An organization depends on its supporting environment for continued inputs to ensure its sustainability and processes these inputs through the recurring and patterned activities and interactions of individuals to yield outputs (Meyer and O’Brien-Pallas, 2010). An organization is therefore essentially a social system. As such, an organization and its subsystems strive to achieve a dynamic steady state whereby regularities in energy flow preserve the character of the system and disturbances prompt system adaptation. To survive, an organization needs to counteract entropy, which is an inevitable process of disorder and dissolution caused by loss of inputs or by inability to transform energies. The following is a summary description of Elmo Health Care Organization (EHCO).
System theory model attempts to relate events and components of an organization thereby leading realization of quality outputs in the organizational system (Johnson, et al, 2007). The approach has the following terminologies.
Inputs – EHCO Imported inputs consist of care recipients, staff, material and fiscal resources and information, which are subsequently transformed in a nursing production subsystem through the work performed, its structure, and its internal work conditions. The inputs are further classified as either maintenance or production; Maintenance Inputs are like the energy imports that sustain system while Production Inputs energy imports which are processed to yield a productive outcome. Throughput- these refer to the System parts that transform the material or energy, EHCO applies this to convert the inputs or the raw materials from its surrounding into products and services with utility to the system itself as well as the environment. Throughput are processes that among others include physical examination of the patients , diagnosing, thinking, planning, decision-making, writing prescription, taking vital signs, operating on a patient, constructing, sorting, making a speech, sharing information, meeting in groups, discussing, melting, hammering and shaping (Marquis and Huston, 2012). Output is the product or service which results from the system’s throughput or processing of materials, energy inputs and human input. Examples of outputs realized by EHCO include health services, better health, software programs, documents, decisions, laws, rules, money, assistance, cars, clothing, bills, and nurse-patient relationships among others. EHCO therefore utilizes the inputs from the surrounding environment and process them into better end products otherwise termed as outputs. The following is the EHCO summary of cycles of events.
- Control relationship that represents hierarchically determined practitioner standards, generated from the accreditation system and given to the EHCO-level system
- Communication relationship which represents the communication of outcomes of the overall system to the EHCO-level system for its own internal control response
- Communicates associations in the outputs of the accreditation and overall systems
- Control relationship which provides feedback from the EHCO’s output to the accreditation system’s input and finally back to one since the cycle is continuous.
Feedback is information about some aspect of data or energy processing that can be used to evaluate & monitor the system & to guide it to more effective performance. For example EHCO can employ questions like, how many patients were are seen in 2 hours clinic? How man medical errors were committed in a hospital? Why were mistakes made? Hospital accreditation reports are an example as are patient satisfaction surveys, sales reports, and test results.
Subsystem is a system which is a part of a larger system. They can work parallel to
EHCO are using the conceptual frameworks in isolation. This therefore is the major problem making EHCO not to successfully realize its goals. Any system must have a goal. The goal is the overall purpose for existence of the system. Examples include; treating patients, to educate student nurses, to produce knowledge, using open system approach, input, throughput and output interrelate. Conceptual frameworks of nursing care based on formulation for the assessment of care quality typically organize patient, nurse, work, work environment, and outcome variables according to structure, process, and outcome, due to an approach for assessing the quality of medical care, rather than on system design and organization (Marquis and Huston 2012). Rationales for including variables in a structure–process–outcome framework have tended to rely on empirical findings, rather than a theoretical understanding of the nature of an organization or the delivery of nursing services. In addition, because linear relationships are frequently assumed between structure, process, and outcome variables, the dynamic interactions between variables are often neglected.
Addressing the problem
To be part of the system any element must have a relationship with at least one element of the system. Any element which has no relationship with any other element of the system cannot be a part of that system. An open system as stated above has the key elements as input, throughput or process, output, feedback; control, environment, and goal. Systems have varying degrees of complexity. The organized components of a system comprise a unified whole that is greater than the sum of its components. To be viable and successful, a system must be goal-directed, able to adapt to changing environment, technology and circumstances, and be governed by feedback and must value continuous leaning and development, creativity and innovation. And to survive, a system must save some of its output to maintain itself. The structure of systems is defined by its components and processes. Various system components have functional and structural relationships between each other and are organized in a way to accomplish a specific function or set of functions. Systems often exchange material, information and/or energy beyond its boundary with other systems, through input and output processes.
Proposed goals and objectives
Promoting, protecting and improving health and social well being
Improving practice learning and development plan Ensuring coherent of activities as well as the key elements of the system
Standards help achieve greater consistency and accountability in the quality of care provided. A range of standards have been developed:
- controls assurance standards to assist organizations demonstrate they are managing environmental risk effectively
- minimum care standards to help agencies provide consistent care
- quality standards for health and social care
- occupational standards as well as inspection standards to support clinical and social care governance to help staff in their everyday work
In order to create a well-designed closed feedback loop among the accreditation, series of adaptive studies related to the relationships need to be pursued. The relationship should be explored with the surveyor-based adaptive study reported upon in the system Implementation of the conclusions augurs well for surveyors ultimately being able to produce valuable feedback to HCOs via the accreditation process.
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