Ashford General Hospital - Final Paper

10 Organization Development and Change

Learning Objectives

After reading this chapter, you should be able to:

• Examine theories of organizational development and applications for health organizations.

• Apply change management principles in health organizations.

• Articulate the dynamics of the change management process in health organizations.

• Describe current change initiatives in health care organizations.

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Section 10.1Introduction to Organizational Development and Change

National Health Reform The Patient Protection and Affordable Care Act of 2010, now more commonly called the Affordable Care Act (ACA) or “Obamacare,” aims to provide Ameri- cans with better health security through comprehensive health insurance reforms to expand both public and private cover- age, hold insurance companies account- able, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans (Medicaid.gov, n.d.). The ACA was, and remains, highly partisan. The final bill was passed by 7 votes, with all 178 Republicans and 34 Democrats in Congress opposing it (Office of the Clerk of the U.S. House of Representatives, 2010). Since its enact- ment, Republicans have voted more than 40 times to repeal it, and 26 states joined in a legal challenge that reached the

Supreme Court in June 2012. The court upheld all aspects of the ACA except a mandate that would have required states to expand Medicaid or lose federal funding for it.

Implementation of the ACA has been a rocky process. As of early 2014, 25 states and the District of Columbia are implementing the Medicaid expansion, 19 are not, and 6 are still debating it (Kai- ser Family Foundation, 2014). The employer mandate requiring all employers with 50 or more full-time equivalent workers to provide health insurance was postponed from January 1, 2014, to the start of 2015 to give employers more time to comply. Implementation of subsidized private health care coverage for individuals has been problematic due to issues with federal and some state online enrollment systems and a greater-than-expected proportion of older, presumably sicker, peo- ple enrolling in the health plans offered.

More than 2,000 pages long, the ACA is an extremely complex law, with equally complex imple- menting regulations from the U.S. Department of Health and Human Services, the federal agency responsible for its implementation. As of May 2013 regulations pursuant to the ACA in the Fed- eral Register totaled more than 20,000 pages (Kessler, 2013). The most comprehensive health reform legislation since the enactment of Medicare and Medicaid in the 1960s, the ACA’s scope and scale impacts nearly all health organizations, both public and private.

10.1 Introduction to Organizational Development and Change

This chapter begins with a discussion of organizational development concepts and theo- ries as a framework for effecting positive changes, illustrated by health care organizational development applications. The change management section focuses on what it means to be, and how to become, an organizational change agent in the most constructive manner.

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Signed into law by President Barack Obama, the Patient Protection and Affordable Care Act of 2010 enacted comprehensive health reform, a positive change for millions of Americans.

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Section 10.2Organizational Development

The chapter concludes the e-textbook with examples of numerous change initiatives cur- rently underway in a variety of health organizations.

10.2 Organizational Development Organizational development (OD) is a planned change process designed to improve organizational effectiveness. Directed by a change agent or line manager whose chief role is that of a facilitator, OD can also be a macro approach that involves the entire organiza- tion and its interrelated, symbiotic parts. OD is fundamentally an education-based pro- gram to cultivate ideals, mindsets, norms, and management practices that encourage and reward positive and productive employee behavior (McLean, 2005).

Relevant Organizational Development Theories for Health Organizations

Social psychologist Kurt Lewin is considered the founding theorist of OD because of his applied behavioral science research in the 1940s. The conceptual framework of OD includes the concepts of group dynamics and action research. Although OD ack- nowledges the significance of top management’s commitment, backing, and immersion, the model asserts a bottom-up approach versus top-down when culture and ethos of the organi- zation upholds such efforts to advance an organization; it also recognizes the need for intentional follow-up to solidify and sustain implemented changes (McLean, 2005).

Lewin (1958) proposed that organi- zational change proceeds in three steps: unfreezing, transformation, and refreezing. During unfreezing, the organization realizes there is need for change. Transformation is the stage where the changes begin to happen. Refreezing entails the implemented change being solid- ified into the organization’s culture. In Lewin’s action research model, OD occurs through use of problem identification, hypothesis development and testing, and data collection and analysis, as illustrated in Figure 10.1. Systems theory, a topic discussed in more detail in Chapter 2, is also associated with OD and suggests the importance of external environ- ments: Organizations take in ideas and resources from the environment and then transform and return them as finished products, improved processes, or expanded knowledge (Britt & Jex, 2008). A thorough understanding of these fundamental concepts is a foundation for successful OD efforts.

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Organizational development involves coalescing to achieve a common goal.

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Section 10.2Organizational Development

Figure 10.1: Lewin’s action research model

Lewin’s action research model of change involves field research, gathering and analyzing data, and planning and implementing change.

Building on Lewin’s foundational research, Douglas McGregor described Theory X and Theory Y management in the mid-1950s. He and Richard Beckhard are credited with coin- ing the term organizational development in 1957 to describe a pioneering, bottom-up change effort. Since then the health care industry has embraced it as a method for developing strategies to initiate and sustain organizational change (Whitlock, 2009). Responding to demands placed on them by the market, consumers, competitors, regulators, and employ- ees, health organizations are increasingly employing OD initiatives as they seek to rede- sign business processes and transform their cultures to become learning organizations that continually reinvent themselves based on external and internal influences.

Best Organizational Development Practices

Best practice involves identifying, studying, and adapting what high-performing organi- zations in the same industry do. It is an approach that has reliably shown results superior to those achieved through other means and thus is used as a benchmark. The practice of OD is entrenched in a divergent set of core values and principles that guide user behavior and actions called interventions. Key OD values include:

• respect and inclusion of all involved; • collaboration to construct dual individual and organizational successes; • authenticity to assist individuals to align actions with touted values; • helping individuals to develop interpersonal relationships within the

organization; • empowerment to intensify autonomy, augment and enrich productivity, and

increase morale; and • democracy and social justice, because people tend to support things that they

have a vested interest and direct participation in shaping (McLean, 2005).

Problem Identification

Hypothesis Development and Testing

Change Recommendations

Change Implementation

Data Collection and Analysis

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Section 10.2Organizational Development

Patient-centered care “replaces our current physician centered system with one that revolves around the patient” (Rickert, 2014 p. 1). The growing movement toward patient-centered care is based on the demonstrated evidence that it is possible to simultaneously improve the quality and reduce the costs of health care. One of its fun- damental tenets is that patients’ views of their health care needs correlate with both satisfaction and outcomes. Physicians who practice patient-centered care improve interactions with patients by employing measurable communication skills and behav- iors. At the same time, they reduce diagnostic testing, prescriptions, hospitalizations, and referrals. For most health organizations, providing patient-centered care would require a major OD intervention.

Health Care Organizational Development Applications

Health organizations are highly complex environments with staff members that possess a wide variety of skill sets that enable them to achieve optimal performance and ser- vice excellence. A culture that supports continued learning helps foster a committed and goal-oriented workforce. A 2005 global human capital study conducted by IBM Business Consulting Services reported: “It is clear that companies that invest in human capital,

Theory in Action: Best Practices for Organizational Development

Flora Richards-Gustafson (2013) provides four best practices for OD designed to develop and maintain effective relations among employees, customers, investors, and other stakeholders. Effectively executed, an OD intervention focuses on achieving objectives, strengthening relationships among employees and business partners, and fostering innovation.

