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Fairview Hospital: An Organizational Analysis Nkechi Ileka Hollis Misiewicz Timothy S. Godfrey, SJ

ANALYSIS Introduction: Organizational Behaviors The study of organizational behavior focuses on individual and group dynamics within an organization, assisting those in leadership to better manage workplace behavior, thus resulting in positive outcomes (Borkowski, 2011). In Chapter 6 of Masterpieces in Health Care Leadership: Cases and Analysis for Best Practice, Pelote and Route (2007) demonstrate through the testimonies of the employees of the Environmental Services Department of Fairview Hospital how the senior leadership of the organization have embarked on a journey to service excellence (p. 84). The purpose of this paper is to describe the significant organizational behaviors reflected in the accounts of various employees of the Environmental Services Department, and to

provide an analysis of the leadership, communication, and change strategies which result in the behavioral competencies that make organizational transformation possible. Leadership Theories Pelote and Route (2007) affirm that the success of the Environmental Services Department is due to the overriding managerial strategy of generating self-confidence within the employees. The directors accomplished this by engendering a sense of respect among the employees for the service they provide, offering appropriate training to them, and setting high standards of performance which the employees are expected to meet. The leadership also empowered employees to be creative in developing their own unique styles of being available to patientssuch as giving hugs to those in need, delivering the morning paper, and even providing foot massages (Pelote & Route, 2007). The managerial strategy of empowering employees is associated with Theory Y in leadership theory (Borkowski, 2011). Theory Y emphasizes the self-direction of

ANALYSIS employees, staff development and education, and employee participation in organizational decision-making (Borkowski, 2011). Fairview Hospital adopted this foundational approach of employee empowerment, but an additional dynamic is present which has elicited such enthusiastic responses within the department.

A recurring theme among the testimonies given by the employees is the care the managers have exhibited for them in various circumstances (Pelote & Route, 2007). One employee recounted a time the department managers came to her home at Christmas with a basket of food (Pelote & Route, 2007). Other leadership theories promote self-directed behavior and participative management, but servant leadership theory highlights this type of personal investment of managers in their staff (Deckard, 2011). Robert Greenleaf (2002) first posited the concept that the servant-leader is servant first (p. 27). This theory of leader as servant has grown in popularity and has focused on three elements of performance coaching by the leader: (a) setting goals, (b) providing the resources and environment to accomplish the goals, and (c) evaluating performance in a timely manner so as to identify developmental needs (Deckard, 2011). Research has shown that nursing managers who employ servant-leader attitudes and behavior have a positive effect on job satisfaction among their staff (Jenkins & Stewart, 2010). Servant leadership has been an effective managerial strategy (Deckard, 2011), demonstrating the transformation that can happen within an organization when management commits to take action to support their team (Pelote & Route, 2007, p. 84). Servant leadership theory, however, is manifested inand supported byseveral

organizational behaviors. Various communication and change strategies associated with

ANALYSIS servant leadership theory have contributed to the positive transformation of the Environmental Services Department at Fairview Hospital. Communication Strategies Communication plays a significant role in managing and leading people. Communication can be defined as the creation or exchange of thoughts, ideas, emotions, and understanding between the sender and receiver (Guo & Sanchez, 2005). Employees are the organizations brain cells, and communication signifies the nervous system that transports information and shared meaning to the essential parts of the organizational body. Effective communication brings knowledge into the organization and distributes it to the employees who need the information (Guo & Sanchez, 2005). Some key elements to effective communication include the desire to communicate, the willingness to understand how others learn, the intent of the communicator, the content that is communicated, the senders credibility, and the time frame involved (Guo & Sanchez,

2005). Communication can flow upward, downward, horizontally, and diagonally within organization. Upward communication involves a communication between supervisors and subordinates. Downward involves passing on information from supervisors to subordinates. Horizontal communication is from manager to manager or from co-worker to co-worker and diagonal flow takes place between different levels of different departments (Guo & Sanchez, 2005, p. 94). The strategy of communication demonstrated at Fairview Hospital exemplifies two of the major intra-organizational communication flows highlighted by Guo & Sanchez (2005) which are upward and downward flows of communication.


