Issues Queensland Health Faces - Term Paper Example

Introduction Queensland Health, a Queensland-based government body provides public health care to Queenslanders. The organisation provides hospital outpatient, inpatient, aged care, emergency care, community care, health promotion programs and mental health care services to the people of Queensland. In the recent years, the organisation has been facing many allegations regarding the culture of Queensland Health. Many find the culture of the organisation to be full of secrecy, over-bureaucratic and intimidating. These are all detrimental to the development of health care. The Consultancy Bureau therefore conducted an independent review of the organisation and provided various recommendations to improve the condition of the organisation. This paper therefore would focus on various issues that the organisation is facing based on the analysis provided by the Consultancy Bureau. Some of the issues that this paper would deal with include impact of employee empowerment on decision making, risks factors involved in empowering employee and making decisions, how to initiate changes in workforce behaviour, countering low morale, high stress level, high absenteeism and lack of participation in employees. The issues of coordination between multidisciplinary team members are also discussed, especially focusing on decision-making and communication process. The paper would also analyse the shared cultural values, beliefs and behaviours emerged within the organisation and how they become cultural problems. The paper would further provide the initial steps to be taken to reform the organisation. 1. Employee empowerment and decision making Taking decisions is one of the most important managerial procedures in an organisation. It has been seen that an organisation which has been able to undertake timely and focused decisions could conduct in a better manner than companies that are slow and not focused about their decision making process. However, the process of decision making also has various issues and disadvantages regarding it. For instance, smaller companies mostly have lesser number of stakeholders and often take rushed decisions which cause major damages. On the other hand large organisations with many stakeholders become very conservative and slow while taking decisions. Nonetheless, the success of an organisation, small or large, depends on taking the right decision (Kennedy & Schleife, 2007). Experts believe that every employee must take interest in creating shared mission and vision within the organisation for the continuous development of the company (Kennedy & Schleife, 2006). However, such an active participation on the part of employee would also require them to gain skill sets and knowledge about how to take decisions without any undue risks. It is also important for the management to make the decision making process transparent and involve the employees in the process as well (Ciulla, 2000). Many companies these days are leveraging the expertise and skills of their employees for improving the quality, reducing the prices and ensuring customer satisfaction (Fitz-enz, 2000). Further, in order to create an atmosphere of innovation in the organisation, it is important to create not only collaboration between the employees and the management but also to empower the employees to take decisions (Michaels et al 2001). The concept of empowerment means using the competencies and strengths of each employee and asking them to proactively become involved in the corporate decision making process (O’Malley 2000). This process of employee empowerment helps in integrating the employees within the organisation and allowing the company to optimise their resources by aligning the employees with the strategy and vision of the company (Reichheld, 2001). In case of healthcare industry, it has become much more imperative to involve the employees in the decision making process as the industry is evolving continuously due to the integration of new technologies and increase in the number of lifestyle-related diseases. Further, in order to provide quality care services, it is imperative for the health care organisations to involve their employees in the decision making process. 1.1. Benefits Employee empowerment is also the best process to deal with issues regarding organisational structure, which includes centralised decision making, silos and over-bureaucratic nature of most healthcare institutions. With the dominance of healthcare system during the 20th century, health institutes created a management model which was discipline-based (Lega & DePietro, 2005). Under this system every manager from all the functional areas such as nursing, clinical divisions, laboratory services, is required to report to the higher management, who in turn report to the chief executive officer. Although, such a centralised organisation structure helped in taking efficient decisions, it has its own limitations (Burton et al 2004). Such management structure does not allow greater integration of the employees and providing innovative solutions in the actual line of duty. For instance, most of the decisions in a healthcare institute are found to be taken by the institute’s management and other high-end officials. However, it is the employees who deliver actual health care, such as the therapists, nurses and pharmacists are impacted by these decisions. It has been often found that the people delivering health care facilities are not sync with the management decisions and many a times do not agree with the decision taken. This results in constant tension and conflict between the two groups and creates silos and bureaucracy in the organisation (Wilson & Pirrie, 2000). However, if the organisation decides to create a less centralised decision making process and involves employees even from the clinical level, it is evident that the organisation would be able to grow in a better manner (Eastaugh, 2001). Many health care institutes in the recent past have provided autonomy to its employees to undertake decisions at their own end while dealing with critical situations. These institutes are creating more decentralised structures enabling the employees at the service line to take independent decisions and become accountable