Despite the above problems, ‘Lack of Teamwork’ is also one of the central problems. Since there are different views between older nurses, younger nurses and student nurses, the relationship between nurses is poor. Nurses do not get along well and agree with others. As a result, antagonisms occur. Because of the antagonisms, nurses finish their job in different ways and it leads to the inconsistence of work done. When Mrs. Smith is not here and hasn’t checked up for performance, the floor becomes slacks and lots of confusions occur.
As a result of the above central problems and the related problems, we observed that there are numerous slipups in Floor A.
FLOOR B
The first central problem we concluded for Floor B is ‘Poor Organization’. The reason of poor organization is Mrs. Rogers gives too many authorities to her subordinate which may not mature enough to make decision alone. As Mrs. Rogers trust her subordinates, it leads to poor organization. The evidence of poor organization includes no regular check ups by Mrs. Rogers, drugs and supplies are not prepared in advance and Mrs. Rogers gives unclear order to her subordinates. Because there are no check ups, student nurses can’t find a channel for feedback. Some of the younger nurses think the above problems is okay while the older nurses dislike with that, so the older nurses and younger nurses disagree with each other.
Nevertheless, the second central problem for Floor B is ‘Loose Supervision’. We conclude that Loose Supervision as one of the central problem because we see that Mrs. Rogers is too lenient. She lets nurses shirk their task without punishment. She allows patients to wander in and out of their rooms and sometimes even run small errands for the nurses. Since there is loose supervision, there are problems maintaining discipline. Nurses have the tendency to shirk certain task. It leads to the jealousy between nurses. As a result of shirking and jealousy, tasks are not getting done sometimes.
In sprite of the above problems, we also end Floor B with the last central problem—‘Crumbles with Pressure’. When the work is heavy, Mrs. Rogers and the nurses tend to be brusque with their patients. Charts are not maintained with scrupulous also when the workload is high. As a result of crumbles under pressure, we observe that there are confusions occur and the requests of patients and their visitors not met promptly.
Step 3
Examination of cause and effect relationship
Floor A
The head nurse, Marilyn Smith is a very organize person. She plans everything ahead, and gives clear order. However, she fails to make the best out of her subordinates. Her uncompromising style and Authoritarian leadership create a formal structure on her floor. Under this structure, communications among nurses are kept at minimum, which will directly result poor human relations. From the hierarchy theory of needs—social, ERG theory—relatedness needs, acquired needs theory—need for affiliation, two factory theory—relationships with peers, we can note that interpersonal relationship will easily affect the motivation in work. In the case, the relationships between nurses and Mrs. Smith are poor, so it is one of the reasons for why nurses are unmotivated and not doing a good job.
Since no trust is established between nurses and the head nurse, Smith does not delegate any responsibilities to her subordinate.
From the hierarchy theory of needs—self actualization, ERG theory—growth needs, acquired needs theory—need for power, two factory theory—responsibility, we can note that one need power to make decision as one of the motivation factor. However, the Head Nurse in Floor A (Smith) has not delegate any power to her subordinate. So we can see that the nurses in floor A have not enough motivation in working hard. Besides, Smith does not spend enough time working with her subordinates and communicating with them. This results a great power distance between her and other nurses.
Both young nurses and student nurses are not motivated doing their jobs. Further, they longer pay attention to Smith’s order and display a poor work attitude. Another important factor causing the attitude is poor work environment, which we will discuss it later.
Under the formal structure on floor A, Everyone needs to follow Smith’s way of doing things, which gives nurses no independence in determining how things should be done. Also, there is a great power distance between Smith and her subordinates. Nurses usually do not receive supports from the head nurses except some routine checks. In addition, old nurses do not share the same view about Smith’s leadership style with young nurses, which create antagonism among them. As a result, the atmosphere on the floor is tense.
According to Maslow’s hierarchy of needs theory in text book, one of the lower order needs is social, which is “a sense of belongingness in one’s relationship with other person”. However, due to the reasons mentioned earlier, this desire leaves unsatisfied. Therefore, tense atmosphere leads to a poor working environment and results that nurses do not response to patients positively.
Another important reason why nurses on floor A have low motivation is that there is no teamwork. According to the content theory in the text book, “Motivation results from the individual’s attempts to satisfy needs.” Also, hierarchy of needs theory states that one of the high order needs is Self-actualization, which is the need to “grow and use abilities to fullest a most creative extent.” However, on floor A, decisions are made by authority rule. There is no discussion about how things should be done and the job assignment within the group. Nurses are not encouraged to involve in decision making. Therefore, most nurses feel unmotivated to their jobs, they only do what they have been asking to do.
The fact that there is no team work on floor A also prevents co-workers form getting to know each other. They don’t have many chances to work together, and to communicate with each other. Therefore, co-workers do not get along, which ultimately leads to antagonism on the floor.
Antagonism among nurses stops them from helping each other. If Smith does not find out a mistake, no one else will stand up to corrected. As a result, the performance on floor A is much dependent on Smith’s ability of supervisory, which can be inconsistent over time. Moreover, the assistant nurse, Brenda, who works closely with other nurses, disagree with Smith’s managing style. Therefore, lots of confusion occurs when Brenda is in charge.
