Organizational Assessment: St. Francis Hospital

Organizational Assessment: St. Francis

HospitalAlicia Steadman, BSN, RNUniversity of Indianapolis

I will look at the ideal and actual:◦ Organizational Information◦ Organizational Culture◦ Resources◦ Outcomes◦ Human Resources◦ Policy

Then, a SWOT analysis will be performed based on this information

Overview

Organizational Information

Ideal◦ Matrix Organizational form

“has the flexibility to adapt to change and to deliver services innovatively and efficiently” (Huber, 2010, p.413)

◦ Open Systems Theory/Contingency Theory Open and adaptive to the environment Complement the environment as well as technology

(Huber, 2010)

Organizational Structure

Actual◦ Program Organizational Form

“Although the corporate structure is shared, each program tends to operate as a semi-autonomous unit with its own management team” (Huber, 2010, p. 412)

Sometimes difficult to coordinate services Isolation from other healthcare professionals

Organizational Structure

Senior Management Team

Medical-Surgical Services Emergency Services

NursingPharmacyPT/OT/RT Respiratory

Therapists

PharmacyNursing

Actual◦ Human Relations School/Participative Decision

Making Democratic leaders who are also open

communicators Improved cooperation between management and

workers (Huber, 2010) System may be viewed as “closed” because it is

difficult to adapt to change Emphasis on the informal aspects of organization

social structure

Organizational Structure

INSERT NURSING ORGANIZATIONAL CHART

Organization Structure

Ideal◦ Flexibility

“In every situation, there is some leadership style that will be effective” (Howell, Bowen, Dorfman, Kerr, & Podsakoff, 1990)

◦ Well-Defined Professional Expectations “an approach to an occupation that distinguishes it

from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment” (Huber, 2010, p.5)

Well-defined with clear expectations and goals of the employees (Weshenfelder, 2005)

Leadership and Professionalism

Actual◦ Flexible, but well-defined expectations

Journey to Success program

“Effective leadership requires a continuous commitment to skill development and core leadership values” (Franciscan Alliance, 2012)

This program emphasizes mentorship, understanding the values and beliefs of the organization, process management, motivation, business ethics, change management, and project management

Leadership and Professionalism

Actual◦ Well-Defined Professional Expectations

Franciscan St. Francis Health Nursing Professional Practice Model approved on 07-05-2011

Components include: Mission and values Patient and family centered Evidenced-based practice Healthy work environment Professional practice Shared leadership

Leadership and Professionalism

Ideal◦ Constant interdisciplinary collaboration at all

levels Collaboration can improve quality outcomes, patient

safety, and reduce health care costs (Dickey, Truten, Gross, & Deitrick, 2011)

Should be done at management level and at the bedside

“Interdisciplinary teams are considered to be essential for the effectiveness of health care organizations and for patient safety” (Huber, 2010, p.236)

Level of Interdisciplinary Collaboration

Actual◦ Selective Interdisciplinary Collaboration

At management level, interdisciplinary approach prevails

At bedside, difficult to bring everyone together

Management is currently working towards interdisciplinary rounds on every inpatient unit

Level of Interdisciplinary Collaboration

Ideal◦ Communication Assessment

Accessibility of information

Communication channels

Clarity of messages

Span of control

Flow control/communication load

The individual communicators (Farley, 1989)

Communication Style and Processes

Actual◦ Communication Assessment

Accessibility of information Access through various resources

Communication channels Whom to talk to/management levels clear

Clarity of messages Pretty clear and concise

Span of control 20-30 nurses

Flow control/communication load Low control of flow

The individual communicators (Farley, 1989) Varies by employee, but professionalism helps

Communication Style and Processes

Ideal◦ Participative change

“the more that a planned change is driven by authoritarian actions, the more that the seeds of future discontent are sown” (Huber, 2010)

Allow participation Help followers process, adapt, and cope Leaders need to focus on people! (Huber, 2010)

Implementing Change

Actual

◦ Participative Change

Shared Governance

Quick & Easy Kaizen

Lean Six Sigma

Implementing Change

Organizational Culture

Ideal◦ Icons easily recognizable and represent the

organization’s values and beliefs Actual

◦ Icons represent the organization as a religious, caring organization

Branding and Symbols

(Franciscan St. Francis Health, 2012)

