The conditions within the health care industry are not static but rather change along with unpredictable shifts in the local and national demographics, economy, and regulatory measures. Health care organizations must be able to navigate an ever changing landscape to remain viable. To do this, there must be willingness to implement changes in the structure, systems, processes, or culture of the organization that would enable adaptation. An organizational analysis is a useful tool in predicting successful change and adaptation in situations of chaos and complexity (Bellot, 2011). This paper is an organizational case study of the University of Pennsylvania Health System and includes a description of the system, its culture, leadership style, level of greatness, and readiness for change.
Complex and Adaptive Systems
Recent health care reforms mandate quality health care and a reduction in health care costs at the same time that the population is aging and experiencing a high prevalence of chronic disease. The external pressure has generated internal pressure in relation to how agents, traditionally independent from each other, within each organization can steer the system forward. Adaptable organizations are known for multidisciplinary collaboration, learning, quality improvement, leadership, patient-centered care, evidence-based practice, change management, and stewardship of limited resources. Given that agents are not machines, the real challenge lies in transforming how they think and behave so that integration and adaptation can be achieved (Bellot, 2011).
The University of Pennsylvania Health System
The mission of the University of Pennsylvania Health System or Penn medicine is to chart the future of medicine in the areas of patient care, education, research and innovation, and leadership (Penn Medicine, 2015). Its vision is to become the nation’s premier health system. The system’s core values are excellence, integrity, diversity, professionalism, individual opportunity, teamwork and collaboration, and tradition (Penn Medicine, 2015). Among its strategic goals are to become a leader in individualized care and innovation, to create an impact on local and international health outcomes, and to establish interdisciplinary educational programs (AAMC, 2013). Its structure depicts a marrying of the School of Medicine and the hospitals and services comprising the health system. Penn Medicine is a non-profit organization with resources derived from revenues, credit, and public and private sponsorships (Penn Medicine, 2014).
The mission and values seem alive and well considering the organization’s achievements. It ranks as the 7th best hospital in the country and 1st in the region and hold a Magnet status for nursing excellence (Penn Medicine, 2015). The School of Medicine is among the top 5 in the U.S. and is the 3rd largest recipient of federal research grants. Penn Medicine also joined the Partnership for Patients initiated by the CMS for the promotion of safe, high quality, and affordable care (Penn Medicine, 2015). It received the Joint Commission’s Gold Seal of Approval for outstanding evidence-based practices associated with improved patient outcomes. These accolades would not have been possible if the organization has not abided by its values.
The Penn Medicine Culture
Learning from past experiences and taking responsibility for the future are two assumptions held by the organization’s members. Awareness of how Penn Medicine’s historical role as pioneer, catalyst, and leader was realized by building on past achievements in the present in order to chart the future and the need to continue this legacy serves as internal pressure underlying the strong motivation among current and new members (Penn Medicine, 2015). Meanwhile, the assumption of high national expectations considering the organization’s use of federal allocations has also contributed to the drive towards continued improvement, excellence, and innovation.
It is the norm for Penn Medicine members to excel in their fields, act professionally, and be team players and collaborators creating collegial, supportive, teaching-learning, and ethical workplace relationships (Penn Medicine, 2015). Intellectual honesty and respect for sociocultural and intellectual diversity are also norms consistent with the value of integrity and diversity. Everyone is also expected to be knowledge workers who employ their individual and group expertise to solve problems and fulfil tasks in the best way possible (Penn Medicine, 2015). Furthermore, historical traditions are valued and kept alive at Penn Medicine and include 3 physicians playing the role of Santa delivering gifts to hospital patients on Christmas morning each year (Penn Medicine, 2014). Among the organization’s sacred cows are the need to achieve and the competitiveness it promotes which can create undue stress among members of the organization.
The organizational climate can be described primarily as bold and innovative because of the strong thrust for research, innovation, and evidence-based practice among health care professionals who consider themselves to be on a continuing journey towards excellence. In the nursing department, a recent innovation was the creation of a patient-family advisory committee that aims to elicit the input of current and former patients and their families in regards to the quality of hospital services (Penn Medicine, 2015). The information is taken into account when plans are made for quality improvement and has elevated patient engagement and participation to a new level.
Because of the fast-paced environment owing to the high rate of new knowledge being generated every day, members of Penn Medicine consider change towards better care as an expected phenomenon and a constant challenge which must be mastered using the application of knowledge into practice. In this sense, members are self-organized to deal with the chaos that new information can bring (Wheatley, 1993). Resistance to change is low, for instance, and change with a clear rationale is welcomed. Although there is collegiality and supportiveness among members, competitiveness requiring continuous quality improvement for the organization to progress towards its vision of being at the forefront of the health care industry can, however, create pressure for high achievements.
