Nursing Home Setting
Effective Communication in a Nursing Home Setting
This paper will discuss a nursing home organization that has a traditional hierarchical structure. With vertical hierarchical structures everyone except the Chief Operating Officer at the top of the pyramid has a manager or team leader to whom they are accountable (Bianca, 2013). Traditionally, having such a structure is associated with clear reporting structures and authority and clear communication of organizational policy from the top of the organization down. Clarity within these two important organizational areas is perceived as an advantage to the vertical hierarchical structure (Bianca, 2013). This is at least partially true within the nursing home discussed here, as the reporting structure and various levels of authority are very transparent to each employee. Thus the organization is gaining some of the advantages that having that very traditional structure can provide.
However, the sharing of knowledge within the organization is not as effective as it could be with restricted communication to a top down direction. This is a known negative characteristic of hierarchical organizations (Bianca, 2013) and is the case within the nursing home. There is a general lack of collaboration outside an employee’s reporting structure. Communication up the hierarchical structure is rare and when it occurs it can reflect negatively upon the individual employee. Needless to say, this does greatly decrease the ability of experienced employees that are at lower hierarchical levels to contribute to the organization’s decision-making process. It also greatly reduces the function of lower level employees in finding solutions to problems, even when the problems are directly related to their responsibility subject area.
For example, when the nursing home attempted to deal with the issue of bedsores or pressure ulcers, the top down program selected by the administration dictated that the nurses utilize a modified Braden scale to assess the patients, an aspect of the program that was perceived to increase workload without decreasing ulcer incidence (Kwong, Lau, Lee, and Kwan, 2011). If a more collaborative approach to communication had been instituted, some aspects of the program, such as the successful training aspect, could have been utilized but the program could have been modified such that the unproductive increase in nursing workload might have been avoided (Kwong, Lau, Lee, and Kwan, 2011). This kind of lack of innovation is a further known negative characteristic of hierarchical organizations (Bianca, 2013). With this example, the use of an inflexible top down communication technique resulted in less effectively implementation of policy.
However, there are many effective communication techniques that can be utilized in the nursing home work environment and could be used to counteract some of the communication issues found within a strict vertical hierarchical structure. In particular, changing communication techniques within the leadership or upper levels of the hierarchy would be most likely to positively impact the organization as a whole. One way to do this would be the use of an open door policy to increase the accessibility of upper management to those from other levels with assurances of no impact on the individual employee for providing input (Hunt and Laughon, 2011). This one change would have an impact that could increase both collaboration and innovation that has been demonstrated as issues within hierarchical organizations.
A second communication technique that could help in organizational communication would be creating specific structures for communicating in less formal manners than just manager to report (Hunt and Laughon, 2011). The structure has both timing structure, to provide predictability, as well as content structure, to increase effectiveness. Some suggested components of this structure would be monthly staff meetings, weekly newsletters, and a bulletin board for impromptu notes or notices to staff as the need arises (Hunt and Laughon, 2011). This structure need not be paper-based, but can be located on the nursing home intranet, if available. Some suggestions for communication content is a focus on key topics in a “just in time” basis so that staff is not overwhelmed with information too far in advance of the need. Other informal methods communication can be daily huddles of smaller teams, and briefings and debriefings for ongoing communication with larger teams. As discussed by Hunt and Laughon, each in person interaction should be given enough time to allow dialogue for the expressions of concerns or asking for clarification (2011).
Within nursing homes, hierarchical organizations are not uncommon. While this provides clear authority and clear routes for communication, this structure can undermine some of the goals of effective communication. In particular, hierarchical organizations can reduce the amount of collaboration and innovation between and within organizational levels, as communication tends to run from managers to reports. There are a number of communication techniques that can be used to counteract these problems including open door policies by those at the top of the hierarchy. Having a communication structure with set timing and expected content can also help these issues. Often, technology can be used to keep these communications consistent and manageable. Finally, an important technique is to promote two-way dialogue to maximize the spread of useful information and suggestions in forming organizational policy and decision-making.
References
Bianca, A. (2013). Pros & cons of a hierarchical organization structure. The Houston Chronicle. On Demand Media. Retrieved from
http://smallbusiness.chron.com/pros-cons-hierarchical-organizational-structure-24276.html
Hunt, P. and Laughon, D. (2011) The nurse leader’s guide to business skills. Danvers, MA: HCPro, Inc.
Kwong, E., Lau, A., Lee, R., and Kwan, R. (2011). A pressure ulcer prevention programme specially designed for nursing homes: does it work? Journal of Clinical Nursing. 20, 2777-86.
