The document discusses frameworks for analyzing organizations and assessing their performance. It provides an overview of two frameworks - learning organizations and complex adaptive systems (CAS). Students are asked to select these two frameworks to analyze the systems and structures of an organization they are familiar with. They should consider how each framework can be used to identify opportunities for performance improvement and share examples from their selected organization.

1. Discussion: Comparing Frameworks for Analyzing
Organizations
Avedis Donabedian’s work generated a pivotal means of
assessing organizational performance relative to structure,
process, and outcomes. However, it is clearly not sufficient to
view health care quality merely in terms of outcomes—the
structures and processes that facilitate these outcomes are
equally as important.
In this Discussion, you consider multiple frameworks that can
be used to analyze an organization. As you proceed, consider
how these frameworks allow you to examine the interplay of
interdependent and related parts and processes that comprise the
systems within an organization, as well as the arrangements or
structures that connect these parts.
To prepare:
Investigate and reflect on the systems and structures of an
organization with which you are familiar. Consider the
following:
What is the reporting structure?
Who holds formal and informal authority?
How many layers of management are there between the frontline
and the highest office-holders of the organization?
How are interdisciplinary teams organized?
How is communication facilitated?
How well integrated is decision making among clinical
personnel and administrative professionals?
How are particular service lines organized?
Which departments, groups, and/or individuals within the
organization are responsible for monitoring matters related to
performance, such as quality and finances?
Select two of the following frameworks:
Learning organizations, presented in the Elkin, Haina, and Cone

2. article
Complex adaptive systems (CAS), presented in the Nesse,
Kutcher, Wood, and Rummans article
Clinical microsystems, presented in the Sabino, Friel, Deitrick,
and Sales-Lopez article
Good to great, presented in the Geller article
The 5 Ps, presented in the ASHP Foundation article
Review the Learning Resources for each of the frameworks that
you selected. Also conduct additional research to strengthen
your understanding of how to use each framework to assess an
organization.
Compare the two frameworks. How could each framework be
used to identify opportunities to improve performance? In
particular, how would you use each of these frameworks to
analyze the organization that you have selected?
Post an analysis of the systems and structures of the
organization you selected, sharing specific examples. Explain
insights that you gained by comparing the two frameworks, and
how each can be used to assess an organization, identify a need
for improvement, and, ultimately, enhance the performance of
an organization.
Read a selection of your colleagues’ responses.
Respond to at least two of your colleagues on two different days
using one or more of the following approaches:
Compare the organizational structure of your colleague’s
selected organization to your own.
Ask a clarifying question.
Select an attribute of the identified organizational structure and
ask your colleague to elaborate on how this attribute is
evidenced in their organization.
Required Readings
Hickey, J. V., & Brosnan, C. A. (2017). Evaluation of health

3. care quality in for DNPs (2nd ed.). New York, NY: Springer
Publishing Company.
Chapter 1, “Evaluation and DNPs: The Mandate for Evaluation”
(pp. 3-36)
Chapter 3, “Conceptual Models for Evaluation in Advanced
Nursing Practice” (pp. 61-86)
Chapter 6, “Evaluating Organizations and Systems” (pp. 127-
142)
Chapter 1 defines microsystem, mesosystem, and macrosystem
and notes that evaluation can focus on one of these levels or all
three. Chapter 5 examines the evaluation of organizations and
systems.
Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013).
Integrating quality and strategy in health care organizations,
Burlington, MA: Jones & Bartlett Publishers.
Chapter 2, “Understanding the Healthcare Organization” (pp.
31–43)
Although this chapter focuses on hospitals, the authors provide
information about strategic planning and organizational
structure that is applicable in many health care settings. The
authors examine financial and quality issues as key aspects of
performance measurement.
Elkin, G., Zhang, H., & Cone, M. (2011). The acceptance of
Senge’s learning organisation model among managers in China:
An interview study. International Journal of Management,
28(4), 354–364.
Retrieved from the Walden Library databases.
This article outlines the five disciplines that Senge argued could
be found in a learning organization. The authors also discuss the
worldview that is inherent in business organizations in China
and explain how this relates to Senge’s theory.
Geller, E. S. (2006). From good to great in safety: What does it
take to be world class? Professional Safety, 51(6), 35–40.
Retrieved from the Walden Library databases.

4. Geller reviews and applies Collin’s foundational Good to Great
theory from its focus on financial success to safety.
Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010).
Framing change for high-value healthcare systems. Journal for
Healthcare Quality, 32(1), 23–28.
Retrieved from the Walden Library databases.
This article explores how to implement change in complex
adaptive systems (CAS) such as health care. The authors purport
that an understanding of the principles of change management
in CAS is critical for success.
Sabino, J. N., Friel, T., Deitrick, L. M., & Salas-Lopez, D.
(2009). Striving for cultural competence in an HIV program:
The transformative impact of a microsystem in a larger health
network. Health & Social Work, 34(4), 309–313.
Retrieved from the Walden Library databases.
The authors discuss cultural competence as part of a patient-
centered perspective on health care delivery. They examine an
approach to creating innovation that originates at the unit
(microsystem) level and can be diffused to the larger health care
environment (macrosystem).
ASHP Foundation. (n.d.). Assessing your microsystem with the
5 Ps. Retrieved February 5, 2012, from
http://www.ashpfoundation.org/lean/CMS9.html
This article discusses 5 Ps—purpose, patients, professionals,
processes, and patterns—that you can analyze to deepen your
understanding of a microsystem.
Document: Course Project Overview (PDF)
Required Media
Laureate Education (Producer). (2013f). Organizational
structures. Retrieved from https://class.waldenu.edu
Note: The approximate length of this media piece is 3 minutes.

5. Dr. Carol Huston discusses the influence of organizational
structure on the delivery of quality care.