Company X: Organization And Leader Analysis

In central Pennsylvania, there are a variety of different healthcare companies that provide a range of services for the residents living within the region. These corporations employ thousands of qualified people in order to provide care and services to those that seek medical attention. The company that I am going to be analyzing is one that has been in the area for well over 100 years, has been recognized locally and nationally for it’s continued service to the local community, and for being one of the first medical facilities in the area to offer advances in robotic single site surgeries. For the sake of privacy, we will refer to this company as, Company X.

Company X started as a small, non-profit healthcare system, that was founded in the city of Harrisburg, Pennsylvania over a century ago. Over the years, Company X had created its own educational system in order to produce qualified individuals for the healthcare field. These schools consisted of a school of nursing, and an advanced nurse anesthetist program. As years progressed, other schools in the area started nursing programs, and Company X found it more cost effective to close down the nursing and anesthesia programs, as the nurses coming out of these other schools were meeting and exceeding the expectations that Company X had for its nurses. Other healthcare hospitals began popping up around the central Pennsylvania region through the decades, and Company X needed to find a way to stay competitive. In the mid 2000’s the Board of Directors decided they needed to bring in someone with a business background as CEO, as the current Medical Director in charge did not fully understand the business aspects of running a company. The new CEO that was hired went on a spree of acquiring the closest competing hospitals, and began expanding the reach of Company X. During his tenure, the CEO at that time brought the other hospitals under the name of Company X, which ousted the different unions that some of the employees at those organizations had relied on for giving them a voice. Other changes that came of the system was the outsourcing of different services such as: housekeeping, food services, and laundry/ linens. Because of this, the individuals that worked in those areas were now without a job, but the CEO of Company X was trying to cut corners where possible to save money, as there were plans in the works to build a new hospital across the river. Besides outsourcing jobs, Company X acquired a robotic surgery program, which was one of the first in the Harrisburg area.

Today, the new and current CEO, restructured Company X and saw what other healthcare organizations across the country were doing, and that was merging with larger entities. This leads us to where Company X is today; a smaller corporation within a larger organization that reaches out towards the western part of the state. Since the merge, Company X has been able to offer the residents of central Pennsylvania a greater variety of services such as: advance treatments for cancer patients, creating a building just for the care of newborns and their mothers, partnering with local doctors offices and walk-in clinics, and offering the newest in weight loss procedures. The objectives at Company X is a model supported by six pillars, all strategically placed in order to provide the best possible care for their patients and community. The first pillar is people, in which Company X strives to provide healthcare that is simple to access and navigate for our community and patients. This means that they provide a strong workforce, with an equally effective management team, while walking with clients through their healthcare experience. Along those lines, we arrive at the second pillar of success, service. By providing excellent service, the organization is able to polish the patient's experiences into one that will keep them coming back for their future healthcare needs.

Quality is the third pillar in the objective model. Company X strives to perform in the top 10% of hospitals nationwide, along with consistently providing a safe environment for their patients and desiring to remove all hospital-acquired injuries and infections from the establishments. Growth and finance are the fourth and fifth pillars in our model. Growing the system by making it an entity where patients seek out physicians, and continuing to revamp and enhance how the system generates revenue, will allow Company X to continue to reach into areas where healthcare is not as accessible as it can be. Incorporating other hospital systems into the current one, allows Company X to offer additional healthcare services, where there were once limited options. The last pillar is community. It was touched on this slightly, when talking about growth and finance. Company X strives to offer transparency about the system to the community, along with improving an environment where patients and their families are able to access resources in order to improve their health and wellness.

At Company X, the culture is one where it is nurse centered because of acquiring Magnet Status. This means that Company X is a nurse friendly hospital, where they highly value and empower nurses in their different positions within the company, from working on the floor all the way up to the Chief Nursing Officer and Vice President of Surgical Services. Because of Magnet, Company X encourages a model called Shared Governance. In this model, nurses on each unit are in different committees such as Quality and Infection Control, where they are able to help identify areas where nursing practice might be able to be improved, and present that to a counsel that meets quarterly.

A2: Leadership Practices of Primary Leader

“Cindy” is the manager of the Operating Room for Company X. She has been in the system for roughly ten years, and has mainly worked at our sister site downtown. Cindy came into her new position a few months ago, as she was once the manager of a surgical team, and now she’s in charge of the whole department. Compared to the previous manager, Cindy’s leadership style is very different and brings a new feel to the Operating Room.

