I.

You Decide Assignment

You Decide Assignment

HS541: Health Service Systems Chief Executive Officer, Kathy Ramirez Address to the Board of Middlefield Hospital As the Chief Executive Officer for the Middlefield Hospital, I am honored to be associated with a wellestablished and large tertiary facility which is well known in the community for providing high quality services. Middlefield Hospital has enjoyed this reputation for over 22 years and I am confident that we can continue to provide these services for many more years. Our facility offers many services that are needed in this community including inpatient and outpatient services. With that said, I am also aware that we are facing some difficult times right now. The opening of a new facility within close proximity to us has had an impact on our staffing, both in our physician and nursing populations. What are the reasons for this shift? What incentives are being offered that are not being offered at our facility? Why has the overall morale of our facility dropped significantly over that past 12 months? These are the type of questions we will explore after specific strategic steps have been implemented. How we respond as a team to these issues will have a major impact on our future. The transformation that is currently underway for our facility which includes the professional healthcare staffing is a challenge for all of leadership to address. We cannot stop these changes from taking place. What we can do is embrace them and implement strategies that can enhance our facility. Thus the only recommendation I would like to propose focuses on the ability of us to work as a team to combat these issues. I recently read an excellent reference book entitled, Organizational Behavior. This book outlined key issues related to actions taken by a team of individuals and compared it to the actions of one individual. A quote from the resource stated, Organizations today run on the foundation of teams and teamwork. Teams that achieve synergy bring out the best in their members in respect to performance, creativity, and enthusiasm. (Organizational Behavior, p. 155) Most of you know that I have been working in this industry for over 25 years and have faced similar difficulties with other facilities. I am aware of the magnitude of these difficulties as I am sure you are also. There are specific strategies to overcome the workforce shortages and to improve the overall employee morale that will be proposed and discussed in detail. In order to provide this information, I have reviewed key issues affecting our hospital and have interviewed a number of individuals but more data is indicated. An immediate step that will be taken will be the establishment of exit interviews. We need specific information on why staff members are leaving and I would like individuals from our Human Capital department to develop specific questions to gain information to the root cause of the voluntary terminations we are experiencing.

According to an article by Martha Frase-Blunt, entitled Making exit interviews work: properly collected and analyzed data can provide valuable insight into employees' attitudes in the journal, HR Magazine, exit interview has three purposes: to learn where the company can improve itself, to make sure employees leave feeling good about their service and, in some cases, [to encourage] the employee to stay under new circumstances. This information will help us pinpoint the rationale why our employees are leaving. Another immediate action that we will take is the formation of a communication committee involving employees and current board members for our facility. The responses should provide us with an indepth analysis of how we view our workplace, both as a board member and as a frontline staff member. In an article published in 2002 by Sober and Sadler, entitled, Improving Organizational Communication and cohesion in a health care setting through employee leadership (Human Organization, 2002) the exchange of specific goals can be developed when we take the time to understand the perspective of our current employees and delve into their vision of what we can do to help our facility. Goals that we will focus on include:

1. Seek out the current issues and solutions from an employees point of view 2. Stimulate the growth of ideas and encourage innovation 3. Encourage the effective implementation of ideas by making recommendations to existing appropriate groups and committees 4. Open communication and build connectedness 5. Be accountable by effectively communicating outcomes of each council 6. Foster accountability by encouraging employees to share the outcomes of their suggestions with others These goals will allow us the ability to remain focused on the outcomes that will help us in the best possible fashion. Once we have gathered the data that is needed to fully understand the issues surrounding our high attrition rate and our decrease in overall employee morale, we can begin to create the atmosphere of positivity that will help us execute additional strategies. Thank you for your attention and your willingness to work as a team.

REFERENCES:

Frase-Blunt, M. (2004). Making exit interviews work: properly collected and analyzed data can provide valuable insight into employees' attitudes. HR Magazine, 2004.

Schermerhorn, J.R., Hunt, J.G., Osborn, R.N., & Uhl-Bien, M. (2010). Organizational Behavior (11th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Sobo, E.J. & Sadler, B.L. (2002). Improving Organizational Communication and cohesion in a health care setting through employee leadership. Human Organization, 1 (3).

__________________________________________________________________________________ II. Report of Strategies and Recommendations

Middlefield Hospital

Report of Strategies and Recommendations

For workforce shortages and employee morals

Executive Summary

Middlefield Hospital has been known throughout the community as a hospital that provides a full array of inpatient and outpatient services. We have been recognized in the community as providing quality care for all of our customers. Today our hospital is faced with many issues that will affect our ability to adequately service our community. This report will discuss in detail the main issues the hospital has been faced with such as:

* New hospital recently opens in the area increasing competition.

