The purpose of my presentation is about the findings and giving recommendations for the problems in the Parkway in the operational level. In order to attain the growth and profit the organization has to sacrifice some short term results for the long term success.
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2. SURVEY RESULT
The survey shows that, the enrolment of patients has been increased year by year, but on the other hand there were many problems booming around the parkway, particularly injuries for the staffs. If they were not aware of that, it will affect the company’s growth as well as profit and they will be less familiarized among the people for their quality of care.
In the mean while, they were lack in motivating the faculty member and they may lose their existing staff members, which gives them a big challenge for recruiting the new staff and giving training that increases the operation cost. These problems will definitely make it difficult to face the stake holders especially the venture capitalist.
FIGURE: 1 – Patients Data
FIGURE: 1 Source: created for the assignment from the given data given in the case study.
3. PROBLEMS IDENTIFICATION:
Parkway is consider as one of the best health care facilities in all over the world and it has won numerous awards and achievements and if they fail to look after these problems they may get a great loss in their growth and profit.
FIGURE: 2 – Problem identification
FIGURE: 2 Source: created for the assignment from the given case study
As the years pass by, the health group focus on expanding beds and enrolling more number of patients in the hospital, but the strength of the nursing staff is less, there staffing problem occurs, its due to the following reasons,
In adequate experience staff
Lack of time management
Lack of cohesiveness
Lack in solid nursing skills (new staff)
Imbalance work life and family balance
Over work load
These problems arouses in the nursing care and it affects the patients in lack of quality care and the staffs in injuries and the management in the recruitment of new staffs and providing training for them. The following things can be done for the above mentioned problems
Proper flexible timings
Nurse staffing ratios should be increased according to the number of patients
Training and development
Packages and allowances can be given for better performance staffs
Good planning and organization skills for the organization(includes both long term and short term plan)
If they fail to ignore the staffing problems, they may lose their well experienced staff as well as increase in the operating cost.
According to Maslow theory,
FIGURE:3 – Maslow theory
FIGURE:3 Source:created for the assignment (google images)
The nursing staff concern more about their basic needs and their safety needs in their life. It’s the duty of management to take care about the staffs in both basic and safety needs to maintain the staff position in their organisation.
(ii) Physical demands
The physical demands refer to the injuries occurs at the time of work, most of the nurses working in parkway were females, so they have to face a lot of work injuries during their work hours. They weren’t strong enough to do some of the physical jobs especially,
Reposition a bed bound patient
Greater patient loads,
Job hazards such as needle stick injuries, violent patients, back injury from moving patients.
Shift work, working on call, or working week ends
Inadequate staff members
Working in emergency environment
These problems usually occur at the nursing units especially in the patient’s room. Here both the nurses and the patients were affected. Mainly the quality of service is affected and which loses a good reputation about the Parkway among the people. In order to overcome this situation the management can appoint some male nurses/care takers.
Documentation plays a vital role in the health industry; the purpose of the documentation is to get an accurate and complete, reflecting a picture of the patient while under the supervision of each nurse. It assists the subsequent faculty to check the patient’s status. The traditional method of maintaining the documents has been pushed back by the improvements in the IT sector and also the purpose of maintaining the e-documentation by is urged by the government to prevent abuse of patient’s record.
The older care givers, who were inexperienced in using the technology, will surely hesitate to accept the e-documentation. These problems occur in the nursing care itself and it affects the people who were in lack of using computer skills (Old staffs) and also the management, in order to give training for the existing faculties.
To overcome this situation, the management can conduct meetings and in service training programs for the inexperience staffs and explain about the advantage of using e-documentation. It’s necessary to intimate the old care givers (nurses), the implementation of e-document is not a sudden process and it’s urged by the government not by the management.
(iv) Focus on filling beds:
Initially Parkway has less number of nursing homes and they gave a better service for the patients, as the years move on they focus on profit and growth by filling more number of beds, getting more number of patients is also serious for them because of the management problems. It happens because of the Management and it directs the marketing people to focus on filling beds. it affects the patients, nurses as well as the management. The Management can slow down the enrolment of patients in the hospital and focus more on the existing hospitals for providing a better quality care.
4. CHANGE MANAGEMENT STRATEGY
Change is the only constant – Heraclitus, Greek philosopher.
