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by Peter Block
by Cathy Kramer
Business News Briefs
for a Change
Comes From Breaking New Ground - Not Ploughing The Old
Cold, scared and alone, lying on a bed in an empty hospital
room, your health placed in the hands of a team of people you don't even
know. It is the responsibility of a group of doctors, nurses and administrators
to see that you get home safely. So do you care if the nurse likes setting
objectives better than writing reports? If not - be glad that somebody does.
A Time of Change
St. Vincent Hospital and Health Care Systems, a
Daughters of Charity hospital, is a healthcare facility with 7,000 employees,
located in Indianapolis, Ind. With over 100 sites throughout the central
region of Indiana, the St. Vincent network experienced a period of rapid
growth during the late 1980s. Combined with dramatic changes in the healthcare
sector - increasing managed care, Medicare and Medicaid reimbursement expectations,
increased customer expectations, technological advancements, role integration,
as well as specialist to generalist transitions - the hospital recognized
the need to examine how it used its workforce. This realization grew into
a new structure called Patient Focused Care.
While the traditional hospital structure was intensely
unit-focused, the new structure required shifting to a continuum-of-care
approach (following the patient from the physician's office, into the units,
and beyond). This broadened approach demanded a major transition in mindset
for people working within these units. It also led to the creation of a
key role called Practice Facilitator which involved coaching, mentoring,
linking and coordinating staff to accomplish the goals of the patient care
In December 1994 nurses from an orthopedics unit
of the hospital requested that research be conducted to bring clearer understanding
to the new and changing responsibilities in their work. The research highlighted
a significant amount of confusion surrounding the responsibilities and expectations
of the Practice Facilitator role. Practice Facilitators were torn between
delivering patient care themselves and responding to the needs of other
patient care providers (doctors, nurses, etc.), and were at risk for feeling
overwhelmed or underutilized. As this research continued throughout other
patient care units, the need for change emerged.
A New Approach to Work Redesign
The McFletcher Corporation, Scottsdale, Ariz.,
is the developer of the assessment inventory used by St. Vincent. It helps
to identify and provide data on the way that work is changing in organizations.
It identifies the way an individual prefers to approach work, compared to
the way the work is actually being done, then engages individuals in determining
what the work actually should be in order to best serve the organization.
Initiated in 1995, the work redesign process eventually including 63 Practice
Facilitator positions and 12 cost centers. added clarity and focus to the
functions of the Practice Facilitator. Complete assessments of each facilitator's
preferred work-style (how they liked to work) and actual work-style (what
they really did) provided a foundation for change.
These statistics were used to create "stress graphs"
that identified the largest discrepancies between actual and preferred work-styles.
The three largest discrepancies indicated: 14 percent of Practice Facilitators
preferred to perform substantially fewer "task activities" (writing
reports, dealing face-to-face with patients), 8 percent preferred substantially
fewer "project activities" (coordinating responsibilities, assigning
tasks to other people, coaching) and 30 percent were experiencing a high
level of stress around "organizational activities" (focusing on
overall goals and results, development plans, growth strategies).
This last group, however, was markedly different from the
first two. Those 30 percent experiencing stress around organizational activities
wanted more, not less, of those goal setting and developmental activities
than they were able to carry out in their work.
You Can't Always Get What You Want
The next step required designing what tasks should
comprise the new role. The key was to move people from what they were doing,
to what they needed to be doing, then mirror that against what they wanted
to be doing.
Everyone worked together - managers, associates and customers
- in assessing the criticality and frequency of their everyday activities.
Low-rated items were removed or delegated. Critical items were added to
the new profile. As that was completed, the new role emerged.
It became clear that a "project orientation" was called for: an
approach where establishing linkages was paramount, ranging from coordinating
multiple team-care specialists on the floor and at the bedside, to connecting
a specific unit to the whole network of St. Vincent Hospitals and Health
Services through various councils. In short, more of the project activities
many Practice Facilitators wanted less of, with no increase in the organizational
activities most desired.
But, You Might Get What You Ask For
The work redesign process clarified the role of
the Practice Facilitator to that of a team leader and the pivotal role for
all coordination, communication and staff development within individual
units. When placed on the previous graph (actual vs. preferred), one thing
immediately stood out: the new Practice Facilitator role was further from
people's preferred style than it was before the work redesign process.
The role that employees themselves had largely designed
actually increased conflicting difference levels.
Jude Magers, an internal organizational development consultant at St. Vincent's
and a registered nurse, sees this as a credit to her fellow employees. She
recalls, "The group responded not by what their preference was in creating
this role, they designed what the organization needed. They could have designed
a more dominant role."
Practice Facilitator's accepted their new roles, facing up to the fact that
while it would be difficult, because it didn't fit with their preferences,
they had created the role themselves based on the work they knew had to
be done. Donna McIntosh-Fletcher, partner, The McFletcher Corp., states
"We find so many organizations don't trust the wisdom of their people.
So they'll have another department design the work, or they'll bring in
consultants to design the work. We've found that without fail, people will
design the work for the sake of their organization if we trust their knowledge
and give them the tools and information needed."
Magers explains that the redesign process has helped
-understand the role of communication and coordination,
and to service communication links vertically and laterally - they did not
previously feel their communication involved anybody else or that they had
to go beyond their unit
- develop a common language that is breaking through communication barriers
and improving communication across traditional functions
- prioritize their own work and improve the efficiency of their day and
- understand the linkage of day-to-day operations to the larger organizational
Magers believes the impact of this process extends even
further. "They [practice facilitators] are now more responsive to change
as an opportunity than a threat. These are probably some of the healthiest
people in our organization today in being able to say, 'Yeah, I can change.
I want to participate in helping to create that change."
St. Vincent's continues to evolve as it moves to accomplish change, while
at the same time preserving and protecting the sacred trust for providing
quality health care which is the central tenet of the hospital's mission.
A truly healthy and encouraging reality.