| Course | NU 651 Leading and Managing in Complex Organizations |
|---|---|
| Unit | Unit 7 |
| Paper type | Governance and committee review |
| Length | About 860 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU 651 Unit 7
Six Committees, No Owner: A Governance Review of How a Community Hospital Decides About Patient Flow
Student Name
Department of Nursing, Herzing University
NU 651: Leading and Managing in Complex Organizations
Instructor Name
March 6, 2026
Six Committees, No Owner: A Governance Review of How a Community Hospital Decides About Patient Flow
Scope and Method
Domain: patient flow, meaning the movement of patients from emergency department arrival through admission, inpatient stay, and discharge, at a composite 300-bed community hospital. I reviewed the charters, membership lists, and 12 months of minutes of every standing committee whose agenda included patient flow, boarding, length of stay, or discharge, and interviewed the chair of each. For each committee I recorded what it is chartered to decide, what it actually decided in the past year, how often it meets, and who attends by role.
The Committees
Six standing committees touch patient flow.
| Committee | Chartered to | Meets | What it actually decided in 12 months | Members by role |
|---|---|---|---|---|
| Capacity Management Committee | Oversee patient flow and recommend improvements | Monthly | No decisions; 11 recommendations forwarded to Operations Council | Directors of nursing units, emergency department, case management, patient flow, bed placement |
| Operations Council | Approve operational changes within budget | Twice a month | Approved 3 of the 11 flow recommendations; deferred 5; 3 not yet discussed | Vice presidents, chief nursing officer, president |
| Nursing Practice Council | Approve nursing practice standards | Monthly | Approved the bed board update standard | Staff nurses, charge nurses, educators |
| Medical Executive Committee | Approve medical staff policies and credentialing | Monthly | Discussed discharge order timing twice; referred to hospitalist group | Elected medical staff officers, department chairs |
| Utilization Review Committee | Review medical necessity of admissions and stays, as federal rules require | Quarterly | Reviewed avoidable day reports; no flow decisions | Physicians, case management director |
| Quality and Patient Safety Committee | Oversee quality measures and report to the board | Monthly | Reviewed boarding on the dashboard each month; no decisions | Vice president of quality, physicians, nursing directors, board member |
What the Review Found
No committee owns patient flow end to end. The Capacity Management Committee is the only group whose charter names patient flow, and its charter gives it authority only to recommend. Its recommendations go to the Operations Council, where flow competes with every other operational topic, and 8 of its 11 recommendations last year were deferred or not discussed. The members of the Capacity Management Committee, the directors who run the departments involved, are the people who know the process best and have no authority as a group to change it.
Medical staff decisions travel a separate route. The Utilization Review Committee exists because federal conditions of participation require hospitals to have a utilization review plan and committee (Utilization Review, 2025, § 482.30), and the Medical Executive Committee derives its authority from the medical staff structure the same regulations require (Medical Staff, 2025, § 482.22). Neither is chartered to decide operational flow questions, and neither receives the Capacity Management Committee's recommendations. The discharge order timing question, which depends on physicians, was referred by the Medical Executive Committee to the hospitalist group, which is not a committee at all.
The same boarding dashboard is presented to four committees each month, by the same analyst, and discussed each time without a decision. Directors in the Capacity Management Committee attend an average of four of these six committees a month, and several described the same topic being discussed repeatedly in different rooms.
Why This Happens
The pattern reflects the structure of hospitals more than any failure of the people involved. Hospitals divide authority among clinical, managerial, and governance groups with different sources of legitimacy, and integrating their work depends on mechanisms that cross those divisions rather than on any one of them (Glouberman & Mintzberg, 2001). A cross-departmental process like patient flow falls between committees built around those divisions.
Recommendations
First, re-charter the Capacity Management Committee as the Patient Flow Committee, with authority to approve changes to cross-departmental flow processes within existing budgets and staffing, and to require departments to implement them, reporting decisions to the Operations Council rather than asking permission. Changes that need new money or new positions would still go to the Operations Council. Second, add the hospitalist group's medical director and the emergency department medical director to the committee as voting members, so that physician decisions about discharge timing are made in the same room as nursing and case management decisions, with any change to medical staff policy still requiring Medical Executive Committee approval. Third, present the boarding dashboard in one committee, the Patient Flow Committee, and send a one-line summary to the others. Fourth, write a decision rights table listing, for each type of flow decision, which committee decides, which is consulted, and which is informed, and review it each year.
What the Recommendations Do Not Change
The Utilization Review Committee keeps its federally required role. The Medical Executive Committee keeps authority over medical staff policy; the recommendations put physicians in the room for operational flow decisions but do not transfer medical staff authority to a management committee. The Nursing Practice Council keeps authority over nursing standards. The aim is to give patient flow one owner, not to take authority from groups whose authority rests on regulation or professional self-governance.
