Examining the Role of Healthcare Managers in Nursing Homes

Introduction

In the field of medical services, the healthcare environment is always considered as a major concern as it is the area where health care services are to be provided to the service users or patients to ensure their enhanced health and well-being. The presence of a well-managed, well-structured, empowering, positive and safe healthcare environment is important to deliver high-quality care to the service users. The presence of an effective healthcare environment is possible for active roles played by the healthcare manager and use of appropriate organisational structure to maintain positive work culture in the environment that promotes high-quality care to be delivered to the patients. Thus, in this study, the role of the healthcare manager in the nursing home which is an area of service provision in the medical field is to be discussed. The way organisation structure influences culture in the healthcare organisation is to be analysed and discussed. Finally, the different organisational structure present in the healthcare social care environment and business is to be explained.

Discussing the role of the healthcare manager

The role of the healthcare manager is based on the area of service provision or care setting where they are operating. The nursing home is one of the key areas of service provision which is a private institution for offering residential accommodation to patients with healthcare difficulties (Lavallée et al., 2018). The role of the healthcare manager in nursing home is to manage and control overall healthcare operation delivered through the nursing facility to the service users. This is because the healthcare managers are responsible for directing use of resources and way of working activities in the nursing home (Kwon et al., 2016). As argued by Salmond and Echevarria (2017), inability of the healthcare managers to manage delivery of services by appropriate use of resources in the healthcare facility leads to hindered health condition of the patient. This is because unsafe care practices are performed making the patient face hindered health consequences. For instance, in the BUPA care home, the irresponsibility of the healthcare manager in controlling and monitoring hot and cold water system lead Mr Ibbertson to develop Legionnaires’ disease. It is waterborne disease leading the patient to develop pneumonia and experience death in the end due to careless management of healthcare facility by the healthcare manager (Liversedge, 2018). The role of healthcare manager in the nursing home is to work with other healthcare professionals in the area to guide them regarding the way improved healthcare delivery of direct healthcare services can be established (Adikari et al., 2020). This is because the healthcare managers have wider knowledge and skills to understand which specific work structures are to be followed by the health professionals while executing their duties so that enhanced and improved direct care services are reached to the patient to help them have satisfactory care. As argued by Mirković (2016), failure of the healthcare managers to work and guide the health professionals involved in delivering direct care to the patients leads to hindered health environment. This is because well-structured services could not be provided by the health professionals out of confusion regarding the way to enhance their care making the patient suffer deteriorated health condition out of the hindered health environment. One such instance is from the Mid Staffordshire Hospital where failure of the healthcare managers to direct health professionals regarding the way they are to manage their work activities to provide improved care led the patients to face hindered health condition such as unhygienic health condition, falls and bruises, abuse and others. This is evident as the healthcare professionals in the hospital reported they got no support from the management and managers when they reported facing complexity in delivering care. It gradually led them to deliver hindered care out of lack of supportive direction regarding the way to resolve working confusion and deliver care support (Smith and Chambers, 2019). In nursing home, the healthcare manager has the role of interacting with patients and their families in aspects of healthcare to determine their experience regarding the care received and probable changed to be made for offering them better satisfaction of care (Freund, 2016). This is because it is responsibility of the healthcare manager to retain enhanced quality care to be delivered by the nursing home. Thus, without interacting with the patients and their family members to receive feedback regarding care experiences in the setting, the managers would be unable to determine the way a better positive and patient-friendly healthcare environment is to be maintained (Hernandez, 2019). The other role of the healthcare manager in the nursing home is to effectively administrate and managemen financial operations in the facility. This is because healthcare managers are responsible to determine the way finances in the nursing homes are to be maintained and flowed so that enhanced profit can be gathered, and expenses can be made to make better adjustment in delivering improved quality care to the service users (Hernandez, 2019). However, failure to execute the role leads the healthcare manager to create financial crisis in the facility which makes them create negative healthcare environment for the patients (Mirković, 2016). For example, the failure of the healthcare manager at the Whitchurch Care Home led them to make the facility experience financial crisis. It eventually led to improper delivery of medication, hindered toilet facilities, broken elevator and others that led to create a negative healthcare environment (Pilmmer, 2020). The other role of the healthcare manager at the nursing home is to ensure that effective risk management is followed in the premises and safety protocols are known by all the staffs to be followed in emergency (Clay-Williams et al., 2017). This is because it is the duty of the healthcare manager in the nursing home to ensure a safe care environment is always managed for enhanced safety for all. The healthcare manager in the nursing also has the role to ensure all the organisational policies and healthcare legislations are appropriately abided and implemented by the staffs to deliver healthcare. This is because it is responsibility of the management to ensure ethical and legal care is provided from the facility to others under all condition (Hernandez, 2019). However, failure to play the role would lead the healthcare manager face legal obligations and make the management face lawsuits (Clay-Williams et al., 2017). This is evident from the instance of Hertfordshire Care Home where due to ineffective role of the healthcare manager, five legislations for fore control and safety in healthcare was violated. It led to fire breakout in the facility and death of two residents in the care home making the manager and management face lawsuits for their irresponsibility in executing their role (BBC, 2019). The role of the healthcare manager in healthcare environment includes managing change or alteration during working to improve the service delivery. They also play the role of identifying in which aspect change is required and act to gather evidence to be used in motivating the subordinates to make them participate in the process (Wojciechowski et al., 2016). According to Lewin’s Change Management theory, effective motivation toward change is to be present in the organisational culture for driving employees in making the change (Hidayat et al., 2020). Thus, healthcare manager in the nursing home is seen to play one of the key roles of change management that are motivating employees for establishing the change. The healthcare manager in the nursing home has the responsibility to conduct daily meeting and manage team of adequate healthcare staffs. This is because it is responsibility of the healthcare manager in nursing home to review practises of the staffs to determine nature of training or alteration of specific working nature for employees to be established so that high-quality care can be delivered (Hernandez, 2019).

