Organizational Assessment: St. Francis Hospital
description
Transcript of Organizational Assessment: St. Francis Hospital
Organizational Assessment: St. Francis
HospitalAlicia Steadman, BSN, RNUniversity of Indianapolis
I will look at the ideal and actual:◦ Organizational Information◦ Organizational Culture◦ Resources◦ Outcomes◦ Human Resources◦ Policy
Then, a SWOT analysis will be performed based on this information
Overview
Organizational Information
Ideal◦ Matrix Organizational form
“has the flexibility to adapt to change and to deliver services innovatively and efficiently” (Huber, 2010, p.413)
◦ Open Systems Theory/Contingency Theory Open and adaptive to the environment Complement the environment as well as technology
(Huber, 2010)
Organizational Structure
Actual◦ Program Organizational Form
“Although the corporate structure is shared, each program tends to operate as a semi-autonomous unit with its own management team” (Huber, 2010, p. 412)
Sometimes difficult to coordinate services Isolation from other healthcare professionals
Organizational Structure
Senior Management Team
Medical-Surgical Services Emergency Services
NursingPharmacyPT/OT/RT Respiratory
Therapists
PharmacyNursing
Actual◦ Human Relations School/Participative Decision
Making Democratic leaders who are also open
communicators Improved cooperation between management and
workers (Huber, 2010) System may be viewed as “closed” because it is
difficult to adapt to change Emphasis on the informal aspects of organization
social structure
Organizational Structure
INSERT NURSING ORGANIZATIONAL CHART
Organization Structure
Ideal◦ Flexibility
“In every situation, there is some leadership style that will be effective” (Howell, Bowen, Dorfman, Kerr, & Podsakoff, 1990)
◦ Well-Defined Professional Expectations “an approach to an occupation that distinguishes it
from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment” (Huber, 2010, p.5)
Well-defined with clear expectations and goals of the employees (Weshenfelder, 2005)
Leadership and Professionalism
Actual◦ Flexible, but well-defined expectations
Journey to Success program
“Effective leadership requires a continuous commitment to skill development and core leadership values” (Franciscan Alliance, 2012)
This program emphasizes mentorship, understanding the values and beliefs of the organization, process management, motivation, business ethics, change management, and project management
Leadership and Professionalism
Actual◦ Well-Defined Professional Expectations
Franciscan St. Francis Health Nursing Professional Practice Model approved on 07-05-2011
Components include: Mission and values Patient and family centered Evidenced-based practice Healthy work environment Professional practice Shared leadership
Leadership and Professionalism
Ideal◦ Constant interdisciplinary collaboration at all
levels Collaboration can improve quality outcomes, patient
safety, and reduce health care costs (Dickey, Truten, Gross, & Deitrick, 2011)
Should be done at management level and at the bedside
“Interdisciplinary teams are considered to be essential for the effectiveness of health care organizations and for patient safety” (Huber, 2010, p.236)
Level of Interdisciplinary Collaboration
Actual◦ Selective Interdisciplinary Collaboration
At management level, interdisciplinary approach prevails
At bedside, difficult to bring everyone together
Management is currently working towards interdisciplinary rounds on every inpatient unit
Level of Interdisciplinary Collaboration
Ideal◦ Communication Assessment
Accessibility of information
Communication channels
Clarity of messages
Span of control
Flow control/communication load
The individual communicators (Farley, 1989)
Communication Style and Processes
Actual◦ Communication Assessment
Accessibility of information Access through various resources
Communication channels Whom to talk to/management levels clear
Clarity of messages Pretty clear and concise
Span of control 20-30 nurses
Flow control/communication load Low control of flow
The individual communicators (Farley, 1989) Varies by employee, but professionalism helps
Communication Style and Processes
Ideal◦ Participative change
“the more that a planned change is driven by authoritarian actions, the more that the seeds of future discontent are sown” (Huber, 2010)
Allow participation Help followers process, adapt, and cope Leaders need to focus on people! (Huber, 2010)
Implementing Change
Actual
◦ Participative Change
Shared Governance
Quick & Easy Kaizen
Lean Six Sigma
Implementing Change
Organizational Culture
