Organization Development in Healthcare: Conversations on Research and Strategies: Volume 10

Table of contents

(32 chapters)
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Dedication

Page xvii
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Preface

Pages xix-xx

Advances in Health Care Management (AHCM) is a research annual that publishes state-of-the-art reviews and research on special topics in the field of health care management. As conceived by the founding coeditors, John D. Blair (Texas Tech University), Myron D. Fottler (University of Central Florida), and Grant T. Savage (University of Alabama at Birmingham), and as originally commissioned by JAI Press, AHCM provides a forum for leading research on health care management. Volumes 1–3 offer reviews of the field, research on selected topics, and best papers from the Health Care Management Division of the Academy of Management. In contrast, volumes 4–7 focus on a range of special topics, from bioterrorism to international health care management to entrepreneurship to patient safety.

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Introduction

Pages xxi-xxvi

Health care organizations provide a unique and insightful microcosm of the many larger challenges health care systems face around the world. To improve our health care industry, one has to first improve the internal health and well-being of the organizations that deliver care every day. In other words, to become a high-functioning industry, the organization has to become healthy first (Lovey, Nadkarni, & Erdelyi, 2007). This book has been crafted to catalyze this journey of creating healthy and vibrant health care organizations through proven strategies and evidence-based practices and in doing so have some part in transforming our global health care industry.

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Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major “change management” initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

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The increasing complexity and dynamicity of their environment compels health care managers to search relentlessly for effective management instruments. One strategic tool that both academics and practitioners have deemed critical to the success of any health care organization is the development of a meaningful mission statement. However, despite the seemingly omnipresence of the concept, studies indicate that creating an effective mission statement seems to be extremely difficult, if not downright frustrating for a lot of health care managers. This inability to create an effective mission statement roots for the greater part in the fact that the previous literature has provided little practical guidance on how health care administrators should formulate and deploy mission statements. Given the increasing pressure on health care organizations to develop an effective mission statement, this chapter (1) provides a detailed analysis of the mission statement concept based on a thorough literature analysis and (b) offers empirically based recommendations on how to successfully formulate and implement a mission statement within a health care organization based on a systematic analysis of relevant empirical research. These analyses and the derived evidence-based recommendations will help health care managers to revive their mission statement and make it more than a piece of paper.

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According to the Census, racial/ethnic minority populations are growing at such a fast rate that by 2050 more than 50% of the population will belong to a minority group (US Census, 2001). The increasing diversity of the U.S. population is one of the many changes that health care delivery organizations need to proactively address in order to better serve their community and improve their performance. In this paper, we argue that cultural competency not only is important from a societal perspective, i.e., reducing health disparities, but can also be a strategy for health care organizations to improve quality, lower cost, and attract customers. We provide detailed recommendations for health care leaders and managers to adopt in order to successfully serve a diverse patient population.

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We appreciate the editors' invitation to comment on these three papers, and we thank the authors for giving us so much food for thought. The papers linked together well conceptually. We can see an organization's mission necessitating cultural competency in service delivery and an organization's culture enhancing or hindering fulfillment of a mission or the commitment to cultural competency. In this commentary we will look at these papers from three different lenses – the nature of evidence, the role of normative admonitions in health care literature, and historical context – as a way to raise questions that link these papers to broader issues that affect health care research. Since we are commenting on the chapters “blind,” we cannot refer to the authors by name. For brevity's sake we will refer to the chapters as the Culture paper, the Mission paper, and the Competency paper.

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Ivanitskaya, Glazer, and Erofeev (2009) suggest that “the most fundamental element of any organization that helps the organization to survive is the individual person” (p. 109). It is the motivation of human capital that makes a health care organization come to life. Health care is a unique industry; its accomplishments are directly dependent upon the competencies and technical skills of its employees. “When people in the workplace fulfill their organizational roles, then the organization thrives” (Ivanitskaya et al., 2009, p. 110). Health care systems will require organizations that thrive and exhibit characteristics of continuous growth, expressing excessive levels of energy and an immense capacity for flourishing. Anticipating the challenges of the next decade, health care organizations must achieve a higher degree of employee engagement to enhance organizational performance and profitability. The data analyzed for this chapter indicate that employees who are engaged are more enthusiastic and aspired to achieve both individual and organizational success. The chapter concludes by suggesting five operating practices to establish an employee engagement culture – defining the employee's role in fulfilling the organization's purpose, selecting employees with capability and passion, supporting and valuing the employee, creating sustainable reward systems, and developing feedback and reinforcement mechanisms.

