Leadership and Management at Ancora Hospital – Health System Example

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"Leadership and Management at Ancora Hospital" is a marvellous example of a paper on the health system. This paper is a critique of leadership and management methods that are currently being used at Ancora Psychiatric Hospital. The respondent in this leadership interview was Evelyn Ngwa at Ancora. She has been a nurse at Ancora since 2001. She started as a charge nurse and was promoted through the ranks from lower management positions to become director of nurses.   When Ancora opened the position of Client Services advocate, she became the best person for this position.

Ngwa received her MSN and NP from University of Medicine and Dentistry of New Jersey which is now Rutgers School of Biomedical and Health Sciences. Ancora Psychiatric Hospital is a 709-bed adult inpatient facility that offers a multidisciplinary team approach to the development and implementation of care. They meet the needs of the mentally ill clients in the areas of admissions, acute and chronic psychiatric units, geropsychiatric units, a sub-acute medical unit, a secure care unit (Forensic), and dual diagnostic unit for the mentally ill and developmentally disabled ( Department of Human Services, 2013).

In this paper, I will discuss organization, budgeting and resource allocation, communication and information systems as well as quality initiatives. Information on these issues was provided by Ngwa through verbal interview and written information obtained through Ancora website. Organization Leadership can be defined as the process of influencing people to accomplish goals (Huber, 2014).   Presently, the democratic leadership style is utilized at Ancora psychiatric hospital.   It is a leadership model whereby the personnel are involved in goal setting, decision making and problem-solving (Huber, 2014).

The mission statement at Ancora is to provide quality comprehensive psychiatric, medical and rehabilitative services that encourage maximum patient independence and movement towards community reintegration within an environment that is safe and caring (Department of Human Services, 2013). The model is congruent with the overall mission statements it motivates patient participation in their own care and involving them in decision making. Authoritarian leadership is also applied interchangeably with a democratic style depending on the prevailing situation. Nevertheless, democratic leadership prevails over the authoritarian style. Laissez-Faire leadership style may not succeed in the agency due to the possibility of generating chaos since it provides little direction, guidance and is likely to fail with regards to decision making.

  Ancora has a tall organization structure with the Chief executive Officer and secretarial Assistant on the top run. Next run is Deputy CEO clinical services followed by Deputy CEO clinical services, Medical Director, Director of quality improvement, Chief Nursing Officer, Management improvement specialist, Executive Assistant and finally the Client Services Advocate (Department of Human Services, 2013).   All department heads meet twice a week to discuss any emerging issues. Ancora is more of an open system organizational model.

Open systems suggest that the organization is affected by not only internal changes but also external environment forces that have a direct influence on the organization (Huber, 2014). Organizational climate is an individual perception of how it feels like to be in the work environment. It is how nurses perceive and feel about practices, procedures, and rewards. The perceptions that people form regarding the work environment are because they focus on that which is important and meaningful to them (Huber, 2014).   During the interview, I did not notice significant interaction between the junior staff and department head.

He seemed to be totally separate from the lower cadre staff. Any meeting between the department head and the junior staff was through an appointment. The junior staff would then go to the fourth floor for the meeting. In my opinion from the observations in the interview, an open-door policy does not exist in the organization. Budgeting and Resource Allocation A Budget can be defined as a written financial plan aimed at controlling the allocation of resources.

It functions both as a planning instrument and an evaluation tool that is useful for financial management. A budget is used to manage programs, plan for goal accomplishment, and control costs (Huber, 2014). The nurse leader stated that she is not directly involved in budgeting. According to her, the budgets for all departments are preset by Trenton, which they have to adhere to. Ancora uses a combination of budgets which include operating budget, capital budget and labour budget. For example, the pool nurse, part-time aid and overtime are paid on a different budget from the full-time employees. The nurse leader at Ancora is faced with numerous staffing and scheduling issues.

There is a constant reordering of staff and pool nurses to ensure there is enough staff for the daily shifts. Pool nurses are mandated to work on weekends in their schedule while working on weekdays is voluntary because of the shortage of nurses on weekends. Three nurses are needed for every ward including a medication nurse, a first and a second charge nurse. The scheduling for a full-time nurse is preset for 8 hours shift from Monday to Friday.

If the nurse is LPN, he/she is required to work every other weekend. Also, there is a weekend shift called AWP in which nurses work 13 hours shift every weekend and one day during the week which they get to choose. The biggest problem facing the agency is the constant exit of the full-time staff at the drop of a hat. In case of harsh weather such as rain or snow, callouts to increase causing problems of replacements for the departures.

Coverage during scheduled vacation, day off, maternity leave, sick days, and worker compensation are ongoing issues at Ancora. The strategic goals are set by the chief executive officer at an annual meeting covering all the goals for the upcoming year. The plan is passed down to the administrative directors and then to the directors of the individual departments. Also, the treatment team sets up goals and objectives with the patient with regards to his/her hospitalization and strives to accomplish these goals prior to discharge. The main objective is to create a safe environment for staff and patients.

Other objectives include decrease and eventually eliminate the use of seclusion and restraint, improve the work environment and improve verbal communication between clinicians. The unit’ s goals are directly related to the agency’ s mission and strategic planning goals. Communication and Information Systems The communication model Ancora Psychiatric Hospital consists of face to face verbal communication, weekly briefs, flyers, intercom, and emails or via telephone. Email communication is encouraged and staff is also encouraged to check their accounts at least once a day for upcoming meetings and activities.

The information systems utilized at Ancora are limited systems called patient tracking systems. Currently, the patient tracking is been used to do shift assignment, to record incident reports, lab orders, appointments and to print daily shift reports. Factors that enhance communication within the nursing department are a shift to shift reports, 24 hour reports, daily meetings and education. Factors that impede communication within the nursing department are resistance to change among some staff, culture, personal space, environment, attitudes values as well as the level of self-esteem. Quality initiatives The legislative and health care mandates that affect Ancora are those that address patient care and safety.

Medicare and Medicaid service are the organizations that effect Ancora hospital.   Quality improvement projects that impact Ancora are violence prevention/restraint/reduction, quality improvement, reducing geriatric falls, decrease psychology workload and improvement of regulatory compliance as well as pressure ulcers prevention. The nurse leader is the patient’ s advocate with a significant role in performance/quality improvement. He/she has a duty of making sure that measures are put in place to protect the patient and ensuring that these measures are followed by the staff.

  The Nurse leader further holds meetings with staff to make sure they are aware of the quality improvement processes. Nurses and physicians work together to promote change and quality of care to the patient in the ward. All the nursing staff and physicians are involved in promoting and improving quality initiatives of the patient under their care. All in all even with these quality improvements, progress in Ancora was still far from where it was supposed to be. In conclusion, psychiatric services have advanced over the years but there is still room for improvement.

Ancora continues to provide quality inpatient psychiatric services for adults primarily using an interdisciplinary team approach. Through the democratic leadership style and sometimes authoritarian leadership, Ancora psychiatric hospital has endeavoured to serve its patients.

References

Department of Human Service (2013). Ancora Psychiatric hospital, retrieved from www.state.nj.us/.../involved/nurses/mentalhph/ancora.html

Diane L. Huber (2014). Leadership & Nursing Care Management, 5th ed. Fort Worth, TX: Saunders

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