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Organizational Behavior in Health Care, Third Edition by Nancy Borkowski

Reprinted for Personal Account, Purdue University Global

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Reprinted with permission as a subscription benefit of Skillport,

Chapter 18: Organization Development

LEARNING OUTCOMES

After completing this chapter, the student should be able to:

Understand the role organization development (OD) plays in an organization's planned changes.

Appreciate the function and responsibilities of the OD professional.

Understand the components of the Action Research Model.

Identify and understand the OD process.

Understand the interventions used in the OD process.

OVERVIEW

Health care has been a dynamic industry in recent history. New reimbursement models, escalating costs, and changing regulations have resulted in an environment fraught with survival struggles. In addition to the financial and structural struggles, real and projected staffing shortages have also resulted in retention issues as well as the infiltration of labor unions into the health care industry. These issues have caused health systems to be in a flux of constant change. Health service organizations (HSOs) need the necessary strategies to successfully implement the required changes for future sustainability. As such, many organizations have turned to experts in the field of organization development (OD) to assist with change initiatives and to help ensure the long-term viability of the HSO.

OD has extensive roots dating back to the early 1900s. Frederick Taylor and his theory of scientific management were extremely influential because the theory advocates exploring ways to increase the productivity of workers. The Hawthorne Studies conducted between 1924 and 1933 also played a predominant role in paving the way for understanding organizational behavior- oriented change processes (Ott, 1996). As the nation progressed through the Industrial Age and through the Depression and two world wars, the emphasis on the way employees were viewed changed as the nation developed a better understanding of employee motivation. In addition, the popularity of labor unions contributed to the organization's motivation for designing a better working environment. The end result of a century of history has been organizations that understand the need to change in order to remain competitive, yet that also recognize that an emphasis on employee satisfaction is critical in meeting organizational goals. The relationship of needing change and striving to understand how employees will react to change is the focus of the field of OD. Meaningful change is a central deliverable of the OD profession (Hanson, Moir, & Wolf, 2011).

*We wish to acknowledge and thank Dr. Lorrie Jones, who was the contributing author of an earlier version of this chapter, which appeared in Organizational Behavior in Health Care (2011), Jones and Bartlett Publishers.

ORGANIZATION DEVELOPMENT

OD is a field that incorporates a number of characteristics. Most agree that OD is a planned process of change (Beckhard, 1969; Burke, 1982) using behavioral science (Beckhard, 1969; Beer, 1980; Burke, 1982; French & Bell, 1990) in an organization-wide process (Beckhard, 1969) utilizing a systematic approach (Beer, 1980; McLagan, 1989) to problem solving with the goal of improving the effectiveness of the organization. On the basis of these characteristics, OD is not a one-time training program, a quick-fix change, or a "flavor of the month" initiative. Rather, OD is designed to be a planned initiative, which may be based on a needs analysis, and utilizes a strategic approach to implement the change.

Many things that occur in an organization deal with some type of change; however, not all are necessarily OD initiatives. For example, expanding a service, such as an emergency department (ED), requires long-term planning, a needs assessment determined by increasing volumes or changing market conditions, a thorough cost-benefit analysis, and a strategic plan. However, this type of change may be successfully implemented without an OD intervention. Why? Although the expansion of the service directly impacts the functioning of the ED staff as well as various other functional units within the hospital, the organization's culture will most probably not be affected by this change initiative. Most employees will likely understand and probably welcome the expansion; therefore, behavioral science intervention is not needed. One of the components of OD that is fundamental to the definition of the field is the behavioral science application. If the ED expansion requires a culture change for the hospital, then the interrelationship between the expansion and the culture shift may require the expertise of an OD professional.

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Cummings and Worley (2009) describe three features of OD that differentiate it from other change initiatives: (1) it applies to an entire system; (2) it involves the impact of behavioral science on the change process; and (3) it includes planned change based on diagnosis, intervention, and redirecting, if necessary.

First, OD applies to an entire system that may include the entire organization or a division, but OD does not involve change directed at a single person or a single unit. For example, the introduction of a new magnetic resonance imaging (MRI) scanner into the newly expanded ED may require training for the radiologic technologists utilizing this new machine, but this training is targeted to new technology and to those specific individuals who will be working with the new equipment.

