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Organizational structures and decentralized decision making in acute care hospitals in British Columbia Von Tettenborn, Linda Irene


The purpose of this study was to provide a descriptive data base of the current status of nursing organizational structures and decentralization of decision-making mechanisms in acute care hospitals in British Columbia(BC). Data were gathered by means of a written questionnaire, developed by the investigator, mailed to the Chief Nurse Administrator(CNA) of all 94 eligible hospitals. Computer and manual analysis of the 62 responses provided information about the demographic characteristics of the institution, the nursing organization, and the CNA; and about elements of the nursing organizational structure related to system of care delivery, information systems, organizational decision making, participatory management strategies, and factors impeding decentralization activities. Additional information about management education and union status of head nurses, provision of education bursaries for staff, and need for comparative resurveys was also sought. The major findings of the survey are: that there is a need for administrative education and experience among CNAs, especially in hospitals under 100 beds; that CNAs need additional nursing management information reports, particularly related to patient classification and workload measurement; that decentralization of decision making to the staff nurse level has to be improved; and that, on average, fewer than half of the recommended participative management strategies are being used. The main factors reported as impeding the ability of CNAs to decentralize decision making in their nursing department(in order of descending importance) are lack of: staff nurse knowledge about decision making; funds to replace staff nurses to attend meetings; head nurse knowledge of management functions; and head nurse support for decentralized decision making. Recommendations are presented for further study and for changes that will facilitate increased decentralization of, and participation in, decision making.

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