for providing quality services to the customers or patients (James, 2006). In fact, the hospitals in the US have been found to evolve over the years in such a manner that the physicians are also considered as the primary consultants and the patients give a fee to utilise their consultancy services. The hospital administration only looks after the management and operational aspects such as managing operating rooms, improving technologies and creating more beds. The physicians are also encouraged to share their decisions with other departments as well (James, 2006). In the recent times, the physicians are also involved actively in the management of a healthcare institute, although the administration still needs to create structures to accommodate the physicians in a permanent manner. In order to provide quality care to the patients, the healthcare organisations would be required to integrate physicians and other service line employees into active management role as well as give autonomy to them to take independent decisions (Lega & DePietro, 2005). In order to address the needs of the individual patient and create a successful business, it is necessary to create a management structure that is not centralised and provides independence to the business units for taking individual decisions (Kaplan & Norton, 2006). For instance, most large organisations have implemented strategies and balanced scorecards to empower the business units and employees to take corporate decisions. The managers of these units usually take the decision as per the values of the company. Thus, the organisations are able to undertake decisions and incorporate business units without resolving to major restructuring of the organisation. Many organisations such as GE and Johnson & Johnson have also used the structure of multidivisional organisation to create a successful business and integrate local units. The management of health care institutes should also create such strategies and enable employees at individual business unit levels to take independent decisions for improving the quality of care provided to the patients (Fay et al, 2006). 1.2. Risk factors In order to make employee decision successful, it is imperative for the empowered employee and team to follow certain code of conduct and take responsible decision. These employees should ensure that they are taking such decisions within the prescribed boundaries of their job descriptions. They need to conduct in a responsible manner while taking important decisions. It is also important for the employees to take decisions that are as per the management philosophy and company mission and vision (Melham, 2004). The employees should not be given their own way of doing things as by the end of the day, the management would be ultimately held responsible for any wrong action on the part of an employee. Further, in spite of individual decisions, the management has to ensure that there is cohesion within the organisation as employee empowerment often creates chaos, with everyone taking a different decision for the same situation (Bashinksy, 2008). Also, not all employees are equipped or skilled enough to take decisions and may take rushed or wrong decisions, which may damage the reputation of the organisation. Thus, it is important to recognise and empower only those employees who have the required skill sets to take such management decisions (Thomas, 2000). Often employee empowerment creates a situation of chaos, wherein the employees feel that they can take any and every decision and therefore, do not need managerial supervision. They stop respecting the management and do not inform about their decisions to their superiors. This results in breaking down of communication between the management and the employees. The organisation structure would eventually disintegrate in such a situation, which would result in greater problems for the company (Bates, 2004, p. 44). In case of a healthcare organisation, such a situation can be dangerous as employees are dealing with a patient’s well being and any wrong decisions without supervision of an expert might result into fatal incidents and damage the reputation of the organisation as well. 2. Initiating changes in workforce behaviour The review of Queensland Health revealed that the manager, leaders and supervisors in the organisation are not able to deal with various complex issues and could not provide proper strategies to ensure employee participation in solving problems or managing non-performing employees. This resulted in creating low morale, high stress level, absenteeism and lack of participation in the employees. Therefore, the organisation should implement various strategies to tackle such situations and create an amiable atmosphere wherein the employees are equally empowered to take their decisions and feel motivated to work towards the success of the organisation. 2.1. Low morale Every organisation has a different way of dealing with changing workforce behavior with most resorting to providing better financial support and benefits to the employees. However, in order to raise the moral of the employees, the organisation needs to look beyond financial factors and provide additional benefits such as looking after employee safety, social benefits and professional development (Bateman & Crant, 2003, p. 12). Studies have indicated that although financial factors such as pay and benefits are significant for hiring employees, retaining them would require organisations to focus on providing opportunities and building long-lasting relationships (Bernathal, 2003 p. 11). Many health organisations have also incorporated incentive practices to change the work environment at the organisational level as well as alter the nature and status of employee position at the service level. Employee performance is often linked with the motivation level of the employees and therefore, it is necessary to keep their morale high by providing them with various incentives and benefits. The management should focus on creating a positive work environment for the employees, wherein the team and the individual employees are provided with a good leader and constant clinical support to take empowered decisions (Cameron, 2005). Further, a robust performance management system should be integrated to provide unbiased and true evaluation of the employees. The employees should be given continuous education and career growth opportunities. Employee benefits should be incorporated at all levels providing mandatory training courses, competitive compensation packages, clinical support, regular rewards etc (Cameron, 2005). 