The multi-specialty center located in southern California is a big hospital devoted to offering state-of-the-art medical care. The center boasts an efficient, easily accessible, effective and convenient medical staff. It is certified by AAAHC and Medicare to carry out special treatment and varied surgical operations. The hospital has superior services and provides high-class options to surgical care. “The specialty center has sufficient operating rooms, ample acute recovery rooms and a two station recovery area. The surgery center is also equipped to accommodate a wide range of surgical services” (Friedman, 2007). This case study will focus on the center where it will seek to explain the impacts of different working environments.
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The core challenge in this case study, is the likelihood of individuals (nurses) to work under pressure and how much more or less their output can be when working under difficult conditions from the top arm of an organization. The other challenge is the determination of the impact in effective management plus the effects of stereotype notions within an organization. The paper will also explore the ability of human beings in managing anxieties when working in groups (in a dangerous setting), their ability to work productively yet carefully and how they can remain vigilant without becoming excessively preoccupied by the dangers they face.
Different areas of specialty have their own different challenges. Factors that sometimes push workers over the limit are not in their pay at the end of the year or month. It is in fact the feeling they get when their services are appreciated by their seniors or the people getting the service. This boosts morale making them give out their best; in turn this leads to job satisfaction. In this case, job satisfaction is strongly correlated with job stress, nurse physician collaboration and autonomy in that order.
The modern day southern California multi-specialty centre, is a big hospital whose main buildings cover over one hundred acres of land in Los Angeles bounded by a thick moat of parking lots and charter businesses. A workforce of seven thousand employees is in place, treating some twenty thousand out-patients in a year. The workforce includes over four hundred physicians and 38 medical officers. Among the people who come here are global celebrities as well as common people with unusual illnesses. These people come to specialists at the centre as the last, best hope after an extensive trail of referrals. Key actors here include the physicians, the executive staff and senior staff physicians headed by a president who serves at the discretion of the executive council through which all important decisions must pass. I am a consultant.
The initial trouble at this center is a leadership vacuum created after the executive ran out of ideas to manage and maintain the present facilities in the organization. They were again not committed to the goals of the hospital, which were to strive to be the best institution of its class in the country. This led to the misuse of the institutional recourses and funds an example being, the operating room which was in disorder as a result of feeble nursing leadership, a top –heavy management team, haphazard records and information system plus a widely unbalanced operation schedules. There was also this issue of limited funding which poses a big problem when there is a need to hire more staff to supplement the ever increasing shortage of staff created as result of the expanding business complex. The limited funding again led to the organization using up the money it had set aside to cushion it against the hard economic times. This made the institution vulnerable because the money would not be enough to run the organization. An administrator (Barbara) took note that there were four management layers between her and the organization, the first thing she had to do was to flatten this out since she knew that the many levels in the chain of command make it difficult for people to feel accountable.
However there were other secondary problems that faced the institution; these included the rhetoric that had plagued the institution which denigrated nurses, administrators and other colleagues. There was need for faculty members who challenge others when aggressive remarks about colleagues are uttered. This was for the facilitating the enhancement in inter-professional collaboration among the various staff levels in the employees. Negative rhetoric generally leads to a decline in staff morale. A drop in staff morale could be directly linked to the management and leadership in an institution. Perceptions like ‘nurses should not be bothered with the top management issues of the organization do kill employees’ morale since they will not have a reason to give better services. They generally lacked motivation, which contributed to a split within the organization mostly into two parts, the ‘front-end’ unit which is made of the executives, and the ‘back-end’ unit which consists mainly of the junior staff. This again makes people who have good credentials not to go to the centre; it is because they are dictated on how high up the corporate ladder a nurse can get. The nurses were again not given the opportunity and authority to operate the way they felt was proportionate with their backgrounds.
Hirschborn (2002) suggested that a work group can divide internally in response to unfavorable situations such as difficult or risky conditions and tasks. The division then becomes a social defense, systems of relationships that helps people control and contain feelings of anxiety when facing difficult work. This was the fragmentation that was between the nurses and their superiors. Other problems include; “Autonomy, defined as the ‘Extent to which nurses have the freedom to act on what they know” (Sloane & Lake, 2007) or “the amount of decision latitude a nurse has over work conditions” (Theorell, 2005).
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When nurses are given more power to act in their workplaces, service delivery and general satisfaction is attained as was seen when Barbara took over. Job stress, referred to as the amount of stress nurses perceive in relationship to their jobs and work environment was reduced (Shader et al., 2001).This further led to the reduction of “burnout a condition of emotional fatigue, depersonalization, and low individual accomplishment that occurs among persons who work with groups at the center” (Maslach & Jackson, 2000). Another aspect that was reduced was, “emotional exhaustion Physical tension, overworking, and role conflict” (Burke, 2001). Work frustration, Work surroundings demands that make difficult achievement of tasks were again eliminate. This led to nurse–physician collaboration jointly sharing information for decision making and problem solving (Bruffey, 2007).
Organizational strengths and weaknesses
The strengths of the southern California multi-specialty centre lie in the available resources at the institution. At the time Barbara Stracher came to the center, it was in a dilapidated situation. The present day hospital however includes state of the art operating rooms that are currently modernized. The center has over 50 rooms most of which are wholly staffed throughout the day. They again run over 100 cases daily and over 5,000 surgical procedures performed annually.
Another one of its strengths is the fact that it is highly rated and the public holds a high opinion about it. This is supported by the number of people they serve, (over five hundred thousand annually) and the high profile international celebrities and the ordinary people with extra-ordinary diseases who come to specialists as their last, best hope of survival. Up to date physicians do not contract with the centre like in private institutions nor does it grant admitting privileges, but then they receive lower remunerations and this generally does not go well with the physicians.
