the organization’s objective (Holt, 1998). If there is no interdependence between departments or organizations then there is nothing to coordinate (Malone & Crowston, 1994).

Dependencies cannot be avoidable, only it can be coordinated to achieve a purposeful goal of the organization. The role of communication in coordination was overlooked by Malone and Crowston.Coordination is usually achieved with some kind of communication or transfer of information. Health care organization being a complex organization cannot be handled by a single man’s perspective, and therefore a completely centralized control is required which is relatively autonomous in the goals they pursue but still interdependent (Hayek, 1945). In this highly diverse organization, coordination between professional groups, patient care units and service components within the organizations is highly important to the performance of health delivery system.

Depending upon the function, organizations are typically differentiated.Within the organization, the degree of differentiation also varies reflecting its structure (Charns & Tweksbury, 1993). For example, in a hospital there are primary clinical departments of medicine, surgery, and neurology, are further differentiated into various subspecialties like cardiology, nephrology within the departments of medicines. This kind of differentiated and specialized organization requires substantial degree of coordination.

Various different kinds of intra-organizational mechanisms are used by health care managers to coordinate work activities.In 1958, two primary types of co-ordinations, programming and feedback was identified by March and Simon. Programming standardizes work activities for all expected requirements whereas feedback coordinates the exchange of information among staff during the work. Later, in 1992, Mintzberg elaborated on the March and Simon’s coordination mechanism by identifying five different mechanism, mutual adjustment, direct supervision, standardization of work processes, standardization of work outputs, and standardization of

worker skills (See table 1). Coordination mechanismDefinitionMutual adjustmentAchieves coordination by the simple process of informal communication among individuals who are not in a hierarchical relationship to one another.

Direct supervisionAchieves coordination by having one person takes the responsibility of others work by giving them instructions and monitoring their actions. Standardization of work processesAchieves coordination by specifying the work processes of people carrying out interrelated tasks like standard admission and discharge procedures. Standardization of work outputAchieves coordination by specifying the results of the work like how the work is performed by the worker.Standardization of work skills and Knowledge Achieves coordination of work by virtue of the related training the workers have received.

Table 1: Coordination Mechanism in Organizations (Mintzberg, 1979) Depending upon the situations various combination of the coordination mechanisms are used by the managers at various levels of success. It is also responsibility of the manager to build an effective coordinated environment in the organization, by standardizing the procedures, guidelines, operation manuals, and job description, and stay alert to identify coordination problems and to resolve them as they arise.

Communication is the process of transferring information from a sender to a receiver with the use of a medium in which the communicated information is understood by both sender and receiver. Medium can be written, verbal or non-verbal. If it is done effectively, one of four things or some combination of them is accomplished: information transmission, motivation, control, and emotive expression (Scott, Mitchell, & Birnbaummore, 1981). Information is the main component with is transferred in any organization for operating activities, resources, alternatives, plans and to make good decision or take appropriate action.

Communicative acts are exchanging information between participants. A

rather precise definition of communicative action by Habermas (adapted from Koningsveld and Mertens, 1992) is:

Communicative action consists of: - A level of shared background on the basis of which the actors create a “shared understanding” (interpret the situation at hand) by means of conversation (formal or informal);

- An operational level that rests on the basis of this “shared understanding” and deals with dependencies and problems related to instrumental action; this operational level consists of the use of regulative “language acts”. Basically there are two kinds of communicative acts: conversational acts that work on level of shared background and consensual acts that work on the operational level. Conversational acts or conversation are often described as informal communicative acts.

In dealing with interdependencies, the current situation is interpreted against a common, shared background, so that conversation can be informal (Koningsveld and Mertens, 1992). For example, within an organization, conversations start around the coffee-machine, or during lunch-breaks, or in hallways, etc.On other hand, consensual acts are explained by Koningsveld and Mertens (1992) as a brief version of communicative acts, where the interpretation of the situation (shared understanding) is given beforehand. An example here might be a surgeon who operates on a patient in coordination with nurses assisting him. Because of the vast amount of standard operating procedures (standardization of work, skills and norms) that are present in this situation, the needed “shared understanding” of the situation at hand is assumed to be implicit.This action type directly relates to the second part of Habermas’s definition of communicative action, namely that its main focus is coordinating problems of instrumental actions with the use of regulative language acts.

