Introduction
As with any organization in any industry, health care organizations are also driven by the need for cost effectiveness. However, in addition to this, healthcare organizations must also ensure that the needs of the community and the health care requirements of all members of the community are addressed adequately. As the emphasis on cost control, patient safety, quality of care increases, there is a need for health care organizations to move away from their current organizational models and adopt more dynamic models that are designed with the needs of the patient as the focal point and which also address the inherent complexities of a healthcare system. Collaborative systems need to be developed in order to improve patient outcomes . Careful study and analysis of the current situation is essential before any changes can be implemented in any organization or system. In this paper, I shall present the organizational analysis of Providence Hospital in Washington, DC. The analysis shall be carried out against the framework provided by Collins and other models which may be relevant. The paper will present an evaluation of the various facets of the hospital including its leadership style, where it stands on the level of greatness and its readiness for change.
Providence Hospital is a 408-bed nonprofit hospital is located near the Catholic University of America and Basilica of the National Shrine of the Immaculate Conception in Washington DC . The hospital is part of the Ascension Health System, the nation’s largest Catholic nonprofit health system. Apart from the easy access to the campus, the hospital is also easily accessible through the Community Physicians Network, which as 17 ambulatory care sites in Washington, D.C. and Maryland. It was founded in 1861, at the invitation of Abraham Lincoln himself. It is the longest continuously operating hospital in Washington, D.C. The mission of the hospital is to provide quality healthcare to all members of the community with especial consideration for the poor and vulnerable . Their core values are service, integrity, creativity, wisdom, reverence and dedication and commitment to provide quality healthcare to community members which is evident in the community healthcare research and free programs that the hospital runs periodically. The leadership is hierarchical with a board of directors on top followed by the Chief Medical Officer and the president/CEO followed by the other executives like the CIO, the Chief Nursing Officer, the CFO and the Vice Presidents of various departments .
The Providence Hospital is a member of Missouri-based Ascension Health which is the country’s largest Catholic nonprofit health system. The underlying guiding force of the hospital is faith-based healthcare and its philosophy is to work towards improving the health of individuals in the community through compassion and justice. The diverse group of medical staff provides assistance in various specialties ranging from bariatric care to geriatric medicine to women’s health.
Organizational Culture
Edgar Schein, in his renowned work in the 1980s called Organizational Culture and Leadership, said that for any organization, its culture is developed by the collective responses of the people who are part of the organization. These responses arise from the need to adapt to internal and external demands of the system and the resulting behaviors, attitudes and values become the norm of the organization and become its culture . Recent developments at the Providence Hospital have resulted in a culture of non-communication which has seen quality of care decline. These developments include intensified efforts by the nursing staff to become unionized , staffing shortages and a change of Chief Executive. An interim CEO was appointed even as the organization searched for a long-term appointment for the position. The new CEO will take over in July 2016 . According to Schein, cited by Belias & Koustelios, leaders play a significant role in creating the culture of an organization . Therefore changes in leadership can impact the culture of the organization. The hospital, however, has a strong learning culture. As recently as 2015, the hospital received a Federal grant to help develop its nurse leadership programs . The aims of the programs are to create nurse leaders who can build teams and use their coordination skills to solve problems using an inter-disciplinary method.
Leadership Style
The organizational structure is hierarchical but as evidenced from the implementation of nurse leadership training programs it is clear that the organization believes in shared governance and is working towards the four principles of share governance that Porter-O’Grady has described namely accountability, equity, partnership and ownership . By providing a learning environment, the leadership favors changes and allows employees to share their innovative ideas which leads to better productivity . At Providence however, recent changes in leadership appear to have resulted in breakdown of communication within employees and between caregivers and patients. This is apparent in a 2016 report by Hospital Safety Score which points to serious communication issues between the groups . The same report also identified that patients in this hospital were at greater risk for infections, in certain cases the risk was much higher than the national average. The report also noted that the number of nurses currently employed was less than what was required for a hospital of this size. This is a good place to apply the concepts of chaos and complexity as prescribed by Margaret Wheatley. Providence Hospital is a large, dynamic system with inherent complexities and as chaos science suggests, the chaos of this large system presents opportunities for creatively applying solutions to the issues that have been identified .
