Why it is necessary for a health care organization to develop a strategic management model that addresses both the concept of change necessary for the growth and sustainability of the organization, and the processes of changing, that is, how does the organization go about accomplishing change?
Write a paper (1,000-1,250 words) that addresses types of health care organizational structure and how each type of structure impacts the process and effectiveness of change. Address the following:
a) Why it is necessary for a health care organization to develop a strategic management model that addresses both the concept of change necessary for the growth and sustainability of the organization, and the processes of changing, that is, how does the organization go about accomplishing change?
b) Differentiate between organizational change and transformational change.
c) Where might an organization obtain examples of leadership models that have proven successful in today’s health care environment?
d) Identify and explain tools and advice that can be utilized to assess leadership effectiveness.
2) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
3) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
40.0 %Address Types of Health Care Organizational Structure, Including How the Type of Structure Impacts the Process and Effectiveness of Change (Demonstrates thorough knowledge of health care organizational structure and how the type of structure impacts the process and effectiveness of change. Clearly differentiates between organizational and transformational change. Introduces appropriate examples of leadership models, tools, and advice.)
30.0 %Integrates Information From Outside Resources Into the Body of Paper (Supports main points with references, examples, and full explanations of how they apply. Thoughtfully, analyzes, evaluates, and describes major points of the criteria.)
7.0 %Assignment Development and Purpose (Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.)
8.0 %Argument Logic and Construction (Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.)
5.0 %Mechanics of Writing (Includes spelling, punctuation, grammar, and language use.) (Writer is clearly in command of standard, written, academic English.)
5.0 %Paper Format (Use of appropriate style for the major and assignment.) (All format elements are correct.)
5.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style.) (In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.)
Organization behavior stems from leadership. Successful leaders assess a given situation and then choose the appropriate leadership style to affect the greatest positive impact on the subordinate effort. The text points out that behavior phases are “attempts to determine what particular behaviors leaders utilize to cause others to follow them. (Johnson, 2009, p. 304) To gain a solid understanding of the concept of Organizational Development (OD) within a particular organization, one needs to:
• Examine the history of where the organization emerged;
• Identify the challenges that are confronting leadership and forcing change; and
• Examine the organization’s leadership’s ability to motivate subordinates to follow.
Historically, health care organizations (HOs) have been social institutions driven by internal challenges. They focused primarily on clinical knowledge and treating the individual for a specific ailment. Today, the organization’s focus is much broader; it involves closer ties to the community it serves by understanding the community’s health status. Economic productivity that insures stability is a key concern to HOs now more than ever. Economic stability permits an organization to confront current challenges as well as position itself to meet future challenges. Current challenges call for immediate organizational change whereas future or emerging challenges call for changes over time.
An Organizational Development Experience
The following example is a real-life experience that provides more insight to OD and behavior theory. These are not the actual names or locations. (Basic story in the following as related by B. Dickens, personal communication, June, 2010)
The Institution’s Background
In 1971, St. Ignatius was an aging hospital providing health care to its community for over fifty years. It was a Catholic institution, as was a large proportion of its subordinate staff. Governance consisted of male and female lay community leaders, Catholic nuns, and Catholic leadership, including the Chief Executive Officer (CEO). Corporate governance is defined as
. . . the ways in which a firm safeguards the interests of its financiers (investors, lenders, and creditors). The modern definition calls it the framework of rules and practices by which a board of directors ensures accountability, fairness, and transparency in the firm’s relationship with its all stakeholders (financiers, customers, management, employees, government, and the community). This framework consists of (1) explicit and implicit contracts between the firm and the stakeholders for distribution of responsibilities, rights, and rewards, (2) procedures for reconciling the sometimes conflicting interests of stakeholders in accordance with their duties, privileges, and roles, and (3) procedures for proper supervision, control, and information-flows to serve as a system of checks-and-balances. (Business Dictionary, 2010)
The newly selected CEO arrived to an inner-city community with a predominately racial minority population in the pre- and post-riot environment of the late 1960s. At the time being outlined here, the Black Panthers were an entity to deal with when developing programs and processes for change.
These and other conditions of the community brought about a need for change and a new OD plan. Among the conditions were:
1. The facility was a 50+ year old, 500-bed hospital.
2. Internal challenges included:
a) The current CEO, a nun, was beyond retirement age, and no plans had been instituted for a potential replacement;
b) Selecting a lay CEO for the first time;
c) A loss of physicians to suburbs, dwindling census, and revenue decreases; and
d) A need for new leadership team and perspective.
These were just some of the more pressing conditions facing the hospital. The new CEO immediately created a team consisting of physician representation (Chief of Staff), Chief Financial Officer, Nursing Director, Medical Records Director, Food Services Director, and Governance representation.