Actual

◦ VIP Program

◦ Daisy award

◦ Encouraging satisfaction and exceptional nursing care

Branding and Symbols

(Franciscan St. Francis Health, 2012)

Ideal◦ Define how the organization feels the business

should be run (Huber, 2010)

◦ Demonstrated by leadership and employees alike

Actual◦ Values based on Christian beliefs◦ Performance reviews view each of these areas for

satisfaction and potential improvements

Values and Beliefs

Values and Beliefs

(Franciscan St. Francis Health, 2012)

Ideal◦ “A guiding framework that describes what the

organization views as its business and future direction” (Huber, 2010, p. 796)

◦ A mission statement reflects the vision of the organization and what it wants to become (Huber, 2010)

Vision and Mission Statements

Actual◦ Mission statement:

Vision and Mission Statements

Continuing Christ’s

ministry in our Franciscan tradition

(Franciscan St. Francis Health, 2012)

Actual

◦ Vision Statement Improve the health of the

community Provide quality services Health needs of poor and

disenfranchised

Vision and Mission Statements

(Franciscan St. Francis Health, 2012)

Ideal

◦ “Unquestioning adherence to authority and tradition is a well-known barrier to the development of knowledge” (Porter-O’Grady & Malloch, 2011)

◦ Tradition cannot always be strict in healthcare

◦ Habits must sometimes be changed

Tradition and Habits

Actual

◦ St. Francis does look toward evidence-based practice to shape new practices

◦ Tradition is part of the mission statement

◦ Some habits are consistent, some habits are changing

Tradition and Habits

Resources

Ideal◦ Staff nurses are aware of budget needs (Huber, 2010)

◦ Nurse managers have multiple resources Actual

◦ Nurse managers offered budget class to aid in creating and managing budget

◦ Finance representatives◦ MSN representative meets with every manager

during budget season (C. Smiley, personal communication, August 1, 2013)

Financial Support

Ideal◦ Administration participation in shared governance

(Huber, 2010)

◦ Magnet Certified hospitals suggest administrative nurses have graduate-degree training (American Nurses Credentialing Center, 2013)

Administrative Support and Expertise

Actual

◦ Shared Leadership Nursing Congress model developed in 2008 (Franciscan St. Francis Health, 2011)

◦ Administration/leadership involved in various committees

◦ Nurse managers are encouraged/required to obtain an MSN

Administrative Support and Expertise

Ideal◦ High development and high functioning

Actual◦ Organizational chart viewed earlier◦ System lines well established◦ High functioning(C. Smiley, personal communication, August 1, 2013)

Sophistication of Nursing Administrative Systems

Outcomes

Ideal◦ Need to determine what should be retained and

what should be left behind (Porter-O’Grady & Malloch, 2011)

◦ Use of multiple surveys (Curran & Totten, 2010)

Stakeholder Satisfaction

Actual

◦ HCAHPS scores/surveys

◦ Press Ganey Scores

◦ Employee Satisfaction Surveys

Stakeholder Satisfaction

(C. Smiley, personal communication, August 1, 2013)

Ideal◦ Used as an improvement process

◦ Organization measures its performance against other similar organizations (Huber, 2010)

◦ Working above the indicated benchmarks

Benchmarking

Actual◦ Utilization of NDNQI data

Benchmarking

Ideal◦ Economic

Producing patient care at the lowest possible cost (Huber, 2010)

Creating a profit◦ Patient Care

Meeting quality indicators and satisfaction scores◦ Employee

Minimal turnover rates

Organizational Effectiveness

Actual◦ Economic◦ St. Francis running at a profit (C. Smiley, personal communication,

August 1, 2013)

◦ Patient Satisfaction Satisfaction scores can be improved

◦ Employee Satisfaction 0.84% turnover

Organizational Effectiveness

Ideal

◦ Organization should never be stagnant

◦ Analyze processes and improve them repeatedly to increase satisfaction (Huber, 2010)

◦ Measure problems, design interventions, implement the change, and monitor the improvement (Huber, 2010)

Continuous Quality Improvement

Actual◦ Business transformation department works

consistently on quality improvement

◦ MSN-trained nurses

◦ Lean Six Sigma

Continuous Quality Improvement

Ideal◦ Find the right “fit”

◦ Complex and detailed process that includes: Advertising Screening Interviewing Coaching (Huber, 2010)

Recruitment/Retention

Actual◦ Organization tries to find the right fit for each

individual unit!