Organizational Framework and Level of Greatness
Jim Collins has said that a great organization is one that has a distinct impact in the industry and continuously delivers superior performance. He also says that for a social sector organization like a hospital the organization’s performance must be first and foremost assessed in relation to its mission and not just its financial results . In this section, I will measure Providence Hospital against the Collins model comprising of the five concepts: Defining “Great”, Level 5 leadership, First Who, The Hedgehog Concept, and Turning the Flywheel. This will help me assess the level of greatness of the hospital.
Defining “Great”: Providence Hospital is well known in the DC area and is respected by the community, however patient reviews of the hospital have been mixed. A common negative that has been reported by patients is the lack of communication from the staff , . Lack of communication can lead to issues like incorrect medication, lack of attention and therefore leads to drop in quality of care. This is a serious issue for a social organization like Providence whose primary objective is to provide care for patients.
Level 5 Leadership: Collins (2001) found that leaders of successful organizations all possessed the capacity to be both legislative and executive in their leadership style. At Providence the changes at the CEO level mean that there could be a shift in leadership styles or it could continue as is. Until now the leadership style has been more executive than legislative.
First Who: In his theory, Collins (2001), had stressed the importance of “getting the right people on the bus”. However it is not only important to hire people who share the leader’s visions it is also important to remove people who are detrimental to the vision. In the light of the hospital’s recent poor record in patient safety and growing non-communication issues it is difficult to tell whether it is the result of having the wrong people on the bus or whether it is a general cultural failure due to the leadership changes.
Hedgehog Concept: The information that I was able to glean about the Providence hospital shows that the leadership is committed to the mission of the hospital, work towards providing quality healthcare to the community and also work towards acquiring and managing resources effectively. The hospital regularly performs community health assessments, runs free camps for health check-ups, and holds the fund-raising Providence Gala for various causes . This shows that the hospital follows the “Hedgehog concept” (Collins, 2001) quite closely. But, there is a very strong need to realize that patients and nursing staff form the core of this business and their welfare must be held paramount.
Turning the Flywheel: The concept is simple in that it says that greatness must be built through the continuous pursuit of an organization’s mission in the same manner as a flywheel (Collins, 2001) – in the same direction continuously. Providence Hospital has over 150 years of history and regard in the community. It also has some of the most talented staff in the country. It is a matter of utilizing the passion and commitment of this staff to fuel the success. Providence Hospital will require certain changes in its leadership before it can achieve consistent level of greatness.
Readiness for Change
Addressing only the symptoms of a problem cannot correct the underlying problem.
A system must be observed as a whole to understand what the cause of the problem is so that correction measures can be implemented effectively . Areas of high leverage are the best way to identify fundamental issues and from there on solutions can be created. According to Newhouse (2010), a company’s readiness for change can be assessed by first ensuring that basic infrastructure is present, adequate frameworks have been referred to assess readiness and there is a possibility of bringing more staff on board. Leadership and learning culture are also critical to assessing readiness. At Providence Hospital resources, leadership and learning culture are present, but nurse staff numbers are not adequate to manage the growing number of patients, which is what is leading to severe communication breakdowns and rise in preventable infections. Over-worked nurses cannot operate effectively.
I find that I shall be able to utilize my position as future nurse practitioner to become the catalyst for the change. I have the perspective of the nurse as well as the patient, since I work more closely with them. I shall be able to represent both these stakeholders when presenting the case for changes to the management. These organizational and leadership models will help me in future to create strategic plans to enhance the workplace experience of nurse practitioners.
Conclusion
Nurses are pivotal to a hospital and are pivotal to transforming healthcare practices. Before implementing any change to an organization’s behavior and culture, a thorough examination of its current state must be done. The findings for Providence Hospital suggest that changes in leadership and a shortage of nurses have led to communication breakdowns and loss in quality care. According to chaos and complexity theory the time is ripe for change. Providence Hospital falls short of its level of greatness. I believe that as a nurse leader I can rise to the need of the hour and provide the necessary support required to bring about positive changes.
References
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