[Solution]Providence Healthcare, Toronto

responses should focus on the leadership issues that you observe in the case study and connect them to the reading you have done so in…

responses should focus on the leadership issues that you observe in the case study and connect them to the reading you have done so in the course. Using APA page format,1.5ft, the report should be minimum two pages in length and should include:
1. Problems/Issues Facing the Organization
2. Possible Solutions
3. Recommended Solution(s)
4. Expected Outcome
 
Boldly Go: Character drives leadership Providence Healthcare.
 
Gabrielle Zephirin
 
 
 
Providence Healthcare, Toronto
Main Problems
· Global financial crisis.
· There is pressure in Ontario’s health care sector to do more with less.
· Deficit threatening and its pension plans at risk could cause staff layoffs and service cutbacks if the organization followed traditional financial pressures.
Solutions to Main Problems
Providence Healthcare’s tagline was helping people, healing lives. Its president and chief executive officer, Josie Walsh, first believed that the problems would be solved by healthcare having a value-based leader who aligned their values as a leader with the values and needs of the organization. Dynamic partnerships, compassionate care, trust, and high accountability were fundamental to promoting innovation and change in an organization. The personal character was one of the primary drivers of organizational success and leadership. Virtues such as humility enable the leader to grow and learn. Integrity develops trust and promotes collaboration. Collaboration encourages teamwork while justice creates decisions seen as reasonable and fair. Temperance aids leaders in taking balanced, reasonable risks and views. Accountability enables the leader to take ownership of their decisions, execute them and expect other people to also o the same. An empathetic and humane leader understands her juniors well. Courage causes leaders to make tough decisions, replace the status quo and take brave actions.
Improving the patient flow could aid in moving patients faster along with the health care system through the acute case to rehab that will decrease the number of expensive level of care (ALC) optional beds. The team at Providence healthcare saw a chance to create a new patient flow and care model that could meet the various needs of patients, donors, regulators, families, other partners, and professionals in the healthcare system. This patient flow was an effective and innovative model that other Ontario healthcare systems would want to use. Pilot testing the new design was essential to test and refine the model, measure its results, and proceed.
Collaborating with other relevant stakeholders enabled the hospital to create networks and establish allies who would share their input and expertise, actively engaging with stakeholders. This collaboration would help identify and support leaders at every leadership level and gain their engagement and support by successive waves of relentless and rapid change. Collaboration would also help shape the TbyD since there will be consultations with leaders of the acute care hospitals since their beginning. Still, it would also help obtain feedback from families and patients and suggestions from donors, the board, and partners. Redeveloping the rehabilitation inpatient units using Transformation by Design (TbyD) is another solution. TbyD was used as a tool to re-create each part of a patient’s journey of their medical care at Providence and Providence took full accountability for patients from when they arrived to when they left. Provide exceptional patient care that would be possible by establishing and applying tools and techniques used in manufacturing and business rather than in hospitals. The tools included quality improvements and lean methodologies such as 3P (Production, Preparation, Process), simulations, 6S, and rapid prototyping. The improvements will, in turn, lead to high quality, extraordinary patient care, productive partnership, and increased staff engagement.
Recommended Solution
Providence healthcare boasts a one hundred and fifty-eight-year history and strong values of responsive innovation and compassionate care. Providence is a leader in palliative care, rehabilitation, and community programs and provides outpatient and inpatient care to more than five thousand people yearly. As one of the largest rehabilitation hospitals in Ontario, the best-recommended solution would be to establish and apply tools and techniques of quality improvements and lean methodology. This establishment would ensure that patients receive high quality and exceptional care and increased staff management. In the current and future world, where there is much competition among healthcare facilities, patients are after quality and efficient care. The increased staff engagement would enable the patients to be uniquely handled by the hospital staff. The close interaction will lead to close monitoring of the patient, and any problem arising may be responded to as soon as it may appear or even before it does.
Outcome Expectation
I expect Providence healthcare to provide its services to an increased number of people, doing more with less, and its patients will obtain a high quality of its services. Patients with diverse medical problems will be treated with ease and with much expertise. This approach to curbing this issue will enable the hospital staff to focus on the patients better and sustain the high-quality standard of services they render. Consequently, there will be an increased patient turn up in Providence healthcare. Luckily, the hospital will quickly attend to the high number of people through its newly developed techniques and tools. When Providence Healthcare takes this initiative, it will be seen as a hospital directed towards fulfilling the needs of its patients by going above and beyond in offering exceptional quality services to them.
 