1. Develop an action plan with clear milestones, deliverables, and accountable staff, and communicate about the plan and progress on a regular basis.

2. Be mindful that executing the action plan is just as important as the plan itself; a best practice objective is to increase productivity during the execution phase at double the rate of the industry average to ensure the company’s future steady growth.

3. Company culture should inspire and support performance-driven teams and individuals to achieve organizational goals and establish accountability for outcomes—and then keep raising the bar and rewarding ongoing successful efforts.

4. Company structure should be streamlined and nimble, with realistic procedures for both customers and employees.

Reflection Questions: 1. How realistic is it to expect productivity to increase at double the rate of the industry

average? What factors would support or constrain achieving this objective? 2. How might an OD initiative help a company streamline its structure and simplify its

procedures?

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Section 10.2Organizational Development

work to develop and retain valued employees, measure and hold peo- ple accountable for that investment, have a powerful competitive advan- tage” (Tay, n.d., par. 3).

Health care organizations are driven by human capital, so management and medical staff development must be an organizational priority for which leaders are held accountable and resources are allocated within operational budgets. Since clinicians typically hold operational leadership positions within medical institutions, if they are not actively participating in staff development efforts, nei- ther they nor the ancillary staff they supervise will grow as managers. Clinical managers particularly need

ongoing education to stay current in the areas of workforce regulations, patient care and safety, advances in health care technology, health policy, and medical research. Staff development should encompass cross-functional training to help ensure continuity, pro- fessional and personal skills improvement, mentoring, and career growth. Added ben- efits for the organization can include higher staff morale, increased job competencies, and patient satisfaction.

Management Staff Development Surprisingly, a large number of managers in health care organizations have had minimal or in some cases no formal managerial training. They may have risen through the ranks through longevity, attrition, turnover, or for performing aspects of a clinical or technical job exceedingly well, but they may not know how to successfully and actively manage a staff. Many managers assume that if an organization hires competent people and pays them competitive wages, their staff will perform well indefinitely. These managers fail to make the connection between organizational performance and staff development (Gesme, Towle, & Wiseman, 2010). Development of staff must be a continual process that the orga- nization takes seriously and encourages wholeheartedly.

Superb management skills and abilities are indispensable for managers in today’s health organizations. Most employees do not leave jobs; they leave bosses—particularly those who do not appreciate them or who lack the competencies to help their subordinates learn and grow by providing learning opportunities and training resources. As Mary Kay Ash, the founder of Mary Kay Cosmetics, said: “People are definitely a company’s greatest asset.. . . A company is only as good as the people it keeps” (as cited in Sylvestre-Williams, 2012, p. 2).

Clinicians already participate in clinical continuing medical education (CME) programs to maintain their licenses and keep up with best practices and new developments specific to

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Organizational development in health care orga- nizations involves people and impacts customers throughout the organization.

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Section 10.2Organizational Development

their professions. While most organizations do not make administrative staff development mandatory, some require managers, especially those in highly visible roles, to complete a certain number of CME hours each year to upgrade their management skills and maintain currency in their administrative specialty fields. The ACHE requires board certified health management professionals to complete 36 credit hours of health care–management con- tinuing education every 3 years, 12 hours of which must be obtained through participating in ACHE in-person educational programs (ACHE, 2013a).

Ledlow and Coppola (2014) recommend the crawl-walk-run approach to health care leadership development. Building on a foundation of knowledge, skills, and abilities, it involves a series of incremental steps with an increasing scope of operational responsibil- ity and oversight of greater numbers of subordinates. The entry-level crawl stage involves acquiring management knowledge and skills; additionally, the junior professional needs to develop and demonstrate analytical skills, initiative, and evaluative thinking to pri- oritize time and tasks for maximum productivity. In the walk stage, prospective leaders apply their management knowledge and skills with a small team of subordinates as a project team leader or supervisor and communicate empirical and evaluative informa- tion to their teams and larger groups. They will learn through experience about the com- plexities and challenges of managing teams and groups on a gradually increasing scale. Other developmental experiences include managing increasingly larger budgets, com- plex multidisciplinary task organization and execution, and strategic planning. The run stage involves leading up to hundreds of people, managing million-dollar budgets, and directing organizational strategies that may impact the lives of thousands of other people through the execution of complex skill sets, refined through a broad range of experience over many years. Conceptual and strategic thinking and the ability to deal effectively with the organization’s governing body are the essential skills of leaders in this executive-level career stage in order to ensure the organization’s future growth.

Medical Staff Development Development of medical staff can be a relatively expensive investment but well worth every penny if done correctly. Recruiting and retaining clinicians is a time-consuming and intricate process, but if done poorly it can severely impact operations, output, morale, and future capabilities. Medical staff development plans enable health organizations to formulate strategies based on future community health care service needs and the number of clinicians needed in each specialty to meet those needs.

Investing the necessary resources in the development of clinical caregivers and leaders provides the organization with the upgraded human capital resources needed to deliver high-quality health services. This investment enables the organization to be branded as a leader in its respective field, region, or both. It also enables staff members to further develop their competencies to adequately address changes and effectively develop and implement new policies.

Medical staff development efforts may take a backseat to more measurable and visible efforts such as clinical and administrative productivity goals. However, there is ample room to pursue both goals and still participate in staff development activities. It is not an either-or choice, especially if the organization insists on and touts the benefits of staff development, which may include increased patient satisfaction, improved outcomes, intellectually stimulating work environments, and higher retention rates.

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Section 10.3Change Management

Governing Body/Board Development Developing a strong and actively engaged governing board is one of the most important leadership responsibilities. Similar to other OD activities, board development is some- thing that the organizational leadership team learns to value over time (Morino, 2004). Experts recommend that governing body members represent the communities the orga- nization serves and possess a mix of expertise. Since most health organizations treat a culturally diverse population, the board should reflect that diversity as well as the staff. Board members’ experiences, wise and often astute guidance, and fresh viewpoints can help position the organization to successfully face the inevitable conflicts and challenges that occur when board members’ opinions differ. Health care organizations, particularly those in nonprofit sectors, have started to supplement their boards by including members who have germane and specialty expertise and who have experienced some of the cus- tomer service issues the organization is likely to encounter (Erwin & Garman, 2009).

Successful change requires top-level organizational support. A strong board that will challenge the status quo and hold the organization’s leaders accountable for performance and outcome measures is needed to make a change initiative successful, believable, and actionable for people throughout the organization. Given their broad scope of responsibil- ities, health organization boards also need development training. Qualifications for board members have often been minimal. By necessity, health organizations are now recogniz- ing the need to recruit board members who possess competencies needed to help them get to the next level and who are open to constantly learning about economic, social, techni- cal, political, and regulatory changes affecting the company (Morino, 2004). By providing additional resources to help board members be successful in their roles and carry out their fiduciary duties, not only does the organization benefit but members are more likely to find board service to be a rewarding experience.

