Culture Change Case #2 Healthcare Acquisition Case

Six months after the merger described in Change and Culture Case Study I, the new administration initiated a significant reduction in force. A decision was made to redesign patient care delivery. The administration's first job redesign recommendation was that of a universal worker. The universal worker would deliver many support services. Aware that this model often failed when implemented in other organizations, your administrator charged you with making redesign work this time.

How would you begin the process of job redesign? Do not consider only the universal worker.

The process of cutting staff is a common practice these days in hopes to lower the costs associated with healthcare (Eaton-Spiva, Buitrago, & Trotter, 2010). This is creating a plethora of problems in job satisfaction and hence job redesign demands the utmost attention in order to mitigate some of the common issues. Furthermore, it is estimated that nearly fifty percent of hospitals are considering some kind of reduction (Intergrated Healthcare Strategies, 2010). These issues include providing a safe, quality healthcare environment, that is conducive to providing adequate care and meeting the patient's needs. One problem that arises is professions are leaving the profession because of ongoing fatigue, heavy workloads, irregular hours, inadequate staffing, and a general feeling of not being valued. These factors can contribute to an extremely stressful work environment. One study found that how an organization reduces its workforce is just as important to whether it does or not (Murphy, 1996).

To begin the job redesign process, there are many factors to consider. First, it is necessary to compile a list of tasks and activities that need to be completed on a regular procedural basis; such as work process data. It is important to gauge these activities appropriately to reduce the possibility of people being given too much of a work load. However, at the same time it is necessary to make sure productivity doesn't suffer because schedules are too lax. Therefore there must be a balancing point to the activity design process.

Using a universal worker is one way to alleviate an excessive job load. This worker can fill in the gaps as necessary to reduce some of the strain on an overworked member of the staff. This worker is generally trained to accomplish a host of relatively unskilled tasks so that this frees some time up for the more trained positions. For example, it was estimated that some nurses spend almost thirty percent of their time on just paperwork (Eaton-Spiva, Buitrago, & Trotter, 2010). Using technology and reducing this burden is an obvious goal however can also lead to poor documentation and regulatory issues. Therefore it is only possible to utilize this strategy on non-value-added processes that can be reduced without compromising patient care (Murphy, 1996).

Organizations that cut the workforce with an across the board strategy also run the risk that their actions might negatively affect the care outcomes of patients. Thus the only solution is to include a task based approach to workforce reductions. Furthermore the tasks associated with any one individual's workload should be sufficient enough to be challenging but limited enough to not overwhelm the professional. A workload skewed in either direction produces inefficiencies that hurt the organization and thus the balancing point must be appropriately identified.

Part B

What work processes and performance expectations must be considered once the design is completed?

Once the design is completed, the transformational aspect of the project begins. It is at this point that a leader must motivate the staff to accept the changes and collect feedback if there are issues in which the design is working properly. For example, if an employee is simply overwhelmed, not due to neglect or incompetence, then the workload must be reassessed and the design augmented. Furthermore, it is rarely the case that a design moves to implementation without any complications.

Therefore, the design must incorporate feedback mechanisms to delineate between design inefficiencies and employee inefficiencies. The latter...

If the employee is found to be the deficiency then there are several options available such as further training or possibly replacement. However, if the design is to blame then the design must be altered so that the job functions are fair to the employee.
Part C

Based on the article by Peter Senge in Week Four, what steps and structures will you put in place to make the organization a true learning organization, and thereby encourage workers and managers to adapt and excel in spite of the changes?

To create a true learning organization you need to have the right people in the right places, this is the key (Collins, 2001). However, once this is accomplished, the next step is to foster a sense of vision with the entire organization. Communicating a vision is one way the employee can gain a sense of what their contribution means in terms of the organization as a whole. As a result, this also helps to foster a sense of commitment to the vision and the organizational goals. Therefore to encourage both workers and managers to adapt and excel, there needs to be a strong sense of vision established and reinforced repeatedly. One way to do this is to analyze any and all conflicts in terms of what they mean to the organizational goals. Constant framing of these goals to employees can increase the likelihood that they become internalized and facilitate team work among the organization.

Part D

How can you plan and control the intra-organizational and inter-organizational communications that must occur to implement the job design changes?

Controlling communications is a difficult proposition. The only avenues available for management is to provide adequate modes or mediums of communication, i.e. email, datasheets, documents and records, and make sure the employees use them properly. If the communication channels are adequately developed than the user should be able to use them intuitively. If, however they are not sufficient and provide a platform that is less than user friendly then it is reasonable to suspect that both training and monitoring will be necessary to ensure the required information transmitted properly.

The distinction between intra-organizational and inter-organizational adds a layer of complexity to the model. When you are dealing with the people in your own department or functional group then this can be thought of as intra-organizational communication. However, it is often the case that functional units need to communicate with other functional units inside the organization. For example, the general practitioner might be required to provide information to the ER in cases of emergency. When communication is needed between sub-organizations this is considered inter-organizational communication.

It is generally easier to communicate with people you interact with on a regular basis. Therefore intra-organizational communication requires a certain level of adherence but if something isn't clear then generally you can have access to that person to ask them to clarify. However, in the case of inter-organizational communication this may not be the case. The other department could be in a different building or even possibly in a different country. Therefore, communications on this level possess significant challenges to the message being provided clearly.

One study has potentially identified how such communication can be better facilitated between inter-organizational functional groups. The study found that in multi-national organizations, the organizations that possessed the strongest sense of a shared vision were able to both transcribe and also interpret information more accurately than organizations that did not possess the same level of vision incorporation (Li, 2005). This has vast implications for management. If management can both act to provide the appropriate channels of communication as well as develop a shared vision then this increases the likelihood that both intra-organizational and inter-organizational communication will stand to be facilitated at the highest possible levels.

Part E

How can management ensure individual job satisfaction for…