Case study 2:

The Sullivan Hospital System. At the Sullivan Hospital System (SHS), CEO Donald Fulton expressed concern over market share losses to other local hospitals over the past 6 to 9 months and declines in patient satisfaction measures. To him and his senior administrators, the need to revise the SHS organisation was clear. It was also clear that such a change would require the enthusiastic participation of all organisational members, including nurses, physicians and managers. At SHS, the senior team consisted of the top administrative teams from the two hospitals in the system. Fulton, CEO of the system and President of the larger of the two hospitals, was joined by Mary Fenton, President of the smaller hospital. Their two styles were considerably different. Whereas Fulton was calm, confident, and mild-mannered, Fenton was assertive, enthusiastic, and energetic. Despite these differences in style, both administrators demonstrated a willingness to lead the change effort. In addition, each of the direct reports was enthusiastic about initiating a change process and was clearly taking whatever initiative Fulton and Fenton would allow or empower them to do. You were contacted by Donald Fulton to conduct a 3-day retreat with the combined management teams and kick off the change process. Based on conversations with admnistrators from other hospitals and industry conferences, the team believed that Total Quality Management (TQM) would be an appropriate intervention for two primary reasons. First, they believe that improving patient care would give physicians a good reason to use the hospital thus improving market share. Second, the primary regulatory body. The Joint Commission on Accrediaton of Healthcare Organisations (JCAHO) had enacted policies some time ago encouraging hospitals to adopt continuous improvement principles. The team readily agreed that they lacked the adequate skills and knowledge associated with implementing a TQM process. This first meeting was to gather together to hear about the history of TQM and the issues that would need to be addressed if TQM were to be implemented. In addition, you guided them through several exercises get the team to examine methods of decision making, how teams solved problems using TQM processes, and to explore their understanding of the hospitals current mission, goals, and strategies. BM020-3-M-MO Page 4 of 5 Level M Asia Pacific University of Technology and Innovation 012021 Although you were concerned about starting the process with a workshop that explored a solution rather than understanding the problem, you remembered Roger Harrisons consulting rule, Start where your client is at, and agreed to conduct the workshop. You were assured by Fulton that the hospital system was committed to making substantial changes and that this was only the first step. In addition, and in support of this commitment, Fulton tells you that he has already agreed in principle to begin a work redesign process in a few of the nursing units at each hospital and has begun to finalise a contact with a large consulting firm to do the work. The workshop was highly praised and you convinced the team to hold off long enough to conduct a diagnosis of the system. Following the retreat, your diagnosis of the SHS organisation employed a variety of data collection activities including interviews with senior managers from both hospitals as well as a sampling of middle managers and staff (for example, nurses, ancillary professionals, and environmental services providers. Questions about the hospitals mission garnered the most consensus and passion. That was almost unanimous commitment that played a prominent role in the delivery of those services bby a Catholicsponsored health care organisation such as SHS. A mission and values statement was clearly posted through the hospital and many of the items in that statement were repeated almost verbatim in the interviews. From there, however, answers about the organisations purpose and objectives became more diverse. With respect to goals and objectives, different stakeholder groups saw them differently. Senior adminstrators were failry clear about the goals listed in the strategic plan. These goals included increasing measurements of patient satisfaction, decreasing the amount of overtime, and increasing market share. However, among middle managers and supervisors, there was little awareness of hospital goals or how people influenced their accomplishment. A question about the hospitals overall direction or how the goals were being achieved yielded a clear split in peoples perceptions. Some believed the hospital achieved its objectives through its designation as the areas primary trauma center. They noted that if someones life were in danger, the best change of survival was to go to SHS. The problem, respondents joked, was that after we save their life, we tend to forget about them. Many, however, held beliefs that could be labelled low cost. That is, objectives were achieved by squeezing out every penny of cost no matter how that impacted patient care. Opinions about the policies governing the hospitals operation supported a general belief that the organisation was too centralised. People felt little empowerment to make decisions. There also were a number of financial policies that were seens as dictated from the corporate office, where shared services existed, including finance, marketing, information systems, and purchasing. Further, several policies limited a managers ability to spend money, especially if it wasnt allocated in budgets. In addition to the managerial sample, a variety of individual contributors and supervisors were interviewed either individually or in small groups to determine the status and characteristics of different organisation design factors. The organisations policy and procedure manuals, annual reports, organisation charts, and other archival information were also reviewed. This data collection effort revealed the following organisation design features:

The hospitals structures were more bureaucratic than organic. Each hospital had a functional structure with a chief executive offier and from two to five direct reports. Both hospitals had directors of nursing services and professional services. The larger hospital had additional directors in special projects, pastoral care, and other staff functions that worked with both hospitals. Traditional staff functions, such as finance, procurement, human resources, BM020-3-M-MO Page 5 of 5 Level M Asia Pacific University of Technology and Innovation 012021 and information services, were centralised at the corporate office. There were a number of formal policies regarding spending, patient care, and so on.

The basic work design of the hospitals could be characterised as traditional. Tasks were narrowly defined (janitor, CCU nurse, admissions clerk, and so on). Further, despite the high levels of required interdependency and complexity involved in patient care, most jobs were individually based. That is, job descriptions detailed the skills, knowledge and activities required of a particular position. Whenever any two departments needed to coordinate their activities, the work was controlled by standard operating procedures, formal paperwork, and tradition.

Information and control systems were old and inflexible. From the staffs perspective, and to some extent even middle managements, little, if any, operational information (that is, about costs, productivity, or levels of patient satisfaction) was shared. Cost information in terms of budgeted versus actual spendingwas available to middle managers and their annual performance reviews were keyed to meeting budgeted targets. Unfortunately, managers knew the information in the system was grossly inaccurate. They felt helpless in affecting change, since the system was centralised in the corporate office. As a result, they devised elaborate methods for getting the right numbers fro the system or duplicated the system by keeping their own records.

Human resource systems, also centralised in the corporate office, were relatively generic. Internal job postings were updated weekly (there was a shortage of nurses at the time). There was little in the way of formal training opportunities beyond the required, technical education reuqirements to maintain currency and certification. Reward systems consisted mainly of a merit-based pay system that awarded raises according to annual performance appraisal results. Raises over the previous few years, however, had not kept pace with inflation. There also were various information recognition systems administered by individual managers.

questions:

3. Explain and discuss in details using a diagram, what is the organisations current structure of Sullivan Hospital Systems. In addition, further discuss in details the key differences of the organisational structure.

4. Discuss in details some of the critical employee involvement issues in the case study, and further suggest to the senior mangement team on how to resolve these issues effectively.

please answer it in details more than 550 words.