10.3 Change Management The fundamental purpose of OD is to develop and sustain change initiatives, often with the assistance of internal or external consultants. Change managers use basic tools or structures envisioned to keep any change attempt under control. The goal is typically to limit the interferences and influences of the proposed change on the organization and its workers. Change management tends to work best with smaller scaled efforts and requires thoughtful planning and delicate implementation. It is crucial that those affected by the change are brought into the planning and implementation to ensure buy-in. They need to know that the change will be practical, achievable, and measurable.

Need for Change

Whenever an organization undertakes a significant change, there will likely be snags. Given that change can be disconcerting and unnerving, it is imperative that employees are empowered to accept the change and become part of the change process. Selling change to people as a vehicle for fast-tracking compliance and implementation is unlikely to pro- duce sustainable change. Organizations that take the time to help staff understand the need for change can better address employees’ resistance and concerns. Employees need an opportunity to grasp what it all means to them, how they will be affected, and what

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Section 10.3Change Management

the organization will look like going forward with the proposed change (Jones, Aguirre, & Calderone, 2004).

Change Management Principles

Since leaders are charged with managing and facilitating change, they should not expect employees to manage the change themselves. Carrying out change is not a transferable responsibility and as such requires leaders to continuously spell out the vision, expecta- tions, impact, and most importantly the need for change. Basic change management prin- ciples include:

• involving, empowering, and communicating with employees transparently about the change;

• understanding intimately where the organization is currently and how the change will help it achieve its goals in the future; and

• developing achievable, measurable metrics at various stages for the change (BusinessBalls.com, n.d.).

Theory in Action: Eight Strategies for Successful Change

John Kotter, formerly a Harvard Business School professor and the author of several best-selling books on management, has researched and published extensively on the subject of organizational change. He provides eight steps to successful change (Kotter, 1995; Kotter International, 2012):

1. Increase urgency. Empower, motivate, and stimulate people to become active in the change.

2. Communicate for buy-in. Communicate the basics of the proposed change with staff. Using social media resources can be useful to help spread the message regarding the change, although face-to-face meetings are necessary and of ultimate importance in conveying the message.

3. Empower action. Provide staff with necessary resources to support the change, eliminate hindrances, and allow for productive feedback while acknowledging and recompensing efforts and accomplishments.

4. Build the guiding team. Align the right staff with strong competencies and a matching strong commitment to the change.

5. Get the vision right. Establish an uncomplicated strategy and vision necessary to drive service and efficiency.

6. Create short-term wins. They should be readily doable and allow for staff to make some small progress as they press forward to the ultimate goal.

7. Do not let up. Create an environment that supports and encourages fortitude and perseverance.

8. Make change stick. Strengthen and boost the value of successful change; embed change into the organizational culture.

Reflection Questions: 1. Suggest some ways to use social media to communicate with employees about an orga-

nizational change. 2. What types of resources are helpful to support an organizational change? 3. At what point should patients or customers be involved in an organizational change?

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Section 10.3Change Management

Kotter’s recommended strategies are general approaches to accomplish the desired change. Each involves many tasks for the health professional tasked with leading a change. Delin- eating and tracking progress implementing the change strategies are important elements of a successful organizational change effort.

Social and Technological Changes Affecting the Health Care Workplace

Emerging technologies such as electronic medical records, social media sites (e.g., Face- book, Twitter, LinkedIn), and transparency have substantially impacted health care orga- nizations, particularly in the past 10 years. Each change can provide positive benefits to the workplace but also pose substantial challenges and risks.

Electronic Health Records (EHRs) Operational in nearly all health care settings, EHRs have demonstrably advanced orga- nizations’ ability to measure and monitor health outcomes. Their use promotes an inte- grated model of care that facilitates population health management. EHR systems are vital for standardizing treatment protocols, collecting detailed information on treatment outcomes, addressing compliance issues, and promoting case management. They typi- cally collect data at the point of care, including patient demographics, physician and staff assessments, treatment results, and data required for compliance with organizational and accrediting agency policies and government regulations (Dunn, 2010).

Evidence of the growing influence of health-information automation on the workplace is abundant and has also generated concerns about data security among both patients and providers. Health organizations are required by the Health Insurance Portability and Accountability Act of 1996 regulations to protect against possible security breaches, both internal and external, and quickly notify patients of any discovered security breakdowns (Dunn, 2010). Additionally, some health organizations find EHRs unwieldy and their reports problematic to understand and translate. Regardless of the issues and concerns surrounding EHRs, they are here to stay. Through the Health Information Technology for Economic and Clinical Health Act of 2009, health care providers received millions of dol- lars in federal stimulus funds promoting their implementation and usage (HealthIT.gov, n.d.). In addition, both public and private payers increasingly require electronic transmis- sion of patient data and service payment claims.

Social Media Social media are web-based tools and technologies used to distribute information and turn communication into interactive dialogues with internal or external audiences (SHRM Research Spotlight, 2011). Social media is transforming the ways in which peo- ple associate and how they share information. Widely used social media vehicles include LinkedIn, Twitter, Myspace, Facebook, Instagram, and Pinterest, and there is a constant

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Section 10.3Change Management

stream of new contenders with new approaches. These types of technolo- gies become popular very quickly, allowing organizations little time to formulate appropriate approaches and reactions or to develop policies on appropriate usage and monitor- ing guidance for employees.

Used appropriately, social media can be of great value to an organization; however, they can be very harmful as well, opening the door to various legal and organizational branding risks. The main legal risk involves violation of confidential patient information. The main organizational branding risks are disclosure of proprietary business information and the posting of negative comments and distorted or incorrect information about the organization. Since customers increasingly go online to rate products and services and share personal experi- ences, more companies have fully embraced social media and encourage their employ- ees and customers to do the same. Social media allows users to influence and define an organization’s brand and online image—a mixed blessing. Some organizations have tried to avoid a social media presence, only to recognize that many users of social media are their own employees, stakeholders, and customers. Members of all these groups have the power to affect their brand and reputation in a positive and negative way through their word of mouth and viral postings.

Organizations that seek to stay current will find appropriate ways to use and leverage social media opportunities, whether it be through advertising, recruiting, or awareness. If they fail to define their own social media presence, they must recognize that others may do it for them—and this may have a positive or negative impact. It is crucial that organi- zations define their own social media footprints that represent their organizations in the best light possible.

Transparency Transparency is a business practice that provides for a clear and continuous display of results. Thanks to online public access to various company materials (e.g., regulatory agency filings, annual reports) and report cards or ratings posted by government and advocacy organizations, consumers, investigative journalists, and other interested parties can easily obtain health care organizational information. Organizational transparency is of paramount importance for health care organizations to effectively distinguish them- selves as viable, ethical, and legitimate organizations. It is a powerful driver of account- ability and a recognized driver of consumer choice. After New York State began publishing outcome data for coronary artery bypass graft (CABG) surgery, mortality rates for that procedure declined by 40%, and hospitals with better outcomes experienced market share growth for such surgeries. Hospitals in several countries, including Sweden, Denmark,

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Social media have dramatically changed interper- sonal communications.