(i) Forms of resistance
Each and every profession has undergone many changes. Over the past few decades, there is a plenty of changes in the nursing profession. In order to attain a good career path, the nursing staffs should be interested in learning the trends in nursing jobs
Mostly people hate change because they don’t like being changed. As changes are approaching towards people, there comes fear and resistance. The resistance may be active or passive, individual, aggressive. Usually people dislike changes for the following reasons.
Fear to lose something they value(e.g. their position or rank)
Misunderstood the change and its applications
Feel difficult to cope up with the new trends.
FIGURE:4 -Types of Resistance:
FIGURE:4 Source: created for the assignment
The resistance change can be classified three groups.
Organization level resistance
Group level resistance
Individual level resistance
Organization level resistance:
It includes the Power and conflict: It occurs when the change may supports for one group and harms other group within the organization.
Differences in functional orientation:
Each and every department with different functions will face the problems and issues in a different way.
People working” within a mechanistic structure are expected to acting certain ways and do not develop the initiative to adjust their behavior to changing conditions”(George et.al)
Group level resistance:
It includes resistance to change due to group norms, group cohesiveness and group think and escalation of commitment.
Individual level resistance:
It includes resistance due to uncertainty and insecurity, selective perception and retention and habit.
Overcoming resistance to change:
The following ways help the staff to overcome the resistance:
Education and environment
Participation and involvement
Facilitation and support
Manipulation and co-optation
Negotiation and agreement
Explicit and implicit coercion
Resistance occurs due to the following reasons,
Too much of work
Relationship with the staffs
Lack in communicating each other
(ii) Resistance in Parkway
The problems which include staffing, physical demands, documentation and focus on filling beds have different resistances among the staffs and the management.
It’s the major problem and staffs are the valuable assets to the organization. The focus on filling beds has been slow down or else sufficient staffs can be appointed according to the number of patients. Better performing staffs should be motivated through monetary and non monetary funds. By organizing some good events (family gathering) will definitely build good relationships among the colleagues and also rejuvenates them.
In general people will look for the safety and healthy in every organization, Parkway is also not an exemplary. The mandatory overtime and reposition with bed bound patients has to be changed. It can be changed by bringing new equipments and appointing male staffs to carry or lift the stout people. Everybody will agree while implementing the change except the experience staffs those who know how to handle the bed bound patients. The experience staff may resist because of their job security, where they can lose their jobs because of the new equipments can reduce their man power.
Maintaining and recording document also an important factor in nursing industry. Nurses are well accustomed in using pen and paper for the document process. The implementation of e-documentation is certainly unacceptable by the old (experience staff). They resist because of their job security and difficult to learn new things.
FOCUS ON FILLING BEDS
The enrolment of patients in the hospital has to be slow down for a particular time, as they have to focus more on the better quality service and developing the existing health care center by implementing the recent technologies. The marketing cum sales team as well as the management were affected by this change. It’s because the marketing people cannot get high pay or commission and also it affects the organizations turn over and growth.
Overcoming the resistances in Parkway
John Kotter of the Harvard business school has followed the Lewin’s three step change model for the approach of implementing changes in the organization.
The kotter’s eight step for plan as follows:
The major problems in parkway are staffing, documentation, physical demands, focus on filling beds
FIGURE:5 – Kotter’s eight- step plan
http://1.bp.blogspot.com/_CMBecWVvif4/TTMQ5nOuh3I/AAAAAAAAAGM/HHmc8LRRhDU/s1600/steps1.jpg FIGURE:5 Source: Google image
Let’s take the problem of e-documentation:
The management should develop a sense of urgency around the need for change and they can develop scenarios showing what could happen in future and also explain them through honest discussions. Eg. less paper work ,easily accessible documents by all. To attain growth as well as success, planning occupies an important role. Before moving to the next step, the management should spend sufficient time before taking decisions. Then create awareness about the implementation of e-documentation and it was the decision taken by the government and not the management. Thirdly, when we try to implement some things, sudden of us there will be many ideas and solutions floating around in our mind. Link and connect all these concepts, so that people can easily understand the management vision. Next stage is communication, mutual exchange of information is needed while transforming their ideas.