Fi nally, the poor work attitude and relation between nurses and patients results a reduced work quality. Moreover, when Smith is not in charge, even more slipups observed.
Floor B
The poor organization on floor B partially results from the fact that Rogers does not assign tasks clearly. Nurses don’t have clear orders about who is responsible for what.
As a result, supplies are not prepared in advance and patient visits request not always went promptly. Also, Rogers does not do check ups on her subordinates regularly.
A possible factor causing the poor organization is that Rogers makes a perceptual distortion, or self- fulfilling prophecy to be exact. According to the textbook, self- fulfilling prophecy is “the tendency to create or find in another situation or individual that which you expected to find in the first place.” Indeed, she assumes that all her subordinates need no direction and will do their job. Therefore, she gives unclear order and never plans tasks ahead.
Since no check ups are been done regularly, nurses usually do not get feedbacks from Rogers. They don’t know whether they are doing a good job or not.
Roger’s unorganized style, especially the way she does not plan tasks, does not gain respects from old nurses. Unlike young nurses, old nurses are more like collectivism and dogmatism, who “emphasis on group interest” and “regard the authority as absolute”. They like to have clear order and timely feedbacks of their performance. However, Rogers does not the diversity of her workforce, she does a good job in allowing individual freedom, but fails to give clear direction to old nurses.
The issue of loose supervision on floor B is associate with Roger’s problem of maintain discipline. Although Rogers keeps a friendly relationship with her subordinates, she does not give reinforcements, which is, according to the textbook, “the administration of a consequence as a result of a behavior”, for their performance. Nurses do not get feedbacks about whether they are doing a good job or not. This may
create a tendency of slacking tasks in the future. This tendency is also largely due to the fact that, as mentioned before, Rogers’s unclear task assignment.
A result of tendency to shirk tasks is that some nurses have more jobs to do than others, or “Felt positive inequity”, according to the textbook. Nurses may begin to jealous each other and more likely reduce their efforts toward work
Again, the confusion on floor B is partially results from the tendency to shirk certain tasks, as we discussed earlier. The other reason is that nurses on this floor are not good under pressure. Indeed, Rogers fails to set up a leadership rule. She is not confident and calm when under pressure, which will affect her team’s performance significantly.
As a result of the confusion, patient’s requests are not met sometimes.
Step 4
Generation of possible alternative solutions
FLOOR A
Formal Structure
- Job enlargement
- Job rotation
- Departmentalization
- Traning workshops/ retreats
- Let staff members choose what floor they want to work on
Bad Human Relations
- Job rotation
- Casual Fridays
- Departmentalization
- Regular group meeting- discussing negatives, positives and improvements
- Have rewards for job well done
- Training workshops/ retreats
- Let staff members choose what floor they want to work on
- 360 degree evaluation
- Self directing work teams
- Increase extrinsic rewards
- have social "potlucks" (social belonging)
- Get rid of Smith
No Team Work
- Job enlargement
- Casual Fridays
- Departmentalization
- Regular group meeting- discussing negatives, positives, and improvements
- Have group meeting
- Training workshops/ retreats
- Let staff members choose what floor they want to work on
- Self directing work teams
- Quality circles
- Job enrichment
- Increase extrinsic rewards
- Have "potlucks" (social belonging)
FLOOR B
Poor Organization
- Structured plans
Attainable goals
Intrinsic rewards
- Training workshops
- Clear, visible, ready day plan
Bad Under Pressure
- For Roger
Job simplification
- For employees
Job enlargement
- TQM
- Training workshops
- Positive reinforcement
- Clear, visible, ready day plan
Loose Supervision
- Punishments
- Departmentalization
Self-directing work teams
Create manual
Patient feedback and based on that evaluate the nurses and the floor performance
- Break down empowerment
Step 5
Examination of the consequences of each alternative solution
Floor A
Get rid of Smith
- N- lose an experienced worker
- N- employer disrespect for new head
- N- possibility of losing older experienced nurses
Empowerment
- P- builds confidence
- P- motivation (because this gives subordinates more say)
- N- student nurses may make rookie mistakes
- N- may alienate Smith
Job Enlargement
- P- forces Smith to delegate and promote different ideas and styles
- P- builds confidence
- N- some nurses may not be able to handle more work
- N- Smith loses control
- N- employees may demand higher pay
Job Enrichment
- P- motivates nurses because they will see the importance of their job
- N- added stress
Job Rotation
- P- good experience for student nurses
- P- reduces boredom
- P- strengthens respect
- P- lessens antagonism amongst employees
- (short term rotations, encourage specialization)
Self-directing work teams
(departmentalization; functional design)
- P- increase employee involvement
- P- breaks down tasks
- P- more connected (ie: teamwork)
- P- “store within a store” concept encouraging pride in work
360 Evaluation
- P- Get real feedback (from multiple sources)
- P- Intrinsic rewards
Quality Control Circles
- P- more feedback
- P- teamwork (involves everyone)
- P- proactive
Casual “Friday”
(birthdays, potlucks)
- P- teamwork
- P- relaxes/relieves tension
- P- will help Smith evolve her style
- N- not really Smith’s style
Group Meetings
(weekly; discuss what is good and bad)
- P- enforces team
- P- helps people communicate effectively
- P- proactive
- P- faster fixing and rewarding problems
Let student nurses/nurses pick floor they want to work on.