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Section 10.4Dynamics of Change

and Canada, post the average wait times for various services. Evidence suggests that wait times improve as a result of the regulatory mandate, since hospitals act to reduce them and thereby improve public perceptions of their performance (Henke, Kelsey, & Whately, 2011).

10.4 Dynamics of Change Health organizations’ internal and external environments are seemingly in a state of con- stant change today. Many are struggling to survive, and all are challenged by escalating costs and payers’ attempts to control these costs through new types of payment systems and financial incentives. Staffing shortages, both actual and projected, and the growing influence of labor unions in the health care workforce have further increased costs and also exacerbated staff retention issues. As organizations operating in a turbulent environ- ment, health organizations are investing more time and resources to address and optimize change dynamics to work in their favor rather than against them (Jones, 2011). Major fac- tors in change dynamics include resistance and barriers to change; assessing readiness to change; leading, managing, and effecting change; and engaging staff.

Resistance and Barriers to Organizational Change

Employees frequently actively or pas-sively resist changes that leaders have determined will help fulfill the organization’s mission and improve the way the organization con- ducts its business or, in the case of health organizations, delivers patient-care services. Typically, before an organization can undertake and implement a change initiative, it will first need to help employees disengage from the old behavior or business process. When the employees understand and buy into the change, they will be more willing to adapt to and adopt the new behaviors required for compliance with the change initiative.

However, some resistance is likely to occur with every significant change initiative, and the first reaction to change is usually negative.

To best tackle this resistance head-on, it is important to create a shared orga- nizational vision of how the change will make the organization better (Cellucci, & Wiggins, 2010). Pexton (2009) cites research conducted by Harvard University and other insti- tutions which found that between 60% and 80% of change initiatives fail to achieve their stated goals. She notes that some of the most success- ful change efforts have involved a heavy focus on organizational cul- ture when implementing business

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A prime reason for resistance to change is employees’ fear that it will mean more work.

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Section 10.4Dynamics of Change

process improvement strategies. Pexton offers eight tips to identify and overcome the most common barriers to change:

1. Be proactive: Expect and prepare for cultural complacency, resistance and skepti- cism. If possible, obtain assistance from outside experts to work through resis- tance, discover the reasons for it, and develop a realistic plan to achieve the goals of the change initiative.

2. Develop a strong communication strategy that clearly and concisely defines the vision and goals of the initiative. Conduct a stakeholder analysis to understand and address the concerns of all individuals and groups impacted by the change.

3. Align performance objectives with the change initiative and hold individuals accountable for achieving them.

4. Demonstrate full leadership support for the initiative through methods such as personally attending progress-reporting sessions and publicly recognizing suc- cesses and contributions.

5. Avoid micromanagement and empower employees to implement the change. 6. Help employees see that the change will make their lives easier, not add to their

workload. 7. Ensure that there are adequate systems, structures, and resources to support the

change. 8. Formulate control plans to track and sustain results.

Pexton (2009) concludes her recommendations with a warning: “The best strategy will run into invisible brick walls if you haven’t adequately addressed the acceptance side. And you can’t lead change if nobody is following you” (p. 2).

Assessing and Creating Readiness to Change

Organizational readiness for change depends on the degree to which organizational mem- bers value the change and how favorably they evaluate three elements of change imple- mentation capability—task demands, resource availability, and situational factors. The latter would include conditions such as organizational culture, climate, policies and pro- cesses, and positive or negative past experience with change. Organizational members are more likely to initiate and support change when organizational readiness is high, result- ing in more effective change implementation (Weiner, 2009).

Assessing Readiness to Change Change begins with a baseline assessment of the organization’s current operations, cul- ture, and market. The experience of an aged care facility illustrates its applicability in a health care organization. An environmental scan serves as an organizational assessment of readiness. The facility conducted such a scan using the Promoting Action on Research Implementation in Health Services (PARiHS) model that incorporates evidence and con- text as dynamic variables influencing change enablement (Gibb, 2013).

The task of the change agent was to facilitate a variety of new behaviors associated with teamwork, which had been developed for a skilled and proficient accredited nurs- ing workforce, to other, less educated patient-care workers. One key goal of the change

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Section 10.4Dynamics of Change

initiative was to include senior personal care workers as operational leaders to comple- ment the more strategic leadership of registered nurses.

The environmental scan was designed to analyze the key organizational attributes of organizational culture, leadership, and performance evaluation. It laid the groundwork for the introduction of an evidence-based teamwork training system that has had some success in acute care and emergency services. However, its transferability to residential aged care required some testing for validation.

The study aimed to define workplace factors that were strengths or enablers to boost the team’s ability to sustain practice changes. Identification of key organizational characteris- tics allowed the organization to recognize cultural impediments and behaviors that could hinder change. The researchers conducted the environmental scan by observing nurses and patient-care workers, interviewing a sample of nurses, holding focus groups with patient-care workers, and meeting with groups of facility residents and family members.

The study results emphasized the primary role of teamwork in organizational change initiatives. When team members have a clear sense of the connection between their own tasks and collective goals, there is more likely to be smooth coordination and higher qual- ity communication among team members and less conflict and uncertainty regarding individual responsibilities. Team members whose individual roles are distinctly defined in relation to the team’s function can better appreciate the contribution of their own task achievement to overall team goals. At the team level, a high level of process clarity pro- vides a structure for individuals to clearly comprehend the procedures that need to be followed for the team to achieve its end goals. Teams lacking a sense of their collective potency are prone to conflict as well as individual underperformance.

Web Field Trip: Change Readiness Survey

Review the Change Readiness Survey at http://www.strategies-for-managing-change.com /change-management-implementation.html and complete Questionnaire #4. Ponder ways in which your organization applies workplace changes and circle the number that is reflective of your experience. Then compare your responses with a coworker or supervisor. A perfect score is 100; anything lower than 20 indicates a possibly strong resistance to change in your organization.

Creating Readiness for Change Readiness means being prepared: having the resources in place and creating the atmosphere to support the change process, possessing a clear vision for the envisioned change, and hav- ing the drive and necessary attitudes to engage with the change to make it succeed. A key element in creating readiness for change is broadening support for a change throughout the organization, for which an effective communication strategy is essential. The change

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Section 10.4Dynamics of Change

leaders, supported by top management, must formulate a clear message about the reason for the change and how it will be accomplished and must deliver it consistently through multiple channels. These channels should include formal presentations and communica- tion vehicles such as the company newsletter, as well as informal communications such as conversations and e-mails. Change leaders should encourage and be prepared to answer questions and be honest about things they do not know (Golden, 2006).