The second feature of OD, outlined by Cummings and Worley (2009), is the impact of behavioral science on the change process. Practitioners in the field of OD recognize the interrelationship of group dynamics, group processes, and culture on the change initiative, and great strides are taken to ensure that this relationship is cultivated throughout the change process to ensure the success of the initiative. In addition, OD practitioners understand the psychological and sociological components of change and work to assist the organization to develop a greater understanding of these dynamics. The importance of the behavioral science approach cannot be understated. Since OD involves change within an organization, the members of that organization will be directly affected by any changes. If a change initiative is implemented without an understanding of how the people within the organization will react and respond to this change, the change is likely to be difficult at best, and completely unsuccessful at worst. The behavioral science component will help the leadership of the organization understand the psychology of change, key phases in a successful change, and the importance of critical mass, as well as barriers to be prepared to overcome any anticipated time frames.

The third feature of OD is that planned change is based on diagnosis, intervention, and redirecting if the change efforts are not progressing as planned. Cummings and Worley (2009) state that OD is focused on improving organizational effectiveness and utilizes a variety of process change techniques. Five components of OD work toward achieving the goals of improving organizational effectiveness through process change techniques: (1) OD is supported by multidisciplinary theories; (2) OD views organizations as open systems; (3) OD recognizes that if one part of the organization is impacted by change, an effect will be felt in another part of the organization; (4) OD is based on action research, which is a continuous examination of the progress of the interventions; and (5) OD is based on data (see Case Study 18-1: Doctor's Hospital's Organizational Change).

Case Study 18–1: Doctor's Hospital's Organizational Change

Doctor's Hospital was facing a serious financial hardship as health care costs continued to spiral out of control and reimbursement plummeted. A new chief executive officer (CEO) was hired to turn things around in an effort to save the hospital. The CEO was determined to change the organization's culture, which he identified as apathetic and accustomed to mediocrity. He noted that the financial performance was suffering, and he attributed much of this to a variety of process issues as well as a lack of focus on the core business of patient care.

The CEO immediately took action to look at financial issues and cut costs. A drastic cost and labor reduction strategy was implemented with an aggressive timeline to turn the financial bottom line around. Within a few months, the hospital started to show less of a financial loss and things seemed to stabilize financially. However, the morale of the staff had taken a significant hit. Turnover increased as a sense of job security decreased, and the impact on the patients began to be seen in an increase in patient complaints and lowered patient satisfaction scores. An employee training program was introduced to reemphasize the need for customer service, but it had no impact on results. Finally, the CEO hired a consultant who performed an assessment. A multilevel program was implemented that incorporated all levels and all aspects of the hospital. This assisted senior management with understanding the linkages between finances, employee morale, and patient satisfaction. After two years, a mindset of accountability started to emerge that began a culture shift to one of service. Finally, all the organizational metrics started moving in the right (and same) direction.

Questions

1. What were the key components of changing the organizational culture?

2. Why wasn't the training effective?

3. Why do you think a culture change was necessary?

4. What steps do you think the consultant recommended in order to effect this change?

THE ORGANIZATION DEVELOPMENT PROFESSIONAL

The behavioral science nature of the field requires that OD practitioners have a particular skill set in order to ensure success.

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The role of the OD practitioner consists of a variety of activities, depending on the relationship between the practitioner and the organization. Gottlieb (2001) suggests that the primary role of the practitioner is assisting clients with achieving clarity and understanding, whereas other roles consist of assisting with diagnosis, assisting with process, providing information, or providing training activities. Ultimately, the OD practitioner primarily facilitates a change initiative in an organization. The OD practitioner is similar to a therapist who guides someone through a difficult time, recommending strategies and enabling the change process. However, just as a good therapist recognizes that ultimately the client must pave his or her own way to success, so does the OD practitioner. The OD practitioner provides the foundation for change, but management must pave the organization's way. Consequently, the relationship between the organization and the OD practitioner requires a delicate balance. The leaders and members of the organization must ultimately work through the process and are responsible for ensuring the success or failure of the initiative. It is critical that OD practitioners establish a psychological distance and set boundaries to clearly define roles in order to ensure a successful relationship (Browne, Cotton, & Golembiewski, 1977) (see Case Study 18-2: What Went Wrong?).

Case Study 18–2: What Went Wrong?

Joan was asked to consult with a hospital that was attempting to enhance organizational effectiveness. She was able to meet briefly with the CEO before she embarked on a series of meetings with front-line managers. The managers were quite informative about the issues they observed in their departments and provided Joan with what she thought was an honest assessment of the issues. After two weeks of meetings, she met again with the CEO to review the data and recommend a course of action. The CEO seemed genuinely interested in what she had to say, but disagreed with many of her conclusions and plan of action. He determined the problem to be poor team dynamics, whereas Joan had suggested that the team issues were a "symptom" of problem processes resulting in role ambiguity and apathy. The CEO decided that the easier course of action was to work on the team dynamics and directed Joan to pursue that course of action.