A major strategy of Fairview Hospital in increasing employee satisfaction is their utilization of upward communication flow. The purposes of upward communication flow are to provide managers with information to make decisions, identify problem areas, collect data for performance assessments, determine staff morale, and reveal employee thoughts and feelings about the organization (Guo & Sanchez, 2005, p. 94). Guo & Sanchez (2005) states that upward communication flow helps employees meet their personal needs, by allowing those in positions of lesser authority to express opinions and perceptions to those with higher authority (p. 94). Fairview Hospital demonstrated the use of upward communication when they incorporated the delivery of newspapers to every patient after one employee took the initiative to buy newspapers for the patients. Another example was when a manager invited an employee, Josephine, to share her strategy of exceeding the hospitals expectation so that management could learn from her example and improve the hospitals performance (Pelote & Route, 2007). One leader from Fairview Hospital stated, I let my leaders do what they know how to do and when I find good people doing good things, I put a spotlight on them and say you will all learn from these folks (Pelote & Route, 2007, p. 65). This is a classic example of the upward communication flow where the Executive Leader empowers his/her subordinates to meet their own personal needs. Another leader stated that the staff satisfaction has increased, and they dont feel like just housekeepers anymore, they feel like an integral part of the process (Pelote & Route, 2007, p. 72). Upward flow communication illustrates the traditional hierarchical model communication in providing a voice for all staff members of the organization and empowering them such that their

ANALYSIS suggestions/ideas are included in the process of change toward a stronger organizational structure. Fairview Hospital also effectively utilizes downward flow to ensure that organizational policies are communicated to the staff. Downward communication involves transferring information from supervisors to frontline staff. This type of communication includes verbal and nonverbal communication such as instructions for completing tasks, as well as communications on a one-to-one basis. (Guo & Sanchez, 2005). Guo & Sanchez (2005) also indicates that this type of communication includes

meeting with employees, writing memos, newsletters, using bulletin boards, and utilizing clinical and administration information systems. Management at Fairview Hospital demonstrated downward communication flow when it communicated that a 100% commitment was required from every employee for the mandatory 2:55 p.m. checkout program. Change Strategies Change within an organization can be a difficult task. At Fairview Hospital the goal of the Environmental Services Department was to exceed the expectations of their patients and to be the best environmental service department in the nation (Pelote & Route, 2007). The managers developed the GO MAD Program to institute change that would lead to the accomplishment of this goal. The GO MAD Program included a 2:55 p.m. check-out procedure which called for staff to return to patient rooms before they left work and ask if the patients needed anything further (Pelote & Route, 2007). As part of the program the Environmental Services Department also provided a newspaper for all patients, as well as silk flower

ANALYSIS arrangements so that no patient would be without flowers (Pelote & Route, 2007). An effective change processlike the GO MAD Programgreatly enhances the chance of reaching goals and the identification of criteria for successful change can guide actions.

Saksvik et al. (2007) developed five criteria for healthy organizational change that reflect change processes such as good communication and the provision of needed information. According to Saksvik et al. (2007), these criteria can lead to successful organizational transformation. The managers and employees within the Environmental

