Organizational Assessment: St. Francis Hospital

Organizational Assessment: St. Francis Hospital

Organizational Assessment: St. Francis Hospital Alicia Steadman, BSN, RN University of Indianapolis Overview 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 Organizational Information Organizational Structure

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 Senior Management Team Medical-Surgical Services Nursing Pharmacy

PT/OT/RT Emergency Services Nursing Pharmacy Respiratory Therapists Organizational Structure 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 Organization Structure

INSERT NURSING ORGANIZATIONAL CHART Leadership and Professionalism 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 Level of Interdisciplinary Collaboration 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 Communication Style and Processes

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 Implementing Change

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 Organizational Culture Branding and Symbols

Ideal Icons easily recognizable and represent the organizations values and beliefs Actual Icons represent the organization as a religious, caring organization (Franciscan St. Francis Health, 2012) Branding and Symbols

Actual VIP Program Daisy award Encouraging satisfaction and exceptional nursing care (Franciscan St. Francis Health, 2012) Values and Beliefs

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 (Franciscan St. Francis Health, 2012) Vision and Mission Statements 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: Continuing Christs ministry in our Franciscan tradition (Franciscan St. Francis Health, 2012)

Vision and Mission Statements Actual Vision Statement Improve the health of the community Provide quality services Health needs of poor and disenfranchised

(Franciscan St. Francis Health, 2012) Tradition and Habits Ideal Unquestioning adherence to authority and tradition is a well-known barrier to the development of knowledge (Porter-OGrady & 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 Resources Financial Support

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) Administrative Support and Expertise 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

Sophistication of Nursing Administrative Systems Ideal High development and high functioning Actual Organizational chart viewed earlier System lines well established

High functioning(C. Smiley, personal communication, August 1, 2013) Outcomes Stakeholder Satisfaction Ideal Need to determine what should be retained and what should be left behind (Porter-OGrady & Malloch, 2011) Use of multiple surveys (Curran & Totten, 2010)

Stakeholder Satisfaction Actual HCAHPS scores/surveys Press Ganey Scores Employee Satisfaction Surveys (C. Smiley, personal communication, August 1, 2013) Benchmarking

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

Organizational Effectiveness 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 Continuous Quality Improvement

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 Recruitment/Retention 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) Diversity in the Workplace 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) Promotion Opportunities

Ideal Develop mentorship and preceptor models (Huber, 2010) Discussions on future goals Actual Mentorship and preceptor models(Franciscan St. Francis Health, 2012) Employee evaluations

Policy Formalized Procedures and Policy Making 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 CongressProfessional Development

Council (Franciscan St. Francis Health,2011) Easily search for on main employee website Decision Making Within the Organization Ideal Decentralizationmiddle and lower levels can make decisions (Huber, 2010)

Actual Decentralization! (Franciscan St. Francis Health, 2011) Shared governance Power Relationships 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 SWOT Analysis Strengths Weaknesses Opportunities Threats

SWOT Analysis 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 2010) (Huber, STRENGTHS WEAKNESSES Operations: --Shared Governance

--Well-developed policies and procedures --NOW ER --Patient Flow --Quality Improvement Programs --Interdisciplinary collaboration Management: --Good power structure --Journey to Success program Products: --Mission and vision focus on

quality --Looking at NDNQI Finances: --Running at a profit --Program Organizational Form --Masters trained management --Quality Indicators/Patient Satisfaction --Development of Labor and Delivery --Annual budget

--Not well expressed OPPORTUNITIES Political: --Well defined nursing guidelines from the ISNA (Indiana State Nurses Association, 2012) THREATS --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% (Sperlings Best Places, 2013) --Unemployment rate higher than U.S. average (Sperlings 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) Strategies for Growth 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 Conclusion 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! Questions? References

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/LegislativeAgenda-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), 126138. 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-physicalactivity/?state=IN Network Indiana. (2013). Indianapolis mayor to announce downtown development plan. Indiana public media. Retrieved from http://indianapublicmedia.org/news/indianapolis-mayor-announce-doWntowndevelopment-plan-52506/ Porter-OGrady, T., & Malloch, K. (2011). Quantum Leadership: Advancing innovation, transforming health care (3rd ed). Sudbury, MA: Jones & Bartlett Learning. Sperlings 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.

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