There are different kinds of

communication in an organization depending upon the flow of information. When the information flows from top to down i. e. from senior level staff to junior level staff, which includes giving directions and information, it is said downward flow. Similar, when it moves from down to top i. e. rom lower level staff to higher level staff, which includes giving suggestions or feedback, it is said upward flow. This type of flow helps in decision – making process, reveal problem areas and generally provide an insight to the thinking of the junior staff. Upward flow becomes more important part of communication with increase in complexity of the organization. Horizontal flow when information flow takes place at the same level that is communication between managers of one department with the manager of other department in the organization.

In the complex organization this type of flow of communication is very important.Finally, the diagonal flow breaks the usual pattern of upward, horizontal and downward flows by cutting across the departments. It is usually rare yet very important in health care organization. This flow of information within an organization has been combined into patterns called communication networks.

There are five types of networks namely chain, Y, wheel, circle, and all-channel. Chain network can be seen in hierarchical pattern that characterizes mainly formal information flow, upward or downward, seen in military and some types of government organizations.Y network shows two people to a superior who reports to two others, for example, 2 staff pharmacists reporting to pharmacy director who in turn reporting to the vice president. Wheel network is a kind of one man rule that is all employees reporting to one

supervisor.

Circle network allows communicators in the network to communicate directly. In this everyone communicates with everyone, there is no superiority. All channel networks is a kind of circle pattern but here everyone communicates with each other. It is like spider web.In circle and all channel networks the information tends to flow faster and effectively than other types of networks. Performance of the organization can be known through many kinds of communication like activity reports, policies to establish standard operating procedures, budgets, and face-to-face directives.

Communication plays a central part in coordination as it enhances control while clarifying duties and responsibilities. Communication plays an important role in coordination. Mutual adjustment is the most basic coordination mechanism as identified by Mintzberg (1989).Mutual adjustment is where organizations start, and mutual adjustment is also the most prominent mechanism in organizations that support sophisticated innovation. According to [Mintzberg, 1989:218], the real root of inefficiency is the high cost of communication.

Mutual adjustment is very costly when the agents have to start from scratch. The larger the shared background, either in terms of shared knowledge of the situation or, more specifically, in terms of behavioral patterns, the more efficient will be the communication processes.To encourage effective communication, organizations must overcome many obstacles that block, filter, and distort messages. Hierarchical organizations tend to promote only vertical flows of information, from top managers to supervisors to workers.

Providing information horizontally, across units, is crucial for coordination. For example, health care providers may not even know how to refer patients for other services within their own facility. Coordination and communication are closely related strategies through which various people and units within the health care organization and link

it to other organization and agencies.Due to the high level of interdependencies that exist in health care organization, coordination and communication becomes more important for the survival of the organization and continue to face the external challenges.

For example, a patient, having a cardiac problem, is directed in cardiology department, but if he/she also has kidney problem then cardiology department has to closely work with nephrology department for the treatment of the patient. Not to forget the nurses and laboratory personnel.The quality of care of the patient greatly, depends on how closely the departments/physicians coordinate and communicate with each other and others. A severe coordination problem may occur, if the skills of different professionals in the organization do not match.

According to Mintzberg, standardization of skills is a “loose coordination mechanism at best”. Hence it is very important that the professionals do not only have the technical skills to perform the instrumental acts on an adequate level, but also the communicative skills – and means - to relate to other professionals.As the health care organization evolved, technologies increases, so do the coordination and communication mechanisms that they use. For example, the shift to e-commerce involves among other things that organizations are confronted with new forms of information technology. On the one hand, this technology reduces uncertainty by creating the opportunity of a shorter time span of definite feedback and by increasing the clarity of information.