2.2. High stress Due to constant interfere from the management many employees have reported high stress levels in their jobs. The pressure to perform under strenuous circumstances has led to employees breaking down and not performing up to the mark. Organisations, especially the centralised ones have a linear reporting structure, wherein the employees are required to report to their immediate supervisor for making any decisions (Crabtree, 2003). Thus, the employees have to fulfill various management regulations as well as conduct their work within the given timeframe. This results in over-working and spending more time in the office. It further impacts the work-life balance of the employees as well and heightens the stress factor. Further, the fear of layoffs and cost-cutting strategies also add on to the stress level. In the healthcare scenario, the stress is also augmented with the employees dealing with life-threatening situations at every moment (Earle, 2005). The organisation should take proactive steps to reduce stress levels in employees. It should act as a role model to control stress factors by adopting various strategies. First and foremost, the organisation should improve its level of communication with the employees. They need to share information with their employees for reducing any uncertainty and discouraging rumors in the organisation. Further, the employees should also be consulted while taking decisions for their welfare. The organisation should provide opportunities to the employees to participate in the decision-making process as well (Garvey, 2004). The organisation should also audit the work schedule of the employees and ensure that the employees are not over-burdened or given unrealistic job roles to perform. The workers should also be made to be valued. The organisation should adopt various rewards and incentives programs at regular intervals. The organisation needs to establish a friendly environment as well, wherein the employees are able to share their problems with the management easily and without any fear. There should be ample opportunities for the employees to interact among each other and share their expertise. Most importantly, the management should look at creating a work-life balance for the employees (Greenberg, 2004). 2.3. High absenteeism High absenteeism is generally seen as the result of lack of motivation and poor management within an organisation. It may result into lower employee productivity and therefore, losses to the companies if not addressed at the right time. Many companies initiate programs such as providing rewards to employees with 100 per cent attendance records. However, such programs are just motivational in nature and might not impact the rest of the employees. Therefore, it is important for the organisation to understand the source of absenteeism and tackle that accordingly (Gubman, 2004). It has been found that in most cases high absenteeism results due to stress in interpersonal relationships within an organisation. This stress might not just be between the employee and the supervisor but it may also occur between employees as well. In case a supervisor is responsible for a hostile environment, the employees would feel de-motivated and remain absent from work in most days. The organsiation should create a procedure wherein high absenteeism should be monitored to find out who is abusing the power to create issues for the employees (Greenberg, 2004). After identifying the trouble area, the management should take proper steps to solve the issue. In case the supervisor lacks some inter-personal skills, he or she should be provided with training and counseling sessions to develop such skills. However, if the problem persists even after giving training and counseling sessions, then the best way to deal with the issue is to remove the supervisor from the company (Gubman, 2004). 2.4. Absence of staff participation In order to make an organisation successful, it is required to ensure that the employees participate in most decision making procedures as well as towards the overall development of the company. The organisation should develop such a culture wherein long-term relationships are developed with the employees and an environment of trust is established. The most important factor that drives employee engagement is to help employees achieve their personal goals and provide them with positive work environment (Effron et al 2003). To ensure maximum participation from employees, the organisation should recognise their work, help in their career development, provide financial and social security and ensure in creating cordial relationships between employees. Organisations should create strategies for improving employee satisfaction by changing company culture. It should allow employees to provide their suggestions and ideas with their managers and implement the good ones in order to boost the employees’ confidence in the system. Further, the management should share their views and ideas with the employees as well and ask them to provide feedback on them (Levin & Sloan, 2005). 