Against Joan's better judgment, she embarked on a team-building initiative involving many months and over 500 employees. As a result of the initiative, there seemed to be some better camaraderie, yet the role ambiguity and other problems persisted. Six months after the completion of the team-building project, the CEO commented at the senior management monthly meeting that it was a waste of time with no significant outcomes and vowed to never hire an OD consultant again.

Questions

1. What went wrong?

2. What should have been done differently?

3. How effective was Joan in her role?

There are many skills that make an OD practitioner successful, including a combination of technical, interpersonal, and consulting skills (Block, 1981).

Technical skills include specific education or training in some area. An example might be specific training in statistical process control whereby a particular process improvement was initiated or a Total Quality Management or Six Sigma program implemented. Specific expertise in the psychology of change management would be another example of an appropriate expertise.

Another skill set of OD practitioners is interpersonal skills. Listening skills are as critical as the ability to maintain a psychological distance. Marginality has also been identified as a key characteristic of an effective OD practitioner (Browne, Cotton, & Golembiewski, 1977; Burke, 1982; Gottlieb, 2001), which involves the ability to be involved in an organization without being unduly influenced (Church, Hurley, & Burke, 1992). The ability to be collaborative is another key characteristic (Argyris, 1970) and involves the ability to facilitate rather than direct activities. In a qualitative analysis conducted by Gottlieb (2001, p. 45), clusters of roles were identified for an OD professional. These roles include:

1. Assisting in clarification, such as by asking questions, challenging, and confronting.

2. Diagnosing, which includes data gathering and the analyzing and interpreting of data.

3. Designing or assisting with the design and implementation of interventions.

4. Providing expert information on organization theory, change, or business issues.

5. Process identification, which includes assisting clients with understanding process options.

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6. Facilitating interventions by guiding and directing groups through process changes or strategies to ensure effective communication during the implementation and intervention.

7. Training activities, which may run the gamut from the training needs assessment through the training design and delivery of training programs.

Overall, depending on the type of initiative, the skill level and role of the OD practitioner will vary. However, one key characteristic is the ability to apply theory to practical application.

OD practitioners are professionals who are employed by the organization, thus serving as an ongoing internal consultant, or organizations may contract for the services of an external consultant. There are pros and cons of each, and the leaders of an organization must be able to identify which type of consultant would be best suited for their organization for the issue at hand. The internal consultant has an advantage over the external consultant because the individual has a working knowledge of the organization, knows the key players, understands what interventions have been attempted previously, and may have access to data without the need to start from scratch. The downside of utilizing an internal consultant is that in some cases the consultant is too close to the individuals working in the organization and may not be able, in the eyes of the leadership of the organization, to separate the relationships.

Additionally, the internal consultant, if it is someone who has been employed by the organization for a length of time, may be blind to the issues that are creating the organizational symptoms, and thus may suffer a loss of objectivity.

In contrast, an external consultant does not have an established psychological connection with the organization, so he or she may bring the objectivity that might be lacking with the internal consultant. In addition, an external consultant is often skilled at a particular intervention or set of interventions that have been used in other organizations, so the consultant brings experiences in the implementation of the intervention. Another advantage of an external consultant is that a particular skill set may exist with the external consultant that the internal consultant may not possess. For example, if an organization wants to implement Six Sigma, the internal consultant may not have the training or skill set to assist with implementation of this complex process. One disadvantage of an external consultant is that there is not a prior relationship with the organization in many cases, so the external OD practitioner must begin with rapport and trust-building steps. This lack of a relationship may, in some cases, hamper the data-collection steps, especially if employees are mistrusting of an outside person. It is interesting, however, that this may also be an advantage to the data-collection initiatives, as often the employees are mistrustful of providing information to an internal person for fear of retaliation.

ACTION RESEARCH

As mentioned earlier, OD is a systematic process. Most OD practitioners use a model of planned change known as the Action Research Model (Cummings & Worley, 2009). According to Rothwell, Sullivan, and McLean (1995), action research can be used as a model to represent the complex activities that occur in a change process. As illustrated in Figure 18-1, the Action Research Model contains eight main steps. This model may, in fact, serve as a road map for change agents to follow as they implement change in an organization (Rothwell et al., 1995). Ultimately, the goal of action research is to base the intervention on initial research, followed by feedback through further data analysis to determine the effectiveness or impact, make adjustments as necessary, and ultimately use the results to support additional research (Rothwell et al., 1995).

STEPS IN THE ORGANIZATION DEVELOPMENT PROCESS

As illustrated in Figure 18-1, traditional OD theorists have identified eight steps to the Action Research Model (Burke, 1982; McLean & Sullivan as cited in Rothwell, Sullivan, & McLean, 1995), which has served as the template for OD practitioners to follow. However, other practitioners have recommended that the model be consolidated into a smaller number of identified steps. The two models are compared in Table 18-1. A few additional points about each of the major steps are worth noting.