Anticipated Objections
Three objections are likely. Vice presidents on the Operations Council may see the re-chartered committee as taking decisions away from them. The response is that the new authority is limited to process changes within existing budgets, the kind of decision the council has been deferring, and that every decision is reported to the council, which can overturn it. The medical staff may object to physicians voting on a management committee. The response is that the physicians would vote on operational flow processes, not on medical staff policy, and that the alternative is continuing to make decisions about physician workflow without physicians present. And directors may worry that a committee with authority will generate more work for their departments. That concern is fair; the decision rights table will require that any change the committee adopts names the department responsible and the resources it needs, so that decisions are not made as though implementation were free.
How the Change Would Be Judged
After one year: the number of flow decisions made and implemented, compared with the 3 of 11 last year; the time from a flow proposal to a decision; and director hours spent in committees on flow topics, which should fall.
References
Glouberman, S., & Mintzberg, H. (2001). Managing the care of health and the cure of disease: Part II: Integration. Health Care Management Review, 26(1), 70-84. https://doi.org/10.1097/00004010-200101000-00007
Medical Staff, 42 C.F.R. § 482.22 (2025).
Utilization Review, 42 C.F.R. § 482.30 (2025).
NU 651 Unit 7 instructions, in plain terms
Unit 7 asks you to review the governance of a domain in your organization, usually through its committees and decision rights. Expect to define the domain, identify the committees and bodies involved, review their charters, membership and decisions, assess whether accountability is clear and recommend changes. Many versions ask about regulatory requirements that shape governance, such as Medicare conditions of participation. Check whether your section expects real committee documents or allows a composite. Distinguish governance, who decides and with what authority, from management, who carries out the work. A count of decisions made and implemented gives the review evidence. Recommendations should respect what regulation requires while fixing gaps in ownership.
How this NU 651 Unit 7 example is built
The review opens with the domain and method, explaining which documents were read and over what period. Each committee is described with its charter, chair, membership and authority, often in a table. The findings section states the main problem in its first sentence and supports it with a count of proposals and decisions. The explanation section uses organizational theory to show the gap results from how hospitals divide authority, not from individual failure. Recommendations are specific, including re-chartering and decision authority within limits. A section on what does not change protects regulatory roles, such as utilization review under 42 CFR 482.30. Objections are anticipated with responses. Evaluation measures give a one-year comparison with the baseline count.
Reading the NU 651 Unit 7 rubric
Herzing's governance rubric generally covers the scope and method, the description of governance structures, the analysis of accountability, the use of theory or regulation, recommendations and writing. Description points reward accurate committee charters and authority. The accountability analysis is often weighted most and earns full marks when gaps and overlaps are shown with evidence such as decision counts. Theory and regulation criteria look for correct use of sources like the Medicare conditions of participation. Recommendation points go to specific changes that respect regulatory requirements. Objection handling and measures may be credited within recommendations. Writing covers clear organization and APA 7 with correct CFR citations.
NU 651 Unit 7 help before you submit
In Unit 7 the usual problem is describing committees without analyzing whether anyone is accountable. Another frequent issue is confusing governance with management, so the review discusses staffing rather than decision rights. Students often recommend eliminating a committee that regulation requires, such as utilization review. Evidence is thin when the review lacks any count of decisions or delays, so the gap looks like opinion. Theory is cited without connection to the findings. Objections from executives who would lose authority are rarely anticipated, though they decide whether a re-charter passes. Some reviews name real committee members. Finally, state what your recommendations leave unchanged, because graders look for awareness that governance changes affect other bodies and their regulatory duties.
Get a NU 651 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NU 651 classroom, plus the committees or the decision domain your review has to cover. We write a custom example with charters set against practice, findings sorted into duplication, gap and dormancy, and one proposal timed through the structure, returned in 24 to 48 hours. The first custom sample is free.
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NU 651 Unit 7 questions, answered
What if I cannot see real committee minutes?
Work from whatever is publicly available and describe what remains in terms of process alone. Charters, membership by role and meeting frequency are often published or well known internally, and a described structure labeled as illustrative supports the review perfectly well. Confidential minutes should stay where they are, and nothing in a submitted paper needs to quote them in order to make the argument.
How many committees should the review cover?
Take the groups that touch a single domain, which is usually four to six, rather than attempting the whole governance structure. A review covering quality, safety, pharmacy and the medical executive group can demonstrate duplication properly, where a survey of twenty bodies can only list them. Say which domain you drew the boundary around and why you drew it there.
Is governance the same thing as management?
They overlap, and this review depends on keeping them apart. Governance decides what the organization may do and holds it to account, while management decides how the work runs day to day. Papers that blur the two end up recommending that a committee supervise a process, which is a manager's job, and the distinction is usually worth a paragraph of its own.
Where can I find a free NU 651 Unit 7 sample paper?
You can read the whole NU 651 Unit 7 patient flow governance review here at no charge, the committees, findings and recommendations. A custom review can examine the committees around a domain in your own organization.
What is the difference between governance and management in a hospital?
Governance decides who has authority to make which decisions and holds them accountable. Management carries out the work within those decisions. This sample shows a hospital where six committees discuss patient flow but none has authority to decide on it.