Od In Healthcare Essay, Research Paper
ORGANIZATIONAL DEVELOPMENT IN HEALTH CARE
In Partial Fulfillment of the Requirements for
Managing Organizational Change
Colorado Springs, CO
9 December 1999
TABLE OF CONTENTS
TABLE OF CONTENTS 1
ORGANIZATIONAL DEVELOPMENT IN HEALTH CARE 2
TRADITIONAL MODELS IN HEALTH CARE 2
THE NEW HEALTH CARE MODEL 4
THE NEW MODEL CHALLENGES AND SUCCESSES 5
Works Cited 8
ORGANIZATIONAL DEVELOPMENT IN HEALTH CARE
The past few decades has seen monumental changes in the Health Care Industry. The changing business climate, in conjunction with technological advances and societal changes have brought health care to the forefront of the American conscious. The traditional model of Health Care is no longer a viable alternative. With information technology becoming more accessible to the public through the Internet, along with a questioning society, an increase in consumer advocacy, and governmental regulations concentrating on the quality and accessibility of health care, the Health Care Industry must change to better suit the needs and desires of the public. Effecting change in an organization is difficult, but changing an entire industry can prove to be almost impossible. For the Health Care Industry to survive the 21st Century, it is imperative that changes are implemented. The process has already begun, but there is yet a long road for the Health Care Industry to travel before it can meet and satisfy the needs of the 21st Century consumer.
TRADITIONAL MODELS IN HEALTH CARE
For many years, the traditional model for health care has served the public well. In this model, the role of health care providers has been that similar to a parent or teacher. The public has depended on these providers to ensure that they received the proper care and
treatment. Hospitals were provider-centered, with the physician at the hub and the patient traveling through a maze of confusion, dependant upon the providers to guide through. Health care was fragmented, with primary and secondary care providers each working independent of the others. Increasing health care costs led to a decreasing accessibility for many Americans. Families have seen their health-related costs rising faster than their incomes. They are paying more for health insurance and for health care. Obviously, the more families spend on health, the less they have for other necessities, such as housing, clothing, and food. (MDAdvice.com 1999) Health care was in a state of flux, traveling from being decentralized system to a hospital-centered system then back to decentralization.
Governmental regulations, along with a changing business climate and general societal changes demanded a change in the Health Care Industry. The pressure for health care reform has led to the rise of managed health care and has forced hospitals and physicians to look for more effective ways to deliver services. (Wordelman, Lemonds, and Goltz 1998) Managed care became the new model for health care. The managed care model was to lead to an increase in the quality of health care while decreasing health care costs. The benefits of managed care were decreased by the capitalistic, provider-based system.
In order for managed care to be effective, cost caps must be in place, and the system has to become patient-centered; not only in the way patients are treated, but in the way they travel through the system and the facilities. Managed Care organizations and the Health Insurance companies have helped maintain costs through capitation. The challenge for Organizational Development in the Health Care Industry is to help create a point-of-service system that is user friendly, effective and meets customer satisfaction. Recent developments in today s health care market, however, signify a fundamental shift in the way the field is structured. And no healthcare organization that intends to stay competitive tomorrow can afford to be a passive witness to these transitions today. (Rooney 1999)
THE NEW HEALTH CARE MODEL
The new Health Care Model is characterized by an integrated health care delivery system. Hospital s evolution, characterized by their and other provider s movement into successful integrated delivery systems, will require new knowledge, talent and training… (Campbell 1998) This is the role of the Organizational Development Practitioner; to help health care providers and organizations learn these new talents and knowledge. The primary model for integrated health care is that of self-directed work teams. Although the concept of multi-disciplinary conferences and workshops in health care is not new, having providers and administrators working as a team in the delivery of care day to day is. With providers of the different disciplines within the health care field working together, the quality of health care is improved. Within the hospital setting, these teams work toward outcomes directed at curing, rehabilitating and even continued well-being of the patient. In the managed care arena, the concept of the gatekeeper or primary care provider acting as a liaison or coordinator of care for the patient can be compared to an integrated team.
Another important aspect of the new health care model is the flow of care or service that the patient must move through for care or treatment. In planning workshops, the staff was challenged to redesign the way patients flow through the health care facilities…The most dramatic result of this challenge was the decision to bring health care to the patient rather than moving patients through the facility. (Wordelman, Lemonds and Goltz 1999) The idea of bringing the care to the patient is almost reminiscent of house calls and rural medicine. This increases customer satisfaction which is an important aspect of the new health care model. A recent study concluded that more than 50% of employers and managed care companies dropped providers who failed to meet customer service standards. (Gropper and Boily 1999) It also provides for a central clearing facility for patient information, easily accessible for any and all providers involved in the care of the patient. This can save the organization and the patient time and money, increasing the quality of care and decreasing costs; the basic premise of managed care.
