Consultative Change Recommendation
Reliable health care centers are a pivotal part of modern society. Cedars-Sinai is among these facilities catering not only to the Los Angeles community but also the entire country. A consultation process takes in identifying the nurse leader and interviewing him or her, an analysis of the organization and evidence-based practice and quality improvement activities (Kennedy et al., 2014). Through a robust consultation, the institution expects a critical analysis of the healthcare facility. The scrutiny covers but is not limited to external measures such as HCAHPS scores, patient metrics, community needs, and a comparison with other facilities in the area to identify the changes or improvements needed.
The Organization
Cedars-Sinai has been in operation for over a century now. It was founded in 1902 by Kaspere Cohn after he donated a two-story building for the course and funded the initial hospital. As it grew, it was relocated twice and hence renamed (Cedars-Sinai Medical Center, 2008). Currently, the facility is the largest nonprofit hospital in the US. It has 882 licensed beds, 2,100 physicians, 2,800 nurses and a wealth of other medical professionals (Cedar-Sinai, n.d.). As per the 2000 census, the hospital catered for approximately 3.9 million residents (Cedars-Sinai Medical Center, 2008). Additionally, Cedars-Sinai prides itself on being the epitome of medical innovation and research as evidenced by the multiple awards the facility receives annually (Shabot & Gardner, 2012). Moreover, it offers fully integrated acute patient, rehabilitation, and ambulatory services. The primary clinical disciplines catered for include medicine, surgery, pediatrics, physical medicine, obstetrics and gynecology, psychiatry, pathology, anesthesia emergency, and imaging (Cedars-Sinai Medical Center, 2008).
Cedars-Sinai Medical Center (CSMC) reorganized its leadership structure in 2004. It is divided into various specialized departments. Overall, there is a president that has eight senior vice presidents reporting to him or her. Each senior vice president heads a particular department. The board of directors is comprised of a volunteer group of community leaders and physicians (Cedars-Sinai, 2017). They have oversight of the medical executive committee (MEC). MEC is composed of physician members voted by the medical staff. As the chief of staff leads the MEC, he or she is required to report to the board monthly. Thus, the institution has grown from a small medical center into a dynamic and celebrated medical center with highly tiered organizational structure.
Primary Needs of the Population
CSMC serves a broad spectrum of patients’ needs nationally. 45.5% of the 3.9 million residents were Hispanic, 12.1 % were African-American, and 10.9% were Asian. Of the total population, it is estimated that about 22% of the patients lived below the poverty line. Additionally, an 18% of the 1.4 million households catered for had difficulty with English (Cedars-Sinai Medical Center, 2008). The significant health needs in these communities include access to primary care, asthma, stress, cancer, diabetes, community safety, heart disease, HIV/AIDS, obesity, homelessness, substance abuse and mental health (Cedars-Sinai, 2016). These issues affecting the community are based on the socioeconomic, behavioral, environmental or clinical factors that contribute to poor health. Stress, trauma, HIV/AIDS, homelessness and substance abuse are significantly associated with low income areas (Cedars-Sinai, 2016). Poverty is a huge issue in generating a toxic community in affected communities. Diabetes and hypertension are connected to an inadequate income to purchase food that is nutritious.
The institution tries to impact the community through the caring for the at risk program. Here, the facility provides free and part-pay services to the uninsured, those with limited means and low income individuals. Besides, it provides health services to the underserved neighborhoods in Los Angeles using mobile medical units in an effort to reduce the health access inequality. CSMC is engaged in sensitizing the youth on the dangers of drinking and driving as well as teaching the elderly on how to live fit and exercise (Cedars-Sinai, 2017). Moreover, the organization is responsible for mentoring and training the next generation of medical practitioners. Lastly, the facility is regularly engaged in innovative research that contributes to significant technological advancements. Therefore, apart from CSMC taking care of a vast number of people it impacts the community through many other ways.
Nurse Leader Role
The nurse leader (Chief Nursing Officer) is responsible for all the nurses in the center. Apart from the basic nursing training, the CNO is required to have advanced training in nursing operations and management. They are responsible for coordinating the nursing effectively within the hospital to ensure that patients receive comprehensive care (Cedars-Sinai Medical Center, 2008). The CNO also leads in negotiation, communication, financial matters, workflow design, change management and organizational behavior. All these role are in accordance with the roles stipulated by the Essentials of Nursing. In the event of a problem, they come up with creative solutions in line with the innovative culture of the organization. The nurses, doctors and other medical practitioners within the organization form the internal stakeholders of the CNO (Cedars-Sinai Medical Center, 2008). On the other hand, the patients, the community, the government, and donors are the external stakeholders of the institution. The organization has designed its operations to maximize its effectiveness in meeting the health needs of the community. It can accomplish this using two strategies in line with the hospital mission. These approaches are prioritized geographical positioning and prioritization of primary care, which the CNO must consider in his or her leadership. Accordingly, the CNO has enough influence to steer the nurses in the right direction regarding the institution’s operations.