Effecting Change

An effective managed change process typically plans for a set series of events to arrive at the desired goal. Successful organizations will first analyze which employees stand to lose something under the new change. This analysis allows organizational leaders to help those affected employees let go of the old and embrace the change; otherwise, resistance left to fester can result in sabotage, inertia, and disengagement. Those effecting change have to be ready, willing, and able to deal with it head on. Enabling employees to connect the change and its benefits to their work can lead to engaged employees uniting to achieve a successful organizational change effort.

To help effect change, organizations may consider offering a variety of rewards for those who contribute and those who comply with the changes. The objective is to reward new positive behaviors and decrease, if not totally eliminate, negative behaviors. Pulling the best and most engaged employees together to demonstrate exemplary action to others in the organization can help steer positive acceptance of the change from those who may still be on the fence or resisting it.

Leading Change Too often, leaders fail to constructively use teams to help bring about change. For some, personal self-interest prevails, frequently as a result of a conflict of interest between per- sonal and organizational goals. Teams are not promoted, individuals are—and individuals need strong track records of accomplishments to advance their careers. Being on a team is far less impressive on a professional’s resume. However, today’s health care organizations and executive recruiters recognize that leading a team is a vital skill for managers and executives. Change is not a one-person show. To be effective, it must include people in every layer of the organization.

Leaders lead change by creating and communicating an inspiring vision and by success- fully spearheading the development of strategies and overseeing their implementation. Only they can provide a vivid and alluring picture of the future for those who will be affected and articulate how the vision can be realized. Communicating the vision and the strategy is a continual process that must occur prior to, during, and after the proposed change, or pre-launch, launch, and post-launch.

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Section 10.4Dynamics of Change

Case Study: Expansion of the Breathmobile Program

The Breathmobile Program is a community-based pediatric disease mobile management program that provides free asthma and respiratory-related specialty care to underserved children at their school sites, primarily in inner cities and environmentally impacted communities. Traditionally, the program treats patients from the ages of 5 to 18. Costs to operate a mobile unit annually can range upward of $350,000 to $500,000.

Launched in 1995 at Los Angeles County–University of Southern California (LAC+USC) Medical Center, the Breathmobile Program consists of eight collaborative sites at various hospitals throughout the nation. While each site operates independently, all collaborate to conduct research and to spearhead best practices, and since inception they have collectively treated more than 200,000 children.

The Breathmobile Program has been funded through grants from government and private foundations, individual donations, and some insurance reimbursements. Some executives at participating sites have agreed to fund their respective programs indefinitely through their operating budgets, although for some this has not been an option. Securing operational funds is critical to overall long-term sustainability of the program and is a constant concern to sites. Action had to be taken to open up new revenue streams for the program to help ensure continued operations for some sites.

Breathmobile regional director Felita Jones approached the sites in 2009 with the idea of expanding into the Head Start Program and targeting children from the ages of 0 to 5, a population that the sites had not focused on before that time. Research showed that many children in this age group were being misdiagnosed with bronchitis and other respiratory conditions and that there was a real need for the services that the Breathmobile Program provided. The proposed program expansion offered opportunities to tap into a new revenue stream by serving a new demographic.

However, the program had successfully operated for nearly 16 years with no major changes or expansions and was a recognized leader in providing top-quality, evidenced-based asthma- related care for pediatric patients. So the idea of an expansion was initially met with some reservations and reluctance. After Jones presented a business plan for the expansion and held numerous one-on-one talks with individual hospitals, two sites (Mattel Children’s Hospital UCLA and Arrowhead Regional Medical Center) agreed to pilot the expansion at their sites, and the others waited to see how the expansion fared.

Within a few months, both programs showed not only a spike in utilization and retention rates but also demonstrated strong outcome measures—reductions in emergency department (ED) visits, hospitalizations, and school absenteeism. Additionally, Jones obtained funding in excess of $900,000 for first-year expansion efforts through the South Coast Air Quality Management District, Port of Long Beach, and First 5 San Bernardino (the administering agency for tobacco tax funds allocated to the county).

The expansion’s success generated interest among the other sites in exploring expansion opportunities at their respective locations. Founding site LAC+USC Medical Center even went so far as to suggest expanding into the foster care system, again opening up a new untargeted resource and new revenue stream.

The program continues to operate throughout Los Angeles, Orange, and San Bernardino Counties; Oakland and the Bay Area; Phoenix, Arizona; Alabama; and Maryland. There are also plans to expand the network to include even more hospital sites in the future, including Atlanta, Georgia; Hawaii; and Massachusetts.

(continued)

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Section 10.4Dynamics of Change

Engaging Staff Engaged employees are invested and excited about their jobs and embody the qualities that promote their organization’s best interests. These employees often feel a strong per- sonal connection to their organizations, which tends to result in increased levels of pro- ductivity as they give the time and discretionary efforts beyond the normal call of duty to achieve organizational goals and meet or surpass industry benchmarks.

Organizations have begun to focus more intensely on engaging staff in retention efforts to stave off expen- sive turnover-related costs. Some organizations believe financial com- pensation is the leading motivator and a sign of whether employees will actively engage or not. Typi- cally, however, displeasure and dis- content with pay is usually not what leads employees to test the waters with other employers, even com- petitors. By championing important nonmonetary rewards (especially career growth opportunities, job recognition, and job tasks that align with employee competencies), health organizations may be more success- ful than by emphasizing compensa- tion. Cultivating employee engagement, providing the necessary resources for employees to be successful, and ensuring that job tasks and responsibilities are well matched to employee competencies are critical success factors for long-lasting organizational change initiatives (Werhane & Royal, 2009).

LuminaStock/iStock/Thinkstock

Engaged employees envision and achieve successful change.

Case Study: Expansion of the Breathmobile Program (continued)

Reflection Questions: 1. How do you think the Breathmobile Program would have been affected if the director

had not proposed expanding into the Head Start Programs? 2. What are the major advantages/disadvantages of the director’s strategy to implement

the change on a pilot or trial basis? 3. What advice would you offer the Breathmobile Program for dealing with its sustain-

ability issues if the director’s suggestion for expansion had not resulted in increased utilization and generation of new revenue?

4. Discuss a time when you have participated in or led positive change in a leadership role. What were the results?

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Section 10.4Dynamics of Change

Since employee engagement has a significant effect on providing health organizations with a competitive edge, organizations have to be willing to pull out all the stops to ensure that employees are fully engaged and empowered to act in ways that help the organiza- tion increase productivity and deliver higher quality care and service.

Institutionalizing Change

Once a change is implemented, the challenge is how to make it last. Leading health orga- nizations are now moving toward the next level of change management, shifting their focus from project-by-project applications toward institutionalizing change in manage- ment practices, processes, capabilities, and competencies.

Theory in Action: Ten Tips to Encourage Continuous Workplace Innovation

The i4cp company report, Human Capital Practices That Drive Innovation, lists the 10 best ways that human resources professionals can encourage continuing workplace creativity and innovation (Stevenson, 2013).

