INSTRUCTIONS: Students will conduct an organizational development diagnosis. From the diagnosis, develop an OD problem statement, collect and analyze data, and identify appropriate interventions to effect change. This paper must be original for this class. 8 pages not including cover or bibliography, APA format.
Organization Diagnosis and Intervention Plan
Organizational Development and Change
Dr. Tim Parker
April 25, 2015
Understanding the need for organizational development in many different businesses and organizations, the Interventional Radiology department within a healthcare system was selected for improvement. After interviewing employees of the department, a diagnosis is made including a number of different issues that need to be addressed. After a diagnosis, areas and processes that needed intervention are given a plan and approach for each. Ultimately, with two effective interventions, the department will grow in areas of communication and process improvement, having an open mindset to future growth.
Gentech Interventional Radiology
Background on Case Study Organization
Gentech Medical Center is a hospital that provides a wide variety of services for those in need. One general department within this organization is the Interventional Radiology department. Interventional Radiology provides a variety of diagnostic and interventional studies. Mainly in diagnostic exams, a contrast liquid that shows up on x-rays is injected into veins or arteries in order to highlight them and visualize what cannot be seen otherwise. With interventional procedures, according to the lead technologist, there is a wide variety of actions that can take place, including: placing cement into fractured bones in order to relieve pain and prevent further fracture; placing dialysis catheters in the veins of patients with kidney failure; action taken against plaque build-up in arteries (stent placement, ballooning and expanding the vessel, or removal of plaque); and the sampling of spinal fluid to allow lab tests to be performed. All of this is done with at least one radiologist, one radiology technologist, and one radiology nurse in the room for each procedure (R. Calvo, personal communication, April 16, 2015). After some procedures, mostly the ones requiring intervention, there is a recovery period in which a nurse monitors a patient while they are waiting on sedation to wear off.
Inputs within the department consist of human capital, physical use of machinery, use of supplies from outside sources, and raw materials and information from its own environment. The human capital is composed of three technologists, four nurses, and one radiologist. There are two different rooms in which these procedures can take place, serving as a physical location for the environment. The machinery used includes: monitoring equipment for patient health statistics; digital radiography equipment allowing for the visualization of activity taking place within the patient using radiation; and a computer system in order to store imaging, access a patient’s chart, and make changes to the chart. Supplies are ordered on a daily basis in order to have necessary sterile supplies when needed. These come form a variety of companies, based on their specialty and knowledge. Raw materials consist of the patient chart that is given from the attending physician within the hospital or the ordering physician from outside the hospital.
According to the charge nurse, the general environment consists of competition between the radiologist and cardiologists, recalls on products and supplies, and unexpected cancellation of procedures. In the task environment, there is some supplier power with new products and companies that have patents on effective ones (C. Lathrop, personal communication, April 16, 2015). Understanding the importance of having advanced technology for the sake of the patient, patented products can easily be sold for thousands of dollars apiece, depending on the product. Some products may be used, but approval for reimbursement of the surgical action may not be given yet. This approval is by Medicare, and without it the organization can lose money based on the amount spent on a patented product.
Transformations occur, according to the radiologist, when radiological services are performed. After these procedures take place, the patient is charged for the supplies utilized as well as the action of diagnosing with x-rays and intervening in a surgical manner for the patient’s benefit. The financial return to the organization is used in order to fund the purchase of necessary supplies, as well as upgrades in machinery when needed (G. Yoder, personal communication, April 16, 2015). With the ability to fund the purchase of high-quality machinery and the salary/wages of the employees, this organization transforms financial gain into high-quality patient care.
The structure is designed with one nurse being in charge of the other three, one technologist in charge of the other two, and the radiologist is not employed by Gentech Medical Center, but has the final say in exam performance since he is the physician actually performing the procedures. The nurse in charge designates a nurse to be in the recovery area for most of the day, and designates patients to the other nurses to monitor during procedures. The lead technologist coordinates with the charge nurse as far as exam scheduling and procedure order is concerned. He also orders supplies, while all three restock the room as supplies come in. All three technologists assist the physician during the procedure, one for each procedure, and apply charges to the patient’s exam chart after the procedure is performed. The radiologist performs the procedures and dictates, according to Medicare standards, in the patient exam chart regarding the procedure performed. According to the lead technologist, the Human Resources department originally is who selects employees, with the help of the supervisor, and monitors the annual evaluation of the employees. Employees receive an annual raise following their evaluation. The amount of their raise can be up to three percent of their current hourly rate, but is dependent on their current ability to meet or exceed expectations voiced upon the start of the employee/employer relationship (R. Calvo, personal communication, April 16, 2015).
Team’s Definition of Diagnosis
The radiology x-ray machines used during the procedure are over ten years old and have their issues. The imaging seems outdated and limiting compared to more modern machines. Dependability is also an issue. Sometimes, mid-procedure, the machine needs to be reset in order to continue use.