One leadership responsibility for Cindy is to lead monthly employee meetings for the department. During these meetings, Cindy presents a powerpoint that informs the staff how the department is performing as far as reaching the goals that were set for the fiscal year. Also, these meetings are designed to communicate upcoming changes within the system of Company X. The staff is often reminded of how these changes will further aid in helping Company X achieve its overall objective and mission. At the end of the meeting, Cindy will often recognize employees that patients noted that have gone “above and beyond” in making their stay better. Monthly meetings are useful in communicating different updates and changes that are happening within Company X to the employees that are not in a management role.Routinely rounding on patients is a leadership responsibility that the manager of the Operating Room also has to perform. This requires the manager to sit down with a patient prior to them going back for surgery, and talk to them about how their stay is going thus far, and what could be done to make it better. There is a series of questions that Cindy will ask each patient, in order to make sure that their needs are being met, while they are in our care before and after surgery. Rounding is a vital way of receiving feedback from patients, so that Company X is able to be molded into an organization where people from the surrounding communities will want to come for their healthcare needs.

Performing semi-annual reviews of each employee is another responsibility of leadership within the department. In the spring, the first review is done known as High, Solid, Low (HSL) showing each member of staff how they are performing halfway through the fiscal year. The HSL evaluation allows employees and the manager to look where the member of staff is, and discuss what can be done in order to be considered a “high” achiever. Also during these meetings, management is able to address if an employee is a “low” achiever. If that is the case an action plan is created in order to set goals for that employee so they can work towards “high” status. Again in the fall, the employees meet with management and review how they are performing within the department, and whether or not they improved from the spring HSL reviews. The fall review is the time when your raise is determined from your performance review, and if the department was able to meet the goals set forth for that fiscal year. By having semi-annual reviews, management is able to meet with the employees and determine who is not performing at the level of expectation the department has set forth.

A3: Leadership Affecting the Organization & Culture

The Surgical Services department of Company X has to uphold the mission of the company on a daily basis. Being the main line of revenue for the organization, the department has to strive to keep infections to a nonexistent level. Having a low infection rate, and providing excellent patient care, will make Company X a more inviting resource for the community when people are looking for a healthcare facility. Staff and management come from a variety of different levels, or hierarchy. In the Operating Room (OR), there is the director, the manager and two clinical managers. As far as staff, it’s the nurses, surgical technologists, and orderlies. Normally the manager calls the shots, and the clinical managers are there to make sure the orders are followed. Even though Company X is considered a “magnet” hospital and nurses are supposed to collaborate on a solution when a problem arrises, the manager usually makes her own decision without other regards. It seems that the environment in this department is changing, and not for the better. The director came from a different facility a year ago, and the manager came from another facility roughly six months ago. The facilities that the upper management team came from run much different than this system does, and they have voiced that they are trying to change it to make the facility run identically to where they came from. What the director and manager do not understand is that the dynamics are different, compared to their other sites. The physicians, staff and patient population is different, and not all sites can operate the same.

Each day the staff is reminded how they need to keep in mind how long they are taking turning around OR suits, and to keep this time as low as they can. Meaning, from the time a patient is wheeled out of the room, clean the room, reset it for the next case, and have the next patient wheeling into the room, should be twenty minutes or less. This is a great goal, but when you’re understaffed it becomes difficult to achieve. Because of situations like this, it lowers staff moral.Not only are room turnovers stressful, it’s also the fact that our department is becoming busier and busier each month, and we do not have the staffing to meet the demands. Because of this, staff is having to spend more time at work whether it be on-call or doing mandatory overtime. As a consequence of being at work so much, staff moral is low, and management doesn’t try to fix it. Management has stated that they cannot get help, and until a new nurse is done being trained, it’s eight months out until we get the help we need. Ironically enough, the director and manager are both nurses that have worked in the OR, and are fully capable of being in rooms if needed. This is a different culture than the management team that was in place a year ago. The previous manager routinely met with the staff to see how things were going in the operating rooms, and addressed the needs of the staff. When it came to decision making, the staff it was directly affecting was asked how they felt about the new ideas, and whether or not they felt the new ideas would hurt or benefit productivity. The previous management made the staff feel more like family, which made the working environment more enjoyable.

