Institutional Realities (an organization apparently off the track)

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Institutional Realities (an organization apparently off the track) This case covers several issues in governance, organization, and clinical management. Names in this case have been changed to preserve anonymity. The case is probably best used when students have completed the entire book, but it could also be used after students read the first five chapters. Religious Health Care operates in a catchment area of 225,000, called Middleville. Summary statistics on Religious and its competitors, from the AHA Guide, are shown in Table 1 below. All of the organizations in the area are not-for-profit; Although Samaritan Hospital and Protestant Hospital have religious origins, they now view themselves as secular, not-for-profit organizations.

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Instructor’s Manual Cases and Longer Exercises The Well-Managed Healthcare Organization, 6ed Institutional Realities (an organization apparently off the track) This case covers several issues in governance, organization, and clinical management. Names in this case have been changed to preserve anonymity. The case is probably best used when students have completed the entire book, but it could also be used after students read the first five chapters. Religious Health Care operates in a catchment area of 225,000, called Middleville. Summary statistics on Religious and its competitors, from the AHA Guide, are shown in Table 1 below. All of the organizations in the area are not-for-profit; Although Samaritan Hospital and Protestant Hospital have religious origins, they now view themselves as secular, not-for-profit organizations. Table 1: Middleville Health Care Systems (From AHA Guide) Name Beds Admissions Census OP Visits Religious 575* 13,000 350 221,000 Samaritan 380 17,000 260 Protestant 350 10,000 180 * Includes 128 beds in long-term care. Births Expenses (000) Personnel 2300 $125,000 2000 175,000 1200 $130,000 1875 40,000 900 $80,000 1200 The governing board of Religious hired a consulting company to evaluate its strategic performance. As part of the consultant’s evaluation, several leaders of Religious’s units were asked their perspective of the organization’s performance. You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction would be recommended as part of your list. Because you know there were about two dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical get discussed. You ask the following questions. Following your questions are the responses of one unit manager. 1. The governing board and the senior management team usually have an agenda that needs more or less continuous attention for several months or years. These are areas for improvement in the core functions or activities of the organization. Please write down what you think the important elements of that agenda are. The respondent answered: This particular hospital is currently undergoing the process of reengineering, which is having significant impacts throughout the organization. Obviously, the CEO of the hospital is seen as the individual of paramount importance who is spearheading this effort. Although a consulting firm has been hired to orchestrate the reengineering efforts, the CEO and other senior management © 2006 John R. Griffith and Kenneth R. White 12 Instructor’s Manual Cases and Longer Exercises The Well-Managed Healthcare Organization, 6ed individuals have taken the brunt of the employees’ verbal assaults related to reengineering. I am not in a senior management position at this hospital. Therefore, I am not privy to what transpires at this particular level within the organization. However, I do know that not all of the board members are in support of the reengineering efforts. In fact, some of them have been rather vocal in public areas of the hospital about their disagreement with the board’s decision to approve the reengineering process. In particular, these board members have been vocal about their non-support of the CEO, related to his desire for reengineering. In my opinion, the chairperson of the board needs to gather together these few disgruntled board members and ensure that they understand the need to stand united (at least in public) over their desire to support the CEO’s reengineering efforts. Whatever disagreements the board members may have needs to remain behind closed doors. It is imperative that the board present a united front of their support of the reengineering process and their support of the CEO as its advocate. I also would encourage the board to direct the CEO to be more visible to the hospital staff as the reengineering process unfolds. One of the concerns has been that the majority of the CEO’s communication with the hospital staff about reengineering has been in writing. If the CEO were more visible to the employees, a positive response would occur. The board should direct the CEO to MBWA (Management by Walking Around). This action would also garner additional board support of the CEO, if it were to be implemented. 