It’s should be clearly stated that to the staffs, proper training and guidance will be given for the e-documentation. Motivate and encourage the senior staff by creating short term wins. Appreciate and reward the people who ever achieving the short term targets. Improve the changes needed for the situation and support them in every way.
Sources of resistance
It comes from the three major sources,
Threats to a person’s position and power
It’s mainly based on the concerns about whether proposed change is a good idea.
Change often creates anxiety, much of it related to what people fear they might lose. (Berman -Rubera,2008 johnston,2008). As per Maslow hierarchy of needs, the basic needs must be at least partially fulfilled before moving to the higher order needs.
Threat to a person’s Position and power:
It’s strongly accepted that, once power has been gained from an organization, it’s hard to give up their status, power and influence.
Creating a leadership strategy
Leadership is an important role in effective and successful management. Every nursing leader or nursing supervisor therefore needs to develop the skills of leadership. It’s the duty of the organization to identify the business challenges in the health industry and it can be analyzed through the annual report of the industry. The management should create awareness and achieving towards to their mission values.
Review the business strategy
It is highly recommended to analyze the company’s market trend and identifying the challenges in the organization. In order to maintain the company’s profit it is essential to get more number of patients, getting into new market and expansion of their networks in different places by providing excellence patient care. To improve the business strategy for the organization they should distinguish among the competitors in the levels of service, quality, innovations..
Recommended leadership styles
Leadership styles in nursing management play a vital role in the management. A nursing leader might either be a nurse manager or nurse supervisor is responsible for the operations of all patient care services. An effective nursing leader must employ the leadership skills according to the situations and the problem faced by her in the group. It’s also the manner of providing directions, implementing plans and motivating people towards success.
FIGURE:6 – Leadership styles
FIGURE:6 Source: created for the assignment
In parkway health care, in order to get the best results and work dedication from the staff it is essential for a leader to chose a good leadership styles. It is also described as the ways and behaviors of a leader towards his team members. There are many ways of describing the leadership style suchas dictatorial,bureaucratic,benevolent,charismatic, participative and abdicatorial. The way of approaching and dealing with the team mebers is very important I n the organisation.
As a consultant I can recommend here the charismatic leadership styles and situational leadership style. In situational leadership style the leader used to define the role and allow the followers to go in the right path and act according to the situations as the leader has to face different problems with differrent personalities.the charismatic leadership styles also allows the follower to impress the leader and they work hard to attract the leaders and it is suitable for only a short term process,here the leader provides an environment mounted with full of energy and positive reinforcements.
The following facts are consider as essential for the leadership skills,
Occupational skills(solid nursing skills)
Organizational skills(time management, survival skills, personal growth essential ingredients)
Human relationship skills (effective use of verbal and non verbal communication)
As we see the parkway case, the total number of staff has been decreased year by year, it might be the job dissatisfaction by the employee or poor leadership skills and organizing possessed by the nursing leaders, and if this situation leads there will be a sudden loss for Parkway.
To overcome this situation, the management should concern about the stability of employee in Parkway. It’s better for them to choose transformational leadership and a good nursing leader should not stick to a particular leadership style. He/she should use the style that needs according to the situation.
FIGURE:7- Inspirational motivation
FIGURE: 7 Source: Google image
Leader behaviors of home directors
As Parkway group is a large group with many home directors. The role of nursing home directors in Parkway health plays an important role in communication process. They convey the message from the top management level to the operation management level. They should poses communication skills to avoid confusions and conflicts and good planning and organizing skills for better administration and managing the team members. The other noblest qualities such as mutual respect, corporate culture, delegation, unity of command, span of control and short chain of command. Good leaders are all good followers. The management can give chances for them in decision making and planning the organization in case of urgency. They are the good communicators between the management and other staff.
Leader behaviors of nurse supervisors
The nurse supervisor plays an eminent role between the management and the staff. They can be polite and considerate to all, not arrogant as they have to see and know the real situations in the nursing care units. He/ She should be helpful while giving instructions or explanations about an event or plan. They can also be a good communicator between the nurse home directors and staffs and receives feedback from the staff and patients for the betterment service in their units. The nursing supervisor can act as a mentor as well as a good facilitator in order to solve their staff personal problems.