- P- more comfort
- P- people choose the management style which best suites them
- N- unrealistic
- N- no control
- N- may not have enough nurses for one floor and too many for another
- N- over time people could change their mind causing more problems
Training Workshops
- P- uniform idea of how the jobs are to be done
- P- helps to identify and solve individual problems
- N- time consuming
- N- expensive
Extrinsic rewards/benefits
- P- motivates
- P- obtainable goal
- N- increased costs
Floor B
Create a clear visible day plan
- P- forces Rogers to organize
- P- clear delegation of responsibilities
- N- time consuming to write up daily
- N- restricting (if people do not go out of lines)
- N- menial tasks may get overlooked
Job simplification for Rogers via job enlargement for nurses
- P- gives Rogers less to focus on so she can get her tasks more organized
- P- gives employees intrinsic rewards by more responsibility to delegated to them
- N- some nurses may not be able to handle
- N- employees may begin to view Rogers as incapable
- N- may take Rogers away from where her presence is appreciated
Create a structured plan
(attainable goals; intrinsic/extrinsic rewards)
- P- MBO
- P- less room for mistakes
- P- highlights idea of increasing organization without being restricting
- P- motivates nurses
- P- focuses on providing nurses with more of the individual attention some greatly desire
- N- extrinsic rewards are costly although highly motivating
Reinforcement
(Positive and Negative; Individual attention)
- P- focuses Rogers energy on giving nurses more feedback
- P- motivates nurses
- P- Rogers will need to be organized in order to implement this important motivational tool
360 Evaluation
- P- intrinsic rewards
- P- non-biased feedback
- P- lets nurses know how they are doing
- P- floor can really get a sense of the job they are doing as a team
- P- informs Rogers and her assistant of what is being done well and what is being done poorly
- P- focuses on the “customers” of their service
Empowerment and TQM
- P- TQM implementation will help team focus
- P- student nurses may respond with an increased sense of importance and maturity
- P- motivator
- N- some may not want more responsibility
Create a simple floor manual outlining procedures to follow when under pressure
(use at own discretion)
- P- will help when floor is under pressure
- P- sets clear expectations
- N- constricts creativity (although procedures not mandatory)
Increase training
- P- should improve floor performance when under pressure and overall
- P- teaches student nurses
- P- reinforces skills of older nurses and head nurse and her assistant
- N- time consuming and costly
Organization workshop for Rogers and her assistant
- P- will help improve their leadership skills
- P- will improve organization
- P- will help floor when under pressure
- N- time consuming and costly
Criteria for how feasible solutions are:
- Solution fits with the personality of the head nurse
- Solution does not change things which are already being done very well
- Evaluate cost of the solution
- Solution should have more positive aspects than negative aspects
Solutions go through the list of criteria and are implemented or released as a result.
Step 6
Alternatives and their Implementation
We now evaluate the alternatives mentioned in step 5 according to their appropriateness in solving the central problems on each floor. We then describe how they could be implemented. Let us consider the alternatives and how they help solve each problem.
FLOOR A
- Training work shop for Head Nurses and Assistants
What problem(s) does it solve?
- Bad human relation
- Formal structure
- Lack of teamwork
The aim of this alternative is to train the nurses in charge so that they will learn what courses of action to implement in order to solve the problems of Bad Human Relations, Formal Structure, and Lack of Team Work. This option is not specific to solving one particular problem, but rather helps build the mind-set necessary to solve each problem.
How does it solve the problem(s)?
This workshop will educate them of organizational behavior theories, so as to improve their managerial skills and general human relations. Essentially, this initiative will lead to the solution of all three of the main issues on this floor: Bad Human Relations, Formal Structure, and Lack of Team Work. Theories of particular concern are Job rotation, Self-directing work teams, 360-degree evaluation, Casual Day, Group Meetings, and Extrinsic Rewards. They can then teach these techniques to the subordinate nurses. First, however, Smith and Green should set out the general goal of the floor in a Mission Statement. This will set the frame work of all employees to learn and apply the new theories.
Implementation:
The hospital could have professionals in the field of management visit the hospital to conduct a workshop over a few days, or weeks. During This time Smith and Green will be taught managerial skills. Most appropriate would be a workshop concentrating on workplace diversity, perception and attitudes, motivation, group work and high performance teams, high performance leadership as well as change and innovation. These skills will help them recognize potential problems on the floor and find solutions to them, while learning to be affective leaders.
Having learnt from the workshop, Smith and Green can now implement some of their knowledge on the floor, as it is appropriate to their situation and the medical field.
