Action Planning Situational Background- Stevens

Action Planning

Situational Background- Stevens Heath Center is a smaller sized (200 bed) hospital in a suburb of a mid-sized American city. For various reasons, not all disclosed to employees, Stevens merged with the larger, Rainier Health Systems who operate a 3 tier hospital campus, several clinics and outpatient facilities, and have a total of 1500 beds available. Previously, Rainer was considered a huge mega-hospital and strong competitor of Stevens. It is now six months since the merger, and a decision was made to redesign patient care delivery. The administration decided that instead of so many specialized workers, a universal worker would be more efficient. This universal worker would have the skills to offer numerous support services. However, at times this model has failed in the past, and it is now incumbent on our department to make the redesign work this time. In order to make this more efficacious this time, the organization has decided to implement a six stage program of job redesign, which will also allow cross training and unique situational analysis in preparation for the new program. The roll out model is shown below.

Step

Model

Issue

Implementation Goal and Project Standards

Job redesign project

Sequence of necessary actions for project

Stages for implementation

Estimation of time needed to carry out, develop schedule

Time constraints in view of patient care

4

Determine accountability for each step

Department and/or manager accountability

5

Estimate cost and necessary resources for each action step

Variable and fixed costs

6

Identify potential problems and/or road blocks and determine how to avoid or minimize

Where might this project hold up?

Step 1 -- Implementation Goal and Project Standards for Job Redesign Model -- Before we can enlist a working model, we must define the new position for all to understand. A universal worker is an employee that is cross-trained in multiple departments that interact with one another, and therefore is able to be more flexible on assignments. For instance, a universal worker can go to a department or situation in which there is a staff shortage, an absence, or even in the case of cross-training RNs for the Emergency and Operating rooms, natural disasters and public emergencies. The value to the organization is enormous, individuals trained in multiple tasks tend to be more vivacious, more willing to step into new situations without fear, and are usually able to see a more holistic approach to individual case loads. There are, of course, drawbacks to this concept -- sometimes quality assurance and employee support are lacking. Other employees feel like someone who is only 20% one job does not have the sense of expertise and can become frustrated. The Universal Worker can also be frustrated with too many multiple horizontal priorities -- given many tasks without the ability to excel at any of them (Pearce, 2007, 269-72).

Step 2 -- Sequencing of Events

Stakeholders

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Administration

Plan

Discuss with staffing

Interview current and potential staff

Implement Training

Review Procedures and Redefine

Current Staff

Meet to understand

Participate in interview process; interview themselves if desired

Participate in training

Participate in evaluation

Potential Universal Workers

Investigation

Participate in interview process

Participate in training

Participate in evaluation

Additional Departmental Staffing

Meet to understand

Allow input

Training if needed

Allow input

Regulatory Bodies

Inform

Apply regulations

Ensure compliance

Step 3 -- Time Issues and Constraints-

Stakeholders

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Time Issues

Administration

Plan

Discuss with staffing

Interview current and potential staff

Implement Training

Review Procedures and Redefine

Scheduling Training within bounds of current patient needs

Current Staff

Meet to understand

Participate in interview process; interview themselves if desired

Participate in training

Participate in evaluation

Staffing availability and shift issues

Potential Universal Workers

Investigation

Participate in interview process

Participate in training

Participate in evaluation

See above

Additional Departmental Staffing

Meet to understand

Allow input

Training if needed

Allow input

May add 20% more to timeframe

Regulatory Bodies

Inform

Apply regulations

Ensure compliance

No control over regulatory bodies

Step 4 -- Accountability - While there are a number of departments involved in this project, the primary accountability for the whole project is the actual project manager and their team. Ideally, this would be someone wish a broad level of experience in administration and/or Human Resources. During the course of this project, that individual would manage an implementation committee filled with department experts who are "on loan" for 20-30% of their time specifically on this project.