The culture at Penn Medicine is that of learning. As knowledge workers, lifelong learning is necessary to remain abreast of developments in the profession. As such, it is common among nurses to seek further education beyond the baccalaureate degree and to be open to in-service education. The organization has a rewards system for clinical excellence and clinical advancement that reinforces professional and practice achievements (Penn Medicine, 2015). Besides individual learning, interdisciplinary learning is also another innovation in the system that promotes the expansion of professional boundaries and thereby interdependence among members of the healthcare team (Penn Medicine, 2015). This proves how interaction can generate creativity and novel behaviors (Plsek & Greenhalgh, 2011). Thus, members portray personal mastery and team learning – two of the dimensions requiring mastery to become a learning organization (Ratnapalan & Uleryk, 2014).
Predominant Leadership Style
The leadership style in Penn Medicine is referred to as collaborative because of the need to involve others from different units, departments, or disciplines. Collaborative leadership, also known as “leaders as teachers,” is characterized by open communication, partnerships or alliances, and mentorship (Penn Medicine, 2014). It is taught at the Penn Medicine Leadership Academy. This type of leadership was credited for the achievement of successful structural reorganization and operational and fiscal improvements in recent years in response to the need for cost-effectiveness. In the nursing department, the leadership is explicitly identified as transformational. It is commonly described as motivating others towards organizational growth by establishing a clear vision, ensuring accountability, engagement, and recognizing the abilities of individuals (Doody & Doody, 2012). Shared governance consistent with Magnet status, a culture of mentorship, inquiry to answer clinical questions, and professional advancement attest to the effectiveness of transformational leadership (Penn Medicine, 2015).
Greatness Level
Historically, Penn Medicine is an organization that always strived to build a legacy or lasting impact on the health care industry and society. The greatness level of Penn Medicine is Stage 4 or building greatness to last. Constant quality improvements have led to constant change all intended to achieve the organization’s long-held purpose which is to become the premier hospital in the country. It is a journey that continues on even with leaders and members leaving because the organization’s values remain constant, a state that fits Collins’ (2006) description of clock building. For example, the tradition of building on the past and creating the future is valued at Penn Medicine. This means that other members will pick up where former members have left off leading to continuity in efforts to achieve the organizational vision and goals.
Organizational Readiness for Change
Readiness is commonly defined as the degree that an organization’s members are psychologically and behaviorally inclined to change implementation (Weiner, Amick & Lee, 2008). Given Penn Medicine’s culture of research, innovation, clinical inquiry, and learning, there is strong readiness for change among its members. Change is an accepted fact in practice and occurs through the process of continuous quality improvement. However, readiness cannot be sustained if it is not developed among new members of the organization and becomes their culture as well (Bellot, 2011). It is therefore important for a DNP to foster readiness to change among new nurses through education, role modeling, and mentoring.
A future improvement plan will benefit from the organizational analysis because it clearly shows what the members, and the organization as a whole, are strong and weak at in relation to change. The strength of Penn Medicine is its culture and organizational climate. A potential weakness is too much focus on competitiveness wherein nurses may be fulfilling the roles of clinician, researcher, or leader that, without an adequate level of support, can lead to burn out. The analysis also reveals the patterns or essence of the organization that can assist in problem-solving (Wheatley, 1993). Thus, the improvement plan should establish balance among the different nursing roles, identify additional forms of support, and guarantee them.
Conclusion
Change implementation is essential in organizational adaptation but is often challenging given the complexity of organizations. A culture and climate compatible with learning and improvement is one factor that determines an organization’s readiness for change. Another factor influencing readiness for change and successful change is leadership style with collaborative and transformational leadership found to be effective. A DNP nurse has an important role to play during adaptation by conducting an organizational analysis, identifying strengths and limitations and tailoring improvement plans to optimize the strengths and rise above the limitations.
References
Association of American Medical Colleges (AAMC) (2013). Advancing the academic health system for the future: Profiles in academic health system leadership. Retrieved from https://www.aamc.org/download/360978/data/pennprofile.pdf
Bellot, J. (2011). Defining and assessing organizational culture. Nursing Forum, 46(1), 29- 37. doi: 10.1111/j.1744-6198.2010.00207.x.
Collins, J. (2006). Where are you on your journey from good to great? Good to great diagnostic tool. Retrieved from http://www.jimcollins.com/tools/diagnostic-toolpdf
Doody, O., & Doody, C.M. (2012). Transformational leadership in nursing practice. British Journal of Nursing, 21(20), 1212-1218. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23132001
Plesk, P.E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323, 625-628. doi: http://dx.doi.org/10.1136/bmj.323.7313.625.
Ratnapalan, S., & Uleryk, E. (2014). Organizational learning in health care organizations. Systems, 2, 24-33. doi:10.3390/systems2010024.
Wheatley, M.J. (1993). Chaos and complexity: What can science teach? OD Practitioner, Winter 1993, 2-10. Retrieved from http://www.margaretwheatley.com/articles/Wheatley-Chaos-and-Complexity.pdf
Weiner, B.J., Amick, H., & Lee, S.D. (2008). Conceptualization and measurement of organizational readiness for change. Medical Care Research and Review, 65(4), 379- 436. doi: 10.1177/1077558708317802.
