Organizational Assessment as Impetus for Change at a Vet Center
Organizational Assessment as an Impetus for Change at a Vet Center
Organizational Context. Every type of organization has, or should have, as a major goal, the need to optimize the productivity of its human resources (Farr, Schuler & Smith, 1993). One organization that has recently assumed critical importance in the U.S. is the Department of Veterans Affairs (VA). Today, the VA is responsible for administering an enormous healthcare and benefits network for its active duty and retired service members and their families at U.S. taxpayer expense.
Among the most prominent of such government-administered programs is the healthcare systems comprised of VA medical centers (VAMCs), outpatient clinics (VAOPCs), community and outreach clinics, and numerous Vet Centers. In fact, taken together, almost one-third of the American population (around 70 million persons who are veterans, dependents and survivors of deceased veterans) are eligible for VA benefits and services. The VA reports that its original 54 hospitals in 1930 have grown to a nationwide healthcare system that includes 173 medical centers (with at least one located in each of the 48 contiguous states, Puerto Rico and the District of Columbia); almost 400 outpatient clinics, community and outreach clinics; 131 nursing home care units and 39 domiciliaries (VA Fact Sheet, 2004).
2. Purpose. Because all organizations are, by definition, comprised of people, making the most of this resource is just good business practice. Therefore, in order to identify problem areas and opportunities for improvement in organizations, a snapshot of how the people in the organization feel about it assumes increasing importance and relevance. This is the fundamental purpose behind any organizational assessment. "Improvement in the quality of work was the original goal of organizational assessment" (Alioth et al., 1993, p. 221). While the need for high performance teams is generally associated with traditional business corporations, such teams have been a mainstay in the healthcare industry for many years (Farr et al., 1993). These authors reports that in recent years, though, the emphasis on teams and teamwork in healthcare organizations in particular has increased.
Farr and his colleagues cite several reasons for this increased focus on developing effective healthcare teams:
a) As the healthcare industry in the United States has become more specialized, sophisticated, complex, and technical, the various disciplines that are involved in the delivery of healthcare have also become increasingly interdependent. "The very nature of health care is bringing providers from numerous disciplines together to address healthcare problems" (Farr et al., 1993, p. 5);
b) Team-based healthcare organizations are widely regarded as being more effective, efficient, and adaptive than bureaucratic, hierarchically structured ones. For instance, Manion et al. (1996) observed that, "Teams are a way... To release potential for improve d productivity, better decisions, and process innovation" (p. 4). Similarly, teams are viewed as being "critical to sustainability in healthcare" organizations and "the basic unit of work" (Porter-O'Grady & Wilson, 1998, p. vii); and c) Healthcare organizations today demand a team-based approach for philosophical reasons (Coopman, 2001).
3. Description and Justification for Conducting an Organizational Assessment. There are a variety of organizational assessment tools that can be used, depending on the type of organization and level of assessment involved (Dallimore & Souza, 2002). Ford (1999) suggests in discussing organizational assessment, the application of any instruments and procedures, tends "to have a common goal of diagnosing an organization's communication strengths and weaknesses by offering a triangulated approach to examining communication practices" (p. 2). Given these general descriptions, virtually any organization can stand to benefit from a well-conducted assessment.
According to Guion, "Any need analysis is useful when it helps people in organizations overcome force of habit in studying organizational problems" (1998, p. 52). However, Farr, Schuler and Smith (1993) also point out that there should also be possibilities to potentially reach the goal of behaving cooperatively at least partly or in other essential components in organizational assessment and selection. In this regard, they say, "Crucial for this is a better knowledge of participants' perceptions of and reactions to selection and assessment situations and of the relationships between individual and organizational perspectives" (p. 4). In order to develop a clear understanding of such perceptions and reactions, it is important to select an appropriate instrument for the purpose.
According to Guion (1998), survey methods are frequently used for organizational assessment purposes precisely because they are standardized and provide a significant return on the investment. Surveys can either be developed in-house or an appropriate model selected that fits the purpose; the former method allows for increased flexibility and individualization of the measures employed, but verifiability and replicability issues then come into play (Leedy, 1992). According to Guion, "Questionnaires can be developed after interviews and conferences to be sure that major questions are asked. They do not, of course, shout out the optimal corrective actions; appropriate action is inferred by people making informed judgments" (p. 52). In order to received timely and accurate "informed judgments," then, this study will survey all employees of a Vet Center located in the author's city of residence.
The Vet Center is question is comprised of one counseling psychologist (who also serves as the Center director), one nurse practitioner, a medical records specialist, a receptionist and two volunteers who work three days a week for 4 hours per day (these individuals are retired and 100% service-connected veterans). The staff members are all federal Civil Service employees, and the volunteers are unpaid; however, they receive free meals and access to the Center's computers which one of them uses for college research).
Application of Survey Data Results. Because Vet Centers are one of the smallest of the VA healthcare facilities providing services directly to veterans, both in terms of size and staff, applying the results of the employee survey will be relatively easy compared to other components in the VA healthcare system.
The VA clinic director will be able to use the results of the employee survey immediately to identify problem areas and potential opportunities for improving the delivery of healthcare services to veteran patients, as well as how the Center administers its human resources function. Supplemental results from future surveys can then be used to determine the effectiveness of any remedial actions taken, as well as identifying any further problem areas that may have developed in the interim.
Justification for Investing Time and Resources in Organizational Assessment. The interunit level of organizational assessment is appropriate for the purposes of this research project. According to Freeman (2001), a number of organizational assessment approaches are research-based and yield useful comparison data across groups of programs. "The methods have been used to assess single programs as well" (Freeman, 2001, p. 121). However, in order to justify the time and resources required to develop, administer, analyze, interpret and implement changes pursuant to an organizational assessment, there must be solid goals in mind that are not focused on collecting vague complaints, but rather identifying specific information that will be helpful in developing measures for improved decision-making and implementation by the Vet Center director (Alioth, Duell, Frei, Hugentobler, & Schurman, 1993).
Necessity for Organizational Assessment.
According to the leadership of three major veteran service organizations, the VA estimated that there were 4.9 million unique veteran patients in Fiscal Year 2003, a 31.5% increase from the 3.7 million projected in 2002. "Today, over 300,000 American veterans are waiting for appointments in VA facilities. For approximately half of those men and women, the waiting period will surpass six months. VA must be adequately funded to meet this growth and end these intolerable waiting periods" (Sisk, Conley & Heath, 2002, p. 3). Furthermore, the challenges facing this organization are going to get worse before they get better for two fundamental reasons:
a) The veteran population continues to get older and the VA will undoubtedly experience an increased demand for the healthcare services that are typically associated with the aging process; and b) America continues to prosecute a costly war on terrorism in Afghanistan and Iraq that is resulting in large numbers of combat casualties and acute psychological trauma; Vet Centers have only experienced moderate success in treating such psychological trauma cases in the past (Sommer & Williams, 1994).
Treating these returning veterans appropriately and effectively has long been a national priority, even if the funding to support such lofty initiatives has not been forthcoming from the Congress. According to Gerber (2003), ever since the 19th century, the government has undertaken to provide all veterans, and particularly disabled veterans, with generous pensions and a vast array of medical, rehabilitation and reintegration services. The government has assumed these responsibilities based on Abraham Lincoln's commitment to provide for "Those who have borne the battle, his widows and his orphans" (Second Inaugural Address).
As a result, this national commitment has come to be based on an understanding that profoundly valorizes the disabled veteran's status. "For these benefits came to be conceived as a right, not a privilege, or charity, or 'welfare,' as that word is used pejoratively in…