3. Multidisciplinary team and impact on decision-making process It is essential to include a multidisciplinary team for providing comprehensive health care services to the patients. Although, the composition of the team may vary from situation to situation, the essence of such teams remain the same, to provide quality care. However, it is also witnessed that due to improper communication and lack of clarity about job roles, conflicts and discords occur in such teams, which is not advantageous for a patient (Fay et al., 2006). A surgeon, a general practitioner, a radiographer (radiographers take X-rays and other medical images), a theatre nurse, a ward nurse, and a ward clerk (ward clerks undertake administrative duties), with different specialisation and skills comprises a diverse team. Such a team is required to provide comprehensive health care services and needs to have higher degree of collaboration among each other. In such a multidisciplinary team, the issues of power play and influencing decision making are the most detrimental towards providing quality care. For instance, a general practitioner and a surgeon would have the highest influencing power and may take most of the decisions regarding a patient. In most cases, radiographers, nurses and ward clerks only follow the instructions given by the physician and the surgeon and do not take any individual decision. This results in a very stiff managerial structure, wherein the lower cadre of the staff is required to implement the decisions taken by the upper management without any questions. However, in order to provide comprehensive healthcare it is important to focus on taking feedbacks from the lower cadre as well. For instance, while treating a mental health patient and performing surgery on him, the decisions of just the practitioner and the surgeon might not be able to give the right condition of the patient. It is also important to interact with the ward nurse to understand the condition of the patient in a better manner. However, in most cases it has been found that the organistional structure is siloed and therefore, effective communication and decision-making process is unable to be taken (Wilson & Pirrie, 2000). Lack of communication or poor communication between the team may result into impacting the treatment of the patient. Such failures in communication mostly result from absence of team commitment, failure to create proper and clear team goals and rigid organisational structure. For instance, a rigid structure would mean lesser communication between the team. The lower cadre staff would not be open with their communication with the upper management as they would constantly fear about hampering their career path, while the upper management would be too complacent to take the feedback from the lower cadre about a patient. So, the surgeon and the physician might take all the decisions while ignoring to take suggestions from the nurses and other staff. This may create issues while taking strategic decisions about a patient as the nurses would be much more knowledgeable about the patient’s condition due to their constant interactions with the patient (Kickul & Posig, 2001). Further, such rigid structure would mean that the nurses and other staff may feel hesitant about communicating any suggestions to the physicians. Due to lack of effective communication, the team would become directionless and would not have any common goal to follow. There would be chaos, absence of coordination and discords over decision making as well. In most situations, it has been seen that feedbacks are rarely sought, the team does not involve in meetings or regular sessions to understand the case properly. Generally, a pre-operation meeting is conducted where the senior members provide guidelines to the junior staff, without seeking any feedbacks from the junior members (Kickul & Posig, 2001). In order to ensure proper teamwork it is essential to create an atmosphere of trust and right working conditions. It is essential for the team to work in a transparent manner and ensure regular communication between various team members. Collaborative efforts between the team are imperative to provide quality services (Dutton, 2003). 4. Cultural problems The case study focused on various cultural issues faced by Queensland Health. Some of these issues included intimidation, bullying and secrecy. It was found that the employees within the organisation indulge in bullying and threatening each other. They do not want to take responsibility of a given situation and often keep important information to themselves. Such values and attitudes are not cohesive for the employees to develop or provide quality patient care (Ciulla, 2000). It was found that Queensland Health’s policy to focus on being within budget had resulted in heightened incidents of bullying and intimidation. The organisation has started with the culture of secrecy by not divulging patient information hiding under the clause of patient confidentiality. However, many claimed that the organisation is not providing proper treatment and their policy of not disclosing the treatment information is caused trouble to them. Some of the information that is not being disclosed to the patients includes the actual size of the waiting lists, which many claims making people wait for a surgery for more than a year (Wood et al., 2006). However, the staff is blaming the problem on constraints of budget and workforce, which has further led to change in the organisational culture and moving towards secrecy and concealment of important data. Such concealment strategies are also supported by the higher management resulting in seeping of irresponsible behavior in the organisation. Further, the Beattie government also encouraged such a culture for its political goals (Wood et al, 2006). The behavior of the employees regarding the organisation has also changed drastically due to the inherent culture of secrecy. Many were angry, resentful and frustrated towards their supervisors and manger and often complained of being intimidated or bullied by them if they asked for additional funding to provide quality care to the patients. Further, the decisions were all taken by the central management and the care givers were only asked to follow them. This created discords and conflicts of opinion. Also, the management was never able to understand the reality of the situation and could not provide decisions that could be implemented in the real world situation (Fay et al, 2006). Further, it was also found that the managers, leaders and supervisors were not able to deal with various complex issues. They were not able to encourage participations from employees to solve a particular issue or to engage the staff in a proper manner. They were also not competent enough to manage non-performing members and many complained that often people who did not perform were promoted or transferred. All these also created a situation of low morale, high absenteeism and high stress (Wood et al, 2006). Experts reviewing the organisation have suggested that a new healthcare monitoring and reporting system should be established and reviewed at regular intervals throughout the year. Further, it was suggested that cultural changes should be implemented by building trust between employees and creating co-ordination between multi-disciplinary teams. The culture of the organisation could only improve if the team is able to solve the problems in a collaborative manner, include the team to undertake decisions, improve the systems within the organisation and enhance the team spirit and motivation level (Kaplan & Norton, 2006). 