Explaining the way organisational structure influences organizational culture

The hierarchical structure of the GP surgery is entirely different from of organisational structure in comparison to the flat structure followed by social enterprise. The joining of the hierarchical GP surgery to the flat social enterprise structure would lead to create a confusing work culture for the GP surgery as they would experience loss of control in taking appropriate decision. It is evident as in hierarchical structure, a well-channelled and well-defined pathway of decision making at work is controlled by two or more layers of hierarchical management from whom instructions are followed by the staffs in systematic way to execute task (Buchanan and Huczynski, 2019). However, in flat organisational structure there is hardly any middle management present who can appropriately control and create well-structured flow of chain of commands for the staffs (Mazorodze and Buckley, 2019). Thus, a chaotic decision-making work culture would be faced by the hierarchical GP surgery on joining the flat structure. The flow of communication when occurs through various layers of management as seen in hierarchical structure, it leads to create distorted interaction of information out of minor error faced at each level of the management in the working culture (Scholz et al., 2017). However, effective communication between upper management and the employees in direct manner is seen to be established in flat organisational structure that leads to create a clarified communicative work environment or culture (Turi and Sorooshian, 2019). Thus, the hierarchical GP surgery on joining the flat social services structure would experience clear communicative work environment where the employees or staffs can directly communicate with the upper management without any middle-level management barriers and distortion of information to be faced that at times hindered their working ability. This is because presence of effective and clarified communicative work culture makes the employees be able to share their grievances and issues directly with the management to be resolved as well as get effective assistance to determine the key goal to be reached through work (Buchanan and Huczynski, 2019). The joining of the small hierarchical GP surgery structure with the flat social services structure would influence the prior to face faster decision-making working culture. This is because in flat organisational structure few people in the management are to be consulted in making decision regarding work as minimum or no presence of hierarchical levels are seen in this structure (Pytel-Kopczynska, 2017). However, in hierarchical structure, even though it may be small it is seen that one or two level of management is to be consulted in making simplest of the work decision which leads the working culture to be time-consuming for the employees (Pilgrim et al., 2020). The Schein’s management theory mentions that artefacts are initial level in the organisational culture and they are physical characteristics of the organisation which when changed can be easily identified (Boström et al., 2017). The joining of the hierarchical GP surgery to the Flat social service structure of the organisation would lead them to face physical characteristics change in the culture as lack of any upper management and differences in management level who would be involved in providing chain of commands for work. However, the flat social structure on joining the hierarchical team would face physical change in their culture as often requirement of the hierarchical team in need of specialised ideas from upper management that may not be present (Turi and Sorooshian, 2019). According to Handy’s theory, a trustful work culture is to be maintained by the management where they trust the employees would do good for them and the organisation. This is because failure of the management to not trust their employees would make them create constrained working method that may not be liked by the employees leading towards development of a hindered relationship between the management and staffs (Nightingale, 2018). The flat organisational social service structure is seen to boost trustful working culture to be developed. This is because in flat organisational structure increased transparency is maintained between employees and management out of direct communication. It led to create close working relationships and discussion between one another making them believe and trust each other out of effective clarification of doubts regarding others that may hinder their trust (Turi and Sorooshian, 2019). However, in hierarchical structure, trust between employees and higher management is hard to be managed due to lack of clear and direct communication opportunity between one another to resolve the issues that are leading to hinder trust (Pilgrim et al., 2020). Therefore, the mall hierarchical GP surgery on joining the flat social service structure would experience establishment of trust working culture which was previously not able to be implemented.

