Internship Involved a Breakdown in

¶ … internship involved a breakdown in a currently applied and implemented system for dealing with soiled bed sheets at the nursing home where the internship occurred. The distinction between policy and strategy is vital to an accurate understanding of the problems that were faced with the breakdown of this system; the overall policy regarding soiled bed sheets at the nursing home was strong, but the specific strategy for achieving this policy is where the breakdown occurred (Alkhafaji 2003).

Standard as well as site-specific nursing home policy dictates a responsibility for all individuals in maintaining the cleanliness of the institution as well as the health and safety of patients, and a specific strategy involving the cleaning of bed sheets soiled with fecal matter had been established as a means of fulfilling this policy objective. A simple SWOT analysis of the strategy in place reveals the significant problem that existed and the simple solution to this problem.

The primary strength of the strategy that was put in place to handle soiled bed sheets was its simplicity and directness. When a bed was discovered to be soiled, strategy dictated that the sheet be immediately removed, bagged, and taken to a soiled utility room, where fecal matter was to be rinsed off before the sheets were placed in a specific bin for later laundry processing.

Many aides, however, were simply leaving the soiled sheets in bags on the floor of this room, without rinsing or placing in line for laundry, revealing the essential weakness of this strategy -- the lack of accountability that resulted. Though monitoring can cause employee stress, it can also be necessary to ensure proper and efficient practices (Griffin & Moorehead 2009). The strategy as it initially stood presented a tremendous opportunity for improvement, one that would create both better health and cleanliness standards as well as improving the efficiency of operations.

This project also presents an opportunity for creating a greater presence for the hierarchy and organization in the nursing home, which is an essential part of the successful administration of any similar institution (Allen 2008). The threats facing the institution from failing to take advantage of these opportunities for improvement are quite substantial, and include a much greater risk for the spread of infection and potentially even violation of certain legal requirements and regulations.

Despite the simplicity of the strategy for carrying out the desired policy, then, the lack of oversight, accountability, and true hierarchical presence made this strategy ineffective and ultimately left the institution quite vulnerable to numerous issues (Griffin & Moorehead 2009; Allen 2008). This particular problem also reflects certain issues with the organizational culture that existed at the institution, which in turn pointed to problems in the perceived value chain in operation due to the relationship that has been noted between the culture and value (Griffin & Moorehead 2009).

Though value creation is often viewed in terms of competition, all value is ultimately derived from internal actions and efficiencies, and is eroded by inefficiencies; the cultural attitude that the soiled sheets were simply "not my problem" in the opinion of the aides created an inefficiency and so eroded value (Alkhafaji 2003). This attitude also ran directly counter to the policy of collective and individual responsibility.

The solution to this problem was very straightforward and simple following the identification of the primary problem (or weakness) of the strategy that had been implemented for dealing with the soiled bed sheets.

Establishing accountability and restoring the presence of the authority and hierarchy that existed in the institution -- and thus reinforcing the cultural and policy principles of collective responsibility for the cleanliness of the institution -- created a new focus on the value chain provided by the organization, which exists to provide quality care to its patients and create peace of mind for family members (Alkhafaji 2003; Griffin & Moorehead 2009; Allen.