 

9 – 4 0 9 – 0 9 0 M A R C H 1 3 , 2 0 0 9
 
________________________________________________________________________________________________________________ Professors Boris Groysberg and Nitin Nohria and Research Associate Deborah Bell prepared this case. This case is based on field research and interviews conducted with nurses and nurse managers. Data, information, and names have been disguised to protect their confidentiality. HBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. Copyright © 2009 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-545-7685, write Harvard Business School Publishing, Boston, MA 02163, or go to www.hbsp.harvard.edu/educators. This publication may not be digitized, photocopied, or otherwise reproduced, posted, or transmitted, without the permission of Harvard Business School.
 
B O R I S G R O Y S B E R G
N I T I N N O H R I A
D E B O R A H B E L L
Barbara Norris: Leading Change in the General Surgery Unit
 
It was 10 PM and Barbara Norris, nurse manager for the large General Surgery Unit (GSU) at Eastern Massachusetts University Hospital (EMU) sat down at her desk to catch her breath. She had been on the unit since 6:30 AM but planned to stay for another two hours to help with the transition from the second to third shift and the orientation of two registered nurses (RN) from the float pool. It had been one month since she had assumed the nurse manager role for the troubled unit. During this time she felt, as she did this evening, tired and overwhelmed.
As nurse manager she was responsible for managing the staff, scheduling and budget for the unit. Her 33-person staff included 25 RNs and eight patient care assistants (PCAs). In her first month as nurse manager she had already lost two RNs and in the six months prior to her joining the unit three RNs had left. But because of the recently instituted hiring freeze at EMU, Barbara was not able to replace some of these positions.
The unit was short-staffed; stress levels were high and employee morale low. In fact, GSU had the
lowest employee satisfaction scores and highest employee turnover rate among all of the departments at EMU. And although its patient satisfaction scores were average, they had been declining steadily over the past few years. Furthermore, GSU was infamous for its culture of confrontation, blaming and favoritism. Relationships were tense not only between the nursing staff but also with many of the unit’s attending physicians.
To make matters worse, over-time could no longer be offered due to additional cost cutting
measures. Hence, if one of her nurses was sick or needed to take personal or vacation time, Barbara could not offer over-time to her own staff to cover such absences but instead had to rely on RNs from the general float pool. But because “floaters” were not familiar with the unit, its specific procedures and care protocols, they more often than not had additional negative effects on staff dynamics and the quality of patient care. Nurse Norris
Barbara grew up in a small town in western Massachusetts. Both her mother and grandmother were nurses, and she developed a deep respect and admiration for the profession at an early age. By
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409-090 Barbara Norris: Leading Change in the General Surgery Unit
2
the time she entered high school she knew that she, too, like her mother and grandmother wanted to be a nurse.
After graduating with honors from the nursing program at Eastern Massachusetts University, Barbara began work at EMU. She worked in the emergency room for four years and moved to the trauma unit about one year before becoming pregnant with her first child. For the next several years she worked part time, one or two shifts per week, had a second child and concentrated on raising her young family.
Barbara returned full-time to the trauma unit and the profession she loved when her children were in grade school. When her two daughters entered high school Barbara, too, was ready for a new challenge and began coursework for a Masters Program in Nursing and Health Care Administration. Her nurse manager, Betty Nolan, who was a mentor and friend, also encouraged her to pursue the Masters in Nursing Administration. Shortly after Barbara completed her program, the nurse manager of EMU’s general surgical unit announced her retirement.
Although GSU’s high turnover and low retention rates were common knowledge throughout the EMU community, Barbara applied for the position in part because she welcomed the opportunity to stay at EMU but also because she welcomed the challenge to try to turn the unit around. After a series of interviews with EMU’s nursing director and administrative leadership, Barbara was offered the job. She consulted with her trusted friend and mentor, Betty Nolan regarding the position in GSU, and Betty did not hold back or mince words: Do not take the job, she cautioned. GSU is a lost cause. Spare yourself the grief and aggravation.
Barbara highly valued Betty’s advice but was also looking for a new challenge in her career and saw the GSU job as an opportunity that was too good to pass.
