ASQ - Team and Workplace Excellence Forum
Success Comes From Breaking New Ground - Not Ploughing The Old

January 1998


Have Faith In Your Future
Popcorn Discusses Consumer Trends, Effects on Business

Success Comes From Breaking New Ground - Not Plowing The Old

Taking It To The Public
Business Community Works With School Leaders to Turn a District Around

A Marriage Of Convenience
Unions, Management Team Up to Counter Takeover, Redesign Organization

The Baldrige Award: Winning Isn't Everything, Improving Is

Cutting Off Your Nose To Spite Your Face


Caring About Place
by Peter Block

People Powered Organization
by Cathy Kramer


Brief Cases
Business News Briefs

Views for a Change

Book Review


Success 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 units.

Confusion Abounds
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."

The Results
Magers explains that the redesign process has helped practice facilitators:

-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 their workweek
- understand the linkage of day-to-day operations to the larger organizational picture

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.

January '98 News for a Change | Email Editor


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