What problem(s) does it solve?
- Formal structure
- Lack of teamwork
A simple, but precious statement that will invoke more productivity and innovation in the organizational structure for the floor; thereby, solving the issue of a formal structure. Additionally, these theories can stimulate better teamwork.
How does it solve the problem(s)?
A mission statement should be prepared for the floor. This will be a broad outline of what they want to accomplish as a team. In essence, this statement would encompass a broad solution to all the problems on the floor. From this all other solution alternatives will ensue. While breaking down the present authoritarian structure on the floor, this statement should acknowledge job rotation, self-directing work team, group meeting, 360 evaluations and empowerment.
Implementation:
The heads of each floor, together with a representative of each group of employees on the floor (students, older nurses, doctors, cleaning staff, etc) and the hospital supervisor, should meet to discuss what goals the floor should achieve and how, while staying in accordance with the hospitals overall mission. Using the hospital’s Mission Statement, they can narrow the statements mentioned therein, so as to govern actions and procedures on each floor. An example could be: “To encourage an efficient and stress-free working environment, while working as a family in giving the best patient care to our customers as only a loving family member would give”.
Breaking it down:
“To encourage an efficient (job rotation) and stress-free (group meetings) working environment, while working as a family (self - directing work teams) in giving the best patient care (evaluated through 360 evaluation for improvement) to our customers as only a loving family member (empowerment) would give”.
What problem(s) does it solve?
- Bad human relation
- Lack of teamwork
This alternative is focused on solving the issues of Bad human relations and Lack of team work.
How does it solve the problem(s)?
This is a type of job enlargement, where nurses are assigned a number of groups of tasks, but in rotation, as opposed to having nurses repeat the same mundane task-group continuously. It increases nurses’ flexibility to perform various tasks at the same level of responsibility. This will also enable nurses to gain understanding and respect for various tasks. This understanding will help them appreciate the work load of others and reduce antagonism on the floor; hence, encourages team work and improving human relations between nurses.
Working in teams will give student nurses the opportunity to ask questions of their superiors. Nurses learn to trust each other, discuss and solve problems, and make the best use of the diverse skills of each member in the team. They will also form friendships and lasting bonds, which will give them psychological comfortable. All this will improves human relations on the floor and encourage teamwork.
Implementation:
Smith and Rogers should first assign a number of nurses, perhaps six nurses; two older and two graduates and two students, into one group. The Smith should then analyze and categorize their floor’s tasks by level of difficulty and skills required, allocating six tasks per task-group. Smith and Green can then assign a group of tasks to a group of nurses. The six tasks can then be rotated among the six nurses in a group. The older, experienced nurses can take the first turn, so as to teach the others. After a period of time, specified by the heads, the nurse-group can switch to another task-group.
- Self-directing work teams
What problem(s) does it solve?
- Bad human relation
- Lack of teamwork
Aimed at solving the problem of Lack of team work, this part of the action plan will bring nurses together in groups and give them the opportunity to make decisions to guide the group for their common success.
How does it solve the problem(s)?
These are teams that are empowered with decision making with regards to planning, implementing and evaluating their own work; essentially being self-managers and directors. Given the opportunity to think and produce ideas, uninhibited by authoritative rule, employees demonstrate more skill and innovation in their ideas and actions. Also, a sense of self satisfaction motivates them to commit more productivity to their work. This would compel Smith to delegate power and it would encourage team work, while providing intrinsic motivation. A powerful sense of team-spirit develops, while relations between nurses improve as a result of implementing self-directing work teams.
Implementation:
Using the grouping method mentioned above under “job rotation”, Smith can delegate some of her decision making powers to the group. Smith will coordinate all the team, over seeing the teams’ performance. The team would be given the authority to plan, perform and evaluate their tasks and overcomes.
What problem(s) does it solve?
- Bad human relation
It solves the issue of bad human relations by helping nurses to see where they go wrong and how they can remedy the underlying problems.
How does it solve the problem(s)?
A step towards TQM and high performance management, nurses can be evaluated by their peers, superiors, subordinates, patients, or any other outside party with whom he/she may deal. From this nurses learn what type of behavior or service is required by the various parties and gains a better understanding of how to deal with these people. This helps to solve the matter of bad human relations.
Implementation:
Using questionnaires, suggestion boxes, as well as requested evaluations by a professional body, the staff can evaluate them selves, each other and be evaluated by parties outside the hospital. Using a computer and a standardized format, the information from the various sources can be fed into a computer. The information can then be analyzed for strong discrepancies in the evaluations, which Smith can discuss with the relevant nurse.
What problem(s) does it solve?
- Bad human relation
- Lack of teamwork
This help resolve bad human relations by reducing stress, while also encouraging team work by giving nurses the opportunity to interact casually
How does it solve the problem(s)?
