The following paper presents a live case study of a healthcare organization requiring change. The goal of the project is to develop an intervention by the OD framework aiming at the improvement of communication between employees and management through the enhancement of leadership practices. The intervention consists of a series of workshops and includes employee surveys as a means of evaluation. The results obtained at the initial stages of the project are consistent with the expectations and suggest a considerable improvement, although further assessment is necessary to conclusively establish the reliability of the results and determine the need for further interventions.
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Project Case Study
The chosen project deals with a healthcare organization changing due to an insufficient pace of growth and high employee turnover. The OD project identifies poor communication and lack of feedback opportunities as reasons behind the discrepancies in performance and low employee engagement. The goals of the project include improvements in employee satisfaction, trust, and responsibility through evaluating and enhancing existing leadership practices. The intervention is implemented on the organizational level and is expected to establish multidirectional communication channels, provide meaningful feedback opportunities for nurses, and provide necessary leadership experience for nursing leaders focused on prior nursing tasks.
Before the intervention, the healthcare organization in question displayed fairly standard results for its field. While the performance was not in decline and showed an acceptable growth rate, the presence of several disruptive factors undermined the effectiveness of the organization. Most prominently, the turnover rate of nursing personnel was high enough to restrict the average level of staff proficiency and, by extension, to limit both growth capacity and customer satisfaction. It is worth noting that a high turnover rate is a common issue in the field of healthcare due to a multitude of factors and does not indicate a particularly low level of performance. However, several issues were identified which offered the possibility of improvement. First, the organization’s leadership was not comprehensive. While nurse leaders were present in the organization and demonstrated exemplary performance in their nursing roles, they could not facilitate a strong workplace culture. Second, communication within the organization was on many occasions top-down with no means of delivering employee feedback to the management. Finally, the evaluation methods focused on performance and did not account for employee engagement, which resulted in a distorted perspective.
Level of System
Since the target organization is comprised of multiple departments and includes interaction between nurses, clinicians, and patients, the most appropriate system to work with is the organization level. First, there is an evident need to establish communication channels between groups (i.e. departments), which makes group level unsuitable (Cummings & Worley, 2014). Second, the intervention targets the feedback process within the hierarchy, which necessitates the organizational-level approach.
Entry into the System
We were contacted by the organization’s management to discuss the unsatisfactory pace of growth, obtain the preliminary information on the existing issues, establish expectations of the client, and provide an explanation to the possible interventions that our team could offer. Also, the entry-stage allowed us to identify existing evaluation techniques and leadership practices that were present in the organization and assess its readiness to change based on previous experience.
The initial needs voiced by the client dealt with insufficient growth rate within the organization. Subsequently, other areas requiring change were identified, such as improvement of communication between departments, employee engagement, a more comprehensive evaluation technique, and feedback opportunities for nurses. Thus, the
Two issues became apparent during the contracting step. First, the client was apparently concerned with exposure associated with the consulting services (Gallos, 2006). While the improvement of organizational culture was clearly their initiative, they were also highly confident with their team of nurse leaders and repeatedly pointed out their recurring activity as proof that the issue cannot be addressed by pursuing this direction. Also, the reluctance to review leadership practices could be perceived as an indication of the fear of loss of control. Both concerns were addressed early in the process to minimize the possibility of resistance later in the course of the intervention.
Second, the integration of just culture in the organization’s framework was perceived by the client as proof of the existence of robust communication channels. While such assertions are not entirely unfounded, they may lead to a distorted perception of results and the emergence of blind spots in the evaluation process (Cheung-Judge & Holbeche, 2015). Thus, to minimize the impact of both barriers early in the course of the project, we identified our area of influence and range of responsibilities, explained the likely outcomes, and pointed to the possible inconsistencies in the existing system to substantiate our outlined course of actions.
Data Collection Methods
While the data retrieved from the client allowed us to identify the likely cause of the turnover and low employee engagement, the additional evaluation was required to conclusively determine the areas of improvement and outline the most appropriate means of intervention. Therefore, two surveys were designed and subjected to nurses. The first one targeted employee engagement and allowed to measure its current level, locate the causes of dissatisfaction and main expectations of the staff, and identify the relationship between the perceived workplace climate and the existing retention rates. The second survey focused on the proficiency of the nurse leaders, the leadership experience provided by them as perceived from nurse practitioners’ perspective, the indicators of successful actions, and the potential areas of improvement of leadership practices. The surveys were administered during the first phase of the project. The results indicated miscommunication between departments, the frequent absence of shared values and clear direction among the staff, and the predominant focus of leaders on their nursing roles rather than solid leadership and guidance. The inability to deliver feedback to the management was often cited as a reason for high levels of stress and declining commitment.