◦ Behavioral-based, standard interview questions◦ Rounding ◦ 30/60/90 Day Window (C. Smiley, personal communication, August 1, 2013)

Recruitment/Retention

Ideal◦ Appropriate variations◦ Have divergent points

of view work for the common good (Huber, 2010)

Actual◦ Discussed in

orientation◦ Many differences

discussed (Franciscan St. Francis Health, 2012)

Diversity in the Workplace

Ideal◦ Develop mentorship and preceptor models

(Huber, 2010)◦ Discussions on future goals

Actual◦ Mentorship and preceptor models(Franciscan St. Francis Health,

2012)

◦ Employee evaluations

Promotion Opportunities

Policy

Ideal◦ Policies guide decision-making to make them

consistent (Huber, 2010)

◦ Procedures indicate the steps necessary to perform different tasks (Huber, 2010)

◦ Focus on best practices

◦ Should be approved by institution and easily retrievable for reference (Huber, 2010)

Formalized Procedures and Policy Making

Actual◦ IOWA Model(Franciscan St. Francis Health,2011)

◦ “LEAP” (Franciscan St. Francis Health,2011)

◦ Nursing Congress—Professional Development Council (Franciscan St. Francis Health,2011)

◦ Easily search for on main employee website

Formalized Procedures and Policy Making

Ideal◦ Decentralization—middle and lower levels can

make decisions (Huber, 2010)

Actual◦ Decentralization! (Franciscan St. Francis Health, 2011)

◦ Shared governance

Decision Making Within the Organization

Ideal◦ Power focuses on upward

influence (Huber, 2010)

◦ How a leader influences followers to take action (Huber, 2010)

◦ A leader is powerful when they develop credibility, show visible achievement, behave correctly, and create dependence (Huber, 2010)

Power Relationships

Actual◦ Based on the individual leader

◦ Power lies with front-line nursing through Shared Governance

◦ Power also lies with effective managers

◦ Good balance, as leadership is actively involved in Shared Governance

Power Relationships

SWOT AnalysisStrengthsWeaknessesOpportunitiesThreats

Strengths and weaknesses internal to the organization are identified (Huber, 2010)

Opportunities and threats are external components to be analyzed (Huber, 2010)

Once identified, analyze all areas to determine impact on the organization (Huber, 2010)

SWOT Analysis

STRENGTHS WEAKNESSESOperations:--Shared Governance--Well-developed policies and procedures--NOW ER

--Patient Flow--Quality Improvement Programs--Interdisciplinary collaboration

Management:--Good power structure--Journey to Success program

--Program Organizational Form--Master’s trained management

Products:--Mission and vision focus on quality--Looking at NDNQI

--Quality Indicators/Patient Satisfaction--Development of Labor and Delivery

Finances:--Running at a profit --Annual budget

--Not well expressed

OPPORTUNITIES THREATSPolitical:--Well defined nursing guidelines from the ISNA (Indiana State Nurses Association, 2012)

--New reimbursement laws from CMS--Legislative staffing ratios (American Nurses Association, 2013)

Social:--Decrease in cigarette smoking and high blood pressure--Increase in preventative testing (Sebelius, Frieden, & Sondik, 2012)

--Obesity among children still on rise(Sebelius, Frieden, & Sondik, 2012)--46% of adults participate in physical activity regularly (Kaiser Family Foundation, 2013)

Economic:--Household income in area higher than US average--Projected job growth of 31.92%(Sperling’s Best Places, 2013)

--Unemployment rate higher than U.S. average (Sperling’s Best Places, 2013)--Out of pocket spending rapidly increasing (Sebelius, Frieden, & Sondik, 2012)

Technological:--Increased diffusion of electronic charting

--Medicare reimbursements reduced by 2015 if no EMR/EHR (MedicalRecords.com Team, 2013)

