Change and Culture Case Study II Part TWO - Essay Example

Change and Culture Case Study II Part TWO Introduction ABC Healthcare, a merged entity between ABC Dental Care and XYZ Healthcare has been operational for the past six months. Many of the organizational change procedures based on Lewin’s and Kotter’s models were introduced and have been found to be effective. The superiority complex of employees from ABC Dental Care has been addressed to and the overall cohesion between the former employees of the merged organizations has improved dramatically. Each departmental staff is now a mixture of employees from both the merged organizations and new ones to ensure adequate staffing levels. As shown in the organizational chart in the previous assignment, departmental heads have been appointed in such a way that representation from both the merged organizations is equally distributed. In order to avoid any ego problems; the CEO of ABC Healthcare was an efficient and an outside person who was previously employed as a vice-president of a well-known health service provider in the country. Six months after the merger, it was seen necessary by the management to implement some major changes within the organization in order to be more competitive in terms of cost of service. One of the features of this organizational change was reduction in the number of employees and the introduction of the concept of ‘universal workers’ who will be trained to perform multiple tasks. This concept will involve major changes in job design across several classes of employees especially among the nursing and administrative staff. Apart from the above, it was decided to implement the concept of organizational learning within the organization as a part of its strategy. The strategy involves the concept of ‘learning organization’s conceptualized by Peter Senge which was first published (and widely accepted) in his bestselling book The Fifth Discipline. This paper reviews the implementation of the concepts of universal worker and organizational change in ABC Healthcare in order to remain efficient in terms of costs, resources, service, and management. Universal worker Employees are an integral part of any organization and are often referred to as one of its most important assets. The management of any organization has to have a balance between employee efficiency and employee satisfaction. In a sense, there is an inherent contradiction between the aims of employees and the management. Employees are concerned with concepts like job security, and adequate compensation while the management is concerned with maximization of efficiency and profits. This contrast needs a balance between employee satisfaction and productivity. Any change by the management towards profit maximization needs to be balanced with employee satisfaction. The concept of a universal worker is a move towards worker productivity which has to be balanced by employee satisfaction. The basic premise behind this concept is reduction in the workforce and using remaining employees to be trained in multiple jobs. As mentioned earlier, the concept of the universal worker is planned to be implemented in ABC Healthcare. According to Tal Widdes, “the tasks carried out in the nursing home and indeed in every other health care setting - have been highly compartmentalized: nurses do the nursing, food service workers prepare the meals, laundry personnel do the laundry, and so on. Staff tends to be task-oriented and the focus is on getting the job done” (Widdes, 1996). Widdes adds that a holistic approach is more practical in terms of improvement in quality of service and savings in cost. In order to provide personalized service, it is better that a service provider understands the needs of his or her client. In such a situation, the management, if possible can train their staff to provide a multitude of services that is dependent on the personal needs of a patient in the case of providing healthcare services. A patient who is weak physically and even emotionally will be more satisfied if the service is more personalized. In a traditional approach, the different services provided to a patient are provided by diverse departments. For example, cleaning and laundry will probably be handled by one department while changing of clothes and sheets will be taken up by another department. The food will be prepared by one department while it will be delivered by or fed to the patient by another department. In such a situation, an organization will need separate staff for each of these functions. The personal likes and dislikes by the patient will not be considered and the service will be more professional rather than personal. But imagine a situation where the caregiver is trained to feed the patient, look after his or her personal hygiene needs, can change the dressings, manage the physiotherapy needs, can move the patient around different departments, and can provide the necessary medication as prescribed by the physician or the surgeon. It is true that a patient cannot have everything according to his or her wishes and will be dependent on what is prescribed by the physician. But even so, a close relationship between the patient and the caregiver will be more satisfying and effective. The theory is that opportunities to serve the patient in diverse situations will result in a closer emotional bonding between the two resulting in more cooperation and understanding of each others requirements and duties. A diet that is liked by the patient may not be approved by the physician due to health reasons. Instead of a cold and clinical refusal, a patient can better adjust to the situation if it is explained patiently by a person who is close and trusted. Multiple tasking can go a long way in facilitating this trust and bonding between patient and caregiver. In a situation where the patient is looked after in his or her own home by family members, most of the above mentioned activities will be performed by one or two family members. They will be attuned to the physical and emotional needs of the patient. If the same function is transferred to a healthcare setting, employees can be trained to perform multiple tasks which will enable them to be closer to the patient. Apart from the above advantages, the concept of universal worker has economic and administrative advantages as well. The organization that has efficient universal workers can reduce the volume of their workforce especially if there is surplus labor. This can result in bringing down labor costs while individual employees can be compensated more for the additional services they provide. This will also result in easier management of the employees which is primarily an administrative function. Hence the advantage of employing universal workers has the advantage of improving service quality as well as