Application of quality management theory on healthcare organizations:
Creating a Deming Organization
Clayton State University
April 22, 2018
I.My Organization and Department
What makes a healthcare organization run more effectively? Is it the way it is managed? The service provided or its surrounding environment? I would like to begin by envisioning a large healthcare organization that is composed of several other large healthcare facilities located in New York City. The largest of the organization is a 300- bed facility and is broken up into departments that are aimed at providing the best quality care to its patients, such as cardiology, women health, cancer treatment centers, physical therapy, emergency department, and pediatrics. It provides a variety of services from, outpatient and inpatient services, radiology and imaging services, laboratory services and emergency services. The mission of our organization is to “provide our patients with the required services in a timely and efficient manner”.
The policies in my organization are highly enforced; they regulate and set performance standards that should be met by both our employees and the other healthcare departments. Our policies set the expectations of the work environment; in addition, they have a major impact on our relationship with our stakeholders. A stakeholder is someone who takes interest in an organization and can be impacted by the actions taken by that organization. As a large healthcare organization, our most valuable asset is our patients and their families, they pay for a service they wish to receive, in addition to our healthcare professionals who are providing the care. Our patients experience in our facility impacts policy changes, and the opinions of our external stakeholder groups that support our healthcare organization. The decisions that are made between each hospital and each department in my facility are mostly centralized. This meaning that the power of making decisions is left up to the top managers of the organization and not up to the workers who are doing the production. Our healthcare professionals are paid on a pay for performance system.
I feel that there are some theories that are critical to apply to successfully complete the transformation of my organization into a Deming one. First, it is important that any organization has adequate resources to sustain its existence and productivity. According to the open system theory, it states that “organizations exist within an environmental context from which it must secure resources, support, and legitimacy in order to survive and operate.” (Weiner, 2012). The external environment of an organization is composed of its suppliers, customers, government, competitors, and the demographics as these factors have an influence on how the organization makes its policies. If an organization sees it competitors change their prices or advertisements they will try to outrun their rival. They will need to depend on their environment for available resources so it is important that organizations negotiate and work together. This applies to a Deming organization because in order to form a system the components must be interdependent and cooperate there should not be any form of competition.
I believe that a leader’s personality, behavior, and leadership style can have an influence on how successful they are in leading their organization in achieving its goals. The contemporary theory of leadership states “how those in leadership roles will respond with a set of behaviors rather than a single response.” This theory distinguishes between two forms of leadership styles, transformational and transactional. Transformational leaders use motivation by inspiration and intellect to lead versus a transactional leader who rewards based on performance and laissez-faire approaches. The structure and design of an organization can either hinder or promote growth in the facility, as it delegates the roles that are required for each department and their influence on decision making. The structural contingency theory states “that there is no one best way to manage an organization it depends on its unique work, environment, and strategy.” (Young, 2012) As different units in our facility perform a variety of tasks we must coordinate our activities, including how well we manage conflicts. This allows us to better integrate creating coordination and interdependence. Lastly, it is critical for managers to know that everyone is different; they must know what motivates their employees. There are some basic needs that are essential for each individual. Using Maslow hierarchy of need theory, which states that individuals want to satisfy a variety of needs in a certain order based on importance. These include physiological, security, belongingness, and esteem and self- actualization. Physiological needs such as air, security includes a secure physical and emotional environment and our esteem and belongings needs are our sense of being accepted, respected and recognized by our peers. A manager must know the difference between extrinsic and intrinsic motivation and how this can impact their employee’s morale and productivity.
II.Transforming my organization to a Deming organization.
To successful turn my organization into a Deming one I will apply Edward Deming’s system of profound knowledge. First I will start with the transformation of myself; which comes from understanding the system of profound knowledge. This system allows me to set better examples, teach those that come in contact with and gain new insight to my life. I will now apply these principles in order to transform my organization; the system of profound knowledge is broken up into the following parts.
A.Appreciation for a system
In regard to this dimension, my organization has an aim, of making our service delivered in an efficient and timely manner. In order to become a system our organization must have an aim, and it must be clear to everyone on our team. To convert my organization to a Deming one, I must focus on being one that is well optimized, and, interdependent. In the text the 7 habits of the highly effective person the author states how the seven habits are an approach to developing personal and interpersonal effectiveness. As we used a maturity continuum, we go from a state of dependence to independence to interdependence. When we are dependent we greatly rely on others, moving towards being more independent focusing on our self and lastly interdependence where we focus on how we can cooperate with others as a team. Learning the seven habits will show me some effective principles that vital to leadership and attaining an interdependent organization. Starting with the first three habits, be proactive, begin with the end in mind and put first things first will allow me to become more independent. I could focus on better managing my time, being more responsible, understanding the difference between leadership and management and becoming more goal-oriented. The last three habits think win-win, seek first to understand than to be understood and synergize will allow me to focus on how I interact with others and how to becoming a better listener. I could apply these habits, to become an effective leader and achieve an interdependent system where my aim would be for everyone to win.