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Change within health care systems is constant as it relates to the external and internal demands that require continual adaptation by providers. This chapter provides a summary of the history and research contributions related to the study of culture and change through the lens of the nursing profession. The review focuses upon nursing research publications and the knowledge gained, ranging from the earliest to current studies. There has been a substantial increase in research interest regarding the relationship between nursing culture and ability to change; however, there is a considerable gap that remains in understanding subgroups such as individual nursing units or departments, consistent use of tools to measure culture, and interventions that have made a difference over time. From a practical perspective, this discussion provides insight into the importance of recognizing the importance of assessing culture and integrating cultural feedback into operational improvement plans.

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Organizational change has been a consistent and growing theme in health care management, and research on the topic reflects this interest. Amid continuously rising health care costs, major regulatory and policy reform, and technological evolution, health care executives continue to search for effective models and methods of leading and directing change to position their organizations in an increasingly unstable industry and sector. As industry leaders look for answers, researchers have shown a growing interest in understanding how health care organizations are evolving to fit the needs of the new marketplace.

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One of the top domestic issues of concern to Americans is access to high-quality and affordable health care, and there is a growing concern about how institutions struggling to survive within this trillion-dollar industry will increase their effectiveness in the future. This chapter outlines a process of leadership development using an action learning approach in one Midwestern health care system over a period of three years. The process addresses both the development of the individual leader as well as the collective leadership capacity in an effort to sustain organizational learning and effectiveness over time. A model is presented that covers four phases or Four C's of development, which includes movement from individual Competency development, to the development of social capital through the enhancement of Connections and Creation of shared understanding, ultimately expanding Capacity for change within the organization. We also address other factors that must be taken into consideration that will either enhance or impede the concentric movement such as culture, sponsor support, and alignment of systems and structures.

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Leaders in health care today are faced with a wide array of complex issues. This chapter describes an innovative physician leadership development program at the Cleveland Clinic intended to enhance the leadership capacities of individuals and the organization. Propositions regarding the program's impact on organizational innovation, organizational commitment, social capital, and the human element of physician practice are offered for future examination.

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Health care in the United States is on the verge of substantial change. Health reform legislation, and the goals it seeks to pursue, are likely to drive transformational change across many corners of the health care system. Preparing for and navigating these changes will, in turn, require health care leaders to learn new approaches to many of the core parts of their jobs (Clark, Savitz, & Pingree, 2010; Shortell & Casalino, 2010). The sheer magnitude of change and uncertainty also seems a likely driver of the uptick in CEO retirement, which rose almost to an annual rate of 18% in 2009, the highest rate increase since the American College of Health care Executives began tracking the statistic in 1981 (American College of Healthcare Executives, 2010). Taken together, these trends suggest the need for leadership development and succession planning has never been greater.

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Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health care organizations.

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Developing greater synergies will become increasingly necessary as the pressure on the health care industry continues to increase. This research looks at the required characteristics to create positive working relationships with clinical staff in a health care organization from the perspective of nonclinical staff. Ten different U.S. hospitals participated in this qualitative study with over 200 individual participants. A recipe for successful relationship building from a nonclinical perspective is included.

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This chapter uses the structural and relational dimension of social capital theory (SCT) as a lens for examining the impact of the supervisor–subordinate relationship on nurses' perceptions of the usefulness of their workplace networks, sociability, and affective commitment. A survey was used to collect data from 1,064 Australian nurses.

The findings suggest that nurses rely on very small workplace networks (typically only one other person) with which they have strong ties. Further, in over half of the cases, the supervisor (the Nurse Unit Manager (NUM)) holds the centric position. Moreover, for those nurses who did not include the NUM in their workplace network, their position appears even worse. For example, the usual reason given by nurses for not including the NUM was that the NUM was unavailable. This is a concern for health care management because the past two decades have delivered many changes to the nursing profession, including a reduction in the number of nursing positions and subsequent higher workloads. The consequences suggest that without effective workplace networks, nurses are working under conditions where solving problems is more difficult.

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In response to the growing evidence that disruptive behaviors within health care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model – Toxic Organization Change System – that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

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It is widely acknowledged that the delivery of health care has been made more complex by a number of factors including technology, information, organizational arrangements, and the increasing burden of chronic illness. This increase in complexity has underscored the need for more effective teamwork and working relationships among health care providers. Although professional education groups such as the Accreditation Council for Graduate Medical Education (ACGME) have mandated competencies such as “work effectively as a member or leader of a health care team or other professional group” since at least 2007, it is clear from both research and anecdotal accounts that there is still room for significant development in this area.