Characteristics of Organization
The organization depends heavily on its mission, vision, and values. Its values include integrity, compassion, teamwork, innovation, and respect (Cedar-Sinai, 2017). Evidently, these values provide the centerpiece of the daily operations of the institution. The other aspect of CSHC strengths is their Prosci’s ADKAR management model to remain flexible with time. The framework is goal oriented and allows the leaders to divert teams to focus on specific health delivery outcomes (Balgorsky, 2014). The design is engineered to better the entire organization by influencing individual member’s change. The other strength is the organization’s innovative culture. CSHC has entire departments dedicated to leaps making significant leaps in advancing medicine. It is only natural that even staff does not involve in the research will pick up on the culture.
Additionally, the institution enjoys a generous funding from its financial stakeholders (Cedars-Sinai Medical Center, 2008). The hospital can meet the healthcare needs of the community per one of its mission statements. Lastly, the institution serves as a training facility where it nurtures and trains young medical talent. Weaknesses of the center include a significant amount of controversy surrounding it. For instance, the facility was under investigation concerning radiation overdose on several patients. It was later found that the medical supplier had sold some faulty equipment to the organization. Poor data security has been reported leading to loss of sensitive patient information. Although, according to David Blake (the chief security officer), the institution has put multiple security safe guards in place to protect patient information and prevent further security breach (Cedars-Sinai, 2014).
Besides, inappropriate handling of blood thinning medicine and denying a liver transplant to a medical marijuana patient has previously put the organization under the spotlight (Landau, 2010). There is a one main opportunity available for the facility; a gradual expansion to other states in the country. This growth would see the hospital opened in all states in the US thereby providing quality health services to the entire nation. All these issues are challenged by one constraint; however, that is, sufficient funding. Although the hospital’s benefactors have been generous, an expansion of such a scale would be too costly to fund. Accordingly, the organization has a powerful culture with strengths, weaknesses, opportunities, and constraints.
Recommendations
Recommendation for Organization Change
CSHC needs a formal organizational change. I recommend Kotler’s 8-step change model as change is inevitable and the model not only address the Institution’s weaknesses but also works with its strengths. First, the management should make the entire organization want change through creating the urgency (Kotter, 2012). This step would involve showing the entire hospital where they are failing either the community or themselves and examining unexploited opportunities. Where the hospital’s operations are not centered to patient’s needs, for instance, the management could inspire the appropriate change. Moreover, it would entail taking into consideration the threats and developing models that show their potential position in the future. As per Kotter’s assertions, at least 75 percent of the organization must see the need for change for the model to be successful (Kotter, 2012). The second step would be to form a strong coalition.
Since change requires strong leadership, it is essential for the CSHC to mobilize the different team leaders and department heads. The management should identify these people and stimulate an emotional commitment as they are the driving force of the model. The third step should be the visualization of change (Kotter, 2012). At this phase, people will often have different ideas of what the transformation will resemble once achieved. The management should create a clear vision to enable everyone understands why they are asked to do something. The vision should revolve around the existing organization values and be brief and straightforward. In this case patient care forms the core of the hospitals operations; accordingly the vision should include elements like high quality of health services including proper procedures for acquiring hospital equipment and handling medication. The fourth step involves communication of the vision. Putting across the idea should be powerful and frequent as there will be pushback from other communications within the institution. Here, the management can also address concerns and anxieties in the institution. Thus, CSHC should utilize Kotter’s management change model.
The second half of the eight-step process involves removing possible obstacles, creating short-term wins, building on change and anchoring the changes in institution’s culture (Kotter, 2012). The fifth step would constitute creating a mechanism that identifies and eliminates any barriers to the prioritizing patient-centeredness. Here, the management can recognize and reward people implementing the change like acknowledging medical practitioners with exceptional patient prioritization practices. Also, a review of the job descriptions to ensure that they are in line with the vision would be fitting. The sixth step is giving the organization a taste of victory. Accordingly, the management should segment long-term projects into sections that can be achieved within a smaller time frame per the set vision. This move should serve as enough motivation for the staff for instance when they receive positive feedback from the patients or see the lives they have changed in the community. Although the management could also throw in incentives.
Once the organization starts achieving goals, CSHC could start building on the change as the seventh step. Even though progress is being made at this phase, Kotter warns against declaring victory prematurely (Kotter, 2012). Instead, the management should continuously look for areas they can improve on for example the surgical outcomes and quality improvement. Furthermore, the organization can set new goals that build on the momentum that has already been achieved. The eighth and final stage should be cementing the changes into the institution’s culture. This phase could involve talking about the progress now and then and recognizing the members of the original change coalition. Therefore, a complete and stepwise implementation of Kotter’s eight-step model should be active in introducing change to the organization.