When Barbara accepted the job, nursing director John Frappewell congratulated her and said, you’re doing the right thing, Barb. I’m counting on you to turn this unit around and do it fast. Barbara thanked him for the vote of confidence but secretly worried that she had taken on more than she could handle.
Also weighing on her mind was the hard, downward turn the economy had taken right around the time she accepted the job. All leading indicators suggested recovery was several months if not years away. EMU’s revenue decreased sharply while costs continued to increase and the hospital leadership had to make difficult decisions to guide the hospital through the economic crisis and to help it stay afloat. They enacted a hiring freeze, stopped all over-time allowance and decreased shift differentials. The administration framed all of these measures within the context of the crisis and for the greater and longer term good. But an overworked and stressed staff could not always muster the good will and foresight needed to take the long view, and tensions were growing in the halls of EMU.
General Surgery Unit (GSU)
The staff in her old organization, the trauma unit, was a close-knit group who worked well together as a team. Many of the nurses were friends, ate lunch or dinner together and some also socialized outside of work. There was a helping culture within the unit; a tone set and finely calibrated by Betty who was respected and well-liked. Betty had earned a reputation as a responsive manager who acknowledged her staff and sought their input on important decisions relevant to the unit.
Soon after Barbara began as nurse manager in GSU, she received requests from 29 of the unit’s staff members for one-on-one meetings and she soon experienced first hand the culture of conflict and blaming she had heard about. For instance, rather than helping and mentoring the newer nursing
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Barbara Norris: Leading Change in the General Surgery Unit 409-090
3
staff, the more senior nurses were often highly critical and complained about them behind their backs. And many of the unit’s RNs including both new and more tenured nurses were frustrated with the PCAs and complained that they had inadequate training and skill sets.
And Barbara also discovered that her predecessor had not kept complete and accurate records of the staffs’ annual performance reviews. Barbara viewed regular informal check-ins and the more formal annual review as critical management tools. And she knew through her own personal experience how open communication and a transparent review system had contributed to her growth and development.
Barbara decided to run an off-site for her GSU staff. At the very least she hoped to provide a forum to begin discussion between members of the unit but her larger hope was that the off-site would inspire the beginning of a turn around for the unit.
The Off-Site
Barbara stood in front of her staff that were not on duty and thus able to attend the offsite. She asked each of them to take a pen and sheet of paper from the basket that was making its way around the room and to write, anonymously, the 2 to 3 things that most frustrated or bothered them about the unit. She then collected all the responses and read them one by one to the group.
Response after response identified lack of collaboration and teamwork, interpersonal and intergroup conflict, doctors who treated them like order takers rather than care givers, administrators who cared more about money than patient care, favoritism, dissatisfaction with staffing levels and performance review procedures… Barbara was blown away by the amount of negativity; she got more than she bargained for with this exercise.
After she had finished reading all the responses Barbara asked if anyone would like to comment or follow up. Her request was met with complete silence. She asked again this time becoming visibly flustered, but still there was no response and just as Barbara was about to ask again Megan Mahoney a recent nursing school graduate who had been on the unit for one year jumped to her feet and exclaimed, you people have no idea how mean you are!
During her month on the unit, Barbara observed Megan to be a very bright and affable nurse who cared deeply about her patients. And in turn Megan seemed to receive a lot of positive feedback from patients and their families.
Megan was upset with some of the senior nurses. I want to feel like I belong and am a member of the team, but I often get indirect negative messages and feedback from you. You make me feel like I am doing everything wrong but won’t address me directly or in a straightforward manner. Megan then shifted uncomfortably in place and her face flushed as she continued to speak. One night a few weeks ago, I overheard two of you talking about me at the desk. She paused and drew a deep breath. You said you were tired of me and all of my questions and called me a pest! Megan’s face fell with this last sentence; her eyes fixed on the floor.