This is a day set a side for nurses and aids to work free of stress, by not having Smith constantly surveying them for mistakes. Also, a casual dress-code can relieve tension and make for a productive day, where the nurses focus on caring for the patients, rather than simply getting the job done. A show of appreciation by hanging-up cards, or even having cake to celebrate birthdays could lighten the days load and make work more enjoyable. In such an atmosphere, people are more willing to forget their animosity and share in the festivities; hence, improving human relation. By being given the opportunity to casually “hangout” with their peers, nurses will form friendships conducive to more coherent, productive teamwork.
Implementation:
Based on recommendations by the nurses, Smith can devote one day of the week for the nurses to ‘take it easy’, bring in cakes to celebrate peer or patient birthdays, or just hang up card of appreciation for one another. However, being that they deal directly with human life and peoples’ health, Smith should specify clear boundaries for behavior during the day. For instance, one room on the floor can be devoted to this cause, so that the noise, people and food don’t affect patient care.
What problem(s) does it solve?
- Bad human relation
- Lack of teamwork
This step too, will help strengthen the team working atmosphere.
How does it solve the problem(s)?
This is a forum for nurses to voice their opinions, suggestions or complaints. Carried out in a professional manner, this forum can help surface issues that may have hindered efficient work, but had been over looked by management. As well suggestions could be made by those directly affected by the issue, as opposed to being solved by people who have no idea of how the issue affects nurses in that situation. For instance, if a student nurse opposes the leadership qualities of her team’s leader, he/she could state and justify the case. By democratically solving this disagreement, Smith can help strengthen human relations between nurses, thus improving teamwork. Furthermore, nurses can point out instances where work becomes slack on the floor and have improvements made.
Implementation:
Each minority group of nurses and parties concerned (student nurses, graduate nurses, or older-nurses) can elect a representative to attend the meeting on their behalf and state the issues of concern. The head of the floor would chair the meeting and take up unsolved issued with her superior, while delegating authority to nurses who seem capable of solving the matter by producing good solutions it. For sensitive issues, such as tension between two nurses, Smith could have nurses email complaints to her and solve them at private meetings with only the people involved.
What problem(s) does it solve?
- Bad human relation
- Lack of teamwork
This suggestion seeks to solve the issues of bad human relations and that of lack of teamwork.
How does it solve the problem(s)?
This is a motivational tool; rewards given to the nurses by Smith, the floor supervisor, or even their peers. The prospect of higher pay for better performance will entice nurses to put more effort into their work. The prospect of a promotion will encourage nurses to demonstrate strong leadership skills in productive work and dealing with friction between other nurses, as well as between others and themselves. This will help ease bad human relations. A kind, motivational word of advice, from a peer to a nurse in a difficult situation will not only give that person the strength to work harder, but will also strengthen bonds for better teamwork.
Implementation:
Smith should maintain a report for the nurses whom she deems to stand out from the rest in performing her daily tasks. This report should be submitted to management on a monthly basis. Based on performance and perseverance of each individual, Smith can recommend to her superior that a person get a promotion, or a cash bonus. Nurses who produce good solutions to problems, or suggestions for improvement, as well as those who seem to demonstrate strong leadership qualities should be highlighted in Smith’s report. Management can then decide whom to reward. This process should be made known to all nurses, so they can set and work towards their goals.
What problem(s) does it solve?
- Formal structure
- Lack of teamwork
Here we aim to solve the matter of formal structure and lack of team work.
How does it solve the problem(s)?
This is where Smith can have nurses from all skill levels to participate in decisions made about how to run Floor b. This alternative directly breaks down the formal structure of Smith’s ‘rule’, by giving decision making power to all nurses. While nurturing a more ‘collegial’ work environment, nurses adopt low power-distance that encourages collectivism. As a result, nurses learn to work in groups.
Implementation:
Adopting a status as a mentor, rather than an authoritarian leader, Smith can give her nurses the power to make certain decisions regarding their daily tasks and come to her for guidance. The nurses may be given decision making power to order drugs as needed for the floor, instead of waiting for Smith to come, check, and reorder the drugs.
What problem(s) does it solve?
- Lack of teamwork
This job design strategy is focused on solving the problem of Lack of team work.
How does it solve the problem(s)?
Redesigning the jobs assigned to nurses can motivate efficiency, fueled by the desire to fulfill their higher-level needs; these are ‘self-actualization’ and ’esteem’ needs. This can be done by including motivational factors such as responsibility, goal achievement, recognition of performance, and personal growth, into the nurses’ jobs. This vertical loading will give nurses duties and authority usually given to managers; thereby, intrinsically rewarding them.
Implementation:
Smith and Green should measure work content and quality of the nurses’ work, essentially looking for managerial qualities and assign more decision making power to nurses demonstrating these skills.
FLOOR B
- Organizational workshop for Rogers and her assistant
What problem(s) does it solve?
As on floor A, the nurses in charge of floor B will benefit from a training workshop, but with emphasis on organization. Rogers and her assistant will learn skills necessary to solve the problems of “Poor organization, Loose supervision, and Inconsistency under pressure”. This option is not specific to solving one particular problem, but rather helps build the mind-set necessary to solve each problem.
How does it solve the problem(s)?