I feel that taking these necessary steps would have some effect on the setting of my organization; I can better observe the results as my team works together and not individually. My employees would be more aware of what the aim of the organization is and what their roles are in the facility. I can observe changes in our external environment, if my organization does not cooperate with our external environment from our suppliers, customer and members of our community as they are a vital part of our healthcare system.
B.Theory of knowledge
In relation to the theory of knowledge, my organization uses a centralized authority where my workers learn a sense of right and wrong from what our top leaders demonstrate and think. To convert to a Deming organization, there are some necessary changes that are needed. As a manger I must first understand how I think and act as this will impact how I make my decisions in my facility. I must encourage my staff to question how they know if what they believe is true. I must create an environment of continuous learning. Instead of relying on top authorities for direction, I will encourage the use of science to build knowledge. As stated by Deming “management is prediction”. We must test our theories through experimentation, to see if our beliefs our supported. In addition I will focus on things that I can’t see and measure in my organization , in the text If Disney ran your hospital the author stated a quote from Edwards Deming “The most important numbers for any organization are unknown and unknowable” as I cannot measure my customer’s perceptions I must base this on prior judgment and experience. I will use knowledge, as they are built on theories which will assist me in predicting the future changes and skills needed to adjust what I thought I knew into a more predictable outcome. I would encourage team learning in my staff where they can acquire knowledge from each other. I would apply Deming’s plan do study act cycle, which allows my organization to obtain knowledge and learning that is essential to understanding my organization from our service and its continuous improvement. We do this by first planning our purpose, formulating a theory and putting that plan into action, and study its effects to see if our plans were successful and the areas that we need to improve in. Based on our results we can then adjust our organizations objectives, goals, mission and methods to better serve our customers.
Some observable impact that I believe these changes; will have on the setting of my organization, is that there would be more exchange of knowledge among my employees, which enhances the learning process of our organization. This impacts how our employees communicate within and outside our departments. Understanding how others think, my employees can better appreciate and learn from each other’s ideas and beliefs without any judgements. In addition, we can better handle disputes that occur in our organization in a more efficient manner. Our organization will be an environment where our employees feel that, their skills and knowledge is valuable to obtaining the aim of our organization. We will use the valuable information we acquired from knowledge, to give better value to our customers; enhancing innovation. I can observe any changes that occur in the organization based on my predictions. This will increase innovation and productivity and will leave our customers more satisfied. This can set us apart from other surrounding healthcare organizations.
C.Knowledge of variation
To measure performance outcome and changes in my organization we rely on the performance of employees. We hold them accountable for any negative results that occur in our facility. In order to change into a Deming organization, I must have an understanding of variation. A variation is a difference or change in an amount or condition that occurs within a certain limit. Variations are present in our daily living, from the way I interact with my employees, and in our products and services. I must have knowledge of the two kinds of variations. The first being common cause of variation which is already built into a system theses can be mistakes, errors and any defects. As the second type special causes of variation are those that occur outside of a system, they are unique events such as a natural disaster. Understanding the predicting behavior and causes of variation is vital to me removing any problems that are present in my organization. In addition to adapting to changes that occur in my external environment, I can adjust to new organizations that enter the market. Secondly, better meeting my customer needs as their demand for care changes. If I do not have a full understanding of the two kinds of variation than my decisions and actions that I make as a manger can make matters worse. I must understand that putting responsibility for problems that occur in my organization solely on my employees and not the system is a wrongful act.
To successfully remove any barriers that are present in my organization, it will take the involvement of my employees. They are some steps that I could take in order to manage the changes or variation that occur in my organization. I would first teach my employees, to also gain a better understanding of what variation is and why is it important to our organization. I could then use strategic management to narrow down my focus on how I plan to reduce variation. I would then formulate a strategy, for instance one that is aimed at improving patient satisfaction and safety and reducing the cost of patient care. I would then formulate my goals, making sure that they are measurable and achievable, this, will allow me to see if any progress is being made in the facility. I could then collect my patient data, from different departments in my facility making sure that that information is reliable, and plot them using a control chart. I would analyze my organizations internal data, by looking at each unit over a time period to see how I managed the organizations performance; I could compare this to any external data that I have collected outside the organization, to better manage variation and adjust my goals.
I would then identify the areas in my organization that I feel needs the most managerial attention. I could choose specific departments that I believe will have the greatest impact on my patient satisfaction and on the finances of my organization. For instance, my emergency department we see high number of patients, in order to better manage patient safety I would make sure that my emergency rooms do not become over-filled. In addition, admitting patients who are not in need of necessary emergency services will cause longer wait times for the ones the patient that do. Lastly, in order to implement the changes, it would take the involvement of my employees. I would provide feedback to better observe any performance changes, I could also implement Deming’s Plan, Do, check, Act cycle as method for continuous improvement.
