Management Interview: Health Service Organization
Introduction
In the course of the discussion, the health care management analysis centers in the Department of Nursing Administration of the chosen institution in Camden, New Jersey, specifically in Cooper University Hospital. The primary source of the discussion comes from the interview of the hospital’s Senior Vice President for Patient Care Services and Chief Nursing Officer – Mrs. Elizabeth D. Bobulski , R.N., M.P.H. The interview with Mrs. Bobulski has been conducted last August 2, 2008, specifically emphasizing on the topics, namely (1) key players of the nursing department, (2) nursing conditions, (3) staffing of workforce, and lastly, (4) coordinative and collaborative systems (e.g. multi-level and integrated performance-based model). During the analysis of this management interview, the discussed points center on conceptual application of health care management, organizational structure and associated activities, and theoretical application on the identified structure and process of management.
Discussion
The first question directed to the interviewee is about the handling and organization within and outside the key players of the hospital. According to Mrs. Bobulski, “the hospital comprises of different heads, who act as the major key persons of the organization. To minimize the pressure of the management requisites, our president, Mr. J.P. Sheridan, has adopted the four-level management concept that shall maintain a level-by-level relay of management concerns.” According to Johnson (2005), different concerns in the field of “reimbursement pressures, staffing shortages, rising costs, changing patient demands, escalating regulatory requirements, and an aging population” confront the few people acting as the key heads of the institution. In order for the management to address appropriate interventions and resolutions, multi-level of leadership, accountability and processes are usually implemented as a form of decentralization of authority (Meuleman, 2008 p.326). In the process of coordination, the top management disseminates the tasks and issue management appropriate to the job description of each key player. As for Mrs. Bobulski, she takes over the following identified tasks, (1) nurse-patient staffing proposals, (2) quality assurance management on nursing service, (3) patient-nurse concerns, (4) recruitment, evaluation and recommendation of nursing staffs and (5) appropriate placement of nurse specialty.
Once the task description of each key player is set, it is necessary for them to abide to these roles; however, due to the increasing complexity of demands within the health care system, there are instances wherein compromises, liabilities and management inconsistencies tend to be inevitable (Roussel, Swansburg and Swansburg, 2005 p.202). According to Mrs. Bobulski, aside from the multi-level leadership model they are using, they are also implementing performance-measurement systems to organize their strategies, patient-workforce demands and coordination. As verbalized, “PM (performance-measurement) system, specifically the integrated system, is currently being implemented in our organization… due to the administration’s business-oriented management… avoiding decline in patient care handling…” According to Stewart and Lockamy (2001), the integrated performance-measurement system model exists for linking performance measurement of the three primary, aggregate, business functions (finance, resource and customer oriented function) and their corresponding business processes for accomplishing a firm’s strategy (p.46, 48). Using these two models as guidelines for maintaining coordination and organizational function, the organization is able to maintain the balance in quality service provision, health care costs, financial stability due to the model’s resource-oriented function, and strategic orientation by preventing the compromise of client care needs with their business orientation.
On the other hand, the interview also analyzes the management procedures being implemented by Mrs. Bobulski within her covered department, specifically on the five major tasks she has identified. According to Mrs. Bobluski, the two most challenging parts in nursing care management are the (1) establishment of appropriate staffing conditions without compromising both patients’ needs and the nurses’ job satisfaction levels, and (2) maintenance of nursing retention among the entire workforce. According to Shortell and Kaluzny (2000), research has shown that inadequate nurse staffing and consequent high workloads are the major problems motivating nurse turnover (p.92). One of the most crucial controversies in the nursing department is retention, job satisfaction and the adequate staffing. According to the organization’s protocol, recruitment, recommendations and staffing proposals are being done by the chief nursing officer. During the process, various considerations (e.g. staff availability, demographics of patient per department, critical care versus standard care diversity, etc.) are being assessed prior to placement and distribution (Shortell and Kaluzny, 1996 p.38). After the proposal phase, the third (chief nurse, assistance chief nurses, public service manager) and fourth (staff nurses and associated groups) level collaborate and discuss the appropriateness, acceptability and effectiveness of the placement and staffing proposal. Lastly, the second (medical director, chief nurse) level, with their approval, directs the proposal to the executive or first level administration for final evaluation and approval. However, according to Mrs. Bobulski, the planning of staffing and nursing service management is not yet the finished part since it is usually the implementation that becomes the most challenging (e.g. re-organization, adjustment of protocols, change of workforce, etc). In the interview, Mrs. Bobulski identifies three major points that she has observed during in the organizational management of nursing department, “in my years of experience, I have observed that the most important factor in handling this nurses is job satisfaction, followed by increasing their reasons for working under your office, and last, motivating them towards their duty…” According to Choi (2006), the three core components (envisioning, empathy, and empowerment) stimulate followers’ need for achievement, need for affiliation, and need for power. From the interviewer’s perspective, motivational theory of charismatic leadership is an effective model to utilize in maintaining the standards of management among the nursing service area.
Conclusion
In conclusion, the interviewers have analyzed and synthesize the implications of the interview and organizational analysis, and found that coordination and system in the management is crucial in balancing the administration within the health care system. In Multi-level Model, Cooper University Hospital is able to decentralize and distribute managerial tasks for more systematic outcomes. Meanwhile, the organization is able to implement their profit-oriented schemes without compromising the needs of their patient by relying to the guidelines of Integrated Performance-Measurement Model. Lastly, staffing and retention controversies emphasized by the interviewee are resolved through (1) appropriate planning of recruitment, recommendation and placement proposals, (2) collaboration and relay of plan from fourth to first level of administration and (3) the application of motivational-charismatic leadership with the three core components – envisioning, empathy, and empowerment.
References
Choi, J. (2006, June). A motivational theory of charismatic leadership: envisioning, empathy, and empowerment. Journal of Leadership & Organizational Studies, 13, 20-24. Retrieved August 1, 2008, from General OneFile via Gale database.
Johnson, S. W. (2005, June). Characteristics of Effective Health Care Managers. The Health Care Manager, 24, 124-128.
Meuleman, L. (2008). Public Management and the Metagovernance of Hierarchies, Networks and Markets. London, New York: Springer Publishing.
Roussel, L., Swansburg, R. C., & Swansburg, R. J. (2005). Management and Leadership for Nurse Administrators. New York, U.S.A: Jones & Bartlett Publishers.
Shortell, S., & Kaluzny, A. D. (1996). Essentials of Health Care Management. New York, U.S.A: Thomson Delmar Learning.
Shortell, S., & Kaluzny, A. D. (2000). Health Care Management: Organization, Design, and Behavior. New York, U.S.A: Thomson Delmar Learning.
Stewart, L. J., & Lockamy, A. (2001, December). Improving Compettitiveness Through Performance-Measurement Systems. Healthcare Manager Financial Management,