Hospital political landscapes can be quite complex to navigate. The complexity of the landscapes includes formal and informal lines of power that can make change quite challenging. To further complicate things, multiple power dynamics can make strategic planning difficult. This paper analyzes the political landscape in a hospital and the affiliated critical issues.
Formal and Informal Lines of Power
At the community-based hospital, there is a perception that there exists a dichotomy between the formal and informal lines of power based on the hierarchical relationships that exist. A formal line of power concerns an individual’s legitimate power by the formal organizational structure or a position that they occupy (Ramos et al., 2019). Formal power structure at the hospital is vested in the hierarchy of positions held within the hospital and include members of the hospital board, the chief executive officer (CEO), chief medical officer (CMO), the chief nursing officer (CNO), and the advance practice registered nurses (APRNs). For instance, the CEO in the given care system is most powerful along the leadership hierarchy. An informal line of power entails the expertise or reference structure in an organization (Ramos et al., 2019). For instance, an individual may have informal power by virtually holding a piece of information or affiliating to a group. In the case study, the 15 resistant APRNs bear informal power, which they are likely to influence policy development and implementation in the care system.
The CMO also enjoys informal power for outstanding work to initiate the orthopedic program and serve the community for a long time. There are many sources of power, but Ramos et al. (2019) find that the main ones include confidence in a group, proficiency in using information, knowledge and communication skills, hierarchy, mediatory roles, organization culture, and capacity control. Power is used to influence intangible gains for the players found within the hospital’s existing power structures. Some of the positive implications of power include ensuring discipline, bringing order, changing behavior, and prompting action plan, while negative implications concern loss of coordination and cooperation (Belaya & Hanf, 2016). It is imperative to note that the authority and decision-making power of each individual varies. However, the contributions of each are necessary to help the hospital achieve the desired magnet status.
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Organizational Power Influences Executive-Level Decision-Making
Organizational power impacts permeate executive-level decision-making and are guided by organization culture, communication, and policies based on the hospital’s hierarchical relationships. In this case, hierarchical relationships concern the power differential explained above. Since each individual in an organization has their share of informal or formal powers, many opinions and interests often arise during decision making. Further, organization decision making is influenced by “technology, diversity, globalization, policy, teamwork, and leadership effectiveness” (Obioma Ejimabo, 2015). These dynamics are critical in theory and practice, as they ensure consensus and effectiveness of conflict resolution. For instance, hospital leadership should methodically and consistently evaluate how various decisions will impact culture, and this can be manifested in teamwork, communication channels, and conflict resolution. This is necessary for ensuring that the leadership views have coherence with the other people’s ‘artifactual’ image of the organization’s values and the expectations of the communities served.
Executive-level decision making should also be cognizant of the power dynamics at play at the healthcare organization. This is premised because power is institutionalized and, therefore, is distributed in a pyramidal manner and people or departments have different expanses of the power vested in each (Rogers, 2017). As such, the expectation is that those involved in decision-making may have conflicts when different perspectives are presented. For instance, in the recommendations of the CMO in transferring the APRNs to the hospitalist group. According to Rogers (2017), power dynamics can be a barricade to a successful transformation. Therefore, it will be essential to adopt a collaborative problem-solving process (Mastio & Dovey, 2019).
Also, the higher the power, it is expected that decision making will be high and vice versa. Nevertheless, a study has found that principles determine high and low decision-making include compatibility between thinking style and the task at hand and the proficiency in information processing (Ayal et al., 2015). The decision-making style shapes the implementation of organizational change, and as such, poor decision-making can derail the institutional and political systems that usually shape the change process. In this case, the APRNs emerge as the force that is attempting to hinder the change process from maintaining the above balance. Ensuring an informed decision-making process necessitates joint management of the APRNs’ transformation and education on the envisaged changes and how it will benefit the APRNs. Davis (2017) suggests that resistance by the APRNs should not be perceived as an obstruction to change to foster seamless transformation.
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Based on a candid evaluation of the internal power structures and my perspectives as the CNO, refinement of the healthcare organization’s culture in line with current practice is vital. In responding to the APRNs’ concerns, the CNO should manage the process of change collaboratively (Davis, 2017). The transformation should be managed by embracing the views of the APRNs and discussing them jointly. Also, an education plan should be conducted to inform ARNPs of the benefits of the proposed changes. Scholarly discourses have established commonality in asserting that a section of an organization can be resistant to change or transformation. Therefore, a network of powers should be leveraged to harness sufficient transformation power (Ramos et al., 2019). The plan comprises the assumption of a positive that the joint discussion will result in a consensus, and the education program will sufficiently transform the 15 APRNs. I also acknowledge that the joint discussion might favor the opposition to challenge implementing the proposed changes.
The Influence of Power on Organizational Policy
The hospital’s formal and informal power structures also impact policies and how they are communicated at different hierarchical levels to achieve specific outcomes. Since policies and communication at the organization will primarily be associated with the new values that the organization stands for insofar as the transition is concerned, the leadership will take cognizance that communication approaches used correspond to the specific descriptive elements spearheads its latest initiatives. Ramos et al. (2019) suggest a consensus approach where a network of specialized power structures is leveraged to develop and implement organization policies. This should be done diligently to avoid adverse impacts on the organization’s power balance (Davis, 2017). A study has found that balance in power harness a politically stable workplace, which fosters employees’ proactivity, creativity, and collaboration (Eldor, 2016). According to Ayal et al. (2015), such a workplace is likely to reveal improved decision-making due to consensus and influences of the power structure.
Source of Power
In achieving a primary strategic objective from the scenario, some perceptions would get depicted based on the following sources of power: authority, rewards, coercion, expertise, reputation, and personal power (Belaya & Hanf, 2016). In this landscape, authority is the ideal source of power. Authority provides the formal line of power, which is obtained by virtue of organizational hierarchy. This will ensure a balance in power and respect to the care system’s decision-making framework (Davis, 2017). For instance, the CNO has legitimate power in the organization, but this power is over the nursing staff alone, so if the APRNs are not employed by nursing, then the CNO has no authority regarding the APRNs. Also, Sagi (2015) explains that authority in organizational decision-making sets a direction for policymaking, sets agendas, and is a powerful tool to manipulate others’ views. However, Sagi (2015) contends that authority may cause adverse implications related to politics, which necessitates a critical review of organizational practices in regards to ethics. For instance, the CNO or other managers may not use their authoritative power to manipulate or threaten the 15 APRNs but seek a consensus through joint discussions and educational programs.
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