Case study essay
Read the below case and then write a paper.
you must have a minimum of 3 scholarly sources (peer-reviewed journal articles). Please ensure that you follow standard APA formatting. Your paper must have a title page and a reference page. You must have a minimum of five (5) in-text citations.
During the paper, answer these questions. DO NOT put this in a question and answer format. Make sure there is an introduction and conclusion, and some parts of the questions as headings and subheadings and follow the recommended outline to ensure that all questions are answered.
Respond to the following questions in an essay (3 page minimum).
1. Assemble the diagnostic data into a framework and prepare feedback to the senior administrators of the hospitals. What’s your sense of the organization’s current structure and employee involvement issues?
2. What changes would you recommend? Is a total quality management intervention appropriate here? What alternatives would you propose?
3. Design an implementation plan for your preferred intervention.
Be sure that you describe the most common organization structures used today as well as their strengths and weaknesses. Describe the employee involvement and how it relates to performance. Consider whether there should be a sociotechnical systems work design.
Selected Cases THE SULLIVAN HOSPITAL SYSTEM
At the Sullivan Hospital System (SHS), CEO Ken Bonnet expressed concern over market share losses to other local hospitals over the past six to nine months and declines in patient satisfaction measures. To him and his senior administrators, the need to revise the SHS organization was clear. It was also clear that such a change would require the enthusiastic participation of all organizational members, including nurses, physicians, and managers.
At SHS, the senior team consisted of the top administrative teams from the two hospitals in the system. Bonnet, CEO of the system and president of the larger of the two hospitals, was joined by Sue Strasburg, president of the smaller hospital. Their two styles were considerably different. Whereas Bonnet was calm, confident, and mild-mannered, Strasburg was assertive, enthusiastic, and energetic. Despite these differences, both administrators demonstrated a willingness to lead the change effort. In addition, each of their direct reports was clearly excited about initiating a change process and was clearly taking whatever initiative Bonnet and Strasburg would allow or empower them to do.
You were contacted by Bonnet to conduct a three-day retreat with the combined management teams and kick off the change process. Based on conversations with administrators from other hospitals and industry conferences, the team believed that the system needed a major overhaul of its Total Quality Management (TQM) process for two primary reasons. First, they believed that an improved patient care process would give physicians a good reason to use the hospital, thus improving market share. Second, although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) had enacted policies some time ago encouraging hospitals to adopt continuous improvement principles, SHS's system was sorely behind the times. The team readily agreed that they lacked the adequate skills and knowledge associated with implementing a more sophisticated TQM process. This first meeting was to gather together to hear about how TQM, engagement, and other strategic change processes had advanced and the issues that would need to be addressed if more sophisticated processes were to be implemented. During the meeting, you guided them through several exercises to get the team to examine methods of decision making, how team-based problem solving had advanced, and explored their understanding of the hospital's current mission, goals, and strategies.
Although you were concerned about starting the process with a workshop that explored a solution rather than understanding the problem, you remembered Roger Harrison's consulting rule, “Start where your client is at,” and agreed to conduct the workshop. You were assured by Bonnet that the hospital system was committed to making substantive changes and that this was only the first step. In addition, and in support of this commitment, Bonnet told you that he had already agreed in principle to begin a work redesign process in a few of the nursing units at each hospital and had begun to finalize a contract with a large consulting firm to do the work. The workshop was highly praised and you convinced the team to hold off on the work design implementation long enough to conduct a diagnosis of the system.
Following the retreat, your diagnosis of the SHS organization employed a variety of data collection activities including interviews with senior managers from both hospitals as well as a sampling of middle managers and staff (for example, nurses, ancillary professionals, and environmental services providers). Questions about the hospital's mission garnered the most consensus and passion. There was almost unanimous commitment to the breadth of services provided and the values that played a prominent role in the delivery of those services by a Catholic-sponsored health care organization, such as SHS. A mission and values statement was clearly posted throughout the hospital and many of the items in that statement were repeated almost verbatim in the interviews.