There are no issues with structure or the Human Resources Management. Strategic issues, on the other hand, do have their place. With the scheduling of exams and procedures, the charge nurse has poor communication skills with his plan and changes made throughout the day. In addition to this, each of the nursing staff do not work together well, so there is even more lack of communication when necessary.
Finally, there is a continual issue with patent cancellations on the day of the procedure. Understanding there are always unpredictable occurrences that prevent things from going as planned, there are numerous incidences in which cancellations could have been prevented had proper communication occurred with the patient.
Case Study Problem Statement
The staff of Gentech Interventional Radiology work together in a somewhat organized manner; however, there are communication issues that cause unnecessary problems. There are unforeseen cancellations with patients that have a tendency to be prevented in advance. Finally, the machines used during the procedure are not as reliable as they should be.
With machine issues, there are times that procedures cannot be performed due to low imaging quality or unforeseen issues with the mechanics. The inability to use a machine as intended can result in: cancelled procedures; wasted supplies; lost time and effort; and the rescheduling of patient procedures.
With the issue of poor communication, there is delay in patient care resulting from confusion/lack of inclusion with the technologists and nurses. In addition, Uddin and Hossain state, “From the perspective of patient perceptions of quality of care, coordination is identified as one of the most important factors” (Uddin & Hossain, 2014). With delay in patient care, there are sometimes supplies wasted and unnecessary overtime pay that results. According to Ang, Swain and Gale, “Communication influences health outcomes such as health status, adherence, and satisfaction. It is also highly modifiable, so it should be a target of intervention studies” Swain (Ang, Swain, & Gale, 2013)
Cancellations immediately before a procedure is scheduled to begin results in wasted supplies as well as time spent in preparation for a procedure that never occurs.
Case Study Purpose Statement
The purpose of this case study organization diagnosis is to develop research questions and identify data collection instruments to assess the causal variables of poor communication, patient cancellations, and machine issues to determine the best change interventions to implement.
Case Study Diagnostic Research Questions
Questions askedin order to guide research include:
1) How can issues with the machine be solved?
2) What is the cause of poor communication and what prevents it from happening as it should?
3) Is there a way to prevent or minimize patient cancellation?
Considering the questions asked and the casual variables to be addressed, there are a number of different methods of collecting needed data. With the issue of poor communication, the best method of data collection is that of a survey. With a survey, employees are free to give their personal opinion more freely and are not limited to specific answers. This is not a quantitative issue, rather a qualitative one, and therefore can be addressed appropriately. Concerning patient cancellation, quantitative data will be collected regarding the reason of cancellation for each patient, then addressing any issues that can be improved, thereby reducing or preventing these cancellations. The machine issues are both quantitative and qualitative, since there is poor image quality as well as mechanical issues. There will be a survey administered for the quality of imaging, then data collected by observation/survey for the reasons of mechanical failure.
In surveys with the employees about the machine issues, there was a unanimous consensus that the machine itself is outdated and inadequate. Abbam states, “There is also mounting evidence that investing in medical devices reduces overall healthcare expenditure and contributes towards better patient outcomes” (Abbam, 2014). In communication with the technologists and the radiologist, it was determined that the hospital is in the process of purchasing a new machine for interventional use in the months to come.
Upon surveying the employees, there is a general consensus that communication is poor due to a lack of set protocols in that area. According to Rybkin and Wilson, “The multitude of applications dedicated to electronic communication reflects the complexity of radiology workflow. Radiologists need to communicate with various members of the healthcare team, for a variety of purposes, under a variety of conditions” (Rybkin & Wilson, 2011). When proper coordination is assumed to happen in a desired manner, this does not always happen. The largest issue continually stated was communication in the transition period between patients. From the four nurses, there is inadequate notification of the time the procedure commences, as well as the time the procedure ends. With this failed communication, turnover time between patients is extended longer than necessary. From the three technologists, there was a great emphasis on the lack of needed coordination with the technologists as far as the scheduling is concerned. There is a difference in logical opinion between the charge nurse and the lead technologist at times, and this could be resolved with consistent communication when needed.
In the process of quantifying reasons for cancellation, which were logged in the charge nurse’s schedule book, the following results were shown from the last six months:
1) Twenty-eight percent of scheduled patients cancel on average.
2) Six percent of the cancellations are due to an allergy that was not addressed and the patient pre-medicated for, resulting in a rescheduled exam.
3) Sixty-two percent of the cancellations were due to the patient taking medications that are contra-indications for the procedure, resulting in a rescheduled exam.
4) Twelve percent of cancellations were due to fever/infection, delaying the procedure until after the infection is gone.
5) Fifteen percent were patients that did not show up for their procedure as scheduled and without notice.
6) Five percent cancelled with advance notice on a day prior to the scheduled procedure.
Considering these percentages, the employees are able to visualize the true ability to discourage unnecessary cancellations. In preparation for intervention, one must consider what the authors Souzdalnitski and Narouze state on the subject. They state, “Thus far, the most reliable solution to this dilemma has been to analyze the details of cancellations for each organization, apply general rules from studies conducted on cancellations, and set reasonable expectations” (Souzdalnitski & Narouze, 2014).