Just then Jennifer Goodwin stood up. Jennifer had worked on the unit for ten years. Barbara had noted Jennifer’s strong skill set especially with new technologies and her wonderful bedside manner. Also, she was one of the few nurses who seemed to go out of her way to help others on the unit.
Jennifer said, I want feedback. It helps me to be a better nurse and to be a better co-worker, but the review process here is a mystery! As is the annual salary increase. I’ve heard that we all receive the same increase regardless of our performance. Is this true? If it is, I don’t think this is fair.
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409-090 Barbara Norris: Leading Change in the General Surgery Unit
4
Jennifer also spoke about how she went above and beyond regarding continuing education requirements and made it a point to bring herself up to speed on all new technologies, although this often meant spending hours of her own time in classes and seminars. I do this because I want to, she said, but I have to admit there’s a part of me that is bothered that I do not receive any type of acknowledgment whether it be verbal or compensatory for my efforts.
Just as Jennifer sat down Louise Scribner moved to the center of the room. Louise had been with EMU for 30 years and worked in GSU for 23 of those 30 years. Barbara knew Louise delivered very good care to patients but noted she was resistant to change, quick to complain and could come across as abrasive to her co-workers.
Louise opened by remarking, sometimes I feel like I spend more time tending to machines than I do tending to patients. She then complained about the support asked for by the younger nurses and PCAs. I don’t have enough time to do my own job, she exclaimed. Everyday I have to make difficult decisions about what I cannot do for patients. I resent this because we have too few nurses in the ward and because some of that staff is inexperienced to boot, I am put in the position of having to pick and choose the care I can give. And after all isn’t that why we are all here? To take care of our patients?
Barbara had planned for this session to last for one hour but they were now passing the 1 ½ hour mark. She was trying to find a way to close the session using some kind of positive take-away. After Louise finished speaking, Barbara stood up and said okay, we have a good overview of our problems but can anyone offer any solutions?
Once again, there was an uncomfortable silence. In the room Barbara recalled how Betty involved the nurses in the trauma unit in decisions regarding staffing to great effect. Barbara said, I do, and smiled. What if, she started, when I’m going to decide on staffing for anything, I involve you? If you tell me, for example, “We need someone to process paperwork on Saturday afternoons,” I can immediately bring that back to a staff meeting and say this is what we have for full time equivalent (FTE). We can either hire a nurse or we can take some of that money and hire a secretarial assistant. What do you want to do? It’s your choice. This is how much money we have. We can take a little bit of the nursing FTE and we can hire a secretarial assistant but we’re going to lose a little nursing time but this is what we have to work with. And you can help me make the decision. I can do the same thing if we have to cut resources.
At the end of the day Barbara sat alone in the retreat center; everyone else had departed but she was using these last few moments to reflect on the day’s events. As she worked through the conversations and revelations, she began to make a list of items that most frustrated or de-motivated her staff:
1. Our culture does not value collaboration and teamwork 2. In GSU you cannot count on others to help you 3. Our work isn’t acknowledged and our contribution often does not feel valued 4. Our job is becoming more administration centered rather than patient centered 5. We do not have enough opportunity to learn and grow 6. Our performance review system is a mystery and does not seem to actually reward good
performers 7. Many assignments are given based on relationships and favoritism 8. We have little input on matters that affect us greatly 9. We feel no one truly defends our interests or advocates on our behalf
Barbara knew she had to set realistic, attainable goals for each item on the list. Could she talk to
her director of nurses and seek a reprieve from the hiring freeze and get more staff for GSU? Would regular unit meetings build community and a healthier culture on the unit? She knew she could
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Barbara Norris: Leading Change in the General Surgery Unit 409-090
5
institute a fair and transparent review process, but she might not have any influence regarding making annual salary increases commensurate with a review outcome. Perhaps there were other forms of acknowledgement she could employ? What should she tell her boss who was awaiting a status report?
 
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