Ideal◦ Icons easily recognizable and represent the
organization’s values and beliefs Actual
◦ Icons represent the organization as a religious, caring organization
Branding and Symbols
(Franciscan St. Francis Health, 2012)
Actual
◦ VIP Program
◦ Daisy award
◦ Encouraging satisfaction and exceptional nursing care
Branding and Symbols
(Franciscan St. Francis Health, 2012)
Ideal◦ Define how the organization feels the business
should be run (Huber, 2010)
◦ Demonstrated by leadership and employees alike
Actual◦ Values based on Christian beliefs◦ Performance reviews view each of these areas for
satisfaction and potential improvements
Values and Beliefs
Values and Beliefs
(Franciscan St. Francis Health, 2012)
Ideal◦ “A guiding framework that describes what the
organization views as its business and future direction” (Huber, 2010, p. 796)
◦ A mission statement reflects the vision of the organization and what it wants to become (Huber, 2010)
Vision and Mission Statements
Actual◦ Mission statement:
Vision and Mission Statements
Continuing Christ’s
ministry in our Franciscan tradition
(Franciscan St. Francis Health, 2012)
Actual
◦ Vision Statement Improve the health of the
community Provide quality services Health needs of poor and
disenfranchised
Vision and Mission Statements
(Franciscan St. Francis Health, 2012)
Ideal
◦ “Unquestioning adherence to authority and tradition is a well-known barrier to the development of knowledge” (Porter-O’Grady & Malloch, 2011)
◦ Tradition cannot always be strict in healthcare
◦ Habits must sometimes be changed
Tradition and Habits
Actual
◦ St. Francis does look toward evidence-based practice to shape new practices
◦ Tradition is part of the mission statement
◦ Some habits are consistent, some habits are changing
Tradition and Habits
Resources
Ideal◦ Staff nurses are aware of budget needs (Huber, 2010)
◦ Nurse managers have multiple resources Actual
◦ Nurse managers offered budget class to aid in creating and managing budget
◦ Finance representatives◦ MSN representative meets with every manager
during budget season (C. Smiley, personal communication, August 1, 2013)
Financial Support
Ideal◦ Administration participation in shared governance
(Huber, 2010)
◦ Magnet Certified hospitals suggest administrative nurses have graduate-degree training (American Nurses Credentialing Center, 2013)
Administrative Support and Expertise
Actual
◦ Shared Leadership Nursing Congress model developed in 2008 (Franciscan St. Francis Health, 2011)
◦ Administration/leadership involved in various committees
◦ Nurse managers are encouraged/required to obtain an MSN
Administrative Support and Expertise
Ideal◦ High development and high functioning
Actual◦ Organizational chart viewed earlier◦ System lines well established◦ High functioning(C. Smiley, personal communication, August 1, 2013)
Sophistication of Nursing Administrative Systems
Outcomes
Ideal◦ Need to determine what should be retained and
what should be left behind (Porter-O’Grady & Malloch, 2011)
◦ Use of multiple surveys (Curran & Totten, 2010)
Stakeholder Satisfaction
Actual
◦ HCAHPS scores/surveys
◦ Press Ganey Scores
◦ Employee Satisfaction Surveys
Stakeholder Satisfaction
(C. Smiley, personal communication, August 1, 2013)
Ideal◦ Used as an improvement process
◦ Organization measures its performance against other similar organizations (Huber, 2010)
◦ Working above the indicated benchmarks
Benchmarking
Actual◦ Utilization of NDNQI data
Benchmarking
Ideal◦ Economic
Producing patient care at the lowest possible cost (Huber, 2010)
Creating a profit◦ Patient Care
Meeting quality indicators and satisfaction scores◦ Employee
Minimal turnover rates
Organizational Effectiveness
Actual◦ Economic◦ St. Francis running at a profit (C. Smiley, personal communication,
August 1, 2013)
◦ Patient Satisfaction Satisfaction scores can be improved
◦ Employee Satisfaction 0.84% turnover
Organizational Effectiveness
Ideal
◦ Organization should never be stagnant
◦ Analyze processes and improve them repeatedly to increase satisfaction (Huber, 2010)
◦ Measure problems, design interventions, implement the change, and monitor the improvement (Huber, 2010)
Continuous Quality Improvement
Actual◦ Business transformation department works
consistently on quality improvement
◦ MSN-trained nurses
◦ Lean Six Sigma
Continuous Quality Improvement
Ideal◦ Find the right “fit”
◦ Complex and detailed process that includes: Advertising Screening Interviewing Coaching (Huber, 2010)
Recruitment/Retention
Actual◦ Organization tries to find the right fit for each
individual unit!