6. Job stress in parkway
Sources of stress:
The stress where it’s defined from a demand perception response” and it’s triggered when there is a mismatch between two (especially individual as well as individuals perception of the ability). Selye (1956) has defined stress as the non specific response body to any demands made on it.
People often think stress may be a work pressure, rush hour traffic, or sick children. According to Selye, stress is the fight or flight response in the body caused by adrenaline and some other stress hormones causing psychological changes such as increased heartbeat, high blood pressure, increased blood sugar, faster breathing, and dry mouth.
The reality of stress in the nursing workplace
Everyone in their profession experience stress in different ways, particularly in nursing /health care industry,75.8% of surveyed nurses experience the stress in their field, virtually they were cited by the acute and chronic effects of stress ,the following were identified as sources of workplace stress for nurses.
Inadequate staffs cover
Relationship with other clinical staff
Leadership and management style
Poor focus of control
Poor group cohesion
Lack of adequate supervisory support
Coping with emotional needs of patients and their families
Poor patient diagnosis
Death and dying
Changes in technology
Constant changes in nursing care delivery
Elder and child care issues
Work place violence
Lawsuits related to job stress
Demands of accreditation/compliance issues
Pressure for immediate results
Colleague’s in experience.
EXTERNAL AND INTERNAL STRESSORS
External stressors include mainly physical conditions or stressful psychological working environments. Internal stressors also affected by both physical and psychological and they mainly worried about the forth coming events.
Potential sources of stress:
The potential sources of stress arise due to the inability of individual or a group. It includes the following factors,
The implementing of new technologies and change in the organization structure can also cause stress to the staff because it’s a challenge for the employee’s skill and its difficult to adapt it easily in a short period of time.
It occurs when there is a target set by the organization that includes over workload and unpleasant colleagues and it includes the task demand factors( individual job potential , working conditions)
FIGURE: 8 – Roles Demands
FIGURE:8 Source: Created for the assignment
All the above factors such as role conflicts and over load occur when the employee is expected to work more than the time limit. The pressures created by the co workers relates to the interpersonal demands.
It influences more about the employee personal life, its particularly concern about the family issues, financial problems and different personality characters.
Consequences of stress
Stressors are additive and it results in various problems which includes physiological, psychological and behavioral changes to an individual
TABLE:1 – Consequences of stress
Loss of memory
Foot or finger tapping
Hair pulling or twirling
Gain or loss weight
Pacing the floor
Inability to make decisions
Sudden change in the social habits
Rapid or difficult breathing
Periods of confusion
Loss of interest in physical appearance
High blood pressure
Wrinkling fore head
TABLE: 1 Source: 60 second stress management by DR. ANDREW GOLISZEK 2008
The main stress in the parkway nursing care is shift allocation and over work load due to increase number of patients. Next come the issues of physical demands and absenteeism due to personal problems for the faculty and it’s hard to maintain their family work balance. Then the documentation also creates a lot of stress to the experienced staff where they feel difficult to adapt it quickly.
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The management should concern about the faculty as they are the valuable assets to the health care and occupies an important role in the growth of the company. They can overcome these problems by proper time management plan and organizing skills and support the experienced staff in all the ways for e documentation and also the management can make sure about that the work is evenly divided and properly utilized and gives them feedback by a mentor from their group, which helps them to learn more things and build a good relationship among the colleagues.
Through the mentor, they can gain support for their career development which includes attending trainings, even they can share their opinion about the organization which helps the organization to serve them in a better way. Employees are highly stressed because they are mounted by too many responsibilities and work. Here some statements are given which can be reduced using in Parkway to the avoid the stress among the employees
Mistrust, unfairness and office politics
Unclear policies and no sense of direction
Career and job ambiguity
No feedback- good or bad
Lack of communications
The greatest stressor in the workplace is “lack of control”
Apart from all these things they can create interest among the employees in their work and provides sufficient period of training for e-documentation. Promotions and incentives can be given to the employees and transparent communication can be used to avoid unnecessary conflicts among the employees. Sabbaticals can be given to the employee those who are interested in pursuing research in their career. Health wellness programs can be organized that helps them to rejuvenate and relax in their work and life. Here comes some modalities to get away from stress, that includes Yoga, Ta chi, Dance, Music, Massage, Journaling, Cognitive restructuring.