This workshop will educate them of organizational and managerial theories, which are most necessary to solve the central problems on floor B. Essentially this initiative will guide Rogers and her assistant in how to institute order and coherent behavior on the floor, so as to deal with poor organization, loose supervision, and inconsistency under pressure. Theories such as ‘reinforcement, 360-degree evaluation, TQM, as well as a clear day plan, a floor manual and a mission statement would be most applicable. They can then enforce these techniques on the floor. First, however, Rogers and her assistant should set out the general goal of the floor in a Mission Statement. This will set the frame work of all employees to learn and apply the new theories.
Implementation:
The hospital could have professionals in the field of management visit the hospital to conduct a workshop over a few days, or weeks. During this time Rogers and her assistant will be taught organizational and managerial skills. Most appropriate would be a workshop concentrating on workplace diversity, perception and attitudes, motivation, group work and high performance teams, high performance leadership as well as change and innovation. These skills will help them recognize potential problems on the floor and find solutions to them, while learning to be affective leaders.
What problem(s) does it solve?
A simple, but precious statement that will invoke more organization in the management structure of the floor; thereby, solving the issue of poor organization. Additionally, these theories can help maintain coherence under pressure.
How does it solve the problem(s)?
A mission statement should be prepared for the floor. This will be a broad outline of what they want to accomplish as a team. In essence, this statement would encompass a broad solution to all the problems on the floor. From this all other solution alternatives will ensue. While breaking down the present authoritarian structure on the floor, this statement should acknowledge job rotation, self-directing work team, group meeting, 360 evaluations and empowerment.
Implementation:
The heads of each floor, together with a representative of each group of employees on the floor (students, older nurses, doctors, cleaning staff, etc) and the hospital supervisor, should meet to discuss what goals the floor should achieve and how, while staying in accordance with the hospitals overall mission. Using the hospital’s Mission Statement, they can narrow the statements mentioned therein, so as to govern actions and procedures on each floor. An example could be: “To encourage an efficient and organized working environment, while working as a family in giving the best patient care to our customers as only a loving family member would give”.
What problem(s) does it solve?
Structuring the jobs to be done will help solve poor organization, loose supervision, and even inconsistency under pressure.
How does it solve the problem(s)?
Sub-problems such as disagreement among nurses about who should perform a given task, unclear orders to subordinates and lack of feedback will be easily remedied if there is were clear instructions laid out for the jobs that each nurse or nurse-group must perform. At the start of a day each nurse can refer his/her duty roster to guide him/her through the day’s tasks. Also, Rogers will know what each nurse is doing and can follow up to give feed back.
Implementation:
Possibly with some guidance from Smith, Rogers should clearly write out, on individual rosters, the routine tasks that each nurse needs to perform during a given day. As most tasks are repeated daily, this will not vary much through the week. The duty roster would be written up for the position that the nurse holds (not just the person), so that if that particular nurse is absent another can take his/her place and carry out the task as they are clearly detailed.
What problem(s) does it solve?
Poor organization, loose supervision, and even inconsistency under pressure will be solved if a manual were created to guide work procedures. However, this alternative will have the strongest effect on solving their weakness in dealing with pressure.
How does it solve the problem(s)?
As with the clear day plan, having a manual that details procedures will help set order into daily procedures, as well as emergency procedures. In case of confusion or conflict nurses can refer the manual to guide them. Timing and quantities for drug orders can be stated in general so that nurses need not run down for supplies repeatedly. Also, the order instated on the floor will help ‘order-orientated’ older nurses get along with the younger ones.
Implementation:
Judging from past experience and daily performance, Rogers and her assistant should create a manual that describes the required behavior for daily use and emergency situations. All personnel should be familiar with this manual and there should be regular rehearsals of emergency procedures.
What problem(s) does it solve?
It solves the issue of loose supervision by guiding Rogers to detect her points of weakness in giving orders. They also learn to remain clam under pressure.
How does it solve the problem(s)?
A step towards TQM and high performance management, nurses can be evaluated by their peers, superiors, subordinates, patients, or any other outside party with whom he/she may deal. From this nurses learn what type of behavior or service is required by the various parties and gains a better understanding of how to deal with these people. Rogers will learn how she could instruct her nurses so that they remain calm and perform efficiently, while nurses will learn their mistake and take precautions.
Implementation:
Using questionnaires, suggestion boxes, as well as requested evaluations by a professional body, the staff can evaluate them selves, each other and be evaluated by parties outside the hospital. Using a computer and a standardized format, the information from the various sources can be fed into a computer. The information can then be analyzed for strong discrepancies in the evaluations, which Smith can discuss with the relevant nurse.
What problem(s) does it solve?
Loose supervision and poor organization on the floor can be solved by application of reinforcement theories, both negative and positive.
How does it solve the problem(s)?
