1. Organizational Assessment: St. Francis Hospital Alicia Steadman, BSN, RN University of Indianapolis

2. Overview • I will look at the ideal and actual: • Organizational Information • Organizational Culture • Resources • Outcomes • Human Resources • Policy • Then, a SWOT analysis will be performed based on this information

3. Organizational Information

4. Organizational Structure • Ideal • Matrix Organizational form • “has the flexibility to adapt to change and to deliver services innovatively and efficiently” (Huber, 2010, p.413) • Open Systems Theory/Contingency Theory • Open and adaptive to the environment • Complement the environment as well as technology (Huber, 2010)

5. Organizational Structure • Actual • Program Organizational Form • “Although the corporate structure is shared, each program tends to operate as a semi-autonomous unit with its own management team” (Huber, 2010, p. 412) • Sometimes difficult to coordinate services • Isolation from other healthcare professionals Senior Management Team Medical-Surgical Services Emergency Services Nursing Nursing Pharmacy Pharmacy PT/OT/RT Respiratory Therapists

6. Organizational Structure • Actual • Human Relations School/Participative Decision Making • Democratic leaders who are also open communicators • Improved cooperation between management and workers (Huber, 2010) • System may be viewed as “closed” because it is difficult to adapt to change • Emphasis on the informal aspects of organization social structure

7. Organization Structure • INSERT NURSING ORGANIZATIONAL CHART

8. Leadership and Professionalism • Ideal • Flexibility • “In every situation, there is some leadership style that will be effective” (Howell, Bowen, Dorfman, Kerr, & Podsakoff, 1990) • Well-Defined Professional Expectations • “an approach to an occupation that distinguishes it from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment” (Huber, 2010, p.5) • Well-defined with clear expectations and goals of the employees (Weshenfelder, 2005)

9. Leadership and Professionalism • Actual • Flexible, but well-defined expectations • Journey to Success program • “Effective leadership requires a continuous commitment to skill development and core leadership values” (Franciscan Alliance, 2012) • This program emphasizes mentorship, understanding the values and beliefs of the organization, process management, motivation, business ethics, change management, and project management

10. Leadership and Professionalism • Actual • Well-Defined Professional Expectations • Franciscan St. Francis Health Nursing Professional Practice Model approved on 07-05-2011 • Components include: • Mission and values • Patient and family centered • Evidenced-based practice • Healthy work environment • Professional practice • Shared leadership

11. Level of Interdisciplinary Collaboration • Ideal • Constant interdisciplinary collaboration at all levels • Collaboration can improve quality outcomes, patient safety, and reduce health care costs (Dickey, Truten, Gross, & Deitrick, 2011) • Should be done at management level and at the bedside • “Interdisciplinary teams are considered to be essential for the effectiveness of health care organizations and for patient safety” (Huber, 2010, p.236)

12. Level of Interdisciplinary Collaboration • Actual • Selective Interdisciplinary Collaboration • At management level, interdisciplinary approach prevails • At bedside, difficult to bring everyone together • Management is currently working towards interdisciplinary rounds on every inpatient unit

13. Communication Style and Processes • Ideal • Communication Assessment • Accessibility of information • Communication channels • Clarity of messages • Span of control • Flow control/communication load • The individual communicators (Farley, 1989)

14. Communication Style and Processes • Actual • Communication Assessment • Accessibility of information • Access through various resources • Communication channels • Whom to talk to/management levels clear • Clarity of messages • Pretty clear and concise • Span of control • 20-30 nurses • Flow control/communication load • Low control of flow • The individual communicators (Farley, 1989) • Varies by employee, but professionalism helps

15. Implementing Change • Ideal • Participative change • “the more that a planned change is driven by authoritarian actions, the more that the seeds of future discontent are sown” (Huber, 2010) • Allow participation • Help followers process, adapt, and cope • Leaders need to focus on people! (Huber, 2010)

16. Implementing Change • Actual • Participative Change • Shared Governance • Quick & Easy Kaizen • Lean Six Sigma

17. Organizational Culture

18. Branding and Symbols • Ideal • Icons easily recognizable and represent the organization’s values and beliefs • Actual • Icons represent the organization as a religious, caring organization • (Franciscan St. Francis Health, 2012)

19. Branding and Symbols • Actual • VIP Program • Daisy award • Encouraging satisfaction and exceptional nursing care • (Franciscan St. Francis Health, 2012)

20. Values and Beliefs • Ideal • Define how the organization feels the business should be run (Huber, 2010) • Demonstrated by leadership and employees alike • Actual • Values based on Christian beliefs • Performance reviews view each of these areas for satisfaction and potential improvements

21. Values and Beliefs (Franciscan St. Francis Health, 2012)

22. Vision and Mission Statements • Ideal • “A guiding framework that describes what the organization views as its business and future direction” (Huber, 2010, p. 796) • A mission statement reflects the vision of the organization and what it wants to become (Huber, 2010)

23. Vision and Mission Statements • Actual • Mission statement: • Continuing Christ’s ministry in our Franciscan tradition (Franciscan St. Francis Health, 2012)

