Safe Patient Care Case Study Essay
Case Study 19-1 titled “Organizational and Cultural Change for Providing Safe Patient Care”, on page 382 through 383, is about a Department of Medicine (DoM) in an urban academic medical center where in the past 2 years there has been cases where patients had needlessly suffered serious harm. Even though the cases were far and in betweeen, and most of the employees were comfortable with the status quo however, “the chairperson’s view of patient care safety meant that there was no place for such incidents.” Incidentally, the patient safety incidences occurred inspite of the fact that the medical center had three department meant to address patient safety. Given that the DoM was responsible for making decision in the patient care process, the chairperson felt the responsibility of addressing the issues more directly. The chairperson solution was to create a committee of “change agents” pulled from various departments at the medical center, and tasked with examining “lapses and problems in the delivery of safe patient care and identify trends and clusters that merited action”. The following knowledge concepts, though covered in class, are not applicable to the selected case study: Intercultural perspectives, Practices of Effective Behavior across cultures – Individual and Group, Multicultural teams,
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Gender and Equality. In this paper, I will be interpreting and applying the following concepts to Case Study 19-1: Human Behavior and Social Relationships, Intercultural Perspectives, Organizational Behavior Theories, Power, Influence, Trust, Cultural Synergy. The case study did not address gender and quality in my opinion.
According to Borkowski, “social perception is how an individual sees others and how others perceive an individual” (P. 55). Also, according to Edgar Schein, “If an organization is to understand its own strengths and weaknesses, and if it is to make informed strategic choices based on realistic assessments of external and internal factors, it must study and understand its own culture.” Culture is not necessarily something that is taught to others, sometimes it’s a way of thinking or assumptions that are held and unconsciously taken for granted. For example the espoused value of the medical center was about “doing more with less” which contributed to adverse patient safety scenarios even though there were physical artifacts such as, quality improvement department, a process improvement oversight committee, and a risk management department, meant to address patient safety.
The chairperson analysis of the organization revealed other cultural norms, which created barriers for the elimination of safety issues. Those barriers included: lack of open exchange of ideas; safety problems were assigned to risk managers, who upon determining root cause of the issues assigned blames, also there was an external factor of the department being located in a high medical malpractice award area, which “promoted a closed, defensive attitude toward patient safety issues.” However, in the face of these behaviors and social relationships and the suffering of patients from needless harm in the hands of medical professionals, the chairperson of the DoM decided on a course of action that will lead to changes in the culture of the medical center. How could one person effect change in an organization?
On page 380 through 381, the textbook documents five interactive elements as being critical for the successful transformation of a healthcare organization to include: strong impetus to change, leadership commitment to quality, improvement initiatives that actively engage staff in meaningful problem solving, integration to bridge traditional intraorganizational boundaries among individual components. In addition to the above characteristics, the chairperson must have power in order to cause integration of traditional intraorganizational boundaries among individual components. According to the case study, the chairperson had “decades of management experience and was politically and culturally savvy” hence the chairperson was qualified to lead this change. Moreover, the chairperson had legitimate power, which is the “authority given to an individual on the basis of a given role or position.” According to Edgar Schein in the "Innovative Cultures and Organizations" white paper (P. 168), “the assumptions, beliefs, values, and biases of the [chairperson] will limit and bias the technical and structural options considered, and will certainly affect the kind of organizational design that is evolved.”
The chairperson addressed the patient safety concern by creating a patient safety committee (PSC) without dismantling the previous committees. Sensing possible opposition to the new committee, from physicians who requested for hard evidence, the chairperson appointed the director of medical resident education to co-chair this new committee. The second co-chair of the PSC was filled by an associate from the medical informatics since the PSC will rely on patient care information systems in most of their activities. In setting up this new committee and strategically staffing the committee, the chairperson of the DoM demonstrated the elements for successfully transforming a healthcare organization. According to Borkowski, one of the eight steps for successful organizational change is “[establishing] a sense of urgency” (P. 379). In this case study, the sense of urgency was triggered by patients being harmed needlessly by medical practitioners. However, the effort of this chairperson met with opposition from his colleagues.