Reinforcement is defined as ‘the enforcement of consequences as a result of certain behavior’. That is, Rogers should immediately reward nurses for productive behavior and penalize those who failing to perform their duties. As their actions have direct consequences, nurses will tend to be more productive and methodical in their work. As Rogers has problems maintaining discipline, this system will help her maintain control over the nurses. Given that Rogers too will be negatively reinforced for poor performance, she will be motivated to be clearer in giving orders; hence, eliminating poor organization.
Implementation:
First Rogers must organize the way she runs the floor, carries out her duties and clarify the orders she gives to her subordinates. She must then monitor and judge the performance of the other nurses. From this she should reward good performance and punish poor performance promptly. As this is a continuously administered strategy, Rogers will have to keep constant watch on her peers and reward those who were previously punished, if they do improve.
What problem(s) does it solve?
Total quality management will help the nurses on floor B run like a well oiled machine; thereby, eliminating loose supervision and inconsistencies when under pressure.
How does it solve the problem(s)?
This requires a combination of 360-degree evaluation, continuous monitoring and striving for improvement and the intrinsic need for every employee to give their best. This is a commitment to providing a quality health care service devoted to customer satisfaction. All nurses should be concerned with continuously improving efficiency and quality, while striving to eliminate mistakes in doing their jobs. For this, Rogers would have to give clear and concise orders to her nurses, while maintaining a cool, stable demeanor even when the ward is in an emergency situation.
Implementation:
By attending an organizational workshop Rogers can learn that, creating a floor manual, performing 360-Evaluation, enforcing reinforcement, as well as having a structured day plan will all have to be used together to achieve TQM.
Step 7
Justification and examination of the expected cause and effect relationships
The implementation of training workshops will directly combat the problems of each floor in a positive growth oriented way. The proposed solution will focus on the main problems that are deterring each floor from working at its full potential. Training workshops are often time consuming, yet the ease that is created by them for conveying new information and policies can not be matched.
The two proposed workshops are as follows:
Floor A (Smith and Rogers) workshop will focus on four main things,
- The Creation of a mission Statement.
- The creation of self directing Work teams.
- The implementation of Extrinsic Rewards.
- The implementation of Group Meetings.
1.) The creation of a mission statement is a very valuable tool for both of these floors to focus on. This statement should be a clear and concise representation of the organizations purpose. It should incorporate measurable criteria to ensure everyone is thinking and acting for a common goal.
2.) The creation of self directing work teams will increase all employees’ involvement. This is done using process reengineering and reforming tasks into uniformly constructive groups that each team will fully control for a distinguished amount of time. These groups will be laid out under a rotating schedule therefore increasing job breadth while creating a more challenging learning / work experience for all participants. The teams will be determined by management evaluating each individual’s experience, knowledge and skill base, to ensure there is an adequate range within each group. Once on a task each group will complete all aspects of this task until the next rotation occurs. This will help to make each employee more a part of this organization, by involving them in all of the necessary task that are entailed. In developing these workshops management is internalizing, and implying most of the necessary determining factors that will make them a High performance Organization.
While determining the break down of each group it is important for management to keep in mind the inputs of group effectiveness, as every member of the group will be responsible for ensuring that the task at hand is fully completed to the best of their abilities. By instilling this responsibility in each employee, we are transforming the floors management style from an authoritarian rule to that of a consensus, and we want this to remain an open system. This transformation will reshape management from a vertical model to that which is more horizontal therefore decentralizing control. Within each group management needs to be ever aware of the possibilities of social loafing to occur, as within group work it is very easy for individuals to shirk tasks and avoid responsibility without any one individual being aware that it is occurring.
Smith may initially find this transformation difficult as she is such an authoritarian ruler, although within time we feel that she will find that a control of each separate group will be more functional, and constructive.
3.) The implementation of extrinsic rewards can dramatically change the quality of work life, as the motivation of ones staff leads to increased performance and therefore job satisfaction. Many would argue that providing rewards in this type of field creates opportunities for overt individualism to occur, and can also create negative inequity when individuals feel that they have received relatively less than others in a similar situation. This self righteous behavior can result in a decrease of attention and or care for the position. However when these rewards are used in ways that do not interfere with day to day operations they can create a more conducive work atmosphere where there is a renewed respect for each task. During this process management is applying the understanding of Vroom’s expectancy theory, by proving that motivation is a result of rational calculation.
When establishing a reward system management must be aware so as not to create a competitive or selfish environment, as this would be damaging for the organization and all involved.
One such reward system to be implemented is the recognition of all special, and or requested events. Such events will include the implementation of potlucks, birthday cards, patient’s birthdays, and all other personal touches that create a friendly work atmosphere for everyone. This will increase employees’ feelings of existence, relatedness and growth within the organization.
4.) The implementation of group meetings will create a way for all staff to communicate openly and effectively. Each self directing work team will elect a different representative to attend the regular meetings on behalf of the group. This will facilitate any discussion employees find important, allowing them a voice to communicate to everyone on the floor. This assists in the break down of centralized control and relieves the projection that Smith has assigned to her staff. Within such a high context culture these meetings can prove to be very important as, having face to face meetings can assist in the determination of key causes and effects.
