Guelph General Hospital

Case Analysis: Guelph General Hospital Golden Gate University MBA 300

Key Strategic Issue/Problem Identification

Jennifer Williams is the senior director of Inpatient Services at Guelph General Hospital (GGH) and leading the GGH Process Improvement Program (GGHPIP) implementation. The program is based on “lean” methodology strategy from manufacturing operations philosophy, but it has been showing positive results from other tested hospitals. Additionally, the program is approved by the government and supported by the Ontario Ministry of Health and Long Term Care, but it has not been thoroughly tested. Their chief executive officer mandated the GGHPIP because of their deteriorating culture and poor performance reviews. GGH was having process inefficiencies, and communication issues, resulting in stressed staff and low morale. Their number of patients is also increasing because of the demand in their area. However, their unsatisfied patients are also increasing due to long waiting time. The patient waiting time is so long, 10.56 percent of their patients left without being seen (Cottrell et al., 2016, p. 2). The GGHPIP was having some progress according to their performance metrics after one year. However, GGH is still faced with the same obstacles during the program’s implementation phase. In addition, they are having power dynamic issues and some of their staff are not buying-in with GGHPIP, resulting in some some staff resigning. Williams need to make some important decisions because their patient’s safety is at risk and they are priority. She need to gather more information, further examine the situation, and identify the root causes these issues so she can make effective decisions.

Alternatives Courses of Action Williams is currently in the execution phase of the GGHPIP, implemented in October 2009. She has seen positive progress in the defined metrics, with some backslide

in the most recent quarter, but has also received some negative feedback regarding patient and staff satisfaction. This has led her to a decision point. She can eliminate the GGHPIP and return to previous practice, stay the current course of action plan, modify the action plan going forward, or come up with an entirely new action plan. Eliminating the GGHIP may allow the GGH ED to return to the original condition, with a possibility of satisfying the patients and staff who raised concerns about the changes. This option could offer a known and steady state with which to evaluate any future changes. However, the EDPIP was part of a government mandate, so there could be funding or licensing consequences for discontinuing the program. Furthermore, the hospital’s metrics, including length of stay, percent of patients seen within target timeframes, percent of patients that left without being seen, and average patient satisfaction scores all improved with the GGHIP. Employee satisfaction scores improved in score range in three categories, stayed the same in two, and decreased in only one category following GGHPIP. The hospital would risk losing all the progress made if they discontinue the program. If Williams decides to stay her current course of action, she can continue to evaluate progress or backslide on currently defined metrics. She can allow more time to see if some of the concerns are related to discomfort in change and dissipate over time. However, she may miss an early warning sign that the current course of action has some problems and could miss the opportunity to redirect it at an early point. If this occurs, she could completely lose buy-in before she has time to adjust the plan.

Williams could maintain the current GGHPIP, but modify it going forward. She could complete a redo loop by asking for the right feedback, collecting additional information to clarify, and making adjustments with consideration to detailed feedback and data (Tichy 2007). This may help realign the key stakeholders involved in this project and identify problems that are surfacing before they become problems that threaten the success of the project. It could also identify causes of the backslide and help maintain future progress. There is a risk in re-evaluating and modifying the current action plan. Williams could potentially lose some support in the program if stakeholders lose confidence due to the appearance of indecisiveness. There is also a risk that staff could get change fatigue. Lastly, Williams could come up with an entirely new plan and move forward with it. In doing this, she may be able to address problems that may be developing, but are not clear or quantified. However, she would also loose demonstrated progress. Again, with this option, she would face potential loss of confidence in performance improvement plans and staff change fatigue, but likely a higher risk with this option. Recommended Course of Action Williams’ recommended course of action is to create a redo loop, which means developing a small team that focuses on data gathering and continuous process improvement in the area of patient satisfaction. Since the key stakeholders are patients, this team will develop a methodology to measure patient satisfaction and determine best practices to address each metric, if necessary. Compared to alternative solutions, this is the best resolution because the GGHPIP already addressed the sluggish internal processes within the hospital in 2009, and the new

focus should revolve around finding more data about patient satisfaction. A patient advocate, or patient satisfaction specialist, who will keep the key stakeholders best interest in mind, will chair the continuous process improvement team. The rest of the team will be composed of nurses, doctors, and hospital administration employees. It is recommended that the team be led by someone other than a doctor or nurse based on historical negative power dynamics reported at GGH. The goals of this alternative include finding data regarding overall patient satisfaction while maintaining current or better metrics for internal practices. This data gathering/process improvement cycle should be implemented within two months, with expectation of more defined metrics at the end of the quarter. Implementation/Action Plan Within the next week, the new team members will be identified and have their first meeting using the “inquiry approach which is a open process designed to generate multiple alternatives, foster the exchange of ideas, and produce a well-tested solution” (Garvin & Roberto, 2001). They will focus on critical processes to achieve the GGHPIP’s vision with the patient as a key stakeholder. The team will consist of the following personnel: a Patient Advocate Specialist, an ER and Inpatient Nurse, a ER and Inpatient Physician, a Quality Improvement Officer, a Pharmacist, a Lab Officer and a Radiology department manager. By having representation from each area, it will pinpoint where the delays in patient care are occuring. The team will be required to gather internal data from day-to-day operations, develop surveys for patients/staff members, and contact hospitals who have used the LEAN technology to see if benchmarks exist. The team will meet the following month to present the results of data collected, determine trends and

isolate bottlenecks in the process. The team will then formulate an actionable plan to be implemented based off findings. The team leader will be the Patient Advocate Specialist because they are usually the best point of contact for patient issues, complaints and concerns. After the revised plan has been approved, successes/failures will be measured by performance metrics and internal assessments for patients/employees. Process improvements are a continual operation until the future state is achieved so obstacles and challenges are inevitable. “Keeping people involved in the process is perhaps the most crucial factor in making a decision and making it stick” (Garvin & Roberto, 2001). The team will be required to meet monthly for the first three months, quarterly thereafter, and Williams will be responsible for continuation of the celebration of short-term gains to reward high performing departments. Case Critique This case analysis was very effective with decision making and critical thinking topics. The story was very relevant because the problems can happen to real-world scenarios which made the decision making and critical thinking exercises very realistic. The readers were put in the position of Jennifer Williams to formulate a strategy that happens in job settings. We were pushed to analyze the situation, brought out different perspectives, and produced various ideas. The team later realized that the authors intentionally left out some critical information to stimulate group discussions and deeper analysis of the situation. Overall, this case study satisfied the academic concept of applying techniques and identifying the elements of making good decisions. References

Cottrell, J., Sathya, A., Allison, A., Korunsky, D., McGillis, S.A., & Nicols, M. (2016) Guelph General Hospital. Ivey Publishing Garvin, D.A., & Roberto, M.A. (2001). What You Don’t Know About Making Decisions. Harvard Business Review. Tichy, N., Bennis, W. (2007). Making Judgement Calls: The Ultimate Act of Leadership. Harvard Business Review.