Two Organizational Behavioral theories - Theory X and Y – documented in the textbook are applicable to this medical center organization. “Theory X states that employees are unintelligent and lazy. They dislike work, avoiding it whenever possible. In addition, employees should be closely controlled because they have little desire for responsibility, have little aptitude for creativity in solving organizational problems, and will resist change. In contrast, Theory Y states that employees are creative and competent, they want meaningful work; they want to contribute; and they want to participate in decision making and leadership functions” (P. 8). It is clear from the case study that the chairperson applied Theory Y to the medical center because upon setting up the PSC, the chairperson noted that “caregivers want to be effective and do well by the patient, take pride in their work, avoid the waste of scarce medical resources by providing efficient care, compete successfully in the local healthcare marketplace on the basis of effective and efficient care, and avoid malpractice (i.e., another waste of scarce medical resources).”
The other aspect of the culture that needed to be changed was the “subconscious” organizational culture of blame that pervaded the department. In a culture where blame and finger-pointing is the norm, it becomes almost impossible to determine what actually went wrong in the first place. A culture of blame and finger-pointing can erode trust and teamwork, and stifle creativity. In changing this aspect of the culture, the chairperson recruited individuals from the different departments as members of the PSC. By recruiting individuals from the different departments to the PSC, the chairperson was able to change the organizational politics from that of “attacking or blaming others” to that of “developing allies and forming power coalitions.” Moreover, cultural change rarely occurs without opposition as people tend to adhere to their comfort zones. “Resistance to change may include: 1) lack of change agent, 2) inadequate financial and / or capacity, 3) poor leadership and resistance to change by senior management, 4) lack of necessary technology, 5) time restraints, or 6) poor market conditions” (Borkowski, 2011). The new committee met some opposition from some in the department, who viewed the new committee as “duplicating the efforts of existing departments and committess.” However, the critics were worn over by the effectiveness and the results from this new committee.
Culture is not just what an organization says, but culture is the embodiment of the actions and beliefs in the organization.
Leaders in an organization play an active role in defining the culture of the organization. The extent to which the original culture remains in the organization will depend on the original primary and secondary reinforcers of the cultural norms that are in place, as well as the investment made by leaders in influencing the organization 's culture. In this case study, the chairperson was able to lead the medical center in solving a patient safety concern without alienating employees, but by creating a better organizational
culture.
References
1. Borkowski, N. (2011). Organizational Behavior In Health Care. (2nd ed.). Sudbury, Mass: Jones and Bartlett Publishers.
2. Schein, E. (November, 1998). Innovation Cultures and Organizations. (Vol. 90s: 88-064). Massachusetts Institute of Technology.
3. Odwazny, R. & McNutt, R. (2011). Organizational and Cultural Change for Providing Safe Patient Care [Case study 19.1]. In N. Borkowski, Organizational Behavior In Health Care (2nd ed.). (pp. 382-383). Sudbury, MA: Jones and Bartlett Publishers.
Gender and Equality. In this paper, I will be interpreting and applying the following concepts to Case Study 19-1: Human Behavior and Social Relationships, Intercultural Perspectives, Organizational Behavior Theories, Power, Influence, Trust, Cultural Synergy. The case study did not address gender and quality in my opinion.
According to Borkowski, “social perception is how an individual sees others and how others perceive an individual” (P. 55). Also, according to Edgar Schein, “If an organization is to understand its own strengths and weaknesses, and if it is to make informed strategic choices based on realistic assessments of external and internal factors, it must study and understand its own culture.” Culture is not necessarily something that is taught to others, sometimes it’s a way of thinking or assumptions that are held and unconsciously taken for granted. For example the espoused value of the medical center was about “doing more with less” which contributed to adverse patient safety scenarios even though there were physical artifacts such as, quality improvement department, a process improvement oversight committee, and a risk management department, meant to address patient safety.
The chairperson analysis of the organization revealed other cultural norms, which created barriers for the elimination of safety issues. Those barriers included: lack of open exchange of ideas; safety problems were assigned to risk managers, who upon determining root cause of the issues assigned blames, also there was an external factor of the department being located in a high medical malpractice award area, which “promoted a closed, defensive attitude toward patient safety issues.” However, in the face of these behaviors and social relationships and the suffering of patients from needless harm in the hands of medical professionals, the chairperson of the DoM decided on a course of action that will lead to changes in the culture of the medical center. How could one person effect change in an organization?