The institution’s weights and scale of compensation in its favor is at par with the additional incentives that reflect the importance placed on professional recognition and scientific achievement. These include technical and secretarial support for research, as well as guarantees of flexible scheduling to allow time for research and travel. The executive council is again made up of the senior staff physicians, and it is headed by a president who serves at the discretion of the executive council through which all important decisions must pass. This has fostered physician-administrator allegiances among staff that many describe as akin to family relationships. The management was also not keen to what was happening as momentum was building among the nurses at the centre for increased authority, as was happening in other institutions. Another problem at the center is that of job stress caused by several factors such as new technology, staff shortages, unpredictable workload, and a poor workflow.
The other threats this institution is facing include the tainting of its own image and sub-serviced equipment could more or less portend a health hazard even to the staff. A tainted public image could also change peoples’ perception about the hospital and this could possibly push its customers and other potential investors away. They would then not get the funds to run even the basic operations leading to its ultimate downfall. Management is also a major problem as it is in a way unable to run and manage the resources of the center effectively.
Alternative course of action
Faced by the myriad of problems, the organization initiated actions to save itself. In the face of all this problems, it had a reputation to protect, guard the confidence of the people including the international celebrities and other prominent figures in the society without breaching its ethics code. The administration of the center decided that it should at all costs uphold integrity. The options now available include, saving money that is used to pay the people acting on various capacities in the many levels of the organization. This is a lot of money that could have been put aside from time to time to help the institution cushion the effects of the adversity of their economy. It could also be used to purchase more equipment so that the hospital could diversify on the needs of its clientele base, this would have led to the overall growth of the organization.
Currently the changing of some of the policies that cover the organizations rules has done the hospital a lot of good. Some of the changed policies included the writing down of a very long list of paraphernalia that a nurse may need time and time again. This used to create a negative perception among the nurses, as it made them feel inferior because the other staff did not do the same. It used to make them feel they are the lesser employees; this hampers their productivity since their surroundings’ aren’t conducive as a work environment. Policies have also been put in place that take care of the worker’s rights. These policies do not only make them comfortable in their various working conditions but also makes them accountable.
To take care of these issues, the board of directors was to consider a total overhaul of the leadership. Most of the leaders at the center have been there for a long time, they practice the same ideas and systems of management that are threatening to bring the hospital down to its knees. They are the same people with oppressive notions towards the nurses yet nurses are an integral part of the institution. The same people have the same ideas and mentalities, which will not bring good to the organization; instead sinking it further down the drain.
Plan of action
Something ought to be done about this situation at the hospital, a meta-analysis on the workers and their environment to ascertain the root cause of the problems. Blegen (2003) using his moderator analysis (a process which entails exposing the nurses to certain conditions and analyzing their reactions in relation to factors around their workplace such as authoritarian leadership, new technology, staff shortage, unpredictable workload and poor workflow), improved standards in the above conditions leading to delivery of better services. This is because the major problem at the hospital is as a result of several internal factors. If handled well, like in Barbara Stracher’s case; there will be a general change in the attitude of the employees and a fresh impetus to produce better services by the nurses will be realized.
The strategies for improving the situation at the center will be proved fruitful when infighting among the employees decreases, accountability is restored and proper management of resources is available. Again they will be successful when the general attitude at the work place is geared towards helping people and improving the standards of work. On the contrary using the hospital as a bridge of success to other levels outside the organization would further lead to its downfall. It would also be a success when the institutional resources are fully utilized, the machines are working efficiently and no member of the staff feels inferior. Barbara Stracher made this her practice; eventually she won the support of the whole staff. She used this opportunity to steer the institution towards a path of discipline, mutual respect and the motivation and protection of the inferior staff. These incentives were responsible for catapulting the institution to one of the best multi-specialty centre in the country currently.
“The physicians, nurses and other staff at the institution share the same vision and intimately understand the rapidly changing environment of health care” (Friedman, 2007). As a result of this interaction, the institution has an even greater ability to identify and get the different approaches to a problem. Improvement in such areas as strategic planning, system development and implementation, management and network development has also been realized. This has boosted the overall ratings of the institution.
The multi-specialty center was initiated to offer physicians and ailing individuals with a high quality and specialized alternative to all types of surgical procedures and referral services. Currently the center is equipped to accommodate a wider selection of surgical procedures. The procedures include “Podiatry, plastic/reconstructive surgery, orthopedic surgery, obstetrics, pain management, infertility treatment and other general procedures” (Friedman, 2007). Despite the challenges expressed in this case study, the center is currently rated among the best multi-specialty centers in the country. This is due to the improvement in strategic planning, better policies, networking, discipline, mutual respect, motivation and dedication. The center has greatly improved due to the initiation of working policies ethical practice and accountability in its management. Due to these incentives the center has an even greater ability to identify and get different approaches to predicaments.
Blegen, M. (2003). Meta analysis change in nursing, New York, NY: Inter-science publishers.
Bruffey, L. (2007). Nurse-physician combinations. New York, NY: Dorrance Publishers.
Burke, D. (2001). Stress management in nursing. Antya. AY: Medical publishing house.
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Friedman, B. (2007). The southern California Multi-specialty center. New York, NY: Inter-science publishers.
Hirschborn, F. (2002). Handling oppressing leadership. London: oxford university press.
Maslach, R., & Jackson, D. (2000). Major accomplishments in nursing. International journal of medical informatics 45(3) 19-21.
Shader, et al (2001). Relationships in nursing and job ethics. New York, NY: Oxford university press.
Sloane, W., & Lake, D. (2007). Autonomy in the practice of nursing. London: McGraw Hill publishers.
Theorell, C. (2009). Major decisions in nursing. International journal of medicine 57(5), 8-11.