Entering and Contracting

The entering and contracting phase is the first critical step in the planned change process. During this stage a contract is developed between the organization and OD practitioner, during which mutual expectations are identified. These expectations should include outcomes expected, such as greater employee satisfaction, increased revenues, lower turnover; length of the engagement; and communication and reporting expectations—for example, who is the primary contact at the organization for the OD practitioner, frequencies of reports and updates, and so on. In addition, ground rules need to be established that outline how to handle sensitive issues such as feedback of difficult information, maintaining employee confidentiality (whether that is an expectation), and how to terminate the engagement if there are concerns or issues from either party (Cummings & Worley, 1997; Rothwell, Sullivan, & McLean, 1995).

Organizational Behavior in Health Care, Third Edition

Reproduced from Cummings, T. G., & Worley, C. G. (1997). Organization development and change (6th ed.).

Organizational Behavior in Health Care, Third Edition

Cincinnati, OH: South-Western College Publishing, pp. 29-30.

Figure 18-1: Action Research Model Table 18-1: Comparison of the Two Models for Action Research

Burke, 1982; McLean and Sullivan, 1989

Cummings and Worley, 1997

Description

1. Entry 1. Entry and contracting

Key leaders identify a need and work to begin the OD process. An OD practitioner is identified and the key components of the working relationship between the organization and practitioner are established. Ground rules, mutual expectations, and deliverables are identified.

2. Startup

3. Assessment and feedback

2. Diagnosing Data-collection techniques are employed to determine the extent of issues identified by the organization. A diagnosis of relevant organizational processes, interpersonal relationships, or group analysis may be employed.

4. Action planning

Steps are taken to work with the organization to ensure long-term success of any intervention. Key relationships are established and mutual plans are developed. The impact of change on any change initiative is reviewed, and steps put into place to assist the organization through the change process.

5. Intervention 3. Planning and implementing change

The planning phase is similar to the action planning phase just listed. The plan is implemented and carried out. The process of managing change is implemented, and steps taken to ensure the success of the intervention.

6. Evaluation 4. Evaluating and institutionalizing change

The change process is evaluated through data analysis and comparison to previous data. The change becomes part of the organization, and the members of the organization begin to adopt these strategies and take ownership for their success.

7. Adoption

8.Separation The OD practitioner begins the disengagement process from the organization if it is an external consultant or the disengagement of the project if it is an internal consultant.

Diagnosis

The diagnosing phase is the second major phase in the general model of planned change. It involves a strategic plan for understanding the organization and gathering, analyzing, and feeding back of information to managers and organization members about the problems or opportunities that exist. When well done, diagnosis clearly points the organization and the OD practitioner toward a set of appropriate intervention activities that will improve organization effectiveness (Cummings & Worley, 2009).

There are various methods of collecting data within the organization. Cummings and Worley (1997) outline the most typically utilized methods. Usually, a variety of methods may be used, with the choice being largely determined by efficiency, sample size, and type of information that is needed. The most commonly used methods include questionnaires, interviews, observations, and unobtrusive methods.

Questionnaires are often the first method used for collecting information from an organization (Cummings & Worley, 1997). Questionnaires are often utilized because of their relative ease of administration and ability to collect information from large groups of people and to provide some response anonymity. Additionally, questionnaires, if developed correctly, enable an efficient means to quantify and analyze information. An experienced OD practitioner understands how to construct an effective tool for capturing the information that would be relevant for performing an organizational analysis. Such expertise is needed because it is important to understand the statistical properties of sample size, the power of results, and scale construction, as well as how to create a nonbiased instrument. Additionally, in the current litigious world, one must work to ensure that there is some validity to any questionnaire that is used in an organization and that it does not seemingly target any particular group of individuals with a biased result.

The construction of a questionnaire with an appropriate scoring scale is critical to the ability to effectively analyze the data. All too often, new OD practitioners create an open-ended questionnaire and send it out to 300 employees in the hopes of collecting a variety of responses, only to discover that there is no easy way to analyze the results since every employee has written something different. Another difficulty in using a questionnaire method is that it is rare that everyone who receives a questionnaire is going to complete it. It is likely that you have received many satisfaction surveys at home, only to throw them in the trash or forget to complete them. The reality is that there is typically a relatively low response rate for questionnaires, and the missing data mean that a piece of the puzzle is missing. This nonresponse bias is impossible to interpret but exists and makes an impact on analysis. Therefore, OD practitioners commonly attempt to send questionnaires to as many employees as possible to ensure a sample with enough respondents to reduce statistical error of the results.