◦ Behavioral-based, standard interview questions◦ Rounding ◦ 30/60/90 Day Window (C. Smiley, personal communication, August 1, 2013)
Recruitment/Retention
Ideal◦ Appropriate variations◦ Have divergent points
of view work for the common good (Huber, 2010)
Actual◦ Discussed in
orientation◦ Many differences
discussed (Franciscan St. Francis Health, 2012)
Diversity in the Workplace
Ideal◦ Develop mentorship and preceptor models
(Huber, 2010)◦ Discussions on future goals
Actual◦ Mentorship and preceptor models(Franciscan St. Francis Health,
2012)
◦ Employee evaluations
Promotion Opportunities
Policy
Ideal◦ Policies guide decision-making to make them
consistent (Huber, 2010)
◦ Procedures indicate the steps necessary to perform different tasks (Huber, 2010)
◦ Focus on best practices
◦ Should be approved by institution and easily retrievable for reference (Huber, 2010)
Formalized Procedures and Policy Making
Actual◦ IOWA Model(Franciscan St. Francis Health,2011)
◦ “LEAP” (Franciscan St. Francis Health,2011)
◦ Nursing Congress—Professional Development Council (Franciscan St. Francis Health,2011)
◦ Easily search for on main employee website
Formalized Procedures and Policy Making
Ideal◦ Decentralization—middle and lower levels can
make decisions (Huber, 2010)
Actual◦ Decentralization! (Franciscan St. Francis Health, 2011)
◦ Shared governance
Decision Making Within the Organization
Ideal◦ Power focuses on upward
influence (Huber, 2010)
◦ How a leader influences followers to take action (Huber, 2010)
◦ A leader is powerful when they develop credibility, show visible achievement, behave correctly, and create dependence (Huber, 2010)
Power Relationships
Actual◦ Based on the individual leader
◦ Power lies with front-line nursing through Shared Governance
◦ Power also lies with effective managers
◦ Good balance, as leadership is actively involved in Shared Governance
Power Relationships
SWOT AnalysisStrengthsWeaknessesOpportunitiesThreats
Strengths and weaknesses internal to the organization are identified (Huber, 2010)
Opportunities and threats are external components to be analyzed (Huber, 2010)
Once identified, analyze all areas to determine impact on the organization (Huber, 2010)
SWOT Analysis
STRENGTHS WEAKNESSESOperations:--Shared Governance--Well-developed policies and procedures--NOW ER
--Patient Flow--Quality Improvement Programs--Interdisciplinary collaboration
Management:--Good power structure--Journey to Success program
--Program Organizational Form--Master’s trained management
Products:--Mission and vision focus on quality--Looking at NDNQI
--Quality Indicators/Patient Satisfaction--Development of Labor and Delivery
Finances:--Running at a profit --Annual budget
--Not well expressed
OPPORTUNITIES THREATSPolitical:--Well defined nursing guidelines from the ISNA (Indiana State Nurses Association, 2012)
--New reimbursement laws from CMS--Legislative staffing ratios (American Nurses Association, 2013)
Social:--Decrease in cigarette smoking and high blood pressure--Increase in preventative testing (Sebelius, Frieden, & Sondik, 2012)
--Obesity among children still on rise(Sebelius, Frieden, & Sondik, 2012)--46% of adults participate in physical activity regularly (Kaiser Family Foundation, 2013)
Economic:--Household income in area higher than US average--Projected job growth of 31.92%(Sperling’s Best Places, 2013)
--Unemployment rate higher than U.S. average (Sperling’s Best Places, 2013)--Out of pocket spending rapidly increasing (Sebelius, Frieden, & Sondik, 2012)
Technological:--Increased diffusion of electronic charting
--Medicare reimbursements reduced by 2015 if no EMR/EHR (MedicalRecords.com Team, 2013)
Improve patient flow Increase interdisciplinary collaboration Education on adult and childhood obesity Create budgeting that occurs more often
than regularly Development of Labor and Delivery
Strategies for Growth
Conclusion
Organizational Information◦ Program form and participative decision-making◦ Opportunity with communication and