reducing costs and administrative responsibilities. In modern management concepts, a flatter hierarchy is more amenable to efficient functioning rather than a tall one where communication between top and low level management is distant and formal. According to Regnier, “ a universal worker staffing philosophy is used to flatten the staff hierarchy. All staff are assigned hands-on care giving responsibilities” (Regnier, 2002, p. 227). In the case of ABC Healthcare, the following strategy with regard to employing universal workers was adopted (in certain areas only). One factor considered was that certain areas are not amenable to generalization especially in the case of physicians and surgeons. These disciplines need to have specialized personnel and cannot implement the concept of a universal worker. It is only common sense to state that ABC Healthcare cannot employ the same physician to handle cardiology and dentistry. Moreover, literature on the concept of a universal worker with regard to healthcare has certain parameters if it is needed to be implemented in its fullest sense. In other words, this is more practical in areas where the professional caregiver is employed to look after the patient in a domestic setting. For example, in case of organizations that provide home nursing services, the concept of universal worker is more practical. The food is prepared in the house and not in a common kitchen as in the case of a hospital like ABC Healthcare. The laundry is limited unlike that is seen in a hospital setting. There is only one patient to look after whereas in a hospital, each staff will have to take care of multiple patients. So, one or two caregivers can handle all the needs of the patient unlike what is required in a larger setting like ABC Healthcare. Taking the above factors into consideration, ABC Healthcare should implement the concept of universal worker in the following manner. As mentioned in the previous assignment, the departments in ABC Healthcare are compartmentalized as follows, namely cardiology, nephrology, dentistry, and urology. It has a common administrative department under which services like food, laundry, cleaning and maintenance are managed. All medical departments except dentistry have inpatients. It is proposed that universal workers be employed in all such departments. Each of these departments which have ten staff nurses will be reduced to half the present number. Each department has fifteen assistants which will be reduced to one third. All staff nurses will now be responsible for cleaning individual rooms apart from their medical duties like providing mediation and changing of dressings. They will also be required to look after billing which is generated from computerized records. This will be forwarded to the administrative sections at the end of each shift. Each of the assistants will be trained in dressing of wounds under the supervision of one staff nurse. In case where patients need physiotherapy, these assistants will be trained to provide the same, again under the supervision of a qualified physiotherapist or staff nurse. They will now be required to bring in food for the patients as well as engage in feeding them if necessary. It is calculated that the work load of all the employees is low enough to make them perform additional duties without stressing them out in any way. The excess staff, as of now will be laid off for a period of three months while ABC Healthcare opens additional departments. They will be required to perform the same kind of duties as implemented in the departments already present. Once this strategy is in place and running, more duties as far as practical can be added to their present work load. Their compensation will now be increased by thirty percent. In the administrative wing, general staff will now be required to serve food as well as serve in the as kitchen assistants. No additional staff will be employed in the administrative section and all the new tasks will be allocated to existing staff after proper training. It is proposed that handling laundry be contracted to third parties since the present workload does not warranty a separate department. The existing staff in the laundry section will have to be laid off or otherwise deputed to other areas in case employees in those departments are unwilling to go along with the proposed changes. This will be the case with the additional staff (laid off) from other departments as well. It is estimated that twenty percent of the required staff will be unwilling to adjust and will leave the organization on their own. As of now, none of the managerial staff are opposed to the idea of change and hence will continue in their present capacities. Job re-designs and job satisfaction Implementing the concept of a universal worker will require extensive re-design of the present duties and tasks being performed by the nursing staff, assistants, and other administrative employees. Apart from obtaining the above mentioned benefits, job redesign could result in intangible benefits like job satisfaction and removal of boredom. Early management theorists were of the opinion that specialization was the key to employee efficiency and productivity. But such theorists ignored the human or psychological aspects of employees and practically considered them to be similar to machines. In other words, like maintaining and servicing of machines, it was considered enough that basic needs like security and adequate compensation was enough in realizing employee productivity. Juravich quoting the HEW report states that “significant numbers of American workers are dissatisfied with the quality of their working lives. Dull, repetitive, seemingly meaningless tasks, offering little challenge or autonomy” (Juravich, 1988, p. 7). This aspect of job re-design is definitely a bonus in the management’s efforts at change. In other words, an employee is normally bound to be more satisfied when diversity with regard to the nature of the tasks that need to be performed in increased. Job satisfaction is in fact a by product of job redesign. In fact, this aspect of employment apart from increased compensation comprises of the following factors that add to job satisfaction. They include job enrichment, job rotation, and job enlargement. It also can involve aspects like job engineering (efficiency through time and motion studies) and socio-technical aspects of a particular job (Slocum, p. 9). It can be safely concluded that implementation of the concept of universal worker in ABC Healthcare will definitely lead to increased performance, commitment, and job satisfaction within the organization. But, as mentioned earlier, this concept is only practical in certain sections of the workforce. Hence job redesign efforts should be initiated for other posts also as far as possible. ABC Healthcare as