A second type of data-collection tool is the use of interviews (Cummings & Worley, 1997). Occasionally, interviews are used as a follow-up to results obtained from a questionnaire, but this method is also used to capture data that cannot be readily

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obtained in the questionnaire. Through a two-way communication approach, an effective interviewer can delve into issues identified by the employee and attempt to get to the heart of any issue identified. However, coding of responses is a hurdle for analyzing the results of the interview. Additionally, the interviewer may hear the responses that the interviewee wants to be heard. This response bias may make it difficult to obtain valid results, but this can be overcome to some degree through effective rapport building and reassurance of confidentiality from the interviewer. The final disadvantage of this approach is that it is very difficult to conduct a large number of interviews, so the sample size tends to be small.

Another method for data collection is that of observation (Cummings & Worley, 1997). An observation is designed to allow the OD practitioner to see firsthand what is occurring with either a particular group of people or a process. For example, one organization might be concerned with the lack of teamwork among a group of employees, and questionnaire data collection revealed a variety of potential reasons for these issues. Because the results were somewhat ambiguous, the OD practitioner might decide to go in and actually observe the interpersonal dynamics occurring among the team members. This might reveal communication patterns, leadership issues, or ineffective conflict resolution strategies within the team that might not be discovered through traditional data-collection strategies. In another example, a process might be observed in order to determine whether there are inherent inefficiencies that might not be recognized by the employees performing the various tasks within the process because they are so accustomed to performing those tasks regularly. Therefore, it is obvious that there are some distinct advantages to the observation method of data collection. However, as with all data-collection techniques, there are also some pitfalls. The most apparent is that employees behave differently simply because they are being observed (known as the "Hawthorne Effect," based on the Hawthorne Studies; see Roethlisberger & Dickson, 1939; Homans, 1950). Many employees become concerned that they will face some outcome if, during the observation, some negative data are collected regarding their work performance. Since ultimately the goal for many employees is job security, it is probable that in some cases the employees may in fact alter their behavior simply to "look good." Additionally, observers face considerable difficulty in coding observed behavior into some type of aggregate result. Observers must also guard against their preconceived ideas of what should occur, so that they are in fact recording actual behavior rather than either an ideal or a judged version of what actually occurred.

Finally, one additional type of data collection frequently utilized by OD practitioners is that of the unobtrusive method (Cummings & Worley, 1997). The interesting component in this type of data collection is that the data are obtained directly from preexisting information. These types of data exist in various formats throughout every organization. Examples of this include financial reports; human resources information such as turnover, vacancy rates, performance appraisals, and exit interviews; safety reports; and customer satisfaction information, to name a few. The advantage of this type of data is that they are relatively easy to utilize once they are obtained, although in some organizations the information systems or mechanisms by which organizations collect information are either cumbersome or in some cases nonexistent. A second advantage of these data is that they are typically free of biases that may be introduced as a result of other data-collection strategies.

Planning and Implementing Change

An enormous variety of interventions are utilized by OD practitioners. According to Cummings and Worley (1997, p. 141), three major criteria are needed for an effective intervention: "(1) the extent to which it fits the organization, (2) the degree to which it is based on casual knowledge of intended outcomes, and (3) the extent to which it transfers competence to manage change to organization members." Essentially, the types of OD interventions that are typically utilized fall into several broad categories (Cummings & Worley, 1997).

A brief overview of these interventions is outlined here, although some are discussed in greater detail later in the chapter. These interventions include:

1. Strategic Interventions: Strategic interventions deal with large-scale organizational strategic issues, such as ensuring the organization maintains a competitive advantage, and marketing strategies, as well as other organizational performance issues. Assessing the organizational environment and external factors impacting performance may identify an intervention whereby a diversification in products or change in geographic location may be identified as the key to long-term organizational success.

2. Technostructural Interventions: Technostructural interventions deal with structural issues within an organization, such as organizational design issues or work design issues. An example of this might be the recognition through data collection that an organization with a functional structure is no longer efficient in its business strategy. The structure is providing some limitations that are ultimately impacting on coordination between products and services and resulting in customer service or quality issues.

3. Human Process Interventions: Human process interventions deal primarily with issues between people within an organization. Often there are distinct communication barriers, a history between employees, or perhaps ineffective leadership. In these interventions the data might point to a problem involving fundamental communication processes, and,

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therefore, the recommended intervention might be a strategy to assist the group with improving interpersonal relationships. An intervention such as communication training involving the Johari Window (a model used to improve communication between individuals; see Luft, 1984) or a team-building strategy might be appropriate in these cases.