Since miscommunication and the lack of feedback options could be traced to inconsistencies in leadership practices, the decision was made to design an intervention that would allow nurse leaders to improve their understanding of responsibilities and tasks (Block, 2011). Thus, a series of workshops was developed that introduced the concepts of sharing values and communicating the vision of the organization to employees. The workshops included coaching for leaders and building leadership competencies. The important component of the intervention was the strong emphasis on feedback and multi-directional communication channels as a crucial aspect of healthy workplace culture and employee satisfaction. Finally, one-on-one coaching was added as one of the options to increase control of the intervention and account for individual leaders’ characteristics.
The workshops were built for groups that included nurse leaders, hospital managers, and selected practitioners. The participants were divided into mixed teams and were assigned tasks of resolving issues common to the field. The decisions were recorded and shared between groups. This allowed the participants to compare their approaches and, more importantly, to negotiate the solutions on equal terms. Whenever the issues of poor communication arose, they were discussed in detail, including the adverse effects associated with them, possible solutions, and potential improvements resulting from the changes. The intervention took place throughout two months, with eight workshops in total.
Since the surveys used at the data collection stage proved useful in measuring the intended outcomes, it was decided to use it throughout the intervention to monitor the results. The initial results were used as a baseline, with two assessments administered in one and two months after the intervention, with two more scheduled in six and twelve months, respectively. The first two results were expected to be higher than the baseline due to two factors: the proximity to the intervention and the perception of direct involvement and lack of challenge. However, the last two evaluation sessions would be more important since they will more accurately describe the long-term effects of the intervention and its robustness.
Outcomes and Next Steps
Currently, we administered three of the four planned surveys. The results are consistent with the expectations, indicating improvements in most of the problematic areas. The employees report a better understanding of the general directions taken by the managerial department, more reliable communication channels, and better readiness of the managers to deal with their concerns. An increased number of respondents also agreed that their feedback makes a difference and is a significant contribution to the development of the organization as a whole. There is also a reported increase in employee satisfaction, with much fewer nurses being stressed by the miscommunication and an overall increase of evaluation of the organization as a desirable place of employment.
It should be acknowledged, however, that the current assertions of success are based entirely on the reports by the participants and are not backed up by hard data. Therefore, the next recommended step would be to obtain annual data on employee turnover and use it to corroborate the findings of the surveys. This would substantiate the results and establish the validity of surveys as an evaluation tool for further use. Another important step is an assessment of the sustainability of nurse leaders after the separation. Additional assessment is required to observe the improvements of leadership practices and activities independently of those directly resulting from the intervention.
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Role of Personal Learning and Relationship with Peer Coach
The technical aspects of the project were developed using my existing knowledge of the OD framework. To account for possible barriers and overlooked issues, I have consulted several additional textbooks and incorporated the obtained knowledge into the framework. In particular, I have expanded the contracting phase to eliminate misunderstanding with the client and detect underlying issues that may surface later in the course of intervention and pose a significant threat to the integrity of the project.
The assistance of peers proved especially useful for designing the evaluation and recommendations. Specifically, I initially overlooked the fact that the surveys used for evaluation could present the distorted picture and may not correspond to the actual results. Besides, the peer coach identified several possible inherent drawbacks of the project that can surface in the long run. For instance, the coach pointed to the possible dependence on external workshops, which prompted me to include a sustainability assessment on the latter stage.
Block, P. (2011). Flawless consulting: A guide to getting your expertise used (3rd ed.). San Francisco, CA: Jossey-Bass.
Cheung-Judge, M. Y., & Holbeche, L. (2015). Organization development: a practitioner’s guide for OD and HR. Philadelphia, PA: Kogan Page Publishers.
Cummings, T. G., & Worley, C. G. (2014). Organization development and change. Stamford, CT: Cengage Learning.
Gallos, J. V. (2006). Organization development. San Francisco, CA: Jossey Bass.