THE NEW MODEL CHALLENGES AND SUCCESSES
There are many challenges facing the health care industry as it goes through the evolutionary process from the old to the new model. As the managed care concept takes a strong foothold in the health care industry, organizations vying for survival find themselves involved in a change effort toward the new model. One such effort that is ongoing is at the Medical Center of Louisiana at New Orleans. They recognized the need for change, and their reengineering efforts centered around a case-management model. When the program was initiated, they encountered some of the problems often associated with any change effort in an organization: resistance. The resistance came from both inside and outside of patient care areas. The concept is for the Case Manager to follow the patients care and progress, ensuring quality care without unnecessary cost or expense. At present, the trial for this model is being tested in the trauma department. As the program developed, staff attitudes changed from resistance to demanding more teams. The program has increased collegial consultation, managerial coaching, team interdependence, and mature professional judgement and creativity. (Godchaux 1999)
Another health care facility that has successfully undergone a change effort is the Detroit Medical Center (DMC). Some of the forces that caused the DMC to consider the need for change were their shrinking inpatient population, increased customer expectations, the rise in managed care and at risk contracts, and the affiliation and mergers of other health care providers and organizations. The only way to combat the problems faced by DMC was to implement an integrated, cost-effective health care delivery system.
A set of guiding principles was developed. These principles served as guides for the change process and as the criteria for evaluating options:
1. establishment of a continuum of care;
2. integration of clinical services across the entire market served;
3. integration of academic programs;
4. meeting/exceeding customer expectations;
5. effecting a consolidation / centralization that makes sense logically, clinically, and economically;
6. development of a system of priorities and overall benefits to the health system (systems thinking);
7. improved community health;
8. increased community input.
(Horak, Campbell and Flaks 1998)
When the dust at DMC settled, they had successfully met the challenge and implemented a change in organizational structure that benefited all involved. An important aspect of the lessons learned from the reorganization of the DMC was what they called the Ten Critical Success Factors. The critical success factors included:
1. Structural changes in governance and management must be part of an overall strategy and plan…
2. Structural change must simplify the decision-making process…
3. Change must begin with governance…
4. An outside consultant or facilitator should be considered…
5. A small, internal change management team should be created…
6. Continuous improvement must be the management philosophy to effectively guide change in the organization…
7. Community and employee support must be part of implementing change…
8. The medical staff must be involved and continually informed of changes…
9. Time frames for implementation must be established and communicated.
10. The CEO, with the core support of governance, is the primary agent of change.
(Horak, Campbell and Flaks 1998)
These are two of the many institutions and organizations in the health care industry that has successfully implemented change to meet the challenge of the future. Unfortunately, for every success, there are as many failures.
As the health care industry strides into the 21st Century, its focus is on survival. Management hierarchies are being replaced by self-directed teams, integrated health care delivery systems are replacing the mazes of confusion that used to surround health care, and the consumer is becoming the primary focus. Managed care and capitation are helping improve quality while decreasing costs. The lesson learned over the past century is that change is not only inevitable, its continuous. The core functions of the teams will change constantly. These changes will reflect the evolution of health care in this country and the adaptations that administrations will need to make in response to those changes. (Blejwas and Marshall 1999)
Blejwas, Lucy and Wendy Marshall. A Supervisory Level Self-Directed Work Team in Health Care. The Health Care Manger. (Jun) : 14-21
Godchaux, Charlotte W. Case Mangers Drive Care Integration. Nursing Management. (Nov) : 32b-32g.
Gropper, Cindy and Alness Boily. Breathing Life into Customer Satisfaction. Nursing Management. (Nov) : 64-68.
Horvak, Bernard J., David J. Campbell and Jeffrey A. Flaks. Strategic Positioning: A Case Study in Governance and Management. Journal of Healthcare Management. (Nov/Dec) : 527-540
Managed Care. Understanding Our Changing Health Care System. MDAdvice.com. Internet: http://www.mdadvice.com/topics/general/info/manage2.htm
Rooney, Mike. Assessing Organizational Viability. Healthcare Executive. (Jul/Aug) 43-44
Wordelman, Scott, Donald K. LeMonds and Howard Glotz. Creating and Establishing a New Health Care Model. The Academy Journal. Internet: http://www.e-architect.com/pia/acadjour/articles/06a.asp