4. Human Resource Management Interventions: Human resource management interventions deal with larger-scale typical human resource issues. Interventions in this arena might be based on data suggesting that there is an exodus of good employees from the organization. Exit interviews might reveal that employees are disenchanted with reward programs or with organizational succession planning. Interventions such as a career planning system might be a way to address such concerns.

Evaluating and Institutionalizing Change

The true test of the effectiveness of an OD intervention is the outcome. In order to truly know whether there is an effective outcome, there has to be some sort of follow-up evaluation and measurement. The follow-up evaluation should be predetermined at the outset and agreed upon by both parties as part of the original contract. Feedback to managers about the intervention's results provides information about whether the changes should be continued, modified, or suspended (Cummings & Worley, 2009). Institutionalizing successful changes involves reinforcing them through feedback, rewards, and training.

It is critical that the OD practitioner be viewed solely as the facilitator of the new process rather than as the owner. It is therefore extremely important that the impact of the intervention be transferred back to the organization. In other words, the organization must transfer responsibility and accountability from the OD practitioner to the organization and with that ensure that the proper steps have been taken to implant the new strategy into the fabric of the organization.

ORGANIZATION DEVELOPMENT INTERVENTIONS

Listed below are some typical OD interventions suggested by Rothwell, Sullivan, and McLean (1995) that might be utilized by OD practitioners:

1. Team Building: Team building can be done in a variety of ways, from providing assessments to team members, team- building workshops, or in-depth group analysis. Regardless of the strategy utilized, the goal is to increase the effectiveness and cohesiveness of either an intact work group or a project team.

2. Process Improvement: The process improvement intervention is designed to look at work processes and the way an individual may work within the process. The goal is to improve efficiency.

3. Total Quality Management: The total quality management intervention is designed to enable groups of people to work together on a single problem and, through a regimented process utilizing specific problem-solving tools, work to solve the issue at hand. Some of the tools that the team is trained to use are Pareto diagrams, cause-and-effect diagrams, brainstorming, and flowcharts, as well as a host of other tools. Team members are trained on these techniques. Teams typically meet regularly over a long period of time in an effort to solve the problem or mission that they have been given. This intervention not only is an effective intervention for problem solving or process improvement, but also impacts on team dynamics and provides opportunities for employee involvement.

4. Work Redesign: The work of Hackman and Oldman (1980) suggests that there is a significant relationship between core job dimensions (skill variety, task identity, task significance, autonomy, and feedback) and critical psychological states (experienced meaningfulness of work, experienced responsibility for outcomes of work, and knowledge of actual results of work activities). The relationships between these produce personal and work outcomes (internal motivation, high-quality work performance, high satisfaction, and low absenteeism and turnover). On the basis of this model, OD practitioners may opt to look at the design of the job to determine what core job dimensions are inherent in the work. Depending on the outcome of the analysis, a redesign of the job may be recommended so that specific psychological states are addressed in the core job.

5. Structural Change: As mentioned earlier, it is possible to change the organizational structure if it is determined that the current structure is ineffective. Changing the structure essentially changes reporting relationships, which is designed to streamline and improve quality outcomes.

6. Training: Training is often seen as the only intervention needed. Often organizations fall into the trap that a training program will be the panacea that addresses and solves all of its organizational issues. This is clearly not the case; however, training is considered to be a very effective intervention when conducted with the right goal in mind or as an adjunct to an additional initiative. The goal of training should be to improve a skill base.

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7. Performance-Management Systems: Performance-management systems intervention is one of the Human Resource Management Interventions. A performance-management system is composed of goal setting, appraisal, and reward systems. Some organizations have none of the components in place; some have one or two components, or all. This intervention may involve designing a performance-management system within an organization where none exists or the redesign of one in an organization with an ineffective system in place. The goal of this strategy is to identify the appropriate mechanisms, specific to an individual, for measuring employee performance.

APPRECIATIVE INQUIRY

A relatively new approach or process for planned change is appreciative inquiry (AI). Where the action research process is primarily deficit based—focusing on the organization's problems and how they can be solved so it functions better—AI focuses on what the organization is doing right (Cummings & Worley, 2009; Fitzgerald, Murrell & Newman, 2002). AI suggests that for organizational change to take place, the organization needs to begin with the recognition of its positive attributes and then ask the questions that will take it along the path toward the organization it visualizes itself becoming (Cooperrider & Srivastva, 1987). Similar to an athlete using visualization to prepare for an upcoming competition, whereby the athlete mentally reviews every step of the competition and visualizes success, so does AI challenge the organization to capitalize on its strengths. AI is a guided change process by an OD practitioner adept at maneuvering through the maze of possibilities that might be exposed through the positive issues identified (see Case Study 18-3: Creating Positive Conversations around Exceptional Healthcare Dining Services). The OD practitioner essentially helps the organization see the future and then sets the organization on a path to make that visualization a reality (Cummings & Worley, 2001).