It may even reduce the degree of information asymmetry, by disclosing relevant information on time to the relevant people involved. However, the rate at which information is being exchanged is much higher than in traditional non e-commerce settings. To adjust with this new

technologies mutual adjustment or horizontal coordination – also referred to as internal networks or lateral relationships (Galbraith, 1994) – is the most significant contemporary development in organization design (Daft, 1998; Minztberg, 1989). See Figure 1. Standardization of work Mutual adjustment

  • Direct Supervision
  • Standardization of outputs
  • Mutual adjustment (In hierarchy)
  • Standardization of skills (In network)

Figure 1: Evolution of coordination mechanisms, adapted from (Mintzberg 1979) Technology, like patient records, voice mails, internet connections, emails, has played a very important role in increasing communication and coordination within the healthcare organization. It transformed the manual patient flow method to advanced flow logistics system.

These reduced the time in decision making, errors mainly due to handwritings, reduce costs of operation and made the resources more transparent.Paper files of patients has replaced by the data on the computer which can be viewed immediately by everyone in the organization by the patient medical record number. Patients information regarding their medical conditions, allergies, medications and personal identification are stored which can be viewed by all physicians treating the patient. In order to use this information effectively, the health care organization must develop good communication and coordination for patient safety, quality of care and overall cost.In developing health care organizations, information technology is spread over the horizontal dimension and is used for coordinating the different departments throughout the organization.

Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system. Personal health records (PHRs) are an emerging technology to enable people to manage their health information and health care transactions electronically.By facilitating a host of health management activities, PHRs have the

potential not only to improve personal and family health but also to support major national health objectives (Lansky, Kanaan, Lemieux, 2005). It was initially found in 1996, to provide healthcare professionals with mobile computing solutions that help improve patient care and curb rising cost. According to Gartner Group, “Efforts to achieve a 50% reduction in medical errors are doomed to failure unless they occur in the context of a computer-based patient record implementation”.

Collaborative coordination and communication between Patients, Physicians, Pharmacists, Hospitals, Medicalert, Patient Keeper and Express Scripts is critical to reduce medical errors while improving compliance and lowering cost. Patient flow logistics and tracking software coordinates patients and resources from admission through discharge. It provides an immediate and comprehensive view of the entire patient flow process with real time tools to manage that flow within and between hospital departments. Recently Kaiser Permanente, founded in 1945 as not – for – profit organization, announced that all of its 8. 7 million members in nine states and the District of Columbia are now covered by an outpatient electronic health record.

Kaiser Permanente Health Connect(TM), is the world's largest privately funded electronic health record. All of Kaiser Permanente's 13,000 physicians now have electronic access to their patients' medical records in every one of their 421 medical offices/clinics.The deployment of Kaiser Permanente HealthConnect has proven to be integral to improving patient safety, coordination of care, enhancing documentation, facilitating clinical decision making and adherence to evidence-based clinical guidelines, and provider and operational efficiency. After the implementation of Kaiser Permanente HealthConnect in the outpatient setting, Kaiser Permanente experienced an immediate and marked increase in the efficiency of outpatient care, in large part

due to now 24/7 availability of members' clinical information at every member contact.Members began using secure messaging and increased use of telephone visits in lieu of in-person visits. Physicians reported that, in many cases, electronic health records enabled them to identify and resolve patients' health issues in the first contact.

Nowadays, software is carefully designed to meet the needs of the health care organization, to help hospitals and other healthcare providers to fulfill their mission of providing superior healthcare – with a low cost.It brings a high degree of integration that enables health care staff to enhance patient care and satisfaction and by providing comprehensive tool to run the organization including financials, human resources, procedures and logistics. Conclusion Dependencies in a health care organization, which is unique, complex and diverse, cannot be managed without coordination and communication. The more differentiation and specialization of labor, the greater the need for coordination and effective communication is required.

With the development of technologies it became easier to coordinate the workflow and develop communication between departments more effectively. That overall improved the inter-department communication and coordination.

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