TAKE 2

Commentary by Glen B. Earl

Glen B. Earl is the department chair of the Industrial/Organizational Psychology Program for The Chicago School of Professional Psychology, Dallas, Texas, campus.

There are several main problems in this case study. With the new addition of the Tower, executives and builders did not take into consideration the effect it would have on employees. It just takes more time and energy to move to and from the new building. This is using up employee time and energy, which was already in short supply.

Today, healthcare is quickly moving to value over volume, care, and costs. Keeping patients healthy versus sick is better for hospital revenue, community wellness, and societal well-being. But the Wellness Institute described here appears to be an afterthought when it ought to be a primary part of the hospital.

Wellness, as Emily postulated, is a two-pronged approach. One prong focuses on the community and keeping patients healthy and out of the hospital. The other prong is patient care in the hospital and immediately afterward. In healthcare, a 30-day-or-less readmission for the same condition is viewed as a direct result of poor patient care by the hospital. Readmissions mean less revenue and a less positive patient experience.

There is also a poor job–person fit between the Wellness Institute and Dr. Jonas as its director. Wellness is now a medical specialty, with a primary care focus and a holistic view of the patient. At its current organizational stage, the Wellness Institute needs a dynamic staff, visionaries, missionaries, and evangelists to win over a staid, entrenched industry culture and the community’s resource allocations, not to mention influence societal norms that perpetuate poor health habits.

Eastlake General Hospital has an outdated organizational culture and structure. Its executive leadership has the hospital focused on the old model of care (volume) instead of the future (value). There also seems to be little or no focus on reducing the increasing employee turnover. At least, the organization certainly does not appear to have a grasp on why their employees are leaving.

To better understand the problems at Eastlake, I’d like to examine voluntary turnover data, employee engagement scores, and patient experience data, as well as best practice comparison data to benchmark against.

Also, I’d like to have more information about the hospital’s organizational culture, physician engagement, and comparison costs between the old and the new hospitals. The hospital’s organizational chart and its strategic plan would be helpful, too. Furthermore, I would like to see the hospital’s career-pathing process, employee development programs, and community outreach efforts.

One area not directly addressed in this case study is employee engagement, although the amount of employee turnover alludes to it. A tool and resource they could use is the employee engagement survey. These really affect two major populations: Higher employee engagement scores point to better results for employees and patients.

Patient experience is fast becoming a major focal point of patient care. In today’s environment, government monetary reimbursement is directly tied to how patients feel about their overall hospital experience. Research consistently links employee engagement and patient experience (Press Ganey 2017). Further, considering that many patient experiences have the potential to be negative by their very nature, hospitals are more and more aware of positively affecting patient visits in any way they can, including examining employee beliefs and mindsets (Hess 2017). Unhappy patients will share more than those who are satisfied (Baird 2014).

Saying that, my first recommendation to Emily is to stop listening to Dr. Jonas’s offer, give her two-week notice, and leave. He is giving her weak promises, even conceding that there would be no more money and extra, voluntary work. And, he indicated that he would stand behind her only if she gets results; that’s not much of a counteroffer.

As for Eastlake, I would recommend focusing on the employee experience and engagement, as well as the patient experience. Further, I would recommend that it focus on its future, what it will take to get there, and what type of organizational structure, culture, and employee type it will take to get it to its new state.

Regarding other staff, where are the senior and middle managers? These groups translate the vision into day-to-day operations, which is a critically important task. Middle management, when armed with courage, compassion, and candor, can become a mighty force for positive organizational change. It is the fulcrum by which an organization is moved.

This is a very common scenario in healthcare. Healthcare systems are ever changing—consolidating here, expanding there. In particular, as older hospitals build new additions, the added square footage significantly affects a clinical employee’s work life. The sheer increase in the amount of walking by bedside clinicians is legendary.

There is always increased turnover when hospitals go through renovations. Many staff decide to leave before the new hospital opens, especially employees who are near retirement. A big part of their rationale is not wanting to deal with all the new technology. Another wave of turnover occurs after the new building opens. Employees gain some experience and may decide, “This is not for me.” When Dallas-based Parkland Hospital moved into its new building, it prepared for expected increased turnover before and after the move by delivering a change-management class to more than 5,000 clinical personnel.

A healthcare organization can avoid many if not all negative issues in this case study. One of the first changes is to move from a hierarchical organizational structure to a more flexible, decentralized one. This gives personnel and work units the freedom and flexibility to make real, just-in-time decisions that affect their local area or work process and product, which are not related to other parts of the organization.

Another action is to assess the organization’s positive deviants. A positive deviant is a department or work unit that excels in the same environment where other personnel and work units do not. Eastlake General Hospital has several areas of excellence, including radiology, geriatric medicine, hospice and palliative care, women’s health, orthopedics, and cardiology. A root cause analysis could help them assess why and how these areas excel, so they could try to replicate it throughout the rest of the hospital.