1. Use technology to enable collaboration and social media tools to share knowledge. 2. Define and demonstrate how the organization values and actively promotes

innovation. 3. Include innovation as a major competency in leadership-development plans and

performance assessments. 4. Tie individual bonuses and/or salary increases to innovation, as well as nonmonetary

incentives that encourage innovators to keep those ideas coming. 5. Have a formal program to find and promote creative and innovative products,

programs, and ideas; otherwise many may go unnoticed and unrealized. 6. Make discrete budget allocations to fund innovation projects external to the enterprise

from nonemployees (e.g., customers, vendors, and stakeholders) who desire to participate in innovation efforts.

7. Provide internal training in creativity and innovation so that anyone can be an innovator.

8. Establish a formalized or structured idea and innovation-review process and provide feedback on how submissions are appraised.

9. Identify and track innovation talent at the undergraduate and graduate levels to attract top students with the potential to become company superstars.

10. Reward innovation with more engaging work and autonomy.

Once an organization effectively moves the change from innovation to an accepted way of operating on a day-to-day basis and all elements of the organization demonstrate con- sistent decision making aligned with the change, the change is considered to be institu- tionalized (Whitlock, 2009). Feedback groups and surveys can be of great use in analyzing the usefulness of the applied change, and they require a concerted effort as organizations attempt to improve workplace creativity and innovation on a systematic level and as an ongoing practice.

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Section 10.5Current Change Initiatives in Health Care Organizations

10.5 Current Change Initiatives in Health Care Organizations

Change in health care organizations is a given and demands employee, organization, and stakeholder engagement to carry out and sustain the change. Organizations are develop- ing a wide variety of change initiatives to engage staff in achieving organizational perfor- mance improvements that respond to growing pressures from both consumers and payers to provide better care at lower cost. Some relevant change initiatives that are center stage in organizations today include:

• consolidation for those organizations that want to pool their resources to provide increased levels of service while having others share the costs;

• systemic and systematic change designed to modify thought processes and prac- tices that are deeply ingrained in the organization;

• the concepts of stepping up and leaning in, where workers are encouraged to take risks and put themselves out there for the greater good of their companies and their professional careers;

• business process improvements that assist organizations to optimize processes and achieve greater efficiency; and

• performance accountability measures to promote ownership of individual and team efforts.

Theory in Action: Ten Catalysts of Change for the Health Care Industry

Health care organizations operate in dynamic, complex, and highly volatile environments, with dwindling financial resources and growing patient populations whose members present with a myriad of unmet needs. The overall trend in the health care industry is payment- and delivery-system reform. Dubow and Lykidis (2011) of the Camden Group consultancy offer 10 catalysts of change driving resource applications and their implications for the health care industry.

1. Clinical integration and care redesign. Providers are obliged to participate in multiple points of access to patient care. They will need to choose prime locations for care centers in their designated service areas and strategically select services and allocate resources for designated sites.

2. Physician critical mass. To successfully market particular clinical services and to reach quality metrics, the organization will need to actively enlist and maintain a critical mass of loyal physicians in particular specialty services.

3. Technology. Admissions and average length of stays are expected to continue declining, given the growing use by physicians of minimally invasive surgery and smaller imaging modalities. This trend will allow more services to be delivered in ambulatory care settings and force realignment of facility-based resources and staffing.

4. Bundled payment. Providers will participate in regional consolidations of expensive specialty care services in response to new CMS incentives.

5. New partnerships. Hospitals will collaborate and contract with experts for delivery of tertiary and lower volume specialty services, permitting them to maintain responsibility for managing patient care while limiting risks.

(continued)

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Section 10.5Current Change Initiatives in Health Care Organizations

Payment reforms increasingly emphasize organizations being benchmarked against the value delivered as measured by increased quality, decreased costs, or both. Thus, health care organizations must tailor their resource-allocation decisions for optimal market and financial performance. Health professionals need to be aware of the factors shaping their industry in order to survive and succeed in an organizational environment that is con- stantly changing.

Consolidation

Consolidation is one practical approach for health care organizations to compete in today’s challenging environment, and it may occur in the form of a merger, an acquisi- tion, or a collaboration. The advantages of collaborative partnerships include expanding services, reducing costs, avoiding some expenditures, and access to professional exper- tise, costly technologies, and population health management resources (Calayang, 2013), as illustrated in Figure 10.2.

Theory in Action: Ten Catalysts of Change for the Health Care Industry (continued)

6. Aging patient pool. Hospitals are likely to face influxes of sicker patients, which will require modifications in the critical care service mix.

7. Remote monitoring. Technological advances will facilitate more sophisticated and expanded home health care services, reducing the need for inpatient observational and postacute care.

8. Physician integration. Strong viable clinician leadership will drive decisions on investments in different areas of the organization.

9. Space planning. Increased costs of building additional space dictated by health care regulations will increase use of modular- and mobile-facility solutions offering significantly lower costs than fixed sites.

10. Strategic partnerships across the care continuum. To help share in cost structures and obtain needed management expertise.

Reflection Questions: 1. Which do you consider the three most important catalysts for change and why? 2. Provide specific examples of changes made by at least three health organizations that

reflect these catalyst factors.

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Section 10.5Current Change Initiatives in Health Care Organizations

In the academic medical center set- ting, consolidation can bring about improved medical staff relationships, improved physician alignment, increa- sed participation by patients, and shar- ing of best practices and quality approaches, including telemedicine programs that provide access to help patients in rural areas and communi- ties. In the past decade the number of health care organizations that have merged or formed different types of alliances has grown substantially. These consolidations reflect efforts not only to share the risks but to join forces to better provide patient-focused resources to the communities they serve. As health care organizations struggle to sustain their operations, many of them, particularly stand- alone sites, have found the idea of consolidation attractive because a key advantage of consolidation is sustain- ability, which can enable organizations to continue to fulfill their mission long term (Calayang, 2013).

Consolidation, however, involves trade-offs, including forfeiture of full independence by each collaborating partner. Organizational and cultural clashes can also derail consolida- tion, which is why it is important that each partner analyze the risks and develop exit strategies in case the partnership does not work out. Some health care industry observ- ers suggest that hospital consolidations generally result in higher prices for consumers in already concentrated efforts where price increases can exceed 20% (Gaynor & Town, 2012). Nevertheless, more and more health care organizations are affiliating with each other in efforts to expand services and enhance their financial position as larger economic bargaining units with payers and providers. Improved access to patients, within the con- straints of Stark laws (previously discussed in Chapter 9), is also a financial motive and benefit. The real challenge in consolidation is in finding a common ground where part- ners work together to complement, rather than duplicate, the services that other partners provide. Other consolidation opportunities available for health organizations that prefer to retain their autonomy include multihospital and multisystem collaborations for group purchasing and the development of shared proprietary information systems.

Figure 10.2: Consolidation chart

Consolidation offers numerous potential benefits.