Discussing different organisational structure in business, health and social care organisation

In order to set a new organisation in the Southwark, a specific organisational structure is to be considered. In healthcare, three common types of organisational structure used include hierarchical structure, flat structure and matrix structure. The hierarchical structure is also known as line structure is the process in which power to direct working nature in the organisation flows from the board of directors to the Chef Executive officer (CEO) and to other levels of other management to reach the bottom where the employees are present to follow the command and work (Malby and Anderson-Wallace, 2016). The advantage of using hierarchical organisation culture is that it helps to provide clarified information about project organisation and division of authorities to the employees. It helps in creating enhanced division of increased responsibilities to be performed at a time in better accomplishment of work (Scholz et al., 2017). The other advantage is that hierarchical organisational structure helps to create work specialisation for each employee based on their abilities and knowledge due to which the employees are seen to show enhanced productivity at work (Greer et al., 2018). The limitation faced in the organisation on using hierarchical structure is that it creates bureaucratic hurdles due to which delay in completion of project occurs and it intends employees to take risks (Choi et al., 2016). The other limitation with hierarchical structure in the organisation is that it encourages employees in prioritising their personal department and directly accessed supervision instead of focussing on the company progress as whole (Choi et al., 2016). It means that through hierarchical structure it may be found that enhancement in marketing department occurs more than the production department. This is because marketing employees are more focused on performing their own task and uplifting their department instead of focusing to help the enhancement of production department that is facing downfall due to their lack of support. The flat organisational structure is a decentralised structure where all the staffs are seen to have similar power in taking decision to manage the business (Patri and Suresh, 2017). The advantage of flat organisational structure is that it provides independence to the staffs and increased responsibility in directing the working nature of the organisation. This is because all the staffs with similar power are seen to independently think and develop decision regarding the way work is to be performed (Turi and Sorooshian, 2019). The advantage of flat organisational structure is that it enhances effective and easy communication between employees to be established. This is because small number of employees are present in the structure with equal power due to which they avoid try to ignore one another out of lack of feeling of superiority over one another (Mansouri et al., 2018). The limitation of flat organisational structure is that there is lack of supervision among employees out of lack of superior and experienced professionals who have greater power and knowledge compared to others in supervising subordinate employees (Bhebhe, 2019). However, the use of flat organisational structure is beneficial as it led to faster implementation of new practices without dispute (Mansouri et al., 2018). The limitation of flat organisational structure is that it shows poor scalability with growth of the company. Thus, it cannot be used as supportive organisational structure for long-term as the companies are intend to growth enhanced business (Mansouri et al., 2018). The matrix organisation structure involves combination of two or more organisational structures which are united to create a balance in management that was otherwise not possible due to limitation being faced while using one single organisational structure (San Cristóbal et al., 2018). The advantage of matrix organisational structure is that it allows the supervisors or upper management in choosing potential employee they think are suitable and best for certain project (Gaspary et al., 2020). Thus, this structure allows effective use of potential talent for right purpose in the organisation. The other advantage of matrix organisational structure is that it allows employee to learn and foster skills beyond their primary roles. Thus, it supports effective career development of the employees which in turn make them feel valued to retain in the organisation (Gaspary et al., 2020). However, the limitation is that in matrix structure effective delineation of managerial roles may not be present leading the manager to face confusion regarding the duties to be performed. Moreover, in matrix structure, the team roles in the organisation are not mentioned due to which effective team-working to accomplish work cannot be established out of conflict and confusion among team members regarding their role (San Cristóbal et al., 2018). In setting the new healthcare organisation at Southwark, the hierarchical organisational structure is to be used instead of flat and matrix organisational structure. This is because hierarchical structure helps to create a complete and well-organised authority within the organisation to create systematic delivery of instructions to accomplish working activities for promoting business and productivity of the organisation (Scholz et al., 2017). However, in flat organisational structure, there is no systemic authority present as each employee has similar power compared to others due to which they involve in conflict and lose ability to effectively manage and direct work activity in enhanced manner to support reaching productivity (Mansouri et al., 2018). The hierarchical organisational structure is to be used as it promotes effective change management to be controlled for assuring improved growth of the organisation. This is because in flat structure where due to presence of confusion among employees with similar power to create change they are found to avoid executing it and deter growth (Mansouri et al., 2018). However, due to presence of experienced individuals with varied skills a clear path of change and advancement is able to be established in turn promoting organisational growth in the long-term (Scholz et al., 2017). The matrix organisational structure is avoided to be used as it involves making continuous change in the management. Thus, implementing it wold led the employees in the new organisation remain in constant fear of what next change is to be made that may not follow in turn making them to work in hindered manner (San Cristóbal et al., 2018).

Conclusion

The above discussion concludes that role of the healthcare manager in nursing home is to direct the working nature of the health professionals in making them delivery quality care and ensuring stabilised financial condition in the organisation. Moreover, they have the role of monitoring working of the employees, ensure risk management and safety working environment, ensure policies and legislations are appropriately followed at work and others. The hierarchical GP surgery team on joining flat social service structure would lack of effective chain or working commands but be able to establish effective communication with management without barrier from superiors. The flat social service structure on joining with the hierarchical GP surgery team would face that the later team members are always in need of specific commands for working. Moreover, they wish to consider one as the superior who would direct their work rather than working collaboratively with similar responsibility. In setting the new organisation at Southwark, the hierarchical organisational structure is to be followed instead of flat and matrix structure.

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