When utilized correctly employee input can be an extremely valuable resource of management, as these people are on the front line. Management by Objective is the process of management working in co-ordination with their staff, in setting goals, and creating plans, and by involving staff in this process we are not only obtaining a wider variety of inputs, but we are also producing a higher level of commitment from staff while manufacturing a greater quality of outputs, while contributing to the emergence of a High Performance Organization.
By instilling these four aspects we are establish a more inclusive and stable employee environment. This will also create a greater sense of value for individual positions, as personal opinions are encouraged, in effect improving self worth. Teamwork will also be dramatically affected as this will enforce discussion and decisions at all levels. Thereby feeding into the five facets of job satisfaction to make this floor even more functional
Floor B workshop will focus on three main things,
- The Creation of a mission statement.
- The creation of a structured plan
- Continuous Reinforcement
1.) As stated in floor A workshop, The creation of a mission statement is a very valuable tool for both of these floors to focus on. The mission statement is a precise statement of purpose which encompasses the organizations reason for being. And therefore this statement should be the basis of decision making within all facets of the organization, by stating who will be served, and how they will be served.
2.) The creation of a structured plan will help to eliminate all ambiguity from day to day tasks, while relieving the role overload that has been inflicted onto Tricia Rogers. This enables employee aptness with little daily help required from management. Consequently this will free management for more critical tasks, while creating less of an opportunity for miscommunication to occur. While preparing this plan it also allows for managements evaluation of each task for necessity, and constructiveness, therefore allowing for continuous improvement to occur, while exhibiting an emergence of the five facets of job satisfaction.
Within this type of structure employees can often feel as though they are not valued for their own personal abilities, although this is far from true. As each individual is relied on more to assist their group when completing a task that reflects their skill base.
3.) Reinforcement within any organization is very important in order to make each employee feel as though their contributions are not going unrecognized. In this particular case we are going to use indirect reinforcement, by creating manuals, and by implementing new evaluation processes. The creation of a floor manual reinforces the importance of outlining policies, procedures, rules, and consecutiveness in all tasks. It also increases everyone’s availability to knowledge within their work environment, and decrease stress at times of pressure by establishing clear expectations. This may in effect contribute to a new understanding of employee existence relatedness, and growth. Many find manuals to be confusing or foreign which can deter usage, so by allowing each floor to tweak the organization of these manuals, it enables them to make them more functional for personal usage.
This floor will also implement 360 evaluations. These evaluations take non-biased remarks from neutral parties in this organization, (patients, and doctors.) and produces feedback about the floor and individuals involved. By using individuals who have no direct input to the participation in the floors duties ensures their opinions are not altered by any personal and or emotional feelings. So in effect we are provided with a fair and straight forward evaluation which can help improve all floor activities. Since many of the participants do not work in this organization some may feel that their opinions hold no real value, but just because they do not understand exactly what needs to be accomplished daily, they can still provide valuable feedback in regards to the working of any organization. Many individuals can also highly under estimate the unspoken influence that is produced by living in such high context culture, and the many ways that this can contribute to behavior. By using these methods to reinforce we are shaping our existing employees and creating new more desired behaviors from an already proficient team by feeding into motivation, performance, and overall satisfaction.
All of these things together help to increase total quality management in all parts of the organization, making this organization even more of a high performance organization. They also create a renewed sense of responsibility for all actions, and help narrow team focus to the sole desired outcome. This new plan also reinforces the five core job characteristics, and brings about an increased sense of importance, maturity and self worth, while bringing this organizations focus solely back onto the customers.
Conclusion
Using the valuable knowledge and analytical skills gained through the study of Organizational Behaviour, we opted to implement the ‘Problem/decision approach’ in examining our project. As such, once the case had been studied, our team focused their diverse skills and experiences on identifying key facts that appeared to be problematic.
Then, using a flow chart to guide us, we identified possible central problems on Floors A and B that seems to contribute to the above identified key facts. We then explained the cause and effect relationships (the connecting arrows) between the sub-problems (the boxes), as well as how they led to the determination of the central problems for each floor. The problems are as follows:
Floor A → Bad Human Relationships
Formal Structure
Lack of Teamwork
Floor B → Poor Organization
Loose Supervision
Crumbles Under Pressure
For these central problems we then outlined possible alternative solutions and examined their consequences, both positive and negative. Criteria for evaluation and implementation of the suggested alternatives were also developed at this crucial stage.
Once feasible solution alternatives were chosen, we detailed what problems they solved, how they did so and recommended possible procedures for implementation of the solutions.
As the final stage of our project, we set the foundation for future modifications to the solutions suggested. Following a flow chart of suggested alternatives leading to expected outcomes, anticipated cause/effect relationships were detailed. Justification was provided as to why the initial solutions were chosen, so that a clear rationale was in place to validate our decisions. Over time actual cause and effect relationships can be observed and necessary changes made accordingly.
Bibliography
Schermerhorn, John R., Jr., James G. Hunt, and Richard N. Osborn. Organizational Behavior. New York: John Wiley & Sons, 2003.
