Change in a Healthcare Organization - Report Example

Strategic Leadership How to Harness Talent From the Periphery to Promote Critical Organizational Change? Metropolis hospital, located in Spanish Harlem in the upper Eastside of Manhattan, boasts a history of providing high quality, effective clinical care since its founding in 1875. Its mission is to deliver culturally sensitive medical care to all who come through its doors regardless of their race, ethnicity, culture, religion, sexual orientation and ability to pay. MHC has lived up to this noble mission for over 200 years – never wavering from it. In “Building Your Company’s Vision”, James C. Collins states: “a very noble mission provides the glue that holds an institution together.” This mission along with its values has helped us to endure and define our reason for existing and remain true to public service. However, recent economic downturns and governmental regulations are impacting our ability to operate and survive on a daily basis. We can no longer rely on public and governmental assistance, as our own goliath government stumbles to its knees and global governmental powers waiver on the brink of economic collapse. Our bright and dedicated leaders are sorely tested as they make torturous decisions to save jobs, continue to provide services, and provide care in the most efficient and effective way possible. Indeed, leadership, once regarded as the powerful force at the helm, can no longer do it alone. I believe that leaders of today are forced to look, not outside of our building structures, i.e., government, but within our own organizational infrastructures for survival and change. The notion that revolutionary change can only come from leadership as we once knew it, paralyzes us into an outdated mindset that will not position us to meet the challenges of future organizational-managerial dynamics. As a result of these, the organization should make changes to shape its spending, but the problem of achieving these is similar to what Chip and Dan explain as the primary obstacle which is a conflict that is built into our brains. A critical piece for moving forward is improving performance to meet these new challenges. On how to meet these challenges, Chip and Dan explains that our minds are ruled by two different systems the rational mind and the emotional mind that compete for control. The rational mind wants a great beach body; the emotional mind wants that Oreo cookie. The rational mind wants to change something at work; the emotional mind loves the comfort of the existing routine. The comfort of the existing routine is what is reflected by the leadership of the hospital relying so much on the government funding and this need to be changed for the hospital to be able to cop up with the emerging challenges. But as the Miway and Saxton article states, non-profits struggle to implement organizational change and the ability to communicate effectively is a critical piece in learning. In fact, in my years of experience, I have never seen an effort to create a learning and knowledge sharing environment that is going to support good communication among our staff. Any learning activity is historically relegated to human resources department there is very little evidence to support that the learning has been effectively shared with the organization. When we are making a decision were often torn between our rational, logical reasons and our emotional, intuitive feelings. Chip and Dan uses imagine of an Elephant and its Rider. The creation of a learning and knowledge environment to support good communications among the staff is a rational reason to obtain change in the organization. One reason for this may be due to the hospital’s historical culture secrecy (Institute of Medicine: to Err is Human, 1999) about information and knowledge and a deliberate reluctance to share information and communicate information among staff. This culture of secreting acts is a barrier to learning that permeates among all disciplines, medical, nursing, and administrative. The culture of secrecy should be approached from the new direction in order to make the big deal changes so vital to a sustainable future. The leadership should look at the "bright spots" or the tiny fraction of things going right rather than the problems, and examining how to direct both the logical and emotional parts of our brains so that they may head in the same direction (Chip and Dan 2010). Consequently, we function in “silos” and healthy communication or sharing of information is not a goal we aspire to achieve. This lack of communication also contributes to medical errors and poor care: (To Err is Human: Institute of Medicine Report November 1999) sites that 66% of all medical errors is due to poor communication. Identification of “bright sports” will get rid of the poor communication in the organization. Here is an example: a patient comes to the ER is triaged and a diagnosis is made that he is having a stroke. For stroke victims, timing is critical because the treatment must be given within one hour of the on-set of the stroke. However, in talking to his wife they find out that he is on a serious heart medication called Coumadin that can have serious contraindications with stroke treatment. They send a blood sample to the lab to measure his Coumadin levels. The lab comes back within 20 minutes. However, the results were never given to the physician taking care of the stroke victim because the nurse who was suppose to get the results, left home during change of shift and never communicated to the on coming nurse that they needed the Coumadin results for the patient. Valuable life saving time has been lost due to breakdown in communication. Nurses play a critical role in the everyday running of the hospital itself. So how does a professional dedicated nurse fail to communicate a critical life-saving result? In a 2008 survey conducted by the Agency for Healthcare Research and Quality (AHRQ) at our hospital, 49% of hospital staff members reported that “Important patient-care information is often lost during shift changes,” 52% agreed that “problems often occur in the exchange of information across hospital units”. In addition to the culture of secrecy mentioned above, the traditional autocratic styles of nursing management does not support individual decision-making and improve communications. “Powerless nurses are ineffective and less satisfied with their jobs (Milissa Manojlovich: Power and Empowerment in Nursing; 2007) Administrators who do not engage in direct patient care are often unaware of the patient care issues that arise in the process of providing healthcare. They are usually more concerned about non-clinical aspects of running a hospital. To overcome these, the organization should apply the three principles of the mind, these are giving clear direction to the logical brain, then motivate the emotional brain, and finally clear the path for change by alteration things so that the right behaviors are easier, and the wrong behaviors harder to follow (Chip and Dan 2010). This will overcome the situation in which the nursing management does not support the individual decision and administrators who do not engage directly with the patients will get proper information directly from the nurses and what need to be done to improve the healthcare. The Milway and Saxton Article suggest four elements of organizational learning that may contribute to improved communication and information sharing. The organization must incorporate the following: 1. Supportive Leaders. 