The Change Process
This team understood that to be successful there were a number of key organizational factors to be addressed. Central to the process was the development of a communication strategy:
• The Vision: A new, modern, 500-bed hospital somewhere within the metropolitan area.
• The Mission: To acquire approval from the Health Care Planning Commission, arrange financing, and begin construction of the proposed hospital.
• The Goal: To complete the mission within two years.
• Among key accomplishments to effecting change were the following:
• Development of internal and external strategies;
• Implementation of developed strategies and a measurement for success;
• Definition of communication strategies that ensured clear and articulate demonstration of vision, mission, and goals (Johnson, 2009, pp. 223-225); and
• Development of methods and tools to monitor and measure outcomes and reward participants.
After the newly elected CEO and his team put into place a strong communications strategy, the next step was to assign specific responsibilities to each member. The team met weekly to review progress or the lack of same. Any lack of progress was addressed by the total team. Any adjustment of strategy and implementation of needed fixes required endorsement by the total team. The total team also met frequently with the Architect and Chief Financial Officer to determine building configuration and costs.
The single most challenging factor was the impact of the riots. If this challenge was not adequately addressed, the vision would remain an unfulfilled dream. The riots themselves brought about an immediate need to respond to the frustrations of the community. The shooting and death of a hospital security guard accelerated the exodus of staff physicians and other personnel, causing further loss of revenue due to the decrease of patients admitted. Furthermore, leadership was faced with not enough physicians to sustain a 500-bed hospital.
Faced with what would seem to be insurmountable problems, the planning team was determined to continue to serve the present community. The team convened to evaluate its options; one option the team considered was to build a new hospital on a proposed community college campus which had been denied federal funding. Weighing all the facts and figures, the team reluctantly concluded that it had no other alternative but to relocate the hospital to a more viable suburban location.
Once the decision to relocate to a suburb became public news, it triggered angry reaction from the community. This anger was fueled and elevated by the local Black Panther Group, who were militant with what they saw as a just cause: To protect the inner-city minority community.
The newly elected CEO was paid a visit by the Panther leadership who insisted that he was not to move the hospital. After this visit, the team reconvened to reconsider their strategy, but concluded that the long-range goals and site for the new hospital would remain the same. However, the team recognized that unless it could placate both the community and the Panthers, all would be lost.
The CEO had several private meetings with the Panther leadership and concluded that the Panthers had a legitimate concern: Not only the safety and well-being of the community, but continued employment for many in the community. A hospital of this size, 500 beds, would employ in the neighborhood of 2,000 persons. The CEO and the Panthers discussed these concerns and negotiated an agreement to find options to protect the jobs of its inner-city workers.
After much discussion, the CEO proposed the establishment of transportation services between the inner city and the suburb where the new facility would be located. The CEO and Governance representatives presented the recommendation to the entire Board, which was ultimately approved. Following the approval, the team proceeded to complete the planning of the proposed hospital:
• A suburban site was selected 15 miles from the existing hospital;
• Architectural plans were completed; and
• Financing via bonds was approved.
The above has presented a realistic picture (the facts of the situation presented are true) of the many challenges facing a 50-year-old, inner-city hospital. From a timing point of view, the Black Panthers’ challenge to the original plan was significant. Had this challenge not been successfully addressed and resolved, the proposed project may not have ever come to fruition. The inner-city hospital may have shut down as a result of doctor flight and fear; or the new structure may have been delayed for years or never built at all. The new hospital and two new satellite facilities that feed into the main hospital complex are located some distance from the main campus, but remain today as viable, flourishing medical facilities.
In summary, it is important to point out that all of the activities described happened in the late 1960s and early 1970s. During that period, the new leadership methodologies used to generate OD concepts and processes were in an early stage.
Organizational Development Models
Two important OD leadership styles used to implement change for an organization to successfully confront a given set of challenges are:
3. Transitional /Transactional (Incremental): A leadership model that addresses both change and the process of changing. Transitional change is associated with incremental adjustments taken towards achieving the desired goal or outcome. Such changes are planned and occur at the divisional level of the organization. Thus, transitional change is a bottom-up process (Johnson, 2009).
4. Transformational (Organization-wide): Transformational leadership style, as with transitional change, is a leadership model that also addresses change, but more specifically addresses change in relation to organizational restructuring. It represents a broad and complex radical shift as the organization reinvents itself (Johnson, 2009).
Change occurring in health care that is inspired or required by external forces is inevitable. Consequently, health care organizations unprepared to make the shift in a timely manner may not survive.
Johnson, J. A. (2009). Health organizations: Theory, behavior, and development. Boston: Jones and Bartlett Publishers.
Corporate Governance. (2010). In BusinessDictionary.com. Retrieved August 26, 2010, from https://www.businessdictionary.com/definition/corporate-governance.html
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