Weisbord Six-Box Model in Health Care Organizations

Introduction to Organizational Diagnosis in Health Care

Marvin Weisbord developed his six-box model of organizational diagnosis to fit any organization, but it is especially helpful in the health care field. From time to time, it benefits any organization to assess its operations and modify them where necessary. "Classically, organization development has been seen as a process of problem solving or of conflict management" (Oleari, 2000, p. 4). To begin, an organizational assessment is necessary. First, a small planning team is formed to represent all areas of the organization and gather input from its members. This team's purpose is to represent each area — or component — and decide what, if anything, needs to change in that area. The diagnosis of these assessments includes input from all areas and all levels of the organization. Any organization can benefit from this initial assessment of needs and wants.

Purpose and Structure

The Weisbord six-box model is a method of assessing an organization's performance across six areas. As one health care writer notes, the model is an excellent tool in the health care industry: "A subacute care organization's diagnosis can determine the appropriateness and profitability of its current business, any gaps that must be rectified, and the action plan that must be undertaken" (Stahl, 1997, p. 1). Thus, applying the six-box model is an important part of overall organizational management, and the model can help identify both areas of need and areas that are successful and do not require attention. As Stahl continues, "According to Weisbord, identifying and solving a problem must be done systematically by the same people, because by so doing, they learn from their own situation and then seek improvement" (Stahl, 1997, p. 1). The model contains six components: purpose, structure, relationships, rewards, helpful mechanisms, and leadership.

Perhaps the most important component of Weisbord's six-box model is purpose — sometimes called strategies in certain versions of the model (Boesen, 2005, p. 13). This component is elemental to the purpose of the organization itself. It helps assess what type of health care business the organization engages in, how this aligns with the overall health care industry, and whether it is viable for the future. Markets and segments continually change, grow, or disappear, so this analysis is especially important. If the answers to these purpose questions differ too far from what the organization is currently accomplishing, leaders may discover they need to entirely change their purpose or drastically alter its central function. Thus, the purpose component could change frequently within an organization, depending on what aspect of health care it addresses and how many other providers offer the same or similar services in the area. All aspects of the model interact with each other, and purpose is most closely aligned with two other components: structure and relationships.

Relationships and Rewards

The next component of the model is structure, which essentially assesses how work is divided within the organization. In the health care industry, it also examines patient satisfaction with the work and service provided, as well as patient success rates. Analysis of this component can point to areas where patient coverage or care is lacking, or identify areas where there are overlapping jobs or assignments. It can also anticipate what patient care needs may arise in the future and how to meet them. This is particularly useful for health care facilities that often have small staffs and must cover a variety of assignments effectively and with great attention to detail. As Stahl notes, "Diagnosing the organization's structure should clarify functional responsibilities and staff accountabilities" (Stahl, 1997, p. 2). Structure interacts most closely with rewards and relationships, which makes sense, as these are all important components of the work-related aspects of an organization.

The relationships component is another important aspect of the model as it relates to staff, management, patients, and others. If this component is dysfunctional, the entire model becomes suspect. The patient is the primary consumer in this model, but in a health care organization there are many other consumer relationships as well — including doctors, managed care representatives, staff, managers, and even family members. There can therefore be many areas where dysfunctional relationships could develop and many areas that may be affected as a result. As Stahl observes, "An ongoing dysfunctional relationship that several freestanding subacute care providers continue to wrestle with is the conflict between the regular SNF nursing staff who have been employees for several years and the newly hired acute care or critical care nurses who often are hired at higher salaries" (Stahl, 1997, p. 2). Relationships interact most closely with purpose and helpful mechanisms.

Conclusion

The Weisbord six-box model is used throughout a wide variety of businesses, communities, and institutions. It is especially helpful in the health care industry, which often follows the same organizational model for years without assessment or updating. The health care field is changing rapidly: more people are aging, people are living longer, and new epidemics such as diabetes and obesity are becoming more prevalent. This means many organizations will find it necessary to change their services and goals, and using the six-box model can make that process quicker, easier, and more complete.