24. Vision and Mission Statements • Actual • Vision Statement • Improve the health of the community • Provide quality services • Health needs of poor and disenfranchised (Franciscan St. Francis Health, 2012)

25. Tradition and Habits • Ideal • “Unquestioning adherence to authority and tradition is a well-known barrier to the development of knowledge” (Porter-O’Grady & Malloch, 2011) • Tradition cannot always be strict in healthcare • Habits must sometimes be changed

26. Tradition and Habits • Actual • St. Francis does look toward evidence-based practice to shape new practices • Tradition is part of the mission statement • Some habits are consistent, some habits are changing

27. Resources

28. Financial Support • Ideal • Staff nurses are aware of budget needs (Huber, 2010) • Nurse managers have multiple resources • Actual • Nurse managers offered budget class to aid in creating and managing budget • Finance representatives • MSN representative meets with every manager during budget season (C. Smiley, personal communication, August 1, 2013)

29. Administrative Support and Expertise • Ideal • Administration participation in shared governance (Huber, 2010) • Magnet Certified hospitals suggest administrative nurses have graduate-degree training (American Nurses Credentialing Center, 2013)

30. Administrative Support and Expertise • Actual • Shared Leadership Nursing Congress model developed in 2008 (Franciscan St. Francis Health, 2011) • Administration/leadership involved in various committees • Nurse managers are encouraged/required to obtain an MSN

31. Sophistication of Nursing Administrative Systems • Ideal • High development and high functioning • Actual • Organizational chart viewed earlier • System lines well established • High functioning(C. Smiley, personal communication, August 1, 2013)

32. Outcomes

33. Stakeholder Satisfaction • Ideal • Need to determine what should be retained and what should be left behind (Porter-O’Grady & Malloch, 2011) • Use of multiple surveys (Curran & Totten, 2010)

34. Stakeholder Satisfaction • Actual • HCAHPS scores/surveys • Press Ganey Scores • Employee Satisfaction Surveys • (C. Smiley, personal communication, August 1, 2013)

35. Benchmarking • Ideal • Used as an improvement process • Organization measures its performance against other similar organizations (Huber, 2010) • Working above the indicated benchmarks

36. Benchmarking • Actual • Utilization of NDNQI data

37. Organizational Effectiveness • Ideal • Economic • Producing patient care at the lowest possible cost (Huber, 2010) • Creating a profit • Patient Care • Meeting quality indicators and satisfaction scores • Employee • Minimal turnover rates

38. Organizational Effectiveness • Actual • Economic • St. Francis running at a profit (C. Smiley, personal communication, August 1, 2013) • Patient Satisfaction • Satisfaction scores can be improved • Employee Satisfaction • 0.84% turnover

39. Continuous Quality Improvement • Ideal • Organization should never be stagnant • Analyze processes and improve them repeatedly to increase satisfaction (Huber, 2010) • Measure problems, design interventions, implement the change, and monitor the improvement (Huber, 2010)

40. Continuous Quality Improvement • Actual • Business transformation department works consistently on quality improvement • MSN-trained nurses • Lean Six Sigma

42. Recruitment/Retention • Ideal • Find the right “fit” • Complex and detailed processthat includes: • Advertising • Screening • Interviewing • Coaching (Huber, 2010)

43. Recruitment/Retention • Actual • Organization tries to find the right fit for each individual unit! • Behavioral-based, standard interview questions • Rounding • 30/60/90 Day Window (C. Smiley, personal communication, August 1, 2013)

44. Diversity in the Workplace • Ideal • Appropriate variations • Have divergent points of view work for the common good (Huber, 2010) • Actual • Discussed in orientation • Many differences discussed (Franciscan St. Francis Health, 2012)

45. Promotion Opportunities • Ideal • Develop mentorship and preceptor models (Huber, 2010) • Discussions on future goals • Actual • Mentorship and preceptor models(Franciscan St. Francis Health, 2012) • Employee evaluations

46. Policy

47. Formalized Procedures and Policy Making • Ideal • Policies guide decision-making to make them consistent (Huber, 2010) • Procedures indicate the steps necessary to perform different tasks (Huber, 2010) • Focus on best practices • Should be approved by institution and easily retrievable for reference (Huber, 2010)

48. Formalized Procedures and Policy Making • Actual • IOWA Model(Franciscan St. Francis Health,2011) • “LEAP”(Franciscan St. Francis Health,2011) • Nursing Congress—Professional Development Council (Franciscan St. Francis Health,2011) • Easily search for on main employee website

49. Decision Making Within the Organization • Ideal • Decentralization—middle and lower levels can make decisions (Huber, 2010) • Actual • Decentralization! (Franciscan St. Francis Health, 2011) • Shared governance

50. Power Relationships • Ideal • Power focuses on upward influence (Huber, 2010) • How a leader influences followers to take action (Huber, 2010) • A leader is powerful when they develop credibility, show visible achievement, behave correctly, and create dependence (Huber, 2010)