On page 380 through 381, the textbook documents five interactive elements as being critical for the successful transformation of a healthcare organization to include: strong impetus to change, leadership commitment to quality, improvement initiatives that actively engage staff in meaningful problem solving, integration to bridge traditional intraorganizational boundaries among individual components. In addition to the above characteristics, the chairperson must have power in order to cause integration of traditional intraorganizational boundaries among individual components. According to the case study, the chairperson had “decades of management experience and was politically and culturally savvy” hence the chairperson was qualified to lead this change. Moreover, the chairperson had legitimate power, which is the “authority given to an individual on the basis of a given role or position.” According to Edgar Schein in the "Innovative Cultures and Organizations" white paper (P. 168), “the assumptions, beliefs, values, and biases of the [chairperson] will limit and bias the technical and structural options considered, and will certainly affect the kind of organizational design that is evolved.”
The chairperson addressed the patient safety concern by creating a patient safety committee (PSC) without dismantling the previous committees. Sensing possible opposition to the new committee, from physicians who requested for hard evidence, the chairperson appointed the director of medical resident education to co-chair this new committee. The second co-chair of the PSC was filled by an associate from the medical informatics since the PSC will rely on patient care information systems in most of their activities. In setting up this new committee and strategically staffing the committee, the chairperson of the DoM demonstrated the elements for successfully transforming a healthcare organization. According to Borkowski, one of the eight steps for successful organizational change is “[establishing] a sense of urgency” (P. 379). In this case study, the sense of urgency was triggered by patients being harmed needlessly by medical practitioners. However, the effort of this chairperson met with opposition from his colleagues.
Two Organizational Behavioral theories - Theory X and Y – documented in the textbook are applicable to this medical center organization. “Theory X states that employees are unintelligent and lazy. They dislike work, avoiding it whenever possible. In addition, employees should be closely controlled because they have little desire for responsibility, have little aptitude for creativity in solving organizational problems, and will resist change. In contrast, Theory Y states that employees are creative and competent, they want meaningful work; they want to contribute; and they want to participate in decision making and leadership functions” (P. 8). It is clear from the case study that the chairperson applied Theory Y to the medical center because upon setting up the PSC, the chairperson noted that “caregivers want to be effective and do well by the patient, take pride in their work, avoid the waste of scarce medical resources by providing efficient care, compete successfully in the local healthcare marketplace on the basis of effective and efficient care, and avoid malpractice (i.e., another waste of scarce medical resources).”
The other aspect of the culture that needed to be changed was the “subconscious” organizational culture of blame that pervaded the department. In a culture where blame and finger-pointing is the norm, it becomes almost impossible to determine what actually went wrong in the first place. A culture of blame and finger-pointing can erode trust and teamwork, and stifle creativity. In changing this aspect of the culture, the chairperson recruited individuals from the different departments as members of the PSC. By recruiting individuals from the different departments to the PSC, the chairperson was able to change the organizational politics from that of “attacking or blaming others” to that of “developing allies and forming power coalitions.” Moreover, cultural change rarely occurs without opposition as people tend to adhere to their comfort zones. “Resistance to change may include: 1) lack of change agent, 2) inadequate financial and / or capacity, 3) poor leadership and resistance to change by senior management, 4) lack of necessary technology, 5) time restraints, or 6) poor market conditions” (Borkowski, 2011). The new committee met some opposition from some in the department, who viewed the new committee as “duplicating the efforts of existing departments and committess.” However, the critics were worn over by the effectiveness and the results from this new committee.
Culture is not just what an organization says, but culture is the embodiment of the actions and beliefs in the organization.
Leaders in an organization play an active role in defining the culture of the organization. The extent to which the original culture remains in the organization will depend on the original primary and secondary reinforcers of the cultural norms that are in place, as well as the investment made by leaders in influencing the organization 's culture. In this case study, the chairperson was able to lead the medical center in solving a patient safety concern without alienating employees, but by creating a better organizational
culture.
References
1. Borkowski, N. (2011). Organizational Behavior In Health Care. (2nd ed.). Sudbury, Mass: Jones and Bartlett Publishers.
2. Schein, E. (November, 1998). Innovation Cultures and Organizations. (Vol. 90s: 88-064). Massachusetts Institute of Technology.
3. Odwazny, R. & McNutt, R. (2011). Organizational and Cultural Change for Providing Safe Patient Care [Case study 19.1]. In N. Borkowski, Organizational Behavior In Health Care (2nd ed.). (pp. 382-383). Sudbury, MA: Jones and Bartlett Publishers.