* Local colleges eliminating its nursing degree program.

* Employee turnover rate exceeding 20%, leading to over a 100 nursing positions vacancies.

* Employee morale deteriorating over the last 12 months.

Presented in the report will be strategies to overcome the new competition, proposals of working with the local colleges, and recommendations which would help improve employee morale as well as decreasing the turnover rate.

Middlefields Competition: The new hospital in the area brings competition for Middlefield Hospital. This affects not only the hospital revenue; it also creates competition for retaining staff. Middlefield is currently losing our medical staff to the new hospital. In efforts to compete with our competitor we have to re-strategies the organization structure. One suggestion would be to renovate our current facility and to include new state of the art technology. Renovating the facility would bring more of an attraction to the hospital. Additional ways are to provide our staff with the most reliable state of the art technology.

Teaming with local colleges: There is a problem with the inadequate capacity of the nursing education pipeline since many American students are interested in nursing careers and most nursing programs have waiting lists of qualified students. To solve this crisis Middlefield Hospital will mobilize its members to support the local nursing programs through a Nursing Workforce Initiative. Workforce initiative would seek to increase nursing school enrollments by developing and strengthening a relationship between Middlefield and Essex University

Information would be gathered to support the development of a new hospital academic partnership by surveying the hospital and school. The objective of the surveys for the hospital would be to show how a nursing shortage would affect the hospital. It would also show that the hospital would have the capacity

to accept more clinical student rotations. The nursing school survey would show the number of applicants that could be admitted if there wasnt insufficient faculty and classroom space.

In 1981 the Nurse Training Act was eliminated by the Omnibus Budget Reconciliation Act (OBRA). Effectively working with the local colleges nursing staff would be able to obtain education support from the federal government through Medicare-direct GME (Graduate Medical Education) funds. 15 percent of these funds are targeted for the hospitals to use to train nurses and other paramedical personnel. (Understanding the U.S. Health Services System 2009).

Employee Turnover Rate & Improving Employee Moral

Nurses have a varied of education and practice competencies which brings different skills to care for patients. They must be able to practice at their fullest capabilities to compete as attractive professional destinations. Those practice environments should recognize and reward the differences that are defined by nurses roles, also by utilizing and compensating nurses according to their skills.

Many factors contribute to the recruiting and retaining qualified nursing staff. One of those factors is the environment in which the care is practice. Low pay rate has been cited by nurses as a professional drawback. The leading factor given for turnover in the nursing profession is workplace issues.

Surveys showed the number one reason for the high nursing turnover is due to dissatisfaction with the job, the supervisor or career prospects. The second most reason is due to the workload and staffing. (1999 study, Mercer, William)

Middlefield would address this issue by introducing greater flexibility into work environment structure and scheduling programs. Rewarding those experienced nurses for serving as mentors and/or preceptors for new nurses. Implement more appropriate salary and benefit programs. Institute appropriate management structures within the health care system. Ensure adequate nursing staff as well as providing nurses with sufficient independence over their practice in all settings and redesign the work to facilitate an aging workforce to remain active in direct care roles.

Conclusion

In conclusion if all of the strategies and recommendations are followed as planned Middlefield Hospital would be viewed as an improved healthcare facility. It would create a more improve operational structure. Develop a relationship with the local schools to promote more nursing programs. Strengthen our ability to compete against competitors. Reducing the turnover rate as well as increasing employee morale.

References

1. Understanding the U.S. Health Services System, 4th edition

Pheobe Lindsey Bartonu

2. Nursing Workforce: shortages and diversity, www.nhfca.org retrieve January 12, 2012

3. William M. Mercer Inc. (1999) Attracting and Retaining Nurses-Survey Results.

www.nursingworld.org retrieved January 13, 2012

References for nonprofit vs for-profit 1. The value of nonprofit health care, www.nonprofithealtcare.org (retrieved January 19,2012) 2. Nonprofit Hospitals and the Provision of Community Benefits, www.cbo.gov (retrieved January 20,2012) 3. Making Profit and Providing Care: Comparing Nonprofit, For-Profit, and Government Hospitals, Horwitz, Jill R.; www.content.healthaffairs.org (retrieved January 20, 2012)

4. Not-for-profit healthcare organizations increase cash, reduce debt to improve financial performanceIndustry Scan, Bolster, Carole J. http://findarticles.coms (retrieved January 20,2012)

5. The Value of Nonprofit Health Care,www.nonprofithealthcare.org (retrieved January 20, 2012)

III.