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Information technology (IT) is an important enabler of organization models (OM) and of innovative strategies, as it fosters information integration and streamlines information flows. Two case studies offer evidence about the strategic use of IT innovation (i.e., digital signature) to foster successful OM and partnerships in health care, while results from a survey and some case studies show how institutional reforms can foster the diffusion of mature technologies (i.e., ERP) as an adaptive strategy of health care organizations. Leadership and clear vision lead to consistency between OM and technology and foster the exploitation full benefits associated with innovation.

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The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

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In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law. This Act, part of the broader “stimulus” legislation, represents the U.S.'s largest investment in health information technology (HIT) to date. More importantly, it sets a vision and provides a plan intended to transform the U.S. health care system to a safer, more efficient place to receive care. To that end, the Act seeks to fundamentally change the path HIT applications' adoption and implementation was taking to ensure that “meaningful use” and interoperability are achieved. However, such bold and sweeping changes will not come without unintended consequences, and their broad scope makes measuring the new public policy's success a challenge.

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This chapter reports on an action research case study of integrated obstetric care in the Netherlands. Efficient and patient-friendly patient flows through integrated care networks are of major societal importance. How to design and develop such interorganizational patient flows is still a nascent research area, especially when dealing with a large number (n>3) of stakeholders. We have shown that a modification of an existing method to support interorganizational collaboration by system dynamics-based group model building (GMB) (the Renga method, Akkermans, 2001) may be effective in achieving such collaboration.

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Hidden behind such frequently used phrases as “The system/policy requires …,” “The organization has decided…” is one simple fact. Systems/policies don't drop from the sky etched in stone tablets and organizations don't decide anything. People make decisions and design systems and write policies. Embracing this fact increases the likelihood that the provision of health care emanates from a “care dealership” in contrast to a “car dealership.” Ignoring this fact leads to less humane, less effective, and more costly health care. This chapter will challenge all of us concerned with caring for all of us – from Organizational Development (OD). Practitioners to CEOs to … to … all of us at some point in our lives – to step up to the need to transform our most basic paradigms. To remind ourselves that human beings give birth to, nurture, sustain, and care for that which we call an organization. In so doing, we will be able to begin to act from the premise that a health care organization is itself a living breathing human organism, a “Patient” in need of care. The quality of care we afford this “Patient” directly and inevitably impacts the quality of care we are afforded as patients. Acting from this premise will transform all of health care, all “care dealerships” … and potentially “car dealerships” as well. OD professionals, therefore, can propel us all to a fourth dimension of caring for all of us.

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As Ovid said, “There is nothing in the whole world which is permanent.” It is this very premise that frames the discoveries in this chapter and the compelling paradox it has raised. What began as a question of how performance is sustained, unveiled a collection of core organizational paradoxes. The findings ultimately suggest that sustained high performance is not a permanent state an organization achieves, but rather it is through perpetual movement and dynamic balance that sustainability occurs.

The idea of sustainability as movement is predicated on the ability of organizational members to move beyond the experience of paradox as an impediment to progress. Through holding three critical “movements” – agile/consistency, collective/individualism, and informative/inquiry – not as paradoxical, but as active polarities, the organizations in the study were able to transcend paradox, and take active steps to continuous achievement in outperforming their peers. The study, focused on a collection of hospitals across the Unites States, reveals powerful stories of care and service, of the profound grace of human capacity, and of clear actions taken to create significant results. All of this was achieved in an environment of great volatility, in essence an unbalanced system. It was the discovery of movement and ultimately of dynamic balancing that allowed the organizations to in this study to move beyond stasis to the continuous “state” of sustaining high performance.

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The following three articles form a sequence of sorts in addressing changes required in our prevailing health care organizations, changes of a magnitude comparable to F.W. Taylor's “scientific management” revolution at the beginning of the 20th century as we seek to “transform the fundamental O.D. paradigm.” All three are based on case studies. And each has its own prescription: three “movements” each with three “key actions” for “constructive disequilibrium”; three “essential elements” for “integrated networks”, and five “dimensions of key day-to-day behavioral practices.”

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Concluding Remarks

Pages 389-392

As we challenged you at the outset, our hope with this book was to do more than inform you. Rather we hope that it will catalyze you to think and act in transformational ways as you address the complex, yet delicate world of healthcare. The tapestry of ideas presented on these pages pulls you through multiple perspectives and healthcare venues big and small. They address revised views on common practice, reframe long-standing management principles, and push at the very edge of how we can continue to make healthcare a healthy and vibrant organizational experience.

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DOI
10.1108/S1474-8231(2011)10
Publication date
Book series
Advances in Health Care Management
Editors
Series copyright holder
Emerald Publishing Limited
ISBN
978-0-85724-709-4
Book series ISSN
1474-8231