Rationale
As previously noted the organizational change model exploits a simple rationale. It can be used to address the weaknesses in the facility while utilizing its strengths. The radiation controversy can be avoided in future using the suggested model. Evidently, the equipment screening procedure exposed the need for an upgrade. Following the eight steps, the CSHC can change related processes in the entire organization. Concerning patient data security, the institution should encrypting employee laptops and use their innovative nature to come up with processes that maximize security. The same applies for handling medication and decisions on organ transplant list.
The strengths the model can utilize is the flexibility of CSHC’s management model that allows teams to be created and directed towards specific tasks. An active stakeholder baking would also be instrumental in providing guidance and direction during the adjustment process. Furthermore, existing values of within the institution can play a significant role in ensuring that required improvements are achieved. These values include teamwork, innovation, respect, and integrity. Consequently, the organization change recommended addresses not only the current weaknesses but also employs the strengths.
Measurement
The suggested alterations need to be assessed over time regarding their efficacy. A national benchmark performance in the health sector is based on the HCAHPS scores, patient metrics, community needs and comparison to other institutions in the area (Ettorchi-Tardy, Levif & Michel, 2012). Hospital Consumer Assessment Health Provider Systems (HCAHPS) is a score that measures the satisfaction patients in all hospitals in the United States. The survey assesses the communication of doctors and nurses, staff responsiveness, the hospital environment, pain management medication communication, food services and the overall rating of the hospital (Ettorchi-Tardy et al., 2012).
On the other hand, patient metrics measure the operational performance of the hospital from the patients’ perspective concerning a quality improvement project. Assessment based on community needs looks at how the change being implemented is impacting the community as a whole. Comparison with nearby institutions evaluates the overall progress of the hospital (Ettorchi-Tardy et al., 2012). Accordingly, these standards can be used to track the effectiveness of change.
A plan to measure the recommended change needs to be in place. This strategy should involve the discussed benchmark standards interactively. HCAHPS should be the primary survey to quantify the impact felt by individual patients regarding the quality of the medical equipment, security of their data, the effectiveness of the medication and fairness of the organ transplant process (Giordano et al., 2010). Patient metrics can also be used to ascertain the results of the previous process. Evaluation of the community should give information on whether the community as a whole feel the change meets their needs or not. Lastly, the hospital should regularly compare the progress of the management change with another facility in the area that has already perfected the sectors that need improving. Therefore, the plan to monitor the enhancement process requires all four benchmark standards to work together
Conclusion
Indeed, Cedars-Sinai Health Center is a titan in the healthcare industry. The facility revels in over a century of serving the people, from humble beginnings to the 882-bed institution that now stands. Apart from the typical hospital, CSHC functions as a research and teaching center. The hospital is divided into clinical disciplines that cater for a broad array of healthcare needs. Located in the Los Angeles area, the hospital meets the needs of over 3 million residents and 1.4 million households. Seeing as it is a nonprofit organization, CSHC is positioned to take care of the underprivileged in the community by addressing problems beyond the medical scope affecting these people. The Chief Nursing Officer in the hospital requires an advanced level of training per The Essentials of Master’s Education in Nursing. They are tasked with leading the nursing fraternity towards meeting the needs of the community. Among the pillars of the medical giant are its mission, vision and core values. The values form the blueprint of the organization’s work ethics. A SWOT analysis of the CSHC reals a substantial amount strengths, weaknesses, opportunities and constraints. Kotter’s eight-step management change forms a recommendable model for the institution to use while effecting the needed adjustments. Also, the management change considers the weight of the hospital’s strengths. A four requirement rationale can be used to track the progress of the model’s implementation per the national benchmark standard.
References
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Cedar-Sinai. (n.d.). About us. Retrieved from https://www.cedars-sinai.edu/About-Us/
Cedars-Sinai. (2014). Ceders-Sinai Health Systems issues notice of data incident. Retrieved from https://www.cedars-sinai.edu/About-Us/News/News-Releases-2014/Cedars-Sinai-Health-System-Issues-Notice-of-Data-Incident-.aspx
Cedars-Sinai. (2016). Cedars-Sinai Medical Center Community health needs assessment. Retrieved from https://www.cedars-sinai.edu/Community-Benefit/Community-Needs-Assessment/2016-2019-Community-Health-Needs-Assesment.pdf
Cedar-Sinai. (2017). Mission, vision and values. Retrieved from https://www.cedars-sinai.edu/About-Us/Mission-Vision-and-Values.aspx
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