management

Organizational Culture

Organizational Culture. For this project, you will come up with an organizational case related to organizational culture. You will then address this issue through both a research and applied framework in which you propose an intervention to resolve the issue.
For each project you need to:
1. Create an organizational situation that pertains to the topic for the module/week
2. Address the issue that you propose through 2 lenses:
a. Provide relevant research
b. Discuss the practical implementation of the intervention

Situation
Aspen Dental has been rapidly expanding around the country looking for Operations Management Trainees to become Operations Managers in a 2-Year Management Development Program. You have recently been employed with Target for 5 years as an Operations Manager, and previously worked as an RN at Baylor, Scott, and White Health for 3 years prior to your experience at Target. You are looking to expand into the healthcare/dental field. After applying and 4 interviews later you are accepted into the Management Trainee Program. One of the first organizational projects you are tasked with is improving the patient care experience. Your mentor, the Senior Vice-President of Operations task you with looking at the ways Patients can become more involved with their experience as well as the current opportunities and strengths the practice possesses.
Upon doing preliminary questioning of patients when introducing yourself you find there is no streamlined communication system, no access to patient MHR (Medical Health Records), inattentive staff leading to high turnover and attrition among colleagues, and overall lackluster environment. Upon deep diving, however; you discover the most critical situation is the patient’s negative interactions with the staff causing them to seek treatment elsewhere at other clinics with better reviews and practices. Overall, patient morale is at an all-time low and the practice has been losing 10 patients a week for the past month. It is critical as emphasized by the Senior VP that you find a way to improve the experience of the patients. He reports that by doing this it will promote you to the next level faster and you will be seen as the one responsible for turning the practice around. You accept the challenge willingly and move forward with the process.

Process Improvement
In order for the practice to improve, research and key components must be highlighted in the beginning. Improving a practice is no easy task and requires serious intervention skills and methodologies that can be instituted in order to better serve the patient experience. The practice situation would be considered a “complex intervention”, which are interventions designed as “many components that act independently and interdependently simultaneously” (Campbell, 2007, p.455). There are five phases that comprise the complex intervention state starting with the preclinical phase that basically determines will the intervention work. The second phase is the modeling phase which asks the question of how the intervention will work. The third and fourth phases are the pilot trial and the random control trail which allows to see the preliminary results of the intervention plan. Finally, the last phase is the implementation (Campbell, 2007, p.456).
However, an example of a situation where the intervention plan was not well thought out was an initiative by the Primary Care Trusts of England in 2000 to hire 1000 mental health workers by 2004 in order to deliver better mental health care to patients. In 2002 one primary care trust decided to pilot the plan by hiring psychology graduates to work in the practices. Their roles included direct work with patients, and supporting the practice operationally (Campbell, 2007, p,456). A randomized control was performed in order to assess the effect these graduates had regarding “mental health symptoms, patient care experience, and the cost regarding effectiveness of care” (Campbell, 2007, para.2). After using 16 practices and 368 patients, three months later the patient satisfaction surveys were higher in the practices where the intervention occurred rather than the control practices. Even though the results were positive, there was no way to support how the workers actually made the patient satisfaction surveys go up due to lack of information and knowledge (Campbell, 2007, para.3). In turn the most important piece of solving the issues at the dental practice will have more to do with how things are done rather than what is done in order to positively affect the patient in the long run.
Practical Application and Implementation
One of the main components affecting the state of the practice is the negative run-ins with staff members. In terms of good research starting with the pre-clinical phase of the complex intervention, a good researcher must “identify existing evidence” (Craig et al; 2008). By using this methodology, an intervention can be established as being able to have a worthwhile effect. The main evidence is that 10 patients have been leaving the practice a week and there have been negative interactions with staff-members that have led to the attrition of patients, which leads to the hypothesis that if staff members are negative then patients will leave the practice. Instead of focusing on the patient experience, the focus then shifts to improve the employee by completing a total transformation of the current employee practices. This will change the operation which may even lead to severe terminations which will directly lead to the training and development of new staff. However, in an effort to save the practice time, money and resources retrofitting the current staff seems to be the optimal plan.
The plan for the existing staff is simple. All current staff members will be required to go to a 3-day Wellness Retreat that teaches the fundamentals of healthcare, patient care service and customer service. Several facilitators and top experts in the field will lead workshops and simulations. At the end of the workshop and seminar the staff will be given set schedules. The schedules with correlate with the new evaluations that will be given each week for a probationary period of 30 days. A satisfactory rating will be given to those staff members who exceed expectations by greeting and welcoming patients, explaining thoroughly healthcare and insurance regulations and payment information, offering items geared toward patient comfort, being attentive and exhibiting great listening skills, and receiving all 4’s and 5’s on patient surveys. A non-satisfactory rating will be given to staff members who are rude and unfriendly to patients, offer no items of comfort to patients, ignore patient request, fail to explain insurance and healthcare regulations, and receiving 1, 2 or 3 on the patient healthcare survey. If after 30 days, a staff member has received a non-satisfactory rating for 2 weeks or more out of the 30 days, he or she will be let go. However, if a staff member receives satisfactory ratings 2 weeks, he or she will receive a 10% raise and removed from the probationary period.
In order to access the effectiveness of the new employee training and development program half of the staff will be trained and the other half will remain untrained until the pilot period is over. Two trained staff members will sit by two untrained staff members during each shift greeting and checking in patients. Each patient will complete a survey on the interaction they had with the respective staff members by the Patient Success Coordinators who will survey patients and evaluate staff. No staff will be held to the terms of the probationary period, they will only think they are being held to the standard. At the end of the pilot a random trial will occur. During this trial all trained staff will greet patients and during schedule change all untrained staff will switch out. The Patient Success Coordinators will again take surveys of the respective staff and evaluate all trained staff members. All untrained staff members will then be trained leaving all members to begin the 30 day probationary period.

Discussion
One of the great assets of the intervention plan is that it allows staff members the opportunity to redeem themselves in a sense. The staff members have obviously been getting away with bead behavior for a long time so it is important to address that behavior head on and allow it to be put to a stop. One of the things that is interesting about the intervention plan is that it allows the trained staff a chance to influence the untrained staff. If the untrained staff observes a difference in the attitudes of the trained staff, it may influence them to have better attitudes towards patients without being trained. Moreover, if they by chance hear about the probationary period from the trained staff, then it will be more of an incentive for them to perform their own corrective actions and introspection without force and threat of termination.
One of the major drawbacks is that one control group will essentially be at a disadvantage or advantage over the other control group. Although all the staff will all be trained and put under the real probationary period together after all training is complete, the trained staff essentially have an advantage over the untrained staff in being able to complete those viable customer service actions before the other untrained group. In addition, it is more than likely the untrained staff will hear from the trained staff that simply put it is time for them to get it together due to the new policies being implemented. The untrained staff if they take the warning and apply it will in essence have had more time to correct their actions than the first trained staff group. All in all, the implementation plan appears to be well thought out and executed as opposed to the earlier plan discovered during research where they knew what intervention plan they did but could not determine how they completed the plan. Ultimately, by holding the staff accountable for their actions, you in turn hold them liable for the patient experience not only because their employments depend on it ,but there is also much to be gained in incentives in regards to doing their jobs well.