5. Initial reform process It would indeed be a difficult task to reform Queensland Health and would require a number of steps to be taken over a period of time. However, the most crucial step that needs to be taken in this case would be motivating the employee and retaining them in the longer run to increase productivity and enhancing commitment towards the organisation. It is imperative to engage the workforce, enhance employee loyalty and retain key talents for the overall development of the company. Higher attrition levels cause major disadvantages for the firm and may impact the bottomline as well. It has been found that the employees may be divided into two groups, one who are engaged and loyal and the other who are not properly engaged and are de-motivated. The second group is the one that spreads rumors and create trouble in the organisation. It is important to identify this group and provide them with proper guidance and support so that they are also motivated and work towards creating a better company culture (Reichheld, 2001). The rate of productivity and retention decline further with the employees becoming confused and distracted. Lack of clarity about their roles and organisational transitions also raises confusion in the minds of the employees (O’Malley, 2000). Thus, in such times, the manager needs to play an important role and create a cohesive environment within the organisation. He or she should be able to recognise the talent of each and every employee and provide them with equal opportunities and enhance their career within the organisation. Further, it is important to deal with each employee at a time and conduct one-on-one interviews at regular periods. A good manager would listen to the problems of the employee and also ask various questions as well. He or she would try to find out if the employee is satisfied in his current position and what the organisation can do more to retain him. Employee satisfaction is found to be the key to any organisation’s growth (Kreisman, 2002). The manager should behave as a catalyst and understand the queries of his people and convey the same to the management. This would create a drop down effect and the management would be aware of all the issues within the organisation. It is also essential to create an open communication style, wherein an employee may reach up to the higher management in case of any trouble with his or her immediate supervisor (Bashinksy, 2008). The employees should also be given constant rewards and recognitions over the period for motivating them. In order to ensure maximum participation from employees, the organisation need to appraise the work done by the employees, help them develop their professional goals by showing them a clear career path, provide them with financial and social security as well as create a cordial relationship between employees and between employees and seniors. The organisation also needs to create strategies for improving employee satisfaction by changing company culture. It needs to encourage employees to provide suggestions and ideas to the management. The company should just not gather these suggestions but also implement some good ones so that the employee confidence in the system is restored. Also, the management should share their ideas and views with the employees and ask them to give them feedbacks on them and incorporate the good ones. Conclusion The paper focused on various issues that Queensland Health is facing based on the analysis provided by the Consultancy Bureau. Some of the issues that the paper dealt with included impact of employee empowerment on decision making, risks factors involved in empowering employee and making decisions and initiainge changes in workforce behaviour. The issues of coordination between multidisciplinary team members were also discussed. The paper also analysed the shared cultural values, beliefs and behaviours emerged within the organisation and how they created cultural issues. The paper further provided initial steps to be taken to reform the organisation. Employee empowerment helps in integrating the employees with the organisation and is imperative for any organisation to implement for growth. In case of healthcare industry, it has important to have the employees being involved in the decision making process due to the emergence of newer technologies and increase in the number of lifestyle-related diseases. Thus, the employee should be involved in the decision making process for providing quality care services. However, it should also be kept in mind that employee empowerment often creates chaos as employees feel that they can take any decision bypassing managerial supervision. They may not respect the management and inform about their decisions as well. This result in communication breakdown and can eventually become detrimental for the patient. The organisation was also found to have an inefficient culture, where the manager, leaders and supervisors in the organisation are not able to deal with various complex issues and could not provide proper strategies to ensure employee participation in solving problems or managing non-performing employees. This resulted in creating low morale, high stress level, absenteeism and lack of participation in the employees. Thus, the organisation should develop strategies to tackle such cultural and workforce issues by empowering the employees and providing benefits and rewards. Cultural changes should also be implemented in the organisation by creating trust between the employees and the management. Problems should be solved in a collaborative manner, which would help in enhancing the team motivation and spirit. It would be a difficult task to reform Queensland Health. 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