Stakeholders

Primary Accountability

Secondary Accountability

Administration

Executive Committee, Board

Director or Manager for Project

Current Staff

Human Resources

HR Contact in Implementation Committee

Potential Universal Workers

Human Resources, Individual Department Heads (Chief of Medical Staff, Chief of Nursing, etc.)

Individual Department Contacts in Implementation Committee

Additional Departmental Staffing

See above and CFO

CFO and Individual Department Contacts in Implementation Committee

Regulatory Bodies

Legal Department

Regulatory Affairs and Compliance Manager

Step 5- Cost issues -- Cost issues for this project are variable and may be buried within the budgets of some departments. However, a cross section of management level employees, in this case we estimate 10-12 on the committee, plus one full time project manager for 6 months would yield the approximate costs:

Full Time Project Manager at Upper Level - $50,000 plus benefit and tax costs = $75,000 for six months

Travel and misc. costs, support, copies, office, etc. = $50,000

Part Time Implementation Team at Manager Level -- 12 at $35,000 plus benefit and tax costs = $46,500 each, or $558,000

Training Costs = $75,000

Regulatory, inspection, relicensing costs = $10,000

Potential facilities and/or office construction = $25,000

Total potential implementation impact = $718,000 with $32,000 override cushion, $750K

Step 6 -- Roadblocks and/or Problems - Change management within an organization, particularly the public sector involves a number of variables: internal and external theory management, change planning and specific strategic and tactical methodologies that will ensure the likelihood of long-term success. Numerous theoretical approaches have been suggested to mitigate change within organizational structures. These theories of change arise within the public and private sectors, academia, global political systems, and even an upward dissemination from entrepreneurial ventures. Within these various rubrics, there is no single, all-encompassing model that fits all situations with equal robustness. Each has its own unique model, resources, and approach; each evolved under differing circumstances; each provides a strategic and tactical vision of success through its own worldview. However, the process of change can be mitigated by deciding on an approach (Six-Sigma, Kaizan, Total Quality Management, Business Process Management, etc.). Working with HR we would use those methods, which all have a common theme -- open communication and understanding -- to help the organization through the issues at hand (Culp, 2001;Choi, 1995).

Similarly, there is no way to ensure 100% job satisfaction with every employee all the time. One can only cross-train, communicate, work on a job extension and stretch plan, and use every potential resource available to allow the employee to self-actualize. Change is frightening to some, but with perserverance, tenacity, and commitment, our organization will be stronger because of it. Additional roadblocks might include government and/or regulatory agencies, personal resistance from some employees, etc. This is why making the plan combine with a new learning organizational paradigm and being sold from the top down will be most effective.

The Implementation Plan - There is an overall expectation that health care workers at all levels have a patient-centered approach to health care, and that there work processes are consumer-centric. Producing exceptional health care is the manner in which services for individuals increase healthy living, health outcomes, and are consistent with current professional standards and knowledge. Since we already have detailed job descriptions and process management reports for current positions that will be part of the Universal Worker's job description, our task is to first evaluate which of those positions are critical, which duties appropriate, and which schedules are flexible for our needs. Working with Human Resources and Department Heads, then, we will apply those strategic goals and tactical skill plans to the new position (Huber, 2006, 830-1).

Change management within an organization, particularly the public sector involves a number of variables: internal and external theory management, change planning and specific strategic and tactical methodologies that will ensure the likelihood of long-term success. Numerous theoretical approaches have been suggested to mitigate change within organizational structures. These theories of change arise within the public and private sectors, academia, global political systems, and even an upward dissemination from entrepreneurial ventures. Within these various rubrics, there is no single, all-encompassing model that fits all situations with equal robustness. Each has its own unique model, resources, and approach; each evolved under differing circumstances; each provides a strategic and tactical vision of success through its own worldview. However, the process of change can be mitigated by deciding on an approach (Six-Sigma, Kaizan, Total Quality Management, Business Process Management, etc.). Working with HR we would use those methods, which all have a common theme -- open communication and understanding -- to help the organization through the issues at hand (Culp, 2001;Choi, 1995).