My goal would be to create an environment where there is continuous improvement, and not to think that all problems come from one type of cause. My organizations vision should show to my employees why continuous improvement is vital to our facility and the steps that we will need to take in order to achieve this goal. The values of my organization should be used as a guide to my employees, In order to encourage them to be more engage, and support the learning process. As a manger I must act as a role model for my staff, as my actions should represent the vision of my organization. Recognizing the accomplishments of my employees and thorough training and development can better build a continuous learning environment, where they feel encourage in building and learning new skills.
I believe that taking these steps to manage change; will have an impact on the work setting of my organization. With a new understanding on how to better embrace the changes of both my internal and external environment this will provide my facility with new oppurtunies. I can conduct an S.W.O.T analysis; to observe the strengths, weakness, oppurtunies and threats in my organization. I can observe what areas of my organizational structure are the strongest and the ones that still need more improvement. I can see what sets my organization sets me apart from the rest, what do my patients feel are the strengths of my organization. I can be able to spot out any trends in my surrounding environment such as the rise of new technology, and any changes in my patient population, emergence of new competitors. In addition to any changes that occur between my customers and stakeholders relationships.
Having a better understanding of managing variation will also reflect on my employees. They will begin to provide their insight on the ways they feel the organization could build continuous improvement and a healthy working environment. For instance if my staff wanted more control over their work schedule, with their insight I will be able to make those necessary changes. I would then observe and increase in my staff morale, leading to more retained workers. In addition, this will save my organization revenue in our recruitment process. All of these observations will allow me to make decisions that will make my organization more efficient, as I will be better equipped to handle its daily operation.
My organization uses ranking and pay for performance as a form of extrinsic motivation, In addition to making decisions using centralization. In order for me to turn my organization into a Deming one, I must first remove the barriers that hinder my employees from having pride in workmanship. I would then abolish the pay for performance system and ranking in my organization and use intrinsic sources of motivation. I must drive out fear, and create an environment that promotes continuous learning and where employees can have joy in work. In order to build intrinsic motivation in my employees, I would show them recognition, institute training on the job, and allow my employees to have control over their work. I must understand everyone learns and is motivated differently, and that I cannot treat everyone the same. Using the type and temperance theory, there are four temperant types; they include the idealist, guardian, rationals and the artisans. In addition, the six personality types include extroverts, introverts, thinker, feeler, judger and perceiver.
Is important that as a manager that I know the type and temperament I am because it can assist in my leadership style that I choose to use, and how I manage my team. I must also be aware of the different personality types that are on my team, so I know what strategies to use to achieve our goal. Each temperant has its own strength and weaknesses that can be used to complete specific tasks in my organization. For instance, an idealist, they are individuals that prefer to learn by discussing, they like to share their ideas with others, so I as a manager would give them a task that gives them the ability to think and educate others through teaching. If my team is filled with temperant that do not support me or the aim of the organization than I will be ineffective leader, this will bring loss to my facility. In addition having too much of one temperant does not bring new skills so this impacts how well we work together as a team. For instance, someone is introverted vs someone who is extroverted will keep to themselves and may not be as competitive as the others. So having a diverse amount of personalities in my organization will be beneficial for bringing differing viewpoints, new values, talents, and skills that can better assist in converting my organization into a Deming one, as transformation is everyone’s responsibility. Some observable impact I think this will have on my organization, would be that my health care professionals will be more intrinsically motivated. The more my employees are motivated the better they will complete their tasks, which will lead to better overall performance and success of our facility. The policies and rules set by my organization will be clear to each professional; this can have a positive impact on the surrounding environment of my organization. Having motivated employees will save me valuable time and resources, if we have health care professionals that are not motivated than they will spend time doing other activities that are not associated with the job.
I will be able to observe a more positive working environment, where my employees are able to contribute to their own work space, build a relationship with other health care professionals as well as with the top management of the facility. As my employees become more satisfied, I will be able to observe retention in my staff, as my staff morale increases they will not seek work in another health care facility. This will save my organization revenue, by not having to select and recruit new health care professionals. I can observe an environment that is free of fear, where my employees are not afraid to provide their opinion, as this can assist in the improvement of our facility. I can observe an environment where my employees have joy in work where they are excited to come each day. To conclude, I will see an increase in patients that enter our facility, as our patient’s perception will begin to increase, and the quality of work provided in the facility will continue to grow. To create a Deming organization, I will not focus just on the everyday interactions between my staff and patients; I will envision the future of my organization. I will find ways to motivate and encourage my staff on how they can better improve, in order to sustain the long term growth of our facility.