2. Culture of Continuous Improvement 3. Defined Learning Structure 4. Intuitive Knowledge Process We have recently introduced a learning model of transformational change that incorporates all these elements. The work is called Breakthrough and relies on multiple activities called RIE’s (Rapid Improvement Events) that are activated throughout the entire organization. It involves multiple interdisciplinary teams as internal and external customers of each other. The heart of the breakthrough process is that it allows sharing and exchange of knowledge. In “The Challenge of Organizational Learning”, there is a table illustration on how to create a knowledge sharing process. “Creating a Knowledge-Sharing Process”, captures the power of knowledge-sharing as main ingredient in Breakthrough. The RIE model give clear direction to the logical part of the brain, then motivate the emotional brain and finally it clears the part for change hence fostering the transformational change. The authors’ state, in the early days, the internet was the world’s greatest library. However, today this knowledge must flow through the organization. This can happen as long as mission and goals are clear and learning is shared throughout the organization. The Knowledge Sharing table teaches us to “capture” knowledge from the periphery of the organization and allow it to stream and cultivate. Support Leaders The breakthrough process begins with a top level tool for Executive Leadership which defines the new change. It is called Transformation Plan of Care (TPOC). It happens each time just before the sanction of RIE (Rapid Improvement Event). During this phase the leaders will identify the key value of initiating a RIE. This charge must be based on eliminating waste and must be aligned with the mission. The process relies on teams. The teams (RIEs) meet for a whole week to implement these changes. There are at least 2 RIEs per month and one Executive Leader must participate on one team for the entire week. Culture of continuous improvement Aligned Beliefs and values The RIE’s (Rapid Improvement Events) is a key in fostering continuous improvement. A RIE is similar to the Total Quality Improvement and performance improvement methodologies started by Demings and Crosby in the 50’s, 60’s, and 70’s. However, RIEs differ from these earlier styles of problem solving methods because they do not take weeks, months, or years to plan and implement. In addition, RIEs are based on making changes that are aligned with the hospital’s mission and vision. Much effort is placed on removing waste from a process and the changes are immediate. Defined Learning structure Every team member is educated on the tools and principles of Breakthrough as they journey to solve the problem. For example, a RIE team may be charged with the goal of improving the length of stay (LOS) in the department of Psychiatry. The goal is to reduce the length of time a patient stays in the hospital due to inefficiencies and wastes in our current processes. The team which is made up of a doctor, housekeeper, nurse, “fresh eyes” (someone not from the unit), and another representative from outside the department will work together for four whole days, never leaving the room to go to their worksites. This process garners the expertise from the people who are closest to the problem. The facilitator (who is staff member) and the Team Leader (who is also staff) have been sent to a training session for facilitation techniques and team leading techniques prior to the event. For each level of learning accomplished they receive recognition: A Team Leader is considered “Green”; the trained facilitator is “Bronze” and the Sensei (the highest level of recognition) is considered “Silver”. Other members of the team may naturally be unfamiliar with the process during the course of the RIE. However the role of the facilitator and team leader is to teach them and guide them as the event unfolds. On the second day of the meeting the team will go on a “GEMBA” walk (Japanese term for “where the truth be told”). The GEMBA walk allows the team to visit the site that is being studied and become more familiar with the flow of activities. Knowledge is captured and the team witnesses for themselves what are the barriers hindering the improvement. Following this, the team applies statistical tools, i.e., the principles of the “vital few” (using flow charts and Pareto Analysis). Pareto analysis is based on the 80/20 rule and allows the team to focus attention on fixing the most important problems contributing to a failing process. Define the Process for each source We use an A3 Problem Solving Methodology that is very logical and sequential. It will help to capture the knowledge information we need by completing the boxes on the A3 format as follows: a. Reason for Action – must be established to ensure we are not wasting the organization’s resources and time in terms of personnel and finance. Sometimes considered the “Burning platform” it is determined by the leadership and stakeholders b. Current State – where are we now or how far have we moved from our mission statement – we gather current data to tell us. c. Target state – Where do we want to be in order to remain true to our mission statement and maintain fiscal – we determine metrics to be monitored. d. Gap Analysis – We use tools such as Fish Bone diagrams to help us identify our gaps and barriers. e. RIE – We then test our theories by going out and actually performing a test based on a new process that is better streamlined, less wasteful and more effective than the previous one. Intuitive Knowledge Processes Standard Work is created. The new process (Standard Work) which results from the RIE is written and posted. Standard work is signed off by all participants, involved, including stakeholders. The standard work is posted visibly in the respective area. All staff huddle on a daily basis around the standard work (which has been posted in a visible area) to ensure that there is compliance or to see if anything needs to be changed or revised. After the standard work is created there is a concentrated effort to communicate the new processes hospital-wide. A meeting at the end of the Team’s week is held in a large auditorium. The leadership and all stake holders are present. The team goes up to the stage and presents their work and findings. The leadership recognizes and thanks the team for their hard work. Their recommendations are accepted and transmitted across the organization. The process owner on the team ensures that the changes are completed and sustained. For the changes to be completed and attained, the process owner of the team should view the emotional side of group members as the Elephant and the rational side as the rider. For example, the Rider holds the reins and seems to be the leader. But the Rider’s control is insecure because the Rider is very small in relation to the Elephant. Anytime the big Elephant and the Rider disagree about which direction to go, the Rider is going to lose since the elephant is carrying him. For the process owner to make progress towards its goal in RIE, the elephant and the rider should move together that is, whether it’s noble or crass, it requires energy for the process owner to drive the Elephant. He’s completely overmatched.” A status report for the progress will be given in 30 day, 60 day and 90 day intervals to all stakeholders. During the RIE process superstars are born as silent individuals from the periphery of the organization are given a voice and an opportunity to participate in high-level policy and decision making moments that remain true to our mission. The Breakthrough process allows this knowledge to be captured and shared across departments. The results are immediate and organizational learning is enhanced. Read More