AI is often explained using the five Ds: Define, Discover, Dream, Design, and Deliver. This approach is described in the five steps below (Fitzgerald, Murrell, & Newman, 2002, pp. 209-211).

Phase 1: Define—The most critical phase of the process is defining the topic(s) for an appreciative inquiry.

Phase 2: Discover—This step typically begins with paired appreciative interviews exploring participants' peak experiences of each topic and what made those experiences possible. Participants look for the best of what happened in the past, and what is currently working well. In this phase, questions are designed to get people talking and telling stories about what they find is most valuable/appreciated, and what works particularly well.

Phase 3: Dream—During this phase, the best of the past is amplified into collectively envisioned and desired futures. In other words, the participants dream of "what might be."

Phase 4: Design—In this phase, participants identify key facets of organizational systems and structures that will be needed to support the realization of their collectively generated dreams. During this step, members determine the types of systems, processes, and strategies that will enable the dream to be realized.

Phase 5: Deliver—During the fifth or implementation phase, participants self-select projects or tasks that they would like to work on or otherwise support. Actions are implemented over time in an iterative, appreciative learning journey. The overall results are changes that occur simultaneously throughout the organization—all serving to support and sustain the dream.

Case Study 18–3: Creating Positive Conversations around Exceptional Healthcare Dining Services

Focus of the Appreciative Inquiry: To have a group of 20 Foodservice Directors discuss and identify their experience with exceptional dining services and transfer that learning to their healthcare facilities.

Client Organization: UHF Purchasing is a group purchasing organization that provides prime vendor contracts, product supply contracts and services to healthcare facilities through a national purchasing agreement. The majority of the participants worked in long term care facilities or small community hospitals throughout the state of Wisconsin. The Food Service Directors meet quarterly to discuss trends and issues affecting the foodservice departments. The AIC consultant was invited in to create positive conversations around the dining experience and to teach the Foodservice Directors to train their staff in an appreciative approach.

Client Objectives/Specific Goals:

Build energy around training regarding excellent customer satisfaction

Educate the Foodservice Directors on an appreciative approach to learning versus gap analysis

Create a dialogue in which Foodservice Directors can share and learn from others in the Purchasing Group

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What Was Done: UHF Purchasing created a learning seminar "Breakfast for Champions" in which Foodservice Directors could get together for four hours. An interview guide was developed to explore in detail the elements that make up an excellent dining experience. The participants paired up for interviews and then shared with the group the stories and their key learning from the interviews. The participants identified themes and elements that contributed to their exceptional dining experience. The participants shared with each other how they could use a similar process for training their staff.

Outcomes:

Collectively the Foodservices Directors created a list of elements for an exceptional dining experience

Foodservice Directors were exposed to an appreciative process for training

Reprinted with permission from Peirick, R. (2003). Creating Positive Conversations around Exceptional Healthcare Dining Services.

SUMMARY

In general, organizational development (OD) is one of the most popular and widely used approaches for implementing organizational change (Waclawski & Church, 2002). Many types of interventions are available and at the disposal of a well- trained OD practitioner. A successful OD initiative will be based on a thorough analysis of any symptoms of problems, with this analysis based on a thorough analysis of data. The partnership with the organization is critical, and the OD practitioner must work to ensure that ultimately the organization understands and accepts that the responsibility for the success of any intervention lies with management.

DISCUSSION QUESTIONS

1. Identify and discuss the various characteristics of OD.

2. Describe the unique features of OD that differentiate it from other change initiatives.

3. How would you describe the role of the OD professional? What skills are necessary for an OD practitioner?

4. Explain the various components of the Action Research Model.

5. Identify and explain the steps necessary in the OD process.

6. Why is data collection so important to the OD process?

7. Identify and explain the various interventions used in the OD process.

8. What is appreciative inquiry, and how is it used in the OD process?

Case Study 18–4: Gateway Hospital

Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. A recent employee satisfaction survey scored well below the national norms on most scales. The hospital has been facing higher than average turnover and vacancy rates. Recruitment for professional positions is very difficult because the hospital has gained a reputation as a bad place to work, especially if one is new; the term "eat their young" seems to be a prevalent description. Salaries are below the local market, as are annual pay increases. Many departments seem to have a critical shortage of staff, and closing services has been a recent topic of discussion.

