Change and Cultural Case Study

Six months after the merger of Mercy Medical Hospitals and the Promedica Health Systems, the new administration initiated a significant reduction in workforce. The decision was made to redesign patient care delivery. The administration’s first job redesign recommendation was that of a universal worker. The universal worker would deliver many support services. Although this is not a fail proof system, the administration wanted other options to be considered as well.

The term universal worker is used when a person is cross trained in many departments, and therefore has a little more assignment flexibility. They are often used in call centers and hospitals to alleviate staff shortages and provide better service without the difficulties of processing so many referrals or dealing with call transfers (webAnswers. com2010). Depending upon the setting, universal worker may be more beneficial. One area that would fall within this area would be assisted living facilities; some of which have been affected since the merger.

While some assisted living facilities still operate within this model, the industry as a whole is moving toward a more holistic approach to care in which the universal worker attends to all the daily living needs of their residents: assistance with ADLs, meal service, light housekeeping, laundry, programming, etc. Rather than dealing with four or five different people to have their needs met, residents are able to relate to one or two staff members who actually know them and are familiar with their needs, their routines, their likes and dislikes.

The result is care that is more personal, customized and consistent (Widdes, 1996). An additional benefit is increased efficiency in staffing, i. e. , while the caregiver is assisting a resident with his bathing, dressing and so on, he or she may also be able to perform other duties, rather than having to call someone to dust off a countertop or clean a bathroom. Ultimately, this approach can result in increased staffing efficiencies. . The universal worker approach also seems to enhance job satisfaction.

Feedback from the staff indicates that they enjoy being responsible for the resident as a whole rather than only one aspect of their care. It is a feeling that undoubtedly enhances the caregiver’s sense of job importance (Widdes, 1996). Training staff to assume responsibilities across departments and even more challenging, reshaping their attitudes and approach to care is an undertaking that requires a commitment to training, retraining and diligent follow up.

It is imperative that management be very much in tune with this philosophy. Because this model often fails when implemented, there are only certain departments such as assisted living that the universal worker would actually be implemented in. For the majority of the facility, we would look at job redesign. In order for objectives to be achieved, thought needs to be given to other areas that will be impacted and may require changes to be implemented (An Organization Redesign Process).

Other organizational systems that may be impacted by the introduction of a performance based reward system include:

• The Information System  – How much information is given to team members, the speed at which they receive it and their ability to us the information to improve results.
• The Training System- New skills training for employees may need to be implemented in order for them to be able to understand how to interpret information, training in new skills in order for the employees to do their jobs for effectively.
• The Organization Structure- Departments may need to be integrated or roles significant changed.
• Decision-making Systems – Consider changing the way decisions are made and the level at which they are made. Authority to decide might need to be taken down to lower levels so that employees are able to make decisions the enable them to more quickly influence or improve the results.
• Tasks and Technologies – Need to be improved in order for the bonus system to achieve its objectives reward people for improved business performance.

Changing an organization through an organization redesign process is a journey and generally a rather long journey.

That is why the following three principles must be understood by anyone who is about to undertake any type of organization redesign:

• The entire system has an effect on each element within the system
• Every element in the system has an effect on the entire system and on each other
• No matter what you do, the two points above always hold true.

When an organization goes through redesign, 1. People need to be identified as being responsible for driving the organization through the process. Those individuals include:

• Organization Leader: Who is generally the most senior person in the organization. This person will set the direction that the process will go in and names the Steering Committee
• Steering Team: Consists of key leaders from the organization and other stakeholders. This teams’ responsibilities include naming and commissioning the Design Team, establishing boundaries and guidelines for the Design Team, approving Design Team recommendation and ensuring the Design Team have the resources (time and money included) they require to get the job done Design Team: Generally consists of employees, half are lower level employees and the other half are upper management. Are responsible for reporting back to their functional teams on design choices being recommended and getting the input of the Implementation Team
• Implementation Team: Basically, the entire organization, who implement the design choices recommended by the Design Team (and approved by the Steering Team).
• Renewal Team: This team is set up after the Implementation Team. It monitors and assesses to what degree the organization design has done, what it has intended to do and make recommendations for further changes as required.
• Consultant: Recommends and teaches the design model, the use of tools and methodology. Provides guidance to ensure the design effort stays on track. Provides expertise regarding best practice design choices and independent advice (An Organization Redesign Process).