a learning organization Apart from implementing the concept of the universal worker, the management of ABC Healthcare has deemed it fit to include the concept of organizational learning as a part of their survival and growth strategy. In a dynamic environment, where change is inevitable, learning as a part of strategy is necessary. Hence the basic definition of the term as conceptualized by Argyris & Schon is “the detection and correction of error” (Lipshitz, Popper, & Friedman, 2006, p. 15). Lipshitz et al add that for learning to be effective, it should be cyclical, evaluative, innovative, critical, and productive. But the concept of this collective learning has been taken a step further by one of the foremost modern thinkers in management, namely Peter Senge in his groundbreaking book The Fifth Discipline. He was the person who coined the term ‘learning organizations’ which he describes as an environment “where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together” (Riggio, Orr, & Shakely, 2003, p. 20). What sets this concept apart from the traditional learning process is the freedom to innovate, the common effort to achieve organizational goals, and the ability to learn together. In other words, the concept where learning was forced on employees for achieving organizational goals is no longer relevant. The employees, collectively and individually, should be able to accept the organizational goal as their own, rather than learning for their own individual benefit of career enhancement. Hence, the concept of learning organization is more practical and relevant in the case of ABC Healthcare. This is also in sync with the organizational change model of Kotter, where he states that a ‘sense of urgency’ and ‘compelling vision’ as implemented when the two healthcare organizations were merged to form ABC Healthcare. The process as explained by Senge in making the organization a learning one is explained below. Peter Senge identifies the following five disciplines to be the innovative technique of learning organizations: Systems thinking Personal mastery Mental models Building shared vision Team learning (Lloyd, 2004, p. 296). What should be noted is that rapid advancements in research and application in the field of medicine takes place and, an organization like ABC Healthcare should be up to date in this field. This requires learning on an organizational level and hence Senge’s disciplines will ideally be suited in such an environment. Systems thinking: Senge has rightly identified that organizations are made up of systems and subsystems. Each department in that sense in ABC Healthcare is either a system or subsystem. Every employee in the organization should be made to feel a part of this so that his or her thinking process will be based on sustaining and developing it. For example, a collective thinking that each employee is a part of service that is devoted to caring the sick and invalid, whatever their roles maybe should be part psyche. Personal mastery: Once the employee has become a part of the system, the next step should be in developing and encouraging personal capabilities. It would appear that this attempt at mastery is primarily dependent on individual attitudes. So, any employee who is keen on improving his or her skills should be encouraged. For example, if an employee of the administration is keen on developing basic nursing skills, the attitude should be encouraged so that the person can become a part of the concept of the universal worker. Mental models: Each individual employee will have their personal perception of their job, their role in the organization, views about their superiors and management, and about the organization as a whole. Employees in ABC Healthcare should teach a mental model that is good for the organization as a whole and also an attitude of personal development and teamwork. Shared vision: The organizational vision of ABC Healthcare should be imbibed in every employee. In this instance, implementation of Kotter’s model has already helped in this regard. Team learning: Learning is school and college is basically for the development of the individual. But in an organizational setting, teamwork is important and hence learning as a team becomes as important as individual learning. Only then can ideas and concepts be shared so the a synergy rather than energy be present within the organization. Leaning in ABC Healthcare should not just be departmental, but should involve people within and outside (intra-organizational) the organization. For example, the laundry which is now being handled by an outside agency should have close interaction with nursing and cleaning staff. Conclusion ABC Healthcare in now in the process of bringing about some major organizational changes, six months after its merger. Two main areas where this is to occur is the introduction of the concept of universal worker and the strategy of learning organization. In the case of the former, the change will only affect certain section like nursing staff and assistants. The advantage is that the monotony of daily routine will be broken resulting in increased job satisfaction and commitment. On a more major level, the concept of ABC Healthcare, as a learning organization will have greater implications on its growth and survival. It is proposed that the five disciplines as conceived by Peter Senge be implemented in its organizational learning strategy. In an dynamic and rapidly evolving field like healthcare, it is inevitable that the two strategies above be implemented as soon as possible. If implemented in a practical way, ABC Healthcare can become a leader in the field while constantly growing and adding new medical disciplines to its existing ones. References Widdes, Tal. (1996, April). Assisted livings universal worker. Nursing Homes. Retrieved 26 May 2009, from CBS Interactive Inc: http://findarticles.com/p/articles/mi_m3830/is_n4_v45/ai_18335705/?tag=content;col1 Slocum, John W. Job Redesign: Improving the Quality of Work Life. Academy of Management Journal. Retrieved 26 May 2009, from: http://sbaweb.wayne.edu/~absel/bkl/jels/3-1b.pdf Regnier, Victor. (2002). Design for assisted living: guidelines for housing the physically and mentally frail. Illustrated Edition: John Wiley and Sons. Juravich, Tom. (1988). Chaos on the Shop Floor: A Workers View of Quality, Productivity, and Management. Reprint Edition: Temple University Press. Lipshitz, R, Popper, M and Friedman, V.J. (2006). Demystifying organizational learning. Illustrated Edition: SAGE. Riggio, RE, Orr, SM and Shakely, J. (2003). Improving leadership in nonprofit organizations. Kravis Leadership Institute. Illustrated Edition: John Wiley and Sons. Lloyd, Robert C. (2004). Quality health care: a guide to developing and using indicators. . Illustrated Edition: Jones & Bartlett Publishers. Read More