Additionally, the financial picture of the organization is bleak. The payor mix has changed; Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding. Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of the hospital processes.

The various stresses appear to be having a significant impact on the overall morale of employees. Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence. Several leaders have been let go in an effort to address issues.

The leadership of Gateway Hospital is extremely concerned about the organizational prognosis and has decided to begin to address the issues by enlisting the assistance of a consulting team. One member of the team is a financial expert who has been hired to address the significant financial issues affecting the hospital. The time frame on fixing the financial issues is one

Organizational Behavior in Health Care, Third Edition

of a critical need; since the environment is rapidly changing, the consultant must get a handle on how to help the hospital operate successfully, given the current financial downslide.

A second member of the team is hired to address the morale and employee issues. A review of the employee opinion survey is conducted, and trends are identified in exit interviews. Employee interviews and focus groups are held in an attempt to determine the root cause of the morale issues, as well as the breakdown in teamwork and communication.

The data collection is discussed with leadership; after a series of discussions, leadership admits that many of the financial pressures have created a "knee-jerk" reaction to staffing issues, often cutting back dramatically on employee hours. This would create a crisis mode and the need to ask employees to work harder. This cycle has created a significant lack of trust from the employees' perspective, coupled with the fact that employees have not felt that they have been apprised of the reasons for the rollercoaster changes and have not been offered any words of appreciation when they have either reduced their hours or worked in a crisis.

The consultant and the leadership agree that in order to fix the "people" issues of the organization, there will need to be a culture shift of leadership and employee interactions so that trust can be rebuilt.

Discussion Questions

1. On the basis of these issues, what OD interventions do you think should be utilized to address the problems this hospital is facing?

2. How would you proceed if you were the consultant in this case?

3. What skill set do you think the practitioner will need in order to be effective in this organization?

4. What type of a timeline would you establish if you were this consultant?

Case Study 18–5: City Hospital

City Hospital is a growing hospital in a large metropolitan city. The hospital is currently experiencing an issue that many other organizations are also facing, that of the multigenerational workforce. The senior leadership of this hospital is the typical "baby boom" generation, but the population of employees is slowly growing into one of a younger workforce. The leadership is struggling to deal with issues such as iPods at work, cell phone use, Internet use, tattoos, body piercing, and so on. Equally troublesome is a different perceived commitment to the job and breakdowns in communication. Leadership has decided to hire an outside consultant to help the organization understand the impact of the multigenerational workforce and to try to become a more cohesive organization.

Discussion Questions

1. Which type of OD intervention is the leadership using in this situation?

2. What obstacles do you see in this situation that may make this intervention more difficult than other types?

3. What recommendations do you have for this situation?

4. What other interpersonal issues exist in organizations besides generational that may create a need for an OD intervention?

REFERENCES

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Organizational Behavior in Health Care, Third Edition

Burke, W. W. (1982). Organization development principles and practices. Glenview, IL: Scott, Foresman.

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Cummings, T. G., & Worley, C. G. (1997). Organization development and change (6th ed.). Cincinnati, OH: South-Western College Publishing.

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Fitzgerald, S. P., Murrell, K. L., & Newman, H. L. (2002). Appreciative inquiry: The new frontier. In J. Waclawski & A. H. Church (Eds.), Organization development: A data-driven approach to organizational change (pp. 203-221). San Francisco, CA: Jossey-Bass.

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Gottlieb, J. Z. (2001). An exploration of organization development practitioners' role concept. Consulting Psychology Journal: Practice and Research, 53(1), 35-51.

Hackman, J., & Oldman, G. (1980). Work redesign. Reading, MA: Addison-Wesley.

Hanson, H., Moir, M. J., & Wolf, J. A. (2011). Organization development in health care: The dialogue continues. In J. A. Wolf, H. Hanson, & M. J. Moir (Eds.), Organization development in health care: High impact practices for a complex and changing environment (pp. 273-279). Charlotte, NC: Information Age Publishing.

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McLagan, P. (1989). Models for HRD practice. Alexandria, VA: American Society for Training and Development.

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Roethlisberger, F. J., & Dickson, W. J. (1939). Management and the worker. Cambridge, MA: Harvard University Press.

Rothwell, W. J., Sullivan, R., & McLean, G. N. (1995). Practicing organization development, a guide for consultants. San Diego, CA: Pfeiffer and Company.

Waclawski, J., & Church, A. H. (2002). Organization development: A data-driven approach to organizational change. San Francisco, CA: Jossey-Bass.

Organizational Behavior in Health Care, Third Edition

Chapter 18: Organization Development
LEARNING OUTCOMES
OVERVIEW
SUMMARY
DISCUSSION QUESTIONS
REFERENCES