From there, however, answers about the organization's purpose and objectives became more diverse. With respect to goals and objectives, different stakeholder groups saw them differently. Senior administrators were fairly clear about the goals listed in the strategic plan. These goals included increasing measurements of patient satisfaction, decreasing the amount of overtime, and increasing market share. However, among middle managers and supervisors, there was little awareness of hospital goals or how people influenced their accomplishment. A question about the hospital's overall direction or how the goals were being achieved yielded a clear split in people's perceptions. Some believed the hospital achieved its objectives through its designation as the area's primary trauma center. They noted that if someone's life were in danger, the best chance of survival was to go to SHS. The problem, respondents joked, was that “after we save their life, we tend to forget about them.” Many, however, held beliefs that could be labeled “low cost.” That is, objectives were achieved by squeezing out every penny of cost no matter how that impacted patient care.
Opinions about the policies governing the hospital's operation supported a general belief that the organization was too centralized. People felt little empowerment to make decisions. There also were a number of financial policies that were seen as dictated from the corporate office, where “shared services” existed, including finance, marketing, information systems, and purchasing. Further, several policies limited a manager's ability to spend money, especially if it wasn't allocated in budgets.
In addition to the managerial sample, a variety of individual contributors and supervisors were interviewed either individually or in small groups to determine the status and characteristics of different organization design factors. The organization's policy and procedure manuals, annual reports, organization charts, and other archival information were also reviewed. This data collection effort revealed the following organization design features:
· • The hospitals' structures were more bureaucratic than organic. Each hospital had a functional structure with a chief executive officer and from two to five direct reports. Both hospitals had directors of nursing services and professional services. The larger hospital had additional directors in special projects, pastoral care, and other staff functions that worked with both hospitals. Traditional staff functions, such as finance, procurement, human resources, and information services, were centralized at the corporate office. There were a number of formal policies regarding spending, patient care, and so on.
· • The basic work design of the hospitals could be characterized as traditional. Tasks were narrowly defined (janitor, CCU nurse, admissions clerk, and so on). Further, despite the high levels of required interdependency and complexity involved in patient care, most jobs were individually based. That is, job descriptions detailed the skills, knowledge, and activities required of a particular position. Whenever any two departments needed to coordinate their activities, the work was controlled by standard operating procedures, formal paperwork, and tradition.
· • Information and control systems were old and inflexible. From the staff's perspective, and to some extent even middle management's, little, if any, operational information (that is, about costs, productivity, or levels of patient satisfaction) was shared. Cost information in terms of budgeted versus actual spending was available to middle managers and their annual performance reviews were keyed to meeting budgeted targets. Unfortunately, managers knew the information in the system was grossly inaccurate. They felt helpless in affecting change, since the system was centralized in the corporate office. As a result, they devised elaborate methods for getting the “right” numbers from the system or duplicated the system by keeping their own records.
· • Human resource systems, also centralized in the corporate office, were relatively generic. Internal job postings were updated weekly (there was a shortage of nurses at the time). There was little in the way of formal training opportunities beyond the required, technical educational requirements to maintain currency and certification. Reward systems consisted mainly of a merit-based pay system that awarded raises according to annual performance appraisal results. Raises over the previous few years, however, had barely kept pace with the cost of living. There also were various informal recognition systems administered by individual managers.
This diagnostic data was discussed and debated among the senior team. A steering committee composed of physicians, managers, nurses, and other leaders from both hospitals was convened, and creating a vision for the system and the change effort became one of their first tasks.
The steering committee spent hours poring over vision statements from other organizations, discussing words and phrases that described what they thought would be an exciting outcome from interacting with the hospital, and trying to satisfy their own needs for something unique and creative. When the first draft of a statement emerged, they spent several months sharing and discussing it with a variety of stakeholders. To their dismay, the initial version was roundly rejected by almost everyone as boring, unimaginative, or unreal. The group discussed the input gathered during these discussions and set about the task of revising the vision. After several additional iterations and a lot of wordsmithing, a new and more powerful vision statement began to emerge. The centerpiece of the vision was the belief that the organization should work in such a way that the patient felt like they were the “center of attention.” Such an orientation to the vision became a powerful rallying point since many of the hospitals' management teams readily understood that there was an existing perception of poor service that needed to be turned around.
The three months spent working and adapting the vision statement was well worth it. As it was presented to people in small meetings and workshops, each word and phrase took on special meaning to organizational members and generated commitment to change.
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