B1: Strengths of the Organization

Company X forged a new pathway about five years ago by being one of the first healthcare organizations in the area to offer robotic assisted surgeries. This is one of the strengths that this company offers compared to it’s competitors. Robotic assisted surgeries allows the patient to have a lower risk of complications related to surgery, is a less invasive procedure, and promotes a faster recovery. Because robotic surgeries are a newer practice, they cost more to perform, which in turn allows for a larger revenue for the system. Though the cost may be higher, patient satisfaction and having a better overall all outcome, can usually outweigh the pricer option for surgery.

Another strength that Company X has over it’s competition, and even it’s sister sites, is that the organization is located right off a major interstate. Being able to get to System X without having to weave through a busy town, or having to travel into the city, makes System X a desirable choice for healthcare. Accessibility is key, as a large portion of our patient population comes from a more rural area, therefore they feel more comfortable traveling to the company, as it is less than a handful of turn off the highway.

B2: Weaknesses of the Organization

Compared to other healthcare organizations in the area, System X is one of companies that does not have an employee union. As the organization grew from one healthcare organization, it started buying up the smaller hospitals in the area which had employee unions. When the companies merged, the name of the organization changed, and when that happened the unions were removed from the system. There is only one major healthcare organization in the area that still has an employee union. Due to not having a union, some employees feel that they do not have a voice.

System X also has another weakness, inefficiency, which can be related to being understaffed. Business has increased over the past year, and System X has incorporated five other healthcare facilities under the company umbrella. Though the company has expanded, many of the employees left before the merge finalized. Along with a large amount of spending to acquire these facilities, System X placed a hiring freeze company wide for any new positions, as they did not meet their financial goals this fiscal year. Now departments are experiencing an increase in their workload, and unable to hire on more staff to properly manage the influx of work. Being understaffed and overworked is starting to take it’s toll on the current employees of System X.

B3: Opportunities of the Organization

One opportunity that could be beneficial to System X, would be to introduce it’s own insurance program to the community. Since the healthcare law was passed back in 2010, there have been many changes to the way people have received health insurance, and how patients are cared for. Many companies across the country have merged together, and in doing so have been able to offer their own health insurance to the surrounding communities. This allows lower insurance rates for consumers, while the healthcare company is able to keep more of the profits generated for the services they offer. Now that System X has merged with other companies, they may be large enough to support introducing their own health insurance programs to the community, to keep consumers returning to their business for their healthcare needs, also while offering a lower price insurance option.Another opportunity that System X could benefit from would be to create a neurology program within the company. In the region, there is only one healthcare resource that offers a neurology department, creating a monopoly on the local patient population. If there is a patient that comes into System X that would need a neurological consult or have aneurysms located in the brain, they would need to be seen at a competitor’s facility. With more people having strokes, developing neuropathy, and being diagnosed with fibromyalgia each year, System X would be able to meet another need from some of their patients that they already take care of.

B4: Threats of the Organization

A big threat to System X is that a major insurance company in the area is considering no longer reimbursing System X for the services offered to their patients. This could be a big deal, as the consumers that are now coming to System X for their healthcare needs, will have to travel to a competitor hospital further away. This in turn lowers the amount of patients coming in for care, and lowers possible revenue. Lower patient population and less revenue will mean jobs lost and increased healthcare costs for those that will still seek out System X for their healthcare needs.Another threat would be the building of a competitor hospital less than a mile away from where System X’s busiest facility is located. The competitor currently has an employee union, and that alone would draw talented staff from working at System X. Also, the major insurance company in the area that is threatening to not reimburse System X, is already accepted at the competitor’s organization, and that would pull patients to the new facility if it were to be built. Pulling patients and staff from System X, who is already on a hiring freeze, would make it extremely difficult to stay competitive financially in an already demanding healthcare field.

C1: Leadership Evaluation - Strengths

The transformational leadership theory is one that has been studied, practiced, and shown to be successful for many decades in running a company. Leaders who practice this theory are also known as inspirational leaders, as they inspire their team to believe in their own potential and the vision of the company (Draft, 2014). Transformational leaders are the type that have a vision for the company, are authentic by not performing just for personal gain, encouraging followers to be creative and develop new ideas, and invest time and energy in their team by recognizing performance as well as efforts (Doody & Doody, 2012). Studies have shown when comparing this theory of leadership against others, people develop into transformational leaders as these traits are not necessarily ones that someone is born with (Fischer, 2016, pg. 2647).