Services Department at Fairview Hospital implemented these five criteria as they sought to accomplish their goal of becoming the best environmental service department in the nation. The first criterion identified by Saksvik et al. (2007) is the awareness of norms. This encompasses knowledge and understanding of what process is currently used to accomplish a specific goal (Saksvik et al, 2007). The Environmental Services staff had always kept the hospital clean but the managers vision was to go beyond this and actually make a difference in the individual lives of the patients. Creating a vision is an important step in moving forward towards organizational change (Erwin, 2009). The second criterion is diversityunderstanding the difference in emotions and reactions to change among employees (Saksvik et al, 2007). Some of the staff of the Environmental Services Department had difficulty with the 2:55 p.m. checkout, so the leadership moved forward slowlyinitiating one small change at a time in order to give everyone time to adjust (Pelote & Route, 2007). Management made it clear, however, that this program was mandatory, and they held supervisors accountable (who, in turn, held the employees accountable) for implementation (Pelote & Route, 2007). The


process took four months to get 80% of the employees to participate fully, with thank you notes sent to those who achieved 100% participation (Pelote & Route, 2007). Saksvik et al. (2007) identify early role clarification as the third criterion for organizational change. Thorough planning is necessary and objectives need to be clear so employees know what to do and how to do it (Saksvik et al., 2007). At Fairview Hospital, the leadership did this, clearly delineating the 2:55 p.m. checkout procedure for the staff (Pelote & Route, 2007). The staffs instructions were to return to the patients rooms five minutes prior to clock out time and ask patients if there was anything else they needed (Pelote & Route, 2007). The fourth criterion is manager availability, which necessitates that managers own the change process as well as be available to provide assistance and guidance to the staff when necessary (Saksvik et al., 2007). Servant leadership theory identifies the leaders role as setting goals, providing necessary resources to attain the goals, and being available for staff as needed (Deckard, 2011). The management at Fairview Hospital employed this criterion in their leadership as evidenced by the statement of one staff member who commented that Management is here to help us . . . They are like the good shepherd. (Pelote & Route, 2007, p. 77). Finally, Saksvik et al. (2007) identify the fifth criteria for organizational change as constructive conflict, which entails receiving feedback from the staff throughout the entire process of the change. At Fairview Hospital, management created an environment where employees could describe the interactions with patients that moved them, and they shared these stories with peers and management (Pelote & Route, 2007). This greatly improved the employees job satisfaction and the pride they took in their workas

ANALYSIS evidenced by the 97% rating in patient satisfaction. Managers acknowledged the performance of staff by sharing the positive comments received from patients and

insisting on the important work of all the staff when the department won the World Class Service Award (Pelote & Route, 2007). Behavioral Competencies Behavioral competencies are the individual skills, knowledge, and ability to lead that identify a superior leader (Deckard, 2011). The leaders at Fairview Hospital displayed many different behavioral competencies. Their servant leadership style lent itself to helping and caring for both patients and staff. Their competency was demonstrated in the respect they showed their employees as members of team, and in the activities they instituted to elicit the feelings and thoughts of the staff (Pelote & Route, 2007). The leaders maintained an open door policy which offered employees the invitation to discuss their professionalas well as personalconcerns, troubles, and triumphs (Pelote & Route, 2007). Masterpiece leaders will often adapt their usual style of leadership to an alternative leadership style depending on the situation (Deckard, 2011). For example, shifting to a leadership style that exerts more power and influence (an authoritative approach) requires the competencies of setting standards for employees and holding them accountable to those standards (Pelote & Route, 2007). The managers at Fairview Hospital adopted a more authoritative style of leadership when they stated to the employees that the 2:55 check-out program was mandatory and that all staff had to participate 100% of the time (Pelote & Route, 2007).

ANALYSIS Conclusion Pelote & Route (2007) identify the Environmental Services Department at


Fairview Hospital as a masterpiece organization due to the behavioral competencies that the leadership exhibited. These competencies include (a) a servant leadership style that emphasized staff development, education, and employee participation in decisionmaking; (b) an upward communication flow that encouraged those of lesser authority to express opinions and ideas to their superiors; and (c) the promotion of institutional change through the provision of necessary resources, availability of management, and the clear communication of expectations and accountability (Pelote & Route, 2007). The stories shared by both directors and employees illustrate that when managers believe in their employees and encourage staff to believe in themselves, organizational transformation can occur with the achievement of service excellence.

ANALYSIS References


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