Increased Agility

Cost Reduction

Higher Service Levels

Reduced Complexity

Source: Used by permission of www.flashdba.com

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Section 10.5Current Change Initiatives in Health Care Organizations

Web Field Trip: Group Purchasing Organizations

Major group purchasing organizations (GPOs) for hospitals include both acute and nonacute care organizations and for-profit and nonprofit businesses (Page, 2010). Check out the list of the nation’s largest hospital GPOs published in 2010 by Becker’s Hospital Review (http://www .beckershospitalreview.com/hospital-management-administration/7-largest-group-purchasing -organizations-for-hospitals.html) and answer the following questions.

Reflection Questions: 1. In addition to its group purchasing program, Premier also provides a range of con-

sulting services. What would be some advantages and disadvantages of using these services?

2. What is the business model for GPOs? Who owns and profits from them? 3. What factors do hospitals consider in

a. deciding whether or not to join a GPO? b. selecting a GPO to join?

Systematic and Systemic Change

Systematic change is a step-by-step procedural approach to alter business processes or practices. Systemic change involves altering organizational beliefs and thought processes. Systematic change is linear and top down or expert driven, whereas systemic change entails the recognition of the interrelationship and interdependencies within the system and its subsystems and the embedment of the system in its environment (Carr, 1997). Two fairly new concepts, stepping up and leaning in, are examples of systematic and systemic approaches to change.

Stepping Up In his 2012 book, Stepping Up: How Taking Responsibility Changes Everything, Dr. John Izzo posits that being accountable can transform both individuals and businesses. A former senior OD consultant for Kaiser Permanente, Izzo argues that taking full responsibility or ownership for ideas and actions results in positive organizational change as well as greater professional and personal satisfaction.

Stepping up starts with speaking up for something you believe in, because it is the right thing to do. In the workplace stepping up involves employees putting their jobs in jeop- ardy, being ostracized by the boss and colleagues, and branded a troublemaker. Speaking up in a positive manner challenges the status quo by demonstrating what one can do individually to improve things. It can stimulate colleagues to step up and excel by giv- ing their best work. And some workplaces encourage employees to step up and identify areas for improvement that will be beneficial to the organization. Employees who step up are actually more apt to get ahead, but only if they do it in a way that is not perceived as finger-pointing and blaming.

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Section 10.5Current Change Initiatives in Health Care Organizations

Ways to step up constructively include actively engaging in the process of developing ideas to improve things, respectfully challenging coworkers to be their very best, and breaking the silence by saying the things others may be thinking but are too afraid to say themselves. Organizational leaders who want to engage their workforce to step up will do well to invite employees to propose ideas and solutions to make the organization more effective. Most of the time, given the same information, people will make the same deci- sion as the leader would. The difference is that when they make it, they are more likely to step up and take responsibility to make the change happen. Dismissing ideas before exploring them and creating an atmosphere of fear (e.g., fear of receiving poor evalua- tions) will result in resentful compliance coupled with passive resistance. For this reason, it is important that organizations create environments that praise efforts and not just the results of those efforts. However, employees must trust that it is safe for them to step up.

Leaning In Author and COO of Facebook Sheryl Sandberg’s book Lean In: Women, Work, and the Will to Lead (2013) offers her theory of change on women in the workforce facing internal barri- ers to leadership positions. Sandberg’s change theory calls for women who are already in powerful positions to help lead the way in transforming and changing the workplace for all women. She argues that the internal struggles that women face in their careers never really get talked about and that women in power need to start the dialogue if no one else will.

Leaning in is a concept that encourages women to become more committed to their careers. Sandberg argues that while there may be some structural barriers to women in reaching top-level positions, when they have the power they also have an obligation to help eliminate obstacles for junior female colleagues attempting to make the same climb. Her top-down change strategy posits that women executives can effectively transform their organizations’ policies toward women, particularly those surrounding the decisions to have children while navigating the corporate ladder.

Sandberg chides women who forego advancement in their careers for family. She encour- ages women who have or plan to have children to keep leaning into their careers, because it is much easier to balance work-family conflicts in a higher level position. The scarcity of women in leadership executive positions is a result of lack of support by organizations coupled with a lack of ambition by those seeking higher positions. Sandberg also reexam- ines the concept of climbing the corporate ladder, suggesting that the path to success is comparable to a jungle gym that offers many different pathways to reach the top, starting with the willingness to lean in and the will to lead.

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Section 10.5Current Change Initiatives in Health Care Organizations

Business Process Improvement

Business process improvement is an intervention designed to closely examine an orga- nization’s operational processes and to propose ways that individuals may work more efficiently within those processes (Jones, 2011) to realize more effective outcomes. There are commonly four roles with varying responsibilities for carrying out business process improvement: business leaders, process owners, operational managers, and process oper- ators. The responsibility of the roles all follow the classic Deming PDCA (plan, do, check, act) cycle, as shown in Figure 10.3. Plan cycle decisions will be made about what the organization may do to improve its processes. In the do cycle, the plans are carried out, sometimes on a trial-run basis to determine their efficacy. The check cycle reviews the process being undertaken for status. In the act cycle, if the process is a success then it is implemented (Arveson, 2014).

Organizational leaders will typically develop the business plans that establish performance objectives. Process owners are responsible for mapping out the processes required to meet the objectives of the business plans. Opera- tional managers are tasked with connecting resources and processes to meet the business plan targets. Process operators absorb and carry out the processes to meet goals of the business plans; they examine performance data to review the capability of the process and create performance improvement reports to measure and track progress (Altremis, 2010).

Health care organizations face ever-larger challenges dealing with health reform man- dates, new documentation and information exchange protocols, and productivity adjust- ments resulting from legislatively imposed staffing requirements. A marketing executive from the MedeAnalytics consultancy esti- mated that a 300-bed hospital would have to cut expenses by more than $6 million in 2012 to maintain its Medicare margins. To improve cash flow and identify areas of potential loss, hospitals must improve the efficiency of the care-delivery process, focusing on the work- flow and key performance indicators (Institute of Financial Operations, 2011).

The New York City Health and Hospitals Corporation developed an electronic system to monitor compliance with medical residents’ work hours after state regulations limiting these hours were strengthened to impose fines on noncompliant facilities. With more than 7,000 medical residents training in its public hospital system, the corporation developed and implemented a simple-to-use yet comprehensive electronic time sheet system that

Figure 10.3: Business process

improvement cycle

Business process improvement is a cyclical process to continuously raise the quality bar.

Source: Dreamstime. (n.d.). Business process improvement diagram. Retrieved March 20, 2014, from http://www. dreamstime.com/stock-image-business-process-improvement- diagram-image13611981

Business

Process

Improvement

P

lan

A ct

Ch ec

k

D o

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Section 10.5Current Change Initiatives in Health Care Organizations

would allow the hospitals to ensure and report compliance with the laws limiting work hours. The time sheet data automatically entered a database that provided immediate, real-time analysis of compliance, thus allowing responsible managers to quickly spot non- compliance and take corrective action (Landesman, Markowitz, & Conde, 2010).

Performance Accountability, Metrics, and Milestones

Accountability and data are the two critical components of performance improvement. Quality performance metrics involve collecting, examining, and reporting data to analyze both processes and performance. Examples include trending against a baseline to track progress achieving a goal and comparing performance against established or desired standards for benchmarking from either internal or external sources (e.g., peer organiza- tion averages, industry standards, and best practice organizations).