Improve patient flow Increase interdisciplinary collaboration Education on adult and childhood obesity Create budgeting that occurs more often

than regularly Development of Labor and Delivery

Strategies for Growth

Conclusion

Organizational Information◦ Program form and participative decision-making◦ Opportunity with communication and

interdisciplinary collaboration◦ Nursing Professional Practice Model

Organizational Culture◦ “Healing Hands”◦ Reflects the Catholic base of the organization◦ Very well-defined and established

Conclusion

Resources◦ Financial information not easily accessible◦ Managers have many resources in order to

properly calculate the budget◦ Administrative support present in shared

governance

Outcomes◦ Various surveys monitor satisfaction◦ Multiple quality improvement projects

Conclusion

Human Resources◦ Interviews/coaching aimed to reduce turnover◦ Education on diversity for every employee

Policy◦ Formalized process of policy-making◦ Requirement of evidence for changes◦ Good balance of power and leadership

Conclusion

SWOT analysis◦ Strengths: NOW ER, running on profit, focus on

quality◦ Weaknesses: Patient flow, interdisciplinary

collaboration, better budgeting◦ Opportunities: Increase in preventative testing,

high average household income, electronic charting

◦ Threats: staffing ratio legislation, high obesity, changes in reimbursement

Conclusion

Overall, St. Francis appears to be a well-run organization

There are opportunities for improvement, but there are many areas that St. Francis is doing well in

I hope to watch the organization grow and aid in the opportunities present!

Conclusion

Questions?

American Nurses Credentialing Center (2013). Average Magnet Organization Characteritics. Retrieved from http://www.nursecredentialing.org/CharacteristicsMagnetOrganizations.aspx

American Nurses Association (2013). Policy & Advocacy: Nurse staffing plans & ratios. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios

Curran, C. R., & Totten, M. K. (2010). Mission, strategy, and stakeholders. Nurse Economics, 28(2), 116-118.

Dickey, L. A., Truten, J., Gross, L. M., & Deitrick, L. M. (2011). Promotion of staff resiliency and interdisciplinary team cohesion through two small-group narrative exchange models designed to facilitate patient- and family-centered care. Journal of Communication in Healthcare, 4(2), 126-138.

Farley, M. J. (1989). Assessing communication in organizations. Journal of Nursing Administration, 19(12), 27-31.

Franciscan Alliance (2012). Journey to success: A Franciscan Alliance leadership development program. Indianapolis, IN.

Franciscan St. Francis Health (2012). Orientation Packet. Indianapolis, IN.

Franciscan St. Francis Health (2011). Franciscan St. Francis Health model for shared leadership nursing congress (2nd ed.). Indianapolis, IN.

References

Howell, J. P., Bowen, D. E., Dorfman, P. W., Kerr, S., & Podsakoff, P. M. (1990). Substitutes for leadership: Effective alternatives to ineffective leadership. Organizational Dynamics, 19(1), 21-38.

Huber, D. L. (2010). Leadership and Nursing Care Management (4th ed.). Maryland Heights, MO: Saunders Elsevier

Indiana State Nurses Association (2012). Indiana State Nurses Association Public Policy Platform. Retrieved from http://www.indiananurses.org/documents/2012PublicPolicyFinal.pdf

Kaiser Family Foundation (2013). State health facts: Percent of adults who participated in moderate or vigorous physical activities. Retrieved from http://kff.org/other/state-indicator/participation-in-physical-activity/?state=IN

Network Indiana. (2013). Indianapolis mayor to announce downtown development plan. Indiana public media. Retrieved from http://indianapublicmedia.org/news/indianapolis-mayor-announce-doWntown-development-plan-52506/

Porter-O’Grady, T., & Malloch, K. (2011). Quantum Leadership: Advancing innovation, transforming health care (3rd ed). Sudbury, MA: Jones & Bartlett Learning.

Sperling’s Best Places (2013). Economy in Franklin township (Marion county), Indiana. Retrieved from http://www.bestplaces.net/economy/city/indiana/franklin_township_(marion_county)

Sebelius, K., Frieden, T. R., & Sondik, E. J. (2012). Health, United States, 2012. Centers for Disease Control. Retrieved from http://www.cdc.gov/nchs/data/hus/hus12.pdf

Weshenfelder, C. (2005). Building professionalism and customer service. Nursing Homes, 30-33.

References