Stress management plan
ABC (Awareness, Belief and Commitment) of stress management:
Frances Johnston (1994) suggested using the ABCs of stress management (awareness, belief and commitment)
Aware-The staff should be aware of their individual responses to stress,
Believe – The concern people affected by stress should have a belief that they can overcome by their behavior,
Commit- The causes of stress can be easily overcome by preventing conflicts and learn new techniques which prevent you from the stress and understand yourself how to react in stressful situations.
All aspects of life are inseparable and inter related -the people mental, physical, emotional, physical and social/ relational aspects are all inter connected and intertwined. Mostly nurses spend much of time with the patients and teaching them how to keep them healthy and lead a happy life, but they are not following in their life. They can apply some of the principles in physical health management and mental health management.
Physical health management which includes deep breathing, good posture, rest, relaxation, proper nutrition and exercise (davidhizar, 1994; posen, 2000; wolinski, 1993)
FIGURE:9 – Physical and mental health management
FIGURE:9 Source: Created for the assignment
Its quite common people use only 45% of their lung capacity when they breathe .It reduces the amount of oxygen supply to the brain and cause them to feel anger, especially at the time of stress. It’s quite interesting you can calm yourself by taking a few deep breathes.
Relax your abdomen and shrug your shoulders a few times to loosen the muscles.
Sleep is an essential thing to relax our body, soul and mind and also it varies with individual. Find out the amount of sleep required for you and arrange your planning and activities according to that and also do the following activities, which keeps you fresh and active throughout the day. Yoga, transcendental meditation, relaxation tapes or music, favorite sports or hobbies and quiet corners or favorite places.
The following methods have been used to reduce stress among the hospital workers (Huckabay and Jagla 1979; Bailey et al. 1980; Koran et al. 1983):
Institution of stress management programs
Regular staff meetings and discussions to communicate feelings, gain support and share innovative ideas
Readily available counseling for a non judgmental source
Flexibility and innovation by supervisors to create alternative job arrangements
Reasonable shift schedules for house staff to other allow adequate time for sleep each day
Group therapy for staff with particularly difficult professional problems such as dealing with cancer patients, chronic illness and death
Organized and efficient work functions environment
Recognition of and action on legitimate complaints regarding overbearing physicians and supervisors
Frequent in-service educational sessions and other opportunities to improve skills and their confidence
Individual approaches such as relaxation exercises and bio feedback to relieve symptoms of stress until the sources are identified and evaluated
More flexibility and worker participation in scheduling
Scheduled rotation of unit assignments
Parkway staffs have been more affected by the stress and the management can concern about this issues and find solutions to overcome the problem. Time management skills is needed to avoid the stress among the people during the shift hours, proper sleeping hours and increase the vacation time which helps to maintain the work family balance. Motivate and encourage them in all possible ways to have a safe and happy work environment.
Organization should come forward to reduce the stress and it helps them to gain the employees stability in the organization.
The national institute for occupational safety and health has identified factors that lead to a healthy, low stress work place (Judkins, Reid, &furlow, 2006: sauter et al., 1999):
Employee recognition for performance
Opportunities for career development
An organizational culture that values the individual
Management decisions that are aligned with organizational values
Collaborative practice and shared governance models.
There is no right way or solution to manage stress and avoid burn out. The ultimate thing is , control yourself and say some positive or motivational words to yourself(e.g. I choose to enjoy this moment)
Parkway, one of the leading health care industries which offer a good service in the nursing sector. Since it has got good reputation among the people, it has to maintain the standards and their quality of care in the nursing care units. As lots of problems has been booming around in the Parkway, it’s essential to rectify the short term problems rather than solving the long term problems. Especially the staffing problems and physical demands should be solved as early as possible than the documentation and focus on filling beds, which helps to maintain a good relationship among the staffs and also creates an interest towards the employee to work in an organization. To maintain a great profit and growth, the management has to take some risks and experimentation. Proper planning, good administrative, organizing skills and time management skills definitely leads a great success for every organization.
Number of figures
Figure: 1 – Patients data
Figure: 2 – Problems identification
Figure: 3 – Maslow theory
Figure: 4 – Types of Resistance
Figure: 5 – Potter’s ei
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