Middlefield Hospital Strategies and Recommendations

Middlefield Hospital Strategies and Recommendations Background: Middlefield Hospital is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area. Problem: As the new CEO, I have learned that the hospital's employee turnover rate exceeds 20%, and there are over 100 nursing vacancies. I have also learned the following facts that may be impacting these workforce shortages: A new hospital has recently opened in your market area that has produced competition for Middlefield Hospital. Employee morale has deteriorated over the last 12 months. Essex University (a local college) is considering eliminating its nursing degree program because there is continual difficulty in recruiting well qualified instructors. Discussion: In order for Middlefield Hospital to remain in business, we must offer cost effective quality care to our customers. We must also change our operational strategy to develop a new strategic marketing plan for offering services in our community. This will require us to think out of the box when it comes to investing in our employees in order to retain the best and brightest for the future of our company. In addition, we must improve our community relations and form a strategic alliance with the local university to ensure the pipeline of new recruits continues to come through our doors for careers in the nursing and healthcare fields. Finally, we need to develop a strategic alliance with our competition to ensure we close the gap on market share for reimbursement and inpatient and outpatient healthcare cost.

Analysis:

Middlefield Hospital (MFH) is not performing because it has neglected its operation strategy and failed to take advantage of its strengths and opportunities as a 400 tertiary care facility in a major urban Northeast area.

MFH has rested on its laurels for providing quality integrated inpatient and outpatient services to its community and has allowed competition to open in its marketing area. MFH has lost focus and neglected investing in its capital and human resources. The breakdown in maintain good internal communication and cooperation among different functional areas has open the door for completion to meet the wants and needs of its demographic population.

MFHs 20% employee turnover rate directly reflects in its lack of attention to its most valuable resource of human capital which has resulted in the deterioration in employee morale over the past 12 months.

MFHs lack of focus on the challenges in its community at the local university level has compounded its problem to continue to form the right alliance necessary for sustained growth through education and employment opportunities for its internal and external growth.

Recommendations: As the new Chief Executive Officer (CEO) of Middlefield Hospital and will form a committee to study ourselves and our competition in an effort to redefine the needs for health services in our commununity, identify resources to meet those needs, assist or advise in the creation of programs to meet the needs, and monitor and evaluate plan implementation. Upon recommendations from the committee I will (1) Cancel services that are not profitable and meet our customers need.

(2) seek to expand our services to reach the school of nursing and offer clinicals at our facility.

(3) Explore the possibility to become a teaching hospital for new nurses, doctors and allied health personnel and while continue to provide world-class healthcare to our patients.

(4) Provide opportunities for our staff to teach at the Essex University 3 months out of the year.

(5) Reduce our turnover by offering recruiting incentives and retention bonuses to combat the hospital's employee turnover of 20% and reduce the nursing vacancy rate by 50% by June 2013.

(6) Hire 2 fulltime healthcare recruiters to attract and retained the best and brightest healthcare personnel in our critical fields with stock options.

(7) See what services we can offer at a competive price to attract other insurance plans.

Conclusion: Responsiveness relates to ability to respond to changing demands. Differentiation can relate to product or service features, quality, reputation, or customer service. Some organizations focus on a single strategy while others employ a combination of strategies. One company that has multiple strategies is Amazon.com. Not only does it offer low cost and quick, reliable deliveries, it also excels in customer service. Organizations fail or perform poorly for a variety of reasons however, being aware of those reasons can help managers avoid making similar mistakes. Among the chief reasons are thefollowing:

Neglecting operations strategy.

Failing to take advantage of strengths and opportunities, and/or failing to recognize competitive

threats.

Putting too much emphasis on short-term financial performance at the expense of research and development.

Placing too much emphasis on product and service design and not enough on process

design and improvement.

Neglecting investments in capital and human resources.

Failing to establish good internal communications and cooperation among different functional

areas.

Failing to consider customer wants and needs.

The key to successfully competing is to determine what customers want and then directing efforts toward meeting (or even exceeding) customer expectations. Two basic issues must be addressed. First: What do the customers want? (Which items on the preceding list of the ways business organizations compete are important to customers?) Second: What is the best way to satisfy those wants?

Operations must work with marketing to obtain information on the relative importance of the various items to each major customer or target market. Understanding competitive issues can help managers develop successful strategies. These strategies have to include the organizations most vital resource of human capital. Companies are as good as the people they hire and retain. Recognizing the value of each employee is critical to keeping turnover rate low.

Work Cited:

Werbach , Adam . Strategy for Sustainability: A Business Manifesto. Boston: Harvard Business Press , 2009 .