Introduction
Hospital residency is a vital element of education for future health professionals in any discipline. It provides a valuable and realistic experience that contributes to the development of professional knowledge and standards. Scenario-based teaching (SBT) is a common methodology employed in medical education aimed at providing complex and realistic case experiences within hospital settings for learners to navigate and apply their academic knowledge and potential skills. SBT provides insight and practice for participants that would not be otherwise achieved in any classroom setting while also providing an opportunity to offer feedback for professional growth (Patel & El Tokhy, 2018). Superiors oversee various educational exercises during hospital residency and can, in many ways, reflect the organizational culture, ranging from support of educating staff to approach to treatment or communication. This paper will describe a problematic SBT scenario and, using theory and practical applications, offer suggestions on the best means to improve organizational culture.
Problem
As part of the medical education in hospital residency, one must engage in patient and family communication regarding their condition, treatment plan, and other relevant information. The hospital in question strongly values efficiency and relies on specific KPI figures. Each patient is seen or treated is allotted a certain time period. Communication is encouraged to be direct and to the point, which often results in relatively blunt interaction with patients and families without forming connections. Health professionals are expected to quickly evaluate, diagnose, and outline further treatment, moving on to the next patient due to the overwhelming number of patients at the hospital in light of the COVID-19 pandemic.
This is an issue in several ways. According to Butler et al. (2018), time spent with patients has direct implications for both the healthcare provider and the patient. Generally, providers are happier and experience greater job satisfaction with more time to interact with patients, while patients experience better outcomes and satisfaction from such interactions as well. Meanwhile, Burgener (2020) and numerous other studies noted that quality patient-provider interaction and communication, particularly on challenging topics, bring multiple benefits ranging from patient satisfaction to safety and better health outcomes. Overall, such an environment is an indicator of an unhealthy organizational culture at this hospital as a patient-centered approach is correct based on evidence.
Plan
The plan is to improve the patient-centered experience and create an environment where providers have the freedom to spend quality time treating and communicating with patients and their families. While the current rotations may be more acceptable in something like ICU settings, physicians and nurses in regular in-patient and out-patient care must be given flexibility in order to improve patient-related outcomes (Bukoh & Siah, 2019). A patient-centered approach allows for better education, patient satisfaction, and implementation of interprofessional care if needed and is associated with increased safety, treatment adherence, reduced hospital stay and lower readmissions (Mason et al., 2018). The plan is to improve the culture of the organization to be patient-centric and focus more on quality of care rather than quantity.
One of the main theories of organizational change management is Lewin’s change model. It involves three steps unfreezing, changing, and refreezing. The premise is that the process of change consists of creating the perception that change is needed, and moving forward with the desired level of behavior, and finally establishing that behavior or culture as the status quo (Hussain et al., 2018). Culture is notoriously difficult to change in an organization. It will require more than a mandate, policy change, or even staff education, it takes a movement that must, at least, seem as if it came naturally from inside the organization. For any organization seeking to change and be more innovative, culture is the most difficult. It may be attractive to pursue operational excellence and efficiency, but these values are contradictory to the culture change necessary, which cannot be achieved through a top-down approach (Walker & Soule, 2017). It has to stem from the collective habits of the employees with a shared perception of the new change.
Therefore, according to Lewin’s model, first, there must be an unfreeze of the current status quo. Elements of ideas regarding the change should be brought up at staff meetings, potentially voted upon via online polls to gauge the staff’s support of the idea. Once determined that change is needed, begin the process of preparation. This includes changing policies and procedures, shifting workflows in the hospital to fit the new system, involving employees in the creation of new policies, and, most importantly, communicating the changes to the staff in a clear manner ahead of time (Ogochi, 2018). The next step is implementing the change, shifting into the new patient-centric system and evaluating the effectiveness of the transition. In large changes like this, there will be potential issues to resolve on multiple fronts, given the complexity of a hospital as an organization. However, this is the stage where it is important to finalize everything according to the realistic status quo and allow the workforce to adapt as the new culture seeps in (Teguh et al., 2019).
Finally, the freezing stage essentially seeks to ingrain the new change and culture into the foundation of the organization. This is crucial to avoid instability or confrontational ideologies within the culture; the whole organization should function on the same principles to maximize the effectiveness of care (Burnes, 2019). All efforts should be made to support the staff in this transition and embrace the new patient-centric approach and culture as a positive change for the betterment of the organization and its services.
Conclusion
Overall, the educational scenario highlighted issues in the hospital’s culture and procedures that focused more on the quantity of care and KPIs, such as the number of patients seen rather than quality. Careful approaches to treatment vital communication between providers and patients and families were largely missing. This was evident in patient and staff dissatisfaction and potentially through measures such as adverse events or other poor health outcomes for the patients. It was proposed that Lewin’s three-step organizational change be utilized to change the hospital culture towards a more patient-centric approach. The numerous benefits this would bring to improved communication and building relationships with patients are much likelier to result in positive health outcomes. The culture change is a complex and challenging element to implement, but with the overwhelming desire of the staff for change and a competent way of approaching policy and workflow change, gradually, the culture can shift towards the new standards. Of course, such large changes require strong leadership and careful guidance by management to ensure that the new methods are supported and promoted while the old ones are viewed as dysfunctional.
References
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