Train the Strategic, Steering and Design Teams.

All teams must have a commitment to the process and be able to understand the process in order to go ahead.

• Environmental Scan: Become aware of the needs and expectations of the external environment: Customers (current and potential), Stakeholders (shareowners and their representatives), Influencers (regulators, suppliers, government, etc. , Competitors and Best in class organizations.
• Develop Vision & Mission Statements: These statements describe why the organization was created, why it exists and its distinctive competence.
• Success Criteria: Nominate the outcomes desired in these four categories: Customers, Stakeholder, People, Community
• Culture: Identify the behaviors, skills and characteristics that the people working in the organization must have, along with the guiding principles that encourage people to use these behaviors and skills, in order to achieve the vision and mission.
• Strategies to Influence: Determine the strategies needed to manage and reduce variability and demands from the external environment. This enables you to meet both the requirements of the external environment as well as achieve your desired performance outcomes.
• Key Performance Indicators: Choose which ones will deliver the business performance required along with inspiring the behaviors and characteristics articulated in the culture.
• Technical System: Analyze and redesign in terms of how tasks are performed, technologies required and the layout of buildings/facilities so that the people and the technical system are integrated for high performance.
• Structural System: Design the structure for each of the three teams: Front Line, Resource (known in traditional organizations as Management) and Strategic so that they foster the culture required delivering high performance.
• Decision Making & Information System: Review: what, where, how decisions are made, what information is needed to make those decisions and how it is stored and captured.
• People System: Review: Competencies, Job Design, Selection, Induction/Orientation, Learning, and Performance Contracting, Career Development.
• Reward System: Review how employee’s contributions are recognized and rewarded. Does the system encourage people to focus on organizational goals?
• Renewal System: Decide how you will regularly review your business and make any design changes needed to ensure continuing optimum performance.
• Develop an Implementation Plan: This plan identifies who is responsible for implementation, time lines, resources requires, potential bottlenecks, and contingency plans
• Execute the plan: When the Implementation Team is kept involved in the process and has input to the Design Team, implementation happens much more quickly and seamlessly. Peter Senge (1990) suggests that team learning is the process of aligning and developing the capacities of a team to create the results its members truly desire. It builds on personal mastery and shared vision. When teams learn together, not only can there be good results for the organization, members will grow more rapidly than could have occurred otherwise.

Virtually all important decisions occur in groups. Teams, not individuals, are the fundamental learning units. Unless a team can learn, the organization cannot learn. Team learning focuses on the learning ability of the group. Adults learn best from each other, by reflecting on how they are addressing problems, questioning assumptions, and receiving feedback from their team and from their results. With team learning, the learning ability of the group becomes greater than the learning ability of any individual in the group (Learning Organisations).

In order to make the work teams function at its optimal performance, there are nine key activities or work functions that must be present. Those functions include:

• Advising – gathering and giving information •Innovating – creating new ideas or brainstorming new ways to tackle old problem
• Promoting – selling the idea to management and gathering all the resources •Developing – once the idea has been sold to management, it then needs to go to the analytical process and be developed.
• Organizing – setting up a structure and resources so that the product, scheme, or service can work. Producing – putting the product or service together.
• Inspecting – watching out for details. Inspection of the high quality must be maintained and accurate records must be kept.
• Maintaining – it is associated with the support services offered in an organization and the general background work done in a team to ensure that its requirements can be met quickly and efficiently.
• Linking – is central to the success of all teams. It is the difference between an effective and an ineffective team.

Someone coordinating all the team members to ensure that there is maximum cooperation and interchange of ideas, reports and experiences (Margerison, C. & McCann D. , 2000). Being able to plan, and control the intra-organizational and inter-organizational communication that must occur to implement the job design changes will be difficult but not impossible. The information that needs to be given out during the job redesign would have to be given to top managers right before it is given out. Then the staff can be in-serviced on the changes that would be going into effect and a question, answer type forum be done.

Once the changes have been implemented, a committee of staff and managers can be appointed to look at the changes and see if there are any additional changes that may need to be implemented because of the initial changes. This is also a way to ensure job satisfaction. If the employee feels that their feedback is worth something and is being listened to, they are more willing to make the changes that need to be made. If individuals enjoy doing a job, they perform at their very best. Giving them the opportunity to be a part of the job redesign, makes them feel as though they have contributed to something and it is worthwhile to the employee.