Understanding the need of quality healthcare within a healthcare facility, issues affecting the patient are of great importance. In order to save valuable time and costly supplies, it is apparent that proper communication must occur between co-workers. Additionally, addressing the issue of patient cancellations will affect both factors as well, ultimately benefitting the patient, the employees, and the facility. The quality of imaging and the machine issues are being addressed financially by the organization; that being said, there seems to be no need to intervene in that area. In the areas that will need intervention, namely communication and cancellations, the leading and managing of these interventions are addressed.
In the communication intervention, there will be process consultation in order to establish a standard method of communication, allowing consistent and reliable communication throughout the day. Nurses, as well as technologists, will form together during this consultation in order to bring them together in solving process problems and finding solutions. This will be necessary; for, as Elf, Frost, Lindahl, and Wijk state, “The importance of collaboration cannot be overemphasized when fostering ownership of and participation in . . . decisions by users” (Elf, Frost, Lindahl, & Wijk, 2015). With the issue of organization between the charge nurse and the lead technologist, team building intervention will occur. This will allow the employees to better understand each other’s role, approach, and mindset, allowing for increased quality of communication between them.
In addressing unnecessary cancellations, sixty-eight percent of cancellations could have been prevented had proper communication occurred in days leading up to the procedure. Fifteen percent, the no-call no-shows, may have been reduced had the patient been contacted in days prior to the procedure as well. The percentage that cancelled due to unpredictable fever and/or infection, as well as the five percent that cancelled ahead of time, cannot be affected or prevented. Once again, looking at the eighty-three percent of cancellations that can be affected in ways that benefit the organization, an increase in communication will help. According to Singhal, Warburton, and Charalambous, “Cancellations on the day of surgery represent a major wastage of resources and can impose significant distress on patients. Minimi[s]ing same day cancellations can improve cost effectiveness and operation theatre running” (Singhal, Warburton, & Charalambous, 2014). Process consultation will be applied, allowing the group the opportunity to discover methods of increased, timely, and effective communication with the patient.
Diagnosis Organization’s Readiness for Change
Within this department, there are varying degrees of seniority that may affect change. The charge nurse has been employed for sixteen years, which is longer than any other employee within this department. That being said, he has seniority over the other three nurses and has the most say considering changes that may occur. However, he does seem to be one of the most resistant to the idea of change, being uncertain about its actual benefit. According to Caruth and Caruth, “This uncertainty results in resistance, especially on the part of individuals with insufficient coping skills. Acquiring both the ability to cope with change both personally and professionally is essential” (Caruth & D, 2013). The lead technologist has been employed in this department for six years, and welcomes the idea of change for the better. The radiologist has been with the current healthcare system for five years, and is ready for change and improvement.
While the charge nurse is the most resistant to change, both nurses and technologists are eager to meet the radiologist’s needs. The charge nurse and the lead technologist are the power bases that can enforce change overall, with great influence from the radiologist. With these interventions including all of the employees, all will be able to feel they had a part in this improvement. This is extremely important for the change to be effective to the utmost extent. Umble and Umble state, “Physcological ownership is critical to generating true enthusiasm and commitment to the project. Therefore, the ideal situation is that every key player gains some psychological ownership of the project” (Umble & Umble, 2014).Once intervention takes place and processes are improved, the employees will see how the benefits of actions affect the workflow process and contribute to patient care. Patients, who are also stakeholders in this system, will unknowingly benefit from these two interventions and a greatly improved department in the healthcare system.
Discuss three lessons learned.
1) In the process of interviewing employees of the Interventional Radiology department, I found that there are multiple ways in which employees interpret the process of the department as a whole. Based on their own experience and knowledge, they may believe that something is adequate, if not faultless, even though there may be seemingly obvious faults to the outside looking in.
2) With experience, comes knowledge, but resistance to change can be grown as well. In speaking with the charge nurse of sixteen years, his attitude seemed to be that of one that simply knew the organization to function as is currently does without any need or ability to change. Even though other employees presented with the desire to change for the better, the charge nurse seemed blind to this idea. However, with proper intervention, I believe that all will see and appreciate the value of changes that are made and see the value in teamwork and communication in the end.
3) Finally, I found that employees were excited about the process of change, but felt a lack of efficacy in creating change by themselves. Galinski, Matos, and Sakai-Oneill state that one of their core principles for bringing about change is, “Unexpected messengers make people pay attention” (Galinsky, Matos, & Sakai-O’Neill, 2013). This was evident in that, although there are leaders within the department, no person felt the ability to initiate without the help of someone new or from the outside, such as an OD practitioner. These interventions show how change can occur for the better, and hopefully will encourage action from the entire group when needed in the future.
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Singhal, R., Warburton, T., & Charalambous, C. (2014). Reducing same day cancellations due to patient related factors in elective orthopaedic surgery. Journal of Perioperative Practice, 24 (4), 70-74.
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