One strength that of the leader I choose was her being an inspirational motivator. My leader is on who is often encouraging the staff to pursue their goals in and out of the organization. In fact, she is the one who encouraged me to go back to school for this program. According to Doody & Doody, a transformational leader is one that will encourage their followers to achieve the goals of the company, while also reaching your personal goals outside the organization (2012). When she’s inspiring the staff, my leader promotes a sense of self-worth amongst the team which motivates them to want to achieve more.

In healthcare there are always changes coming down the pike, and my leader is one that often looks for new ways to solve problems. Transformational leaders are ones who encourage the proposal of new ideas in the workplace (Doody & Doody, 2012, pg. 1213). One example is brainstorming a new way to secure patient positioning items to the bed, without using tape. We no longer are trying to use tape because when you remove the tape from the mattress, it tears the seams apart, and the mattresses in the operating room are costly to replace. One evening after the cases were finished, myself and two other coworkers played around with different methods of securing positioning equipment to the table without tape. We were able to come up with a way to keep the patient safe, and use items we already had in order to keep costs low, to secure patient positioning items to the table without causing any harm to the mattresses.

As mentioned earlier in the paper, after the mandatory staff meetings, my leader will often recognize a team member and congratulate them on their work performance, or if they have achieved something beneficial to them. A transformational leader keeps staff moral high and tries to make sure the staff is satisfied with their job (Welford, 2002). If staff is happy where they are working, the company will be able to retain that person who becomes more and more of an asset as they their experience increases.

C2: Leadership Evaluation - Weaknesses

Authors Doody & Doody talk about how a transformational leader will be a role model for staff to mirror, and when this happens there is less resistance to change (2012, pg. 1212). My leader is newer to our department, and she has been trying to change different things around the unit without any consideration from the staff. The biggest change she is making is to the flexibility of the schedule. There is a lot of animosity from the staff about not working their set schedules that previous administration allowed them to have for the past four years. Changing a someones schedule without consulting them, after it has been in place for a long period of time, can have very negative outcomes, as many of the staff members would need to rearrange their childcare situations. Being flexible is important when it comes to being a leader in the healthcare department, especially when you are performing surgical procedures. My leader is one that is not being flexible, as we are understaffed and she refuses to come into a surgical suite to help when needed. According to Welford, a leader must maintain the trust and pride of their followers and sustain their own credibility (2002). Working in the operating room, a person in leadership is one that should be able to jump into any surgical case and be able to take over if need be. The current leader has had training in only one type of service, and we do not do that service in our department, and she will not go into rooms because she does not know the surgeons or cases. Because of her unwillingness to assist when we need help, I feel that we do not have a leader and we are left to flounder in certain situations.

Draft states that transformational leaders are ones that should be able to challenge their followers to look for a new way to solve an old problem (2014). That is not that case with our current leader. It seems that she only wants to hear new ideas, if she notices a problem and asks for help solving it. Otherwise, if she didn’t ask about, she doesn’t want to hear about it. Because of this type of attitude, I feel that we are unable to fix some of the underlying problems that are in the department, due to the fact that we would be ridiculed if we brought the issue to management. As stated earlier in the strengths section, the leader is good at inspiring free thought and new ideas, but only if it’s her idea to do so.

C3: Leadership Evaluation - Recommendations

I have come up with three recommendations that relate to the transformational leadership theory, that can help the leader of our department be more successful, and that will in turn help the organization. The first recommendation is for the leader to have more charisma. Having charisma helps motivate the rest of the team, and allows both the leadership and followers to be on the same level, striving to achieve the same goals (Welford, 2002). Having charisma will help keep the team upbeat, as we are understaffed and need that extra boost now and again to keep pushing through the work week.

The second recommendation for my leader is to find common ground with the staff before making big changes to the department. This directly relates to the leadership style I have chosen, as transformational leaders “...find common ground to enlist followers in the change process,” (Draft, 2014). By making this little change to her leadership practice, the leader will not have as much push back from the staff when changes are going to be made to the schedule. This will benefit the organization by raising the moral of the staff, as they will feel included in the decision making processes.

The third recommendation for the leader would be to promote conferences for the staff to attend throughout the year. This recommendation relates to the transformational leadership theory because it is encouraging the staff to continue their education. It will benefit the leader because the staff is staying current on the different practices in surgery, and better ways to improve patient outcomes. When patient outcomes are better, the chances of having a readmission decreases, therefore financial reimbursement to the department increases. Doody & Doody state that when nurses attend different educational conferences, they are able to return with that information and share it with the rest of the staff (2012). Knowledge is power, and by sharing that knowledge with the staff, their power and skills also increase.