Assignment: Utilization Management

Communication across departments is an area that would benefit from an improvement project in our organization (an insurance company). I work as a utilization nurse reviewer, where my responsibilities include inspecting claims to decide whether or not the claims should be reimbursed. Communication between departments in the company is poor, which may impact the quality of services provided by the organization. This can be attributed to a broken flow of information whereby information is not adequately shared internally, and this affects employees’ productivity (Arab & Muneeb, 2019). Besides, poor communication has led to occasional conflict between the head of departments, which can negatively impact work processes and workflow.

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Nursing theories that can be applied to address the communication problem include Dyadic Interpersonal Communication Model, Experiential Communication Theories, and Peplau’s Interpersonal Relations Theory. The Dyadic Model illustrates the dynamic interactive process that transpires between two parties, a sender and a recipient. A source or sender (encoder) seeks to be understood by the other person or recipient (decoder), who processes, analyzes, interprets, and understands the message. The decoder responds to the message as per their interpretation of the message (Solomon et al., 2021). The feedback process in the Dyadic model enables the encoder to confirm or modify messages.

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The model explains that communication takes place within a context that is influenced by the circumstances, content, perception, attitude, and emotional and physical state of the encoder and decoder. These factors can also alter the message or the delivery of the message (Solomon et al., 2021). Therefore, this is the best applicable theory to address poor interdepartmental communication since it can help novice and experienced employees to communicate by applying the feedback process to confirm the accuracy and correspondence of verbal and nonverbal messages.

References

Arab, Z., & Muneeb, A. (2019). Effective Communication as a Strategy for Enhancing Organisational Performance. Management, 2(1), 1-19.

Solomon, D. H., Brinberg, M., Bodie, G. D., Jones, S., & Ram, N. (2021). A dynamic dyadic systems approach to interpersonal communication. Journal of Communication, 71(6), 1001-1026. https://doi.org/10.1093/joc/jqab035

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Assignment: Utilization Management