Accountability Accountability involves taking ownership and assigning responsibility for accomplishing goals, completing tasks, and continually seeking ways to make things better. It should be, though often is not, embedded within every crevice of an organization and in every operational process, recognized and rewarded for every individual and team effort. Orga- nizations that lack accountability typically find their performance improvement efforts ineffective. High performance is highly correlated to organization attitudes and practices regarding accountability. Much too often, the concept of accountability in organizations only becomes serious when some undesirable action or event occurs. Forward-thinking organizations will incorporate accountability throughout the organization to shape, drive, and deliver superior organizational outcomes.

Provider pay-for-performance (P4P) has become an increasingly popular practice among a range of public and private payers, including Medicare and Medicaid. More than 40 private sector P4P programs were in place as of October 2012, the CMS has funded sev- eral demonstration projects (most notably the Value-Based Purchasing Program), and the ACA expands P4P incentives for both physicians and hospitals participating in Medicare that meet quality-improvement criteria. Evaluations of P4P to date have shown mixed results. A study of the private Premier Hospital Quality Incentive Demonstration Project found that although early results showed promising improvements in quality compared to a control group, after 5 years there were no significant differences between participat- ing P4P hospitals and nonparticipating peer institutions. A separate study of the Medicare Premier Hospital Quality Incentive Demonstration Project found no differences over a 5-year period in mortality rates for several conditions between demonstration and control group hospitals (James, 2012). Still, James (2012) predicts that as implementation of the ACA proceeds, P4P programs are likely to proliferate across the country.

Metrics and Milestones Performance metrics should foster organizational efficacy, productivity, efficiency, and performance improvement and should intertwine best practices connected to the perfor- mance being analyzed. Key health organizational performance metrics include customer

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Section 10.6 Summary and Resources

satisfaction, product or service quality, and costs. These metrics are just a few of the quan- titative measures that demonstrate improvements or identify gaps or declines in organi- zational performance. When developing performance metrics it is crucial to include the staff on the ground level who are accountable for carrying out the tasks to be measured, because they are responsible for the work output and quality and know firsthand the intricacies of each.

Organizational goals describe the desired outcome, but they also need to specify account- ability. A commonly used acronym that captures the attributes of effective goals is SMART (Whetten & Cameron, 2011). While SMART goals are more commonly used at the indi- vidual employee level, they are also applicable to organizational goals.

S = Specific (clear and concentrated and easily explained and translated) M = Measurable (provides for consequential statistical analysis) A = Attainable (practical and attainable) R = Realistic (is cost effective and fits into organizations limitations) T = Timely (achievable within specified time frame)

As organizations seek to reduce administrative overhead by streamlining their manage- ment structures, the scope of functional responsibilities for senior-level managers in many of these organizations has expanded substantially in recent years. More so now than ever, to keep track of projects and people for whose performance they are accountable requires them to develop or adapt sophisticated yet easy-to-use data-management systems to con- tinually monitor key organizational metrics to drive results.

Studer (2013) lists key metrics for hospitals to track daily: patient volume, significant service and engagement issues, overtime expenses, no-shows, start times for new cases, number of patients who leave before service can be provided in the ED, and amount of time clinicians spend with each patient in the ED—from assessment to admittance to departure time, among others. Items to monitor quarterly include metrics that focus on quality, clinicians, and employees, in addition to board engagement and charitable efforts. Annual appraisals can resolve around intensively focused leadership reviews, assessment of vendor contracts, and valuation of system auditing. The Studer Group website offers many other useful resources for hospitals to proactively self-monitor their performance: https://www.studergroup.com.

10.6 Summary and Resources

Chapter Summary The purpose of OD is to improve organizational effectiveness, which involves changes in people’s thinking and behaviors. Health care organizations are increasingly using OD ini- tiatives to change the way they do business in a turbulent, rapidly changing environment.

Change happens. Organizations must find ways to adapt and successfully embrace it while moving forward to stay competitive. When resistance arises, it is often a part of the change process and should be expected. Employees resist and respond to the change

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Section 10.6 Summary and Resources

due to their perceived individual losses more than the actual change. Turbulent environ- mental conditions, market shifts, and political upheavals impacting the health care indus- try require a strategic management model that addresses change and changing. Health organization leaders must be attentive to the harbingers of external change as well as internal organizational signals of shifts in employee, patient, and stakeholder needs and expectations. Successful organizations are those that have the will and the skill to recog- nize the need for change and to readily yet thoughtfully make needed changes. Conse- quently, everyone in the organization has an active and fundamental role to play in OD and change management.

Critical Thinking and Discussion Questions 1. What role do organizational leaders play in developing vision and employee

buy-in for change? 2. Are there circumstances in which organizations should focus on securing the

compliance of employees in accepting change rather than seeking out their com- mitment to the change? Explain.

3. Compare and contrast Kotter’s strategies and Pexton’s tips for organizational change.

4. Describe the benefits of health care organizations participating in consolidation efforts.

5. How do organizations effectively engage employees to step up and speak out to improve organizational performance improvements?

6. Discuss the importance of and methods for achieving performance accountability in health care organizations.

Key Terms

action research (Lewin) The application of classical social science research methods to business settings, including problem defi- nition, hypothesis formulation and testing, and data collection and analysis.

business process improvement A data- driven initiative to study a company’s operations and propose methods by which they can become more efficient.

change agent The individual or group responsible for implementing change.

consolidation The unification or alli- ances among organizations to better utilize resources.

discretionary effort An employee’s willingness to go the extra mile for the organization.

employer mandate A legal requirement for an individual or corporate employer to provide health insurance to employees.

environmental scan An assessment of an organization’s internal and external envi- ronment for strategic planning and change management purposes, considering cur- rent and emerging social, technological, economic, and political factors.

institutionalizing change Achieving con- sistency in decision making by all elements of the organization.

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Section 10.6 Summary and Resources

leaning in (Sandberg) Intensified com- mitment and involvement; a challenge to women managers issued by Facebook COO Sheryl Sandberg in her 2013 book bearing that title.

metrics Performance measures designed to drive improvement and track progress through specific quantifiable goals based on individual and team expected work outputs.

organizational development (OD) A series of planned, ongoing and inter- locked organization-wide effort and change initiatives to increase an organiza- tion’s effectiveness.

refreezing (Lewin) The final stage of Lewin’s organizational change model, where changes become instilled into the organizational culture.

stepping up (Izzo) Taking full responsibil- ity for one’s ideas and actions.

systematic change Planned organiza- tional change, effected through a series of procedures.

systemic change Change that becomes deeply ingrained in an organization’s pro- cesses and culture.

transformation (Lewin) The middle stage of Lewin’s organizational change model, where changes occur.

transparency The practice of being open about results and practices.

unfreezing (Lewin) The first stage of Lewin’s organizational change model, where the organization recognizes and acknowledges that change is needed.

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