interdisciplinary collaboration◦ Nursing Professional Practice Model
Organizational Culture◦ “Healing Hands”◦ Reflects the Catholic base of the organization◦ Very well-defined and established
Conclusion
Resources◦ Financial information not easily accessible◦ Managers have many resources in order to
properly calculate the budget◦ Administrative support present in shared
governance
Outcomes◦ Various surveys monitor satisfaction◦ Multiple quality improvement projects
Conclusion
Human Resources◦ Interviews/coaching aimed to reduce turnover◦ Education on diversity for every employee
Policy◦ Formalized process of policy-making◦ Requirement of evidence for changes◦ Good balance of power and leadership
Conclusion
SWOT analysis◦ Strengths: NOW ER, running on profit, focus on
quality◦ Weaknesses: Patient flow, interdisciplinary
collaboration, better budgeting◦ Opportunities: Increase in preventative testing,
high average household income, electronic charting
◦ Threats: staffing ratio legislation, high obesity, changes in reimbursement
Conclusion
Overall, St. Francis appears to be a well-run organization
There are opportunities for improvement, but there are many areas that St. Francis is doing well in
I hope to watch the organization grow and aid in the opportunities present!
Conclusion
Questions?
American Nurses Credentialing Center (2013). Average Magnet Organization Characteritics. Retrieved from http://www.nursecredentialing.org/CharacteristicsMagnetOrganizations.aspx
American Nurses Association (2013). Policy & Advocacy: Nurse staffing plans & ratios. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios
Curran, C. R., & Totten, M. K. (2010). Mission, strategy, and stakeholders. Nurse Economics, 28(2), 116-118.
Dickey, L. A., Truten, J., Gross, L. M., & Deitrick, L. M. (2011). Promotion of staff resiliency and interdisciplinary team cohesion through two small-group narrative exchange models designed to facilitate patient- and family-centered care. Journal of Communication in Healthcare, 4(2), 126-138.
Farley, M. J. (1989). Assessing communication in organizations. Journal of Nursing Administration, 19(12), 27-31.
Franciscan Alliance (2012). Journey to success: A Franciscan Alliance leadership development program. Indianapolis, IN.
Franciscan St. Francis Health (2012). Orientation Packet. Indianapolis, IN.
Franciscan St. Francis Health (2011). Franciscan St. Francis Health model for shared leadership nursing congress (2nd ed.). Indianapolis, IN.
References
Howell, J. P., Bowen, D. E., Dorfman, P. W., Kerr, S., & Podsakoff, P. M. (1990). Substitutes for leadership: Effective alternatives to ineffective leadership. Organizational Dynamics, 19(1), 21-38.
Huber, D. L. (2010). Leadership and Nursing Care Management (4th ed.). Maryland Heights, MO: Saunders Elsevier
Indiana State Nurses Association (2012). Indiana State Nurses Association Public Policy Platform. Retrieved from http://www.indiananurses.org/documents/2012PublicPolicyFinal.pdf
Kaiser Family Foundation (2013). State health facts: Percent of adults who participated in moderate or vigorous physical activities. Retrieved from http://kff.org/other/state-indicator/participation-in-physical-activity/?state=IN
Network Indiana. (2013). Indianapolis mayor to announce downtown development plan. Indiana public media. Retrieved from http://indianapublicmedia.org/news/indianapolis-mayor-announce-doWntown-development-plan-52506/
Porter-O’Grady, T., & Malloch, K. (2011). Quantum Leadership: Advancing innovation, transforming health care (3rd ed). Sudbury, MA: Jones & Bartlett Learning.
Sperling’s Best Places (2013). Economy in Franklin township (Marion county), Indiana. Retrieved from http://www.bestplaces.net/economy/city/indiana/franklin_township_(marion_county)
Sebelius, K., Frieden, T. R., & Sondik, E. J. (2012). Health, United States, 2012. Centers for Disease Control. Retrieved from http://www.cdc.gov/nchs/data/hus/hus12.pdf
Weshenfelder, C. (2005). Building professionalism and customer service. Nursing Homes, 30-33.
References