2. Many organizations now use balanced scorecard or multiple dimensions of performance measurement, such as productivity, profit, market trends, quality, patient satisfaction, and worker satisfaction. Tell us how Religious is using multiple dimensions of performance measurement. The respondent answered: This particular organization has been quite reticent to share particulars of how the organization is doing. Therefore, I have not been privy to copies of board reports that detail information of this nature. However, I can write of two dimensions about which there are definitely opportunities for improvement: (1) patient and family satisfactions and (2) provider satisfaction. First, patient and family satisfaction have been decreasing at the hospital for the previous eighteen months. The hospital uses a firm to tabulate the responses from discharged patient questionnaires. Prior to the start-up of the reengineering process, satisfaction scores on the returned surveys averaged in the 91st percentile. Since the reengineering process began, satisfaction has dropped to below the 85th percentile. Measures that could be taken to assess this significant decrease include soliciting input from both management and staff about what can be done to reverse this trend. Also, we need to look at responses on the surveys and identify © 2006 John R. Griffith and Kenneth R. White 13 Instructor’s Manual Cases and Longer Exercises The Well-Managed Healthcare Organization, 6ed any patterns or trends. Then we need to have specific plans to address these patterns or trends. I believe the board needs to direct the CEO to engage in additional one-on-one meetings with the employees. I think hospital employees truly want to do their best. They are just frightened of what reengineering could mean to their specific positions. In addition, perhaps the establishment of a mission services program would benefit the hospital at this time. Although there is a mission statement, there is no real formal process to ensure that the mission statement is carried out throughout the organization. Core values could be developed and inculcated throughout the hospital family. That would go a long way toward improving patient satisfaction, I believe. Second, provider satisfaction is an area in which improvement opportunities exist. Specifically, morale within the organization seems to be at an all-time low. No numbers are available, although human resources has postponed the triennial employee satisfaction survey for more than 18 months. I believe that some type of formal mechanism needs to be established in which the employees can express their concerns to a supervisor without fear of reprisal. One issue has been that employees sometimes fear airing out their concerns because they believe their positions may be in jeopardy. This practice is supposed to exist in reality. It is imperative that the board becomes more proactive in ensuring that employees are comfortable in sharing their feelings about issues. The environment of fear needs to be replaced with an environment of freedom. The CEO should be charged with the directive to proceed in this direction. 3. How does your organization deal with service line or patient outcomes control? Do you have protocols for common inpatient diseases? For common outpatient conditions? How are these developed and kept up-to-date? For what kinds of patients are Medicare and managed care contracts profitable? What should be your next steps to get better at managing specific patient groups? The respondent answered: Few systems are currently in place at this hospital that address patient outcomes control. However, that will soon change, as the first Care Center under reengineering is brought on board within the next month or so. The next steps in getting better at final product management are therefore underway. Specifically, a case management system is being developed at the hospital. This department will consist of 15 individuals who will be responsible for ensuring that patients are channeled through the continuum of care at appropriate times. A component of the case management function will be the incorporation of critical paths into the care regime. It is my understanding that protocols for common inpatient diseases and common outpatient conditions do exist at this hospital. Because my area of responsibility is the skilled nursing facility, I am not in a position to be heavily © 2006 John R. Griffith and Kenneth R. White 14 Instructor’s Manual Cases and Longer Exercises The Well-Managed Healthcare Organization, 6ed involved with these protocols. However, they have been developed and kept upto-date by the utilization review department. This hospital is making a profit on Medicare patients because there is a large skilled nursing facility (SNF) physically located on the fifth floor of the building. Initially, the SNF had 26 beds. However, to meet the volume of Medicare business, 12 additional beds were recently added. The physicians are more willing to discharge their Medicare patients from the acute care sections earlier if they know the patients will go to the hospital-based SNF. Once the three-day acute care stay is met, many of the Medicare patients are discharged to the subacute level. A long-term acute care hospital has recently begun operations at the hospital. This hospital-within-a-hospital concept will assist in ensuring that ventilator patients and patients needing months of wound therapy related to Stage IV wounds can leave the acute care setting and go to